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What is PTSD?
Post-Traumatic Stress Disorder (PTSD) is a mental health condition triggered by exposure to a traumatic event involving actual or threatened death, serious injury, or sexual violence. According to the DSM-5, PTSD is classified under Trauma- and Stressor-Related Disorders and requires symptoms to persist for more than one month with significant functional impairment (American Psychiatric Association, 2013). The ICD-11 defines PTSD by three core symptom clusters: re-experiencing, avoidance, and heightened threat perception, lasting at least several weeks (World Health Organization, 2022).
Symptoms of PTSD
Per DSM-5, PTSD symptoms are grouped into four clusters:
- Intrusion Symptoms:
- Recurrent, involuntary traumatic memories or flashbacks.
- Distressing dreams related to the event.
- Intense psychological/physical distress to trauma reminders.
- Avoidance:
- Avoiding trauma-related thoughts, people, places, or activities.
- Negative Alterations in Cognition/Mood:
- Inability to recall key aspects of the trauma.
- Persistent negative beliefs (e.g., “The world is entirely dangerous”).
- Detachment from others or diminished interest in activities.
- Persistent guilt, shame, or fear.
- Arousal/Reactivity Symptoms:
- Hypervigilance.
- Exaggerated startle response.
- Irritability or aggression.
- Sleep disturbances or concentration issues.
ICD-11 simplifies criteria to:
- Re-experiencing, avoidance, and hypervigilance, with functional impairment.
Symptoms must not stem from substance use, medical conditions, or other psychiatric disorders (e.g., psychosis).
Types of PTSD and Related Conditions
- Acute Stress Disorder (ASD): Similar symptoms occurring 3 days to 1 month post-trauma (DSM-5).
- Complex PTSD (CPTSD): Recognized in ICD-11, includes PTSD symptoms plus chronic emotional dysregulation, negative self-concept, and interpersonal difficulties from prolonged trauma (e.g., childhood abuse).
- Dissociative Subtype (DSM-5): PTSD with depersonalization/derealization symptoms.
- Delayed-Onset PTSD: Symptoms emerge ≥6 months post-trauma (Oxford Textbook of Psychiatry).
Causes of PTSD
PTSD develops from a combination of factors:
- Biological: Hyperactive amygdala (fear processing), hypoactive prefrontal cortex (emotional regulation), and dysregulated HPA axis (stress response). Genetic vulnerability (e.g., FKBP5 gene) increases risk (Kaplan & Sadock’s Synopsis of Psychiatry).
- Psychological: Pre-existing anxiety, maladaptive coping strategies, or cognitive biases (e.g., overestimating danger).
- Environmental: Trauma severity, lack of social support, or cumulative trauma (e.g., combat exposure, assault) (Maudsley Guidelines).
Diagnosing PTSD
Clinical Interview: Assess trauma exposure, symptom clusters, duration, and functional impact (DSM-5/ICD-11).
- Standardized Tools:
- Clinician-Administered PTSD Scale (CAPS-5).
- PTSD Checklist for DSM-5 (PCL-5).
- Rule-Outs: Exclude TBI, substance use, or medical conditions mimicking symptoms (e.g., hyperthyroidism).
- Differential Diagnosis: Distinguish from adjustment disorder, OCD, or borderline personality disorder (NICE Guidelines).
Treatment for PTSD
Evidence-based interventions include:
- Psychotherapy:
- Prolonged Exposure (PE): Gradual confrontation with trauma memories.
- Cognitive Processing Therapy (CPT): Challenges and reframes trauma-related beliefs.
- Eye Movement Desensitization and Reprocessing (EMDR): Uses bilateral stimulation to process trauma.
- Trauma-Focused CBT (TF-CBT): Effective for children and adolescents (NICE Guidelines).
- Pharmacotherapy:
- First-line: SSRIs (sertraline, paroxetine) and SNRIs (venlafaxine) to reduce hyperarousal and intrusive symptoms (Maudsley Prescribing Guidelines).
- Adjuncts: Prazosin for nightmares, atypical antipsychotics (e.g., risperidone) for severe dissociation/aggression.
- Adjunctive Therapies:
- Mindfulness-Based Stress Reduction (MBSR).
- Group therapy for peer support.
- Lifestyle Modifications: Regular exercise, sleep hygiene, and avoiding alcohol/drugs (Oxford Textbook of Psychiatry).
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