Post-traumatic stress disorder

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 four 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 conditions such as depression, anxiety, anger, and substance use disorder.

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 interventions 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.

PTSD may develop following exposure to one 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.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. https://ebooks.appi.org/product/diagnostic-statistical-manual-mental-disorders-fifth-edition-text-revision-dsm5tr

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), PTSD is characterized by four 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.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. https://ebooks.appi.org/product/diagnostic-statistical-manual-mental-disorders-fifth-edition-text-revision-dsm5tr

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.[2]World Health Organization. International statistical classification of diseases and related health problems (ICD). 11th revision. 2025 [internet publication]. https://www.who.int/standards/classifications/classification-of-diseases [3]Maercker A, Cloitre M, Bachem R, et al. Complex post-traumatic stress disorder. Lancet. 2022 Jul 2;400(10345):60-72. http://www.ncbi.nlm.nih.gov/pubmed/35780794?tool=bestpractice.com ​​

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.[4]American Psychological Association. Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. Feb 2025 [internet publication]. https://www.apa.org/ptsd-guideline

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.