ICD-10 code: F43.10
Post-traumatic stress disorder (PTSD) is part of a cluster of diagnoses called the trauma- and stressor-related disorders. Trauma- and stressor-related disorders are a group of psychiatric conditions that include:
These disorders are characterized by an adverse reaction to one or more traumatic or unusually stressful experiences.
The Diagnostic and Statistical Manual of Mental Disorders-5th Edition defines traumatic events as situations in which the individual experiences, is threatened with, or witnesses serious injury, death, or sexual violence. Repeated exposure to extreme details of traumatic events as part of an individual's employment (e.g., a police officer or social worker who regularly encounters details of child abuse) also qualifies as a traumatic event.
PTSD and acute stress disorder are both characterized by a set of adverse cognitive, behavioral, and emotional changes that occur after experience of one or more traumatic events. Both disorders are characterized by intrusive and upsetting memories of the traumatic event(s), adverse cognitive and emotional changes (e.g., very negative beliefs about the world; persistent dysphoria or anger), avoidance behaviors (including avoiding thinking about the event), and increased autonomic reactivity. Acute stress disorder is diagnosed when the symptoms occur in the month following the traumatic event. PTSD is diagnosed when the symptoms persist for one month or longer following the traumatic event.
Reactive attachment disorder (RAD) is diagnosed only in children and is characterized by inhibited and emotionally withdrawn behaviors toward the child's caregiver(s), along with other social and emotional disturbances. RAD is an adverse reaction to neglect, repeated changes in caregivers (e.g., frequent changes in foster care), or rearing in adverse circumstances (e.g., institutions with inadequate availability of caregivers).
PTSD is a psychiatric disorder that affects approximately 1-2% of adults. The prevalence of traumatic events is significantly higher, affecting up to 30% of adults, and many individuals do not develop PTSD as a result of these experiences.
Therefore, PTSD should be diagnosed only when the individual experiences impairment or distress associated with the following symptoms in the aftermath of the traumatic experience:
Many of these symptoms are normal responses to traumatic events, and will remit over time. Therefore, PTSD is diagnosed only when the symptoms last one month or longer and lead to clinically significant distress or impairment. Symptoms do not need to occur immediately following the trauma for a PTSD diagnosis to be warranted. Some individuals experience a delayed onset of PTSD, in which symptoms do not begin until weeks, months, or longer following the trauma. The specifier "with delayed onset" is applied when symptoms do not reach full diagnostic criteria until 6 months after the trauma.
PTSD may also be specified as occurring "with dissociative symptoms." Dissociative symptoms can include depersonalization, in which the person feels detached from him or herself or as though he or she is "out of body" in some way, or derealization, in which the person experiences his or her surroundings as dreamlike or unreal in some way.
PTSD severity can range from mild to debilitating. In severe cases, PTSD can lead to inability to work, go to school, or have enjoyable relationships. Most people with PTSD also have other psychiatric conditions, most commonly depressive disorders, substance use disorders, and anxiety disorders.
Comorbidity of PTSD with substance use disorders has been explained in terms of self-medication (i.e., individuals use substances to medicate painful PTSD symptoms), although withdrawal states may exacerbate PTSD symptoms.
PTSD is characterized by abnormalities of brain function which are thought to contribute to symptoms. In particular, evidence points to abnormalities in neuroendocrine systems (in particular the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axes), neurotransmitter systems (in particular norepinephrine, serotonin, and corticotropin-releasing factor), and certain brain regions (in particular the amygdala and hippocampus) that are thought to underlie hyperarousal and other symptoms associated with PTSD. In addition, avoidance of trauma-related cues is thought to contribute to the persistence of PTSD by preventing fear extinction and new learning. Similarly, avoidance of trauma-related memories is thought to exacerbate the frequency and intensity of those memories. The disorder is thought to have a genetic component, although having a genetic predisposition to PTSD does not necessarily mean that someone will develop PTSD.
PTSD is treatable. Published treatment guidelines for PTSD include those from the American Psychiatric Association, the Society of Clinical Psychology, and the National Institute for Clinical Excellence.
First Line Treatments
For more information about drug prescribing in PTSD, click here.
Additional Treatments to Consider
In cases of nonresponse to first-line treatment, clinical research suggests that the following treatments are effective:
In addition, research suggests that the following treatments are promising: