Post-Traumatic Stress Disorder (PTSD) develops in some individuals following exposure to traumatic events. This article covers assessment and evidence-based treatment approaches.
EPIDEMIOLOGY
- Lifetime prevalence: 6-8%
- Higher rates in military populations, first responders
- Women have higher rates than men
- Risk factors: prior trauma, lack of social support, peritraumatic dissociation
DIAGNOSTIC CRITERIA (DSM5)
Criterion A Trauma Exposure
Direct experience, witnessing, learning about trauma to close family/friend, or repeated exposure to aversive details
Criterion B Intrusion Symptoms (≥1)
- Intrusive memories
- Distressing dreams
- Dissociative reactions (flashbacks)
- Psychological distress at reminders
- Physiological reactions to reminders
Criterion C Avoidance (≥1)
- Avoidance of distressing memories/thoughts
- Avoidance of external reminders
Criterion D Negative Alterations in Cognition and Mood (≥2)
- Inability to recall important aspects of trauma
- Persistent negative beliefs
- Distorted cognitions about cause/consequences
- Persistent negative emotional state
- Diminished interest in activities
- Detachment from others
- Inability to experience positive emotions
Criterion E Alterations in Arousal (≥2)
- Irritability/anger outbursts
- Reckless or self-destructive behavior
- Hypervigilance
- Exaggerated startle
- Concentration difficulties
- Sleep disturbance
Duration ≥1 month, causing significant distress/impairment
TREATMENT
TraumaFocused Psychotherapies (Firstline)
1. Prolonged Exposure (PE)
2. Cognitive Processing Therapy (CPT)
3. Eye Movement Desensitization and Reprocessing (EMDR)
Pharmacotherapy
First-line: SSRIs (sertraline, paroxetine - FDA approved)
Second-line: Venlafaxine, prazosin (for nightmares)
Not recommended: Benzodiazepines (may interfere with fear extinction)
COMORBIDITIES
- Major depression (50%)
- Substance use disorders (30-50%)
- Other anxiety disorders
- Traumatic brain injury (military populations)
PROGNOSIS
Without treatment, PTSD often becomes chronic. With evidence-based treatment, significant improvement in 60-80% of patients.