post-traumatic stress disorder

post-traumatic stress disorder
Field	Psychiatry, Clinical psychology
Causes	Exposure to a traumatic event
Diagnosis	Based on symptoms
Treatment	Psychotherapy, Medication
Medication	Selective serotonin reuptake inhibitors, Serotonin–norepinephrine reuptake inhibitors

post-traumatic stress disorder. It is a mental health condition triggered by experiencing or witnessing a terrifying event. The disorder is characterized by persistent, distressing symptoms that interfere with daily functioning. Diagnosis is clinical, based on criteria outlined in manuals like the Diagnostic and Statistical Manual of Mental Disorders.

Signs and symptoms

Core symptoms are grouped into intrusion, avoidance, negative alterations in cognition and mood, and hyperarousal. Intrusion symptoms include recurrent, involuntary memories such as flashbacks and distressing dreams related to the trauma. Avoidance involves steering clear of reminders, including places, people, or conversations associated with the event. Negative alterations may manifest as persistent negative emotional states, distorted blame of self or others, and diminished interest in activities. Hyperarousal symptoms include Irritability, hypervigilance, exaggerated startle response, and problems with concentration and sleep. Individuals may also experience dissociative reactions, feeling detached from reality. These symptoms cause significant distress or impairment in social, occupational, or other important areas, as recognized by organizations like the American Psychiatric Association.

Causes and risk factors

The primary cause is exposure to actual or threatened death, serious injury, or sexual violence. Common traumatic events include military combat, Sexual assault, natural disasters, serious accidents, and acts of terrorism. Not everyone exposed develops it; risk factors influence susceptibility. Biological factors include a family history of anxiety disorders or depression and differences in brain regions like the Amygdala and Hippocampus. Psychological risk factors encompass pre-existing mental health conditions, early childhood adversity, and a lack of social support. The severity, proximity, and duration of the trauma are significant, with events like the Holocaust, the Vietnam War, and the September 11 attacks providing extensive study contexts. Certain professions, such as first responders, firefighters, and police officers, face elevated risk due to frequent exposure.

Diagnosis

Diagnosis is made by a qualified professional, such as a Psychiatrist or Clinical psychologist, through a comprehensive clinical interview. The assessment evaluates if symptoms meet specific criteria, primarily those in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association. Key requirements include a history of trauma exposure, the presence of symptoms from all four clusters for more than one month, and significant functional impairment. Tools like the Clinician-Administered PTSD Scale are often used for structured assessment. Differential diagnosis is crucial to rule out other conditions with overlapping symptoms, such as Adjustment disorder, Acute stress disorder, Generalized anxiety disorder, and Traumatic brain injury. The International Classification of Diseases (ICD-11) by the World Health Organization provides alternative diagnostic guidelines used globally.

Management and treatment

First-line treatments are specific psychotherapies. Cognitive behavioral therapy is foundational, with particular efficacy from Prolonged exposure therapy and Cognitive processing therapy. Eye movement desensitization and reprocessing is another strongly recommended modality. Pharmacotherapy often involves Selective serotonin reuptake inhibitors like Sertraline and Paroxetine, or Serotonin–norepinephrine reuptake inhibitors such as Venlafaxine, approved by agencies like the Food and Drug Administration. Other interventions include Group therapy, often used by the United States Department of Veterans Affairs for veterans, and emerging treatments like MDMA-assisted psychotherapy under research by organizations like the Multidisciplinary Association for Psychedelic Studies. Management also focuses on treating co-occurring conditions like Substance use disorder and Major depressive disorder.

Epidemiology

It is a globally prevalent disorder. Lifetime prevalence varies by country and population but is estimated to affect a significant portion of the general population. Rates are substantially higher among groups exposed to severe trauma; studies of Vietnam War veterans, survivors of the Rwandan Genocide, and refugees from conflicts like the Syrian Civil War report very high incidence. In the United States, the National Comorbidity Survey and studies by the National Institute of Mental Health provide key epidemiological data. Women are diagnosed at approximately twice the rate of men, partly due to higher rates of exposure to certain traumas like Sexual assault. The disorder can develop at any age, including in children following events like school shootings or abuse.

History and culture

Descriptions of trauma-related symptoms appear in ancient texts, including Herodotus's account of a soldier at the Battle of Marathon. Modern conceptualization began with observations in the late 19th century, such as Jean-Martin Charcot's work on Hysteria. It was prominently recognized during World War I as "shell shock" or "war neurosis," treated by physicians like W. H. R. Rivers at Craiglockhart War Hospital. The diagnosis entered the Diagnostic and Statistical Manual of Mental Disorders in 1980, heavily influenced by research on veterans of the Vietnam War and advocacy by groups like Vietnam Veterans of America. Cultural portrayals have increased understanding, from the play The Silver Tassie to films like The Deer Hunter and American Sniper. Contemporary awareness is shaped by discussions around trauma in military personnel, first responders, and survivors of events like the September 11 attacks.

Category:Anxiety disorders Category:Trauma and stressor related disorders