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Post-traumatic stress disorder

"PTSD" and "Post traumatic" redirect here. For the Mike Shinoda album, see Post Traumatic. For other uses, see PTSD (disambiguation). For CPTSD, see Complex post-traumatic stress disorder.

Post-traumatic stress disorder
An illustration of a person experiencing a flashback
SpecialtyPsychiatry, clinical psychology
SymptomsDisturbing thoughts, feelings, or dreams related to the event; mental or physical distress to trauma-related cues; efforts to avoid trauma-related situations; increased fight-or-flight response[1]
ComplicationsSuicide; cardiac, respiratory, musculoskeletal, gastrointestinal, and immunological disorders [2]
Duration> 1 month[a]
CausesExposure to a traumatic event[1]
Diagnostic methodBased on symptoms[2]
TreatmentCounseling, medication,[4] MDMA-assisted psychotherapy,[5] selective serotonin reuptake inhibitors[6]
Frequency8.7% (lifetime risk); 3.5% (12-month risk) (US)[7]

Post-traumatic stress disorder (PTSD)[b] is a mental and behavioral disorder[8] that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being.[1][9] Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response.[1][4][10] These symptoms last for more than a month after the event and can include triggers such as misophonia.[1] Young children are less likely to show distress, but instead may express their memories through play.[1] A person with PTSD is at a higher risk of suicide and intentional self-harm.[2][11]

Most people who experience traumatic events do not develop PTSD.[2] People who experience interpersonal violence such as rape, other sexual assaults, being kidnapped, stalking, physical abuse by an intimate partner, and childhood abuse are more likely to develop PTSD than those who experience non-assault based trauma, such as accidents and natural disasters.[12][13][14] Those who experience prolonged trauma, such as slavery, concentration camps, or chronic domestic abuse, may develop complex post-traumatic stress disorder (C-PTSD). C-PTSD is similar to PTSD, but has a distinct effect on a person's emotional regulation and core identity.[15][16]

Prevention may be possible when counselling is targeted at those with early symptoms, but is not effective when provided to all trauma-exposed individuals regardless of whether symptoms are present.[2] The main treatments for people with PTSD are counselling (psychotherapy) and medication.[4][17] Antidepressants of the SSRI or SNRI type are the first-line medications used for PTSD and are moderately beneficial for about half of people.[6] Benefits from medication are less than those seen with counselling.[2] It is not known whether using medications and counselling together has greater benefit than either method separately.[2][18] Medications, other than some SSRIs or SNRIs, do not have enough evidence to support their use and, in the case of benzodiazepines, may worsen outcomes.[19][20]

In the United States, about 3.5% of adults have PTSD in a given year, and 9% of people develop it at some point in their life.[1] In much of the rest of the world, rates during a given year are between 0.5% and 1%.[1] Higher rates may occur in regions of armed conflict.[2] It is more common in women than men.[4][21]

Symptoms of trauma-related mental disorders have been documented since at least the time of the ancient Greeks.[22] A few instances of evidence of post-traumatic illness have been argued to exist from the seventeenth and eighteenth centuries, such as the diary of Samuel Pepys, who described intrusive and distressing symptoms following the 1666 Fire of London.[23] During the world wars, the condition was known under various terms, including 'shell shock', 'war nerves', neurasthenia and 'combat neurosis'.[24][25] The term "post-traumatic stress disorder" came into use in the 1970s, in large part due to the diagnoses of U.S. military veterans of the Vietnam War.[26] It was officially recognized by the American Psychiatric Association in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).[27]

