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Post-traumatic stress disorder

Last reviewed: 3 Sep 2024
Last updated: 04 Jun 2024

Summary

Definition

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
Full details

Other diagnostic factors

  • depression
  • alcohol or substance misuse
  • anxiety
Full details

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 use
  • female sex
  • younger age
Full details

Diagnostic tests

1st tests to order

  • PTSD Checklist for DSM-5 (PCL-5)
  • Trauma Screening Questionnaire (TSQ)
  • Posttraumatic Diagnostic Scale (PDS-5)
  • International Trauma Questionnaire (ITQ)
Full details

Tests 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)
Full details

Treatment algorithm

ONGOING

not pregnant or breast-feeding

pregnant or breast-feeding

Contributors

Authors

Mathew Hoskins, MBBCh, MSc, MRCPsych

Consultant Psychiatrist 

Cardiff and Vale University Health Board 

Cardiff

Wales

Disclosures

MH is Principal Investigator for a Phase 2 clinical trial of MDMA-assisted therapy in PTSD, sponsored by the Multidisciplinary Association of Psychedelic Studies; he has been reimbursed for training expenses. He is a co-founder of a medical cannabis private clinic in Wales and receives payment for consultations. 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

Cardiff

Wales

Disclosures

CL is one of the originators of Spring, a digital guided self help program for PTSD. CL is an author of references cited in this topic.

Acknowledgements

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

NY

Disclosures

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

London

UK

Disclosures

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 information

    Post-traumatic stress disorder: what is it?

    Post-traumatic stress disorder: what treatments work?

    More Patient information
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