Post-traumatic stress disorder (PTSD) may develop (either immediately or delayed) following exposure to a stressful event or situation of an exceptionally threatening or catastrophic nature.
According to DSM-5, it is characterised by 4 groups of symptoms: intrusion symptoms, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity. These symptoms must impair function for a diagnosis to be made.
More often than not, presentation is comorbid with problems such as depression, anxiety, anger, and substance misuse.
Assessment should cover physical, psychological, and social needs, and an assessment of risk: this can be facilitated by the use of screening questionnaires and a clinical interview schedule.
Trauma-focused psychological treatments are the most effective treatment. Pharmacotherapy may be used in patients who do not respond to, cannot tolerate, do not want, or do not have access to psychological therapies.
Post-traumatic stress disorder (PTSD) may develop following exposure to 1 or more traumatic events such as deliberate acts of interpersonal violence, severe accidents, disasters, or military action. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), it is characterised by 4 types of symptoms: intrusions (e.g., flashbacks, intrusive images and sensory impressions, dreams/nightmares); avoidance (e.g., avoiding people, situations, or circumstances resembling or associated with the event); negative alterations in mood and cognition (e.g., feeling alienated from others, constricted affect, diminished interest in significant activities, distorted negative beliefs about oneself or the world, and inability to remember key features of the traumatic event); and alterations in arousal or reactivity (e.g., hypervigilance for threat, exaggerated startle response, irritability, difficulty concentrating, and sleep problems). These symptoms must impair function for a diagnosis to be made.
Complex PTSD (CPTSD) is a new diagnosis in ICD-11 that is applied to people who have experienced prolonged, repeated, or multiple forms of traumatic exposure such as childhood abuse or torture. The evidence for diagnosis and treatment of CPTSD is still in its relatively early stages; at present CPTSD remains beyond scope of this topic.
This topic does not cover PTSD in children.
History and exam
Key diagnostic factors
- exposure and response to trauma
- intrusion symptoms
- avoidance symptoms
- negative alterations in cognitions and mood
- alterations in arousal and reactivity
Other diagnostic factors
- alcohol or substance misuse
- serious accident
- witness of school violence or domestic violence
- natural disaster
- terrorist attack
- combat exposure
- traumatic brain injury
- sudden death of loved one
- victimisation by attacker
- previous trauma
- multiple major life stressors
- low social support
- history of mental disorder
- history of drug and alcohol misuse
- female sex
- younger age
1st investigations to order
- PTSD Checklist for DSM-5 (PCL-5)
- Trauma Screening Questionnaire (TSQ)
- Posttraumatic Diagnostic Scale (PDS-5)
- International Trauma Questionnaire (ITQ)
Investigations to consider
- Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)
- PTSD Symptom Scale-Interview for DSM-5 (PSS-I-5)
- International Trauma Interview (ITI)
not pregnant or breastfeeding
pregnant or breastfeeding
Mathew Hoskins, MBBCh, MSc, MRCPsych
Cardiff and Vale University Health Board
MH is an author of references cited in this topic.
Catrin Lewis, BSc, PhD
National Centre for Mental Health
Institute of Psychological Medicine and Clinical Neurosciences
School of Medicine
CL is an author of references cited in this topic.
Dr Mathew Hoskins, and Dr Catrin Lewis would like to gratefully acknowledge Dr Stanley Zammit, Dr Neil P. Roberts, Dr Jonathan I. Bisson, and Dr Steve Wood, previous contributors to this topic.
Mort Rubinstein, MD
Deputy Associate Chief of Staff
VA New York Harbor Healthcare System
Clinical Associate Professor
New York University School of Medicine
MR declares that he has no competing interests.
Neil Greenberg, MD, MRCPsych
Defence Professor of Mental Health, Visiting Professor of Psychiatry, and Co-Director
Academic Centre for Defence Mental Health
King's College London
NG has been principal investigator on studies with research funding greater than 6 figures USD. NG is a director of a company providing early intervention training for traumatic stress (the company does not provide PTSD treatment services).
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