Post-Traumatic Stress Disorder

Overview – Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition that develops in response to experiencing or witnessing traumatic events. It is marked by distressing recollections, emotional numbing, and heightened arousal. While most individuals experience acute stress following trauma, only some develop PTSD—often due to a complex interplay of neurobiological, psychological, and social factors. Effective treatment, including trauma-focused cognitive behavioural therapy and pharmacotherapy, can significantly improve long-term outcomes.

Definition

PTSD is a trauma- and stressor-related disorder characterised by persistent psychological distress following exposure to a traumatic event involving actual or threatened death, serious injury, or sexual violence. It manifests with intrusive symptoms, avoidance behaviours, mood disturbances, and hyperarousal, lasting more than one month and causing functional impairment.

Epidemiology

• Affects ≈65% of men and 50% of women during their lifetime after trauma exposure
• High-risk groups:
  • Refugees, asylum seekers
  • Military and emergency personnel
  • Victims of sexual assault, natural disasters, terrorism, and car accidents
  • Minority groups, criminals, and crime victims

Aetiology

Causative Factor

• A trauma or stressor is necessary, but not sufficient—vulnerability varies by individual

Risk Factors

• Female gender
• Childhood trauma
• Inadequate social support
• Personality traits (e.g. borderline, dependent, antisocial)
• External locus of control (perceived helplessness)
• Excessive alcohol intake
• Genetic predisposition to psychiatric illness

Pathophysiology

• Neuroendocrine changes:
  • ↑ Corticotropin-releasing hormone (CRH) → ↑ ACTH → ↑ Cortisol
• Structural/functional brain alterations:
  • Amygdala hyperactivation → fear/stress responses
  • Hippocampal changes → impaired memory integration
  • Prefrontal cortex hypoactivation → poor emotion regulation

Clinical Features

Three core symptom domains:

1. Intrusion

• Flashbacks, nightmares
• Intense distress or physical reactivity to trauma cues

2. Avoidance and Emotional Numbing

• Avoiding reminders (places, people, thoughts)
• Restricted affect and detachment from others

3. Hyperarousal

• Irritability, exaggerated startle response
• Sleep disturbance, poor concentration
• Symptoms must persist >1 month and cause social/occupational impairment

DSM-5 Diagnostic Criteria

A. Exposure

• Direct experience, witnessing, learning about close contacts’ trauma, or repeated exposure to traumatic details (e.g. first responders)

B. Intrusion Symptoms

• Recurrent memories, dreams, flashbacks
• Distress or physiological reactions to trauma cues

C. Avoidance

• Efforts to avoid distressing thoughts or reminders

D. Cognition and Mood Changes

• Negative beliefs, blame, emotional numbing, detachment, loss of interest

E. Arousal Changes

• Irritability, hypervigilance, reckless behaviour, sleep and concentration problems

F–H.

• Duration >1 month
• Functional impairment
• Not due to substances or medical condition

Differential Diagnosis

• Acute stress disorder
• Generalised anxiety disorder
• Major depressive disorder
• Adjustment disorder
• Obsessive compulsive disorder
• Psychotic disorders

Investigations and Screening

• Screening tools (positive if score ≥4/7):
  • Avoidance behaviours
  • Loss of interest or future planning
  • Emotional detachment
  • Sleep difficulties
  • Startle response
• Consider full psychiatric assessment including substance use

Management

Psychological

• Trauma-focused CBT
• Psychoeducation, normalisation, desensitisation
• Coping strategies (e.g. relaxation training)
• Supportive counselling, group therapy
• Hypnosis (adjunctive use in some cases)

Pharmacological

• First-line: SSRIs (e.g. sertraline, paroxetine)
• Others:
  • Monoamine oxidase inhibitors (MAOIs)
  • Anticonvulsants (e.g. carbamazepine) – for mood stabilisation and hyperarousal
  • Sleep agents if needed

Supportive Measures

• Ensure sleep hygiene
• Establish strong social support networks
• Address comorbidities: substance use, depression, anxiety disorders

Complications

• Major depression
• Panic disorder, agoraphobia, OCD
• Substance abuse
• Relationship breakdown
• Occupational and social disability
• PTSD in children may present differently and require child-specific tools

Summary – Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder is a debilitating response to trauma, characterised by intrusive thoughts, emotional numbing, and hyperarousal that persist beyond one month. It is often underdiagnosed but can be effectively treated with trauma-focused CBT and antidepressant medication. Screening and support for comorbid conditions are essential. For a broader context, see our Psychiatry & Mental Health Overview page.