Definition and Diagnosis
Post-Traumatic Stress Disorder (PTSD) develops after exposure to actual or threatened death, serious injury, or sexual violence, and is characterized by intrusive re-experiencing of the event, avoidance of trauma-related reminders, negative changes in mood and cognition, and heightened arousal lasting more than a month.
Epidemiology
Lifetime prevalence of PTSD is estimated at around 6-9% in the general population, with higher rates among individuals exposed to combat, assault, or disaster. Women are diagnosed roughly twice as often as men, partly reflecting differences in trauma exposure type.
Risk Factors
Risk factors include the severity and nature of the trauma, lack of social support afterward, prior mental health history, and additional life stressors during recovery. Peritraumatic dissociation and a history of childhood trauma also increase vulnerability.
Symptoms and Subtypes
Symptoms include intrusive memories or nightmares, flashbacks, avoidance of trauma reminders, negative beliefs about oneself or the world, emotional numbing, hypervigilance, and an exaggerated startle response. Symptoms must persist for more than a month and cause significant distress or impairment.
Diagnosis
Diagnosis follows DSM-5-TR criteria across four symptom clusters (intrusion, avoidance, negative alterations in cognition/mood, and arousal), confirmed through detailed clinical interview and validated trauma screening tools. Clinicians also assess for co-occurring depression, anxiety, or substance use.
Treatment
Trauma-focused psychotherapies, such as Prolonged Exposure, Cognitive Processing Therapy, and EMDR, are first-line treatments with strong evidence. SSRIs and SNRIs are also used, particularly when psychotherapy alone is insufficient or unavailable.
Prognosis
Many individuals show significant improvement with trauma-focused treatment, though some experience a more chronic course, especially with repeated or prolonged trauma exposure. Early intervention after trauma is associated with a lower likelihood of the disorder becoming chronic.
Reference
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).