POST TRAUMATIC STRESS DISORDER

Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder that can develop following exposure to a traumatic event involving actual or threatened death, serious injury, or sexual violence. The trauma may be experienced directly, witnessed, or learned about occurring to a close loved one. In some cases, repeated exposure to traumatic details—such as in first responders—can also lead to PTSD.

PTSD is classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under Trauma- and Stressor-Related Disorders.

Core Symptom Clusters of PTSD:

To o meet diagnostic criteria, symptoms must persist for at least one month and cause significant distress or impairment in functioning. The four primary symptom categories are:

  1. Intrusion Symptoms

    • Recurrent, involuntary, and distressing memories of the traumatic event

    • Nightmares or flashbacks

    • Intense psychological or physiological distress when exposed to trauma-related cues

  2. Avoidance

    • Efforts to avoid thoughts, feelings, people, places, or activities that are reminders of the trauma

  3. Negative Alterations in Cognition and Mood

    • Persistent negative beliefs about self or the world

    • Distorted blame of self or others

    • Emotional numbing, detachment, or inability to feel positive emotions

  4. Alterations in Arousal and Reactivity

    • Hypervigilance, exaggerated startle response

    • Irritability, angry outbursts, or reckless/self-destructive behavior

    • Sleep disturbance and concentration problems

Etiology and Risk Factors:

Not everyone exposed to trauma develops PTSD. Risk factors include:

  • Pre-trauma vulnerabilities (e.g., prior mental health issues, childhood adversity)

  • Severity and nature of the trauma (e.g., interpersonal violence, betrayal trauma, combat)

  • Lack of social support or ongoing stress after the event

  • Neurobiological factors, including dysregulation of the HPA axis and changes in brain regions like the amygdala, hippocampus, and prefrontal cortex

Associated Features and Comorbidities:

PTSD is frequently associated with:

  • Depression and anxiety disorders

  • Substance use disorders

  • Dissociation and personality changes

  • Chronic pain and somatic symptoms

  • Suicidal ideation or behaviors

In some individuals, particularly those exposed to prolonged or repeated trauma, symptoms may meet criteria for Complex PTSD (C-PTSD), which includes additional difficulties in emotional regulation, identity, and relationships.

Evidence-based treatments for PTSD include:

  • Trauma-focused psychotherapies:

    • Prolonged Exposure (PE) Therapy

    • Cognitive Processing Therapy (CPT)

    • Eye Movement Desensitization and Reprocessing (EMDR)

  • Pharmacotherapy:

    • SSRIs (e.g., sertraline, paroxetine) are FDA-approved for PTSD

    • Prazosin may help with trauma-related nightmares

  • Somatic and body-based therapies, mindfulness, and peer support may be valuable adjuncts

Early intervention, trauma-informed care, and long-term support significantly improve outcomes.