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Post-Traumatic Stress Disorder (PTSD)

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ℹ️ About

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that develops after exposure to actual or threatened death, serious injury, or sexual violence.
⚔️ Common triggers: military combat, natural disasters, sexual assault, accidents, terrorism, or life-threatening events.
🕒 Symptoms can appear soon after trauma, but often have a delayed onset (months–years).

📐 Diagnostic Criteria

Symptoms persist for >1 month after trauma.
Cause significant distress or functional impairment (social, occupational, personal).
Not due to substances, medications, or another medical condition.

⚠️ Core Symptom Clusters

Re-experiencing: 💭 Flashbacks, intrusive thoughts, distressing nightmares.
Avoidance: 🚫 Avoiding reminders (people, places, activities, conversations).
Negative mood/cognition: 😞 Guilt, shame, numbness, detachment, loss of interest.
Hyperarousal: 😠 Irritability, insomnia, exaggerated startle, hypervigilance.

🧬 Risk Factors

Previous trauma or childhood adversity.
Family history of mental illness.
Weak social support after trauma.
Pre-existing anxiety, depression, or personality traits.

🤝 Comorbidities

😔 Depression (very common).
🍷 Substance misuse (often self-medication).
😰 Other anxiety disorders (panic, GAD, phobias).
⚕️ Physical: chronic pain, cardiovascular disease, GI disorders.

🔎 Investigations

Psychiatric assessment: Detailed trauma history, symptoms, functional impact.
Screening tools: 📋 PTSD Checklist (PCL-5), Impact of Event Scale (IES-R).
Exclude mimics: depression, substance misuse, head injury.

🛠️ Management (NICE NG116, 2018)

Psychological therapy (first-line):
- 🧠 Trauma-focused CBT – reprocessing trauma memories, modifying beliefs.
- 📖 Prolonged Exposure Therapy – systematic exposure to trauma memories and reminders.
- 👁️ EMDR (Eye Movement Desensitisation & Reprocessing) – bilateral stimulation during trauma recall.
Medications (adjuncts, not first-line):
- 💊 SSRIs (e.g. sertraline, paroxetine) – NICE-approved.
- 🔁 SNRIs (e.g. venlafaxine) – alternative option.
- 🌙 Prazosin – may help trauma-related nightmares (off-label UK).
- 🚫 Benzodiazepines – avoid (dependence risk, poor long-term outcome).
Supportive measures:
- Strong family & peer support networks.
- Lifestyle: regular exercise, healthy sleep, reducing alcohol/caffeine.
- Consider peer/veteran groups, survivor networks.

📈 Prognosis

Recovery possible with early, sustained intervention.
Without treatment, symptoms may become chronic and disabling.
⏱️ Early recognition and access to trauma-focused therapy improve outcomes.

🔗 References

⚡ Post-Traumatic Stress Disorder (PTSD) – Clinical Cases

Case 1 – Road Traffic Accident Survivor A 29-year-old woman, previously healthy, presents 3 months after a serious car crash in which her friend died. She describes intrusive flashbacks, nightmares, and avoids driving. She startles easily at loud noises and feels detached from others. No alcohol misuse or head injury. Teaching point: PTSD typically begins within 6 months of trauma and features re-experiencing, avoidance, hyperarousal, and emotional numbing. First-line management: trauma-focused CBT or EMDR; pharmacotherapy (SSRI such as sertraline) if psychotherapy unavailable or refused.

Case 2 – Combat Veteran with Delayed Onset PTSD A 42-year-old ex-serviceman presents with anger outbursts, poor sleep, and alcohol misuse. He left the military 10 years ago but recently witnessed a violent assault, triggering recurrent memories of deployment in Afghanistan. He feels guilty about events during service and avoids news reports about war. Teaching point: PTSD may show delayed onset or reactivation years after trauma. Comorbidity with depression, substance misuse, and relationship breakdown is common. Treatment: structured trauma therapy plus gradual alcohol reduction and social reintegration support.

Case 3 – Complex PTSD Following Prolonged Abuse A 36-year-old woman with a history of childhood sexual abuse reports chronic anxiety, self-blame, emotional dysregulation, and difficulty trusting others. She has nightmares but also long-standing interpersonal problems and dissociative episodes. Teaching point: Complex PTSD arises after prolonged, repeated trauma (e.g. abuse, captivity). Management requires phase-based therapy: (1) safety & stabilisation, (2) trauma processing, (3) reintegration. Often multidisciplinary — psychology, psychiatry, and social care.

💡 Clinical pearl: PTSD is not weakness but a maladaptive survival response. Always screen for suicidal ideation, substance misuse, and comorbid depression. Early psychological intervention after trauma (but not “debriefing”) improves long-term outcomes. 🌿

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