Post-traumatic stress disorder

Last reviewed: 1 Sep 2023
Last updated: 28 Feb 2023



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
More key diagnostic factors

Other diagnostic factors

  • depression
  • alcohol or substance misuse
  • anxiety
Other diagnostic factors

Risk factors

  • serious accident
  • witness of school violence or domestic violence
  • natural disaster
  • terrorist attack
  • torture
  • combat exposure
  • traumatic brain injury
  • sudden death of loved one
  • molestation
  • rape
  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • PTSD Checklist for DSM-5 (PCL-5)
  • Trauma Screening Questionnaire (TSQ)
  • Posttraumatic Diagnostic Scale (PDS-5)
  • International Trauma Questionnaire (ITQ)
More 1st investigations to order

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)
More investigations to consider

Treatment algorithm


not pregnant or breast-feeding

pregnant or breast-feeding



Mathew Hoskins, MBBCh, MSc, MRCPsych

Consultant Psychiatrist 

Cardiff and Vale University Health Board 




MH is an author of references cited in this topic.

Catrin Lewis, BSc, PhD

Research Associate

National Centre for Mental Health

Institute of Psychological Medicine and Clinical Neurosciences

School of Medicine

Cardiff University




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.

Peer reviewers

Mort Rubinstein, MD

Deputy Associate Chief of Staff

Mental Health

VA New York Harbor Healthcare System

Clinical Associate Professor

New York University School of Medicine

New York



MR declares that he has no competing interests.

Neil Greenberg, MD, MRCPsych

Surgeon Commander

Royal Navy

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).

  • Post-traumatic stress disorder images
  • Differentials

    • Depression
    • Specific phobias
    • Panic disorder
    More Differentials
  • Guidelines

    • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)
    • Screening and intervention for mental health disorders and substance use and misuse in the acute trauma patient
    More Guidelines
  • Patient leaflets

    Post-traumatic stress disorder: what is it?

    Post-traumatic stress disorder: what treatments work?

    More Patient leaflets
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