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-TR, PTSD is characterized by 4 groups of symptoms: intrusion symptoms, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity. These symptoms must persist for more than 1 month and cause functional impairment 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 involving actual or threatened death, serious injury, or sexual violence. Exposure can be through directly experiencing the traumatic event, witnessing the event as it occurred to others, learning that the event occurred to a family member or a close friend, or indirect exposure in the course of occupational duties. War, physical assault, terrorist attacks, and natural disasters are all examples of traumatic events.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), PTSD is characterized by 4 types of symptoms: intrusions, avoidance, negative alterations in mood and cognition, and alterations in arousal or reactivity. These symptoms must persist for more than 1 month and cause functional impairment for a diagnosis to be made.
Complex PTSD (CPTSD) is the name given to another, related mental health condition that can occur after any type of traumatic event, but tends to occur more commonly after chronic, repeated, or prolonged traumas that are nearly impossible to escape from. These include childhood abuse, childhood emotional neglect, domestic violence, or exposure to sustained civil war, torture, or community violence.
People with CPTSD have all the characteristic features of PTSD, as well as additional difficulties in how they experience their emotions, negative thoughts and feelings about themselves, and how they form relationships with other people.
The full criteria for CPTSD can be found in the Diagnostic criteria section; otherwise, CPTSD remains beyond the 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
- victimization 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 breast-feeding
pregnant or breast-feeding
- Specific phobias
- Panic disorder
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)
- Guidelines for the prevention and treatment of acute stress disorder, posttraumatic stress disorder and complex PTSD
Post-traumatic stress disorder: what is it?
Post-traumatic stress disorder: what treatments work?More Patient leaflets
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