Teaching Point | PTSD Date: 12/12/2017

Post-Traumatic Stress Disorder (PTSD)

 Definition: A disorder that develops secondary to experiencing or observing a generally catastrophic
experience/event, which is life-threatening or otherwise traumatic.
 Most common traumatic events include:
o War exposure from the perspective of a civilian or a combatant
o Physical assault (physical abuse of a child, robbery)
o Sexual violence (rape, assault)
 Characterized by the following clinical features:
o Re-experiencing of the event through intrusive thoughts, flashbacks, memories and nightmares
o Hypervigilance/hyperarousal
o Negative alterations in thoughts/mood and emotional numbing
o Avoidance of stimuli associated with the traumatic event
o Causes significant distress/impaired functioning
 Timeline:
o PTSD: Onset > 1 month after event with symptoms persisting > 1 month
 Most commonly, symptoms begin within 3 months after trauma
 If symptoms begin ≥6 months after traumatic event exposure, it can be called delayed-
onset PTSD.
o Acute Stress-Disorder: Onset < 1 month after event with symptoms persisting < 1 month

 Epidemiology:
o Lifetime prevalence of PTSD: ≈8%
o Higher prevalence in women, most likely due to greater risk of exposure to traumatic events,
particularly rape and other forms of interpersonal violence
 Other Useful Info:
o 80% of patients with PTSD have another mental disorder (e.g., MDD, bipolar disorder, anxiety
disorder, substance use disorder).
o 50% of patients with PTSD have complete recovery within 3 months.
o Symptoms tend to diminish with older age.
o Most common neuroanatomical finding in PTSD