  1. ^ a b c d e f g h i American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. pp. 271–80. ISBN 978-0-89042-555-8.
  2. ^ a b c d e f g h Bisson JI, Cosgrove S, Lewis C, Robert NP (November 2015). "Post-traumatic stress disorder". BMJ. 351: h6161. doi:10.1136/bmj.h6161. PMC 4663500. PMID 26611143.
  3. ^ "Post-Traumatic Stress Disorder". www.nimh.nih.gov. Retrieved 13 January 2024.
  4. ^ a b c d "Post-Traumatic Stress Disorder". National Institute of Mental Health. February 2016. Archived from the original on 9 March 2016. Retrieved 10 March 2016.
  5. ^ "Notice of final decision to amend (or not amend) the current Poisons Standard – June 2022 ACMS #38 – Psilocybine and MDMA". Therapeutic Goods Administration, Department of Health and Aged Care, Australian Government. Retrieved 19 April 2023.
  6. ^ a b Berger W, Mendlowicz MV, Marques-Portella C, Kinrys G, Fontenelle LF, Marmar CR, et al. (March 2009). "Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: a systematic review". Progress in Neuro-Psychopharmacology & Biological Psychiatry. 33 (2): 169–80. doi:10.1016/j.pnpbp.2008.12.004. PMC 2720612. PMID 19141307.
  7. ^ Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association. 2013. p. 276. ISBN 978-0-89042-555-8. OCLC 830807378.
  8. ^ Sartorius N, Henderson A, Strotzka H, Lipowski Z, Yu-cun S, You-xin X, et al. "The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines" (PDF). www.who.int World Health Organization. Microsoft Word. bluebook.doc. p. 110. Retrieved 3 July 2021 – via Microsoft Bing.
  9. ^ "Post-traumatic stress disorder (PTSD) – Symptoms and causes". Mayo Clinic. Retrieved 8 October 2019.
  10. ^ Forman-Hoffman V, Cook Middleton J, Feltner C, Gaynes BN, Palmieri Weber R, Bann C, et al. (17 May 2018). Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update (Report). Agency for Healthcare Research and Quality (AHRQ). doi:10.23970/ahrqepccer207. PMID 30204376. Archived from the original on 10 July 2018. Retrieved 25 August 2020.
  11. ^ Panagioti M, Gooding PA, Triantafyllou K, Tarrier N (April 2015). "Suicidality and posttraumatic stress disorder (PTSD) in adolescents: a systematic review and meta-analysis". Social Psychiatry and Psychiatric Epidemiology. 50 (4): 525–537. doi:10.1007/s00127-014-0978-x. PMID 25398198. S2CID 23314414.
  12. ^ Zoladz PR, Diamond DM (June 2013). "Current status on behavioral and biological markers of PTSD: a search for clarity in a conflicting literature". Neuroscience and Biobehavioral Reviews. 37 (5): 860–895. doi:10.1016/j.neubiorev.2013.03.024. PMID 23567521. S2CID 14440116.
  13. ^ Kessler RC, Aguilar-Gaxiola S, Alonso J, Benjet C, Bromet EJ, Cardoso G, et al. (27 October 2017). "Trauma and PTSD in the WHO World Mental Health Surveys". European Journal of Psychotraumatology. 8 (sup5): 1353383. doi:10.1080/20008198.2017.1353383. PMC 5632781. PMID 29075426. As detailed in another recent WMH report, conditional risk of PTSD after trauma exposure is 4.0%, but varies significantly by trauma type. The highest conditional risk is associated with being raped (19.0%), physical abuse by a romantic partner (11.7%), being kidnapped (11.0%), and being sexually assaulted other than rape (10.5%). In terms of broader categories, the traumas associated with the highest PTSD risk are those involving intimate partner or sexual violence (11.4%), and other traumas (9.2%), with aggregate conditional risk much lower in the other broad trauma categories (2.0–5.4%) [citations omitted; emphasis added].
  14. ^ Darves-Bornoz JM, Alonso J, de Girolamo G, de Graaf R, Haro JM, Kovess-Masfety V, et al. (October 2008). "Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey". Journal of Traumatic Stress. 21 (5): 455–462. doi:10.1002/jts.20357. PMID 18956444. In univariate analyses adjusted on gender, six events were found to be the most significantly associated with PTSD ( p < .001) among individuals exposed to at least one event. They were being raped (OR = 8.9), being beaten up by spouse or romantic partner (OR = 7.3), experiencing an undisclosed private event (OR = 5.5), having a child with serious illness (OR = 5.1), being beaten up by a caregiver (OR = 4.5), or being stalked (OR = 4.2)" [OR = odds ratio].
  15. ^ Brewin CR, Cloitre M, Hyland P, Shevlin M, Maercker A, Bryant RA, et al. (December 2017). "A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD" (PDF). Clinical Psychology Review. 58: 1–15. doi:10.1016/j.cpr.2017.09.001. PMID 29029837. S2CID 4874961.
  16. ^ Zhai Y, Du X (30 May 2024). "Trends in Diagnosed Posttraumatic Stress Disorder and Acute Stress Disorder in US College Students, 2017-2022". JAMA Network Open. 7 (5): e2413874. doi:10.1001/jamanetworkopen.2024.13874. ISSN 2574-3805. PMC 11140522. PMID 38814646.
  17. ^ Haagen JF, Smid GE, Knipscheer JW, Kleber RJ (August 2015). "The efficacy of recommended treatments for veterans with PTSD: A metaregression analysis". Clinical Psychology Review. 40: 184–94. doi:10.1016/j.cpr.2015.06.008. hdl:1874/330054. PMID 26164548.
  18. ^ Hetrick SE, Purcell R, Garner B, Parslow R (July 2010). "Combined pharmacotherapy and psychological therapies for post traumatic stress disorder (PTSD)" (PDF). The Cochrane Database of Systematic Reviews (7): CD007316. doi:10.1002/14651858.CD007316.pub2. PMID 20614457.
  19. ^ Guina J, Rossetter SR, DeRHODES BJ, Nahhas RW, Welton RS (July 2015). "Benzodiazepines for PTSD: A Systematic Review and Meta-Analysis". Journal of Psychiatric Practice. 21 (4): 281–303. doi:10.1097/pra.0000000000000091. PMID 26164054. S2CID 24968844.
  20. ^ Hoskins M, Pearce J, Bethell A, Dankova L, Barbui C, Tol WA, et al. (February 2015). "Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis". The British Journal of Psychiatry. 206 (2): 93–100. doi:10.1192/bjp.bp.114.148551. PMID 25644881. Some drugs have a small positive impact on PTSD symptoms
  21. ^ "Study: PTSD among college students jumps, especially during COVID shutdowns". Health News Florida. 30 July 2024. Retrieved 31 July 2024.
  22. ^ Carlstedt R (2009). Handbook of Integrative Clinical Psychology, Psychiatry, and Behavioral Medicine Perspectives, Practices, and Research. New York: Springer Pub. Co. p. 353. ISBN 978-0-8261-1095-4 – via Google Books.
  23. ^ O'Brien S (1998). Traumatic Events and Mental Health. Cambridge University Press. p. 7.
  24. ^ Herman J (2015). Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror. Basic Books. p. 9. ISBN 978-0-465-09873-6 – via Google Books.
  25. ^ After War: A Conversation with Author Nancy Sherman, by John Waters, Real Clear Defense, 4 June 2015
  26. ^ Klykylo WM (2012). "15". Clinical child psychiatry (3 ed.). Chichester, West Sussex, UK: John Wiley & Sons. ISBN 978-1-119-96770-5 – via Google Books.
  27. ^ Friedman MJ (October 2013). "Finalizing PTSD in DSM-5: getting here from there and where to go next". Journal of Traumatic Stress. 26 (5): 548–56. doi:10.1002/jts.21840. PMID 24151001.


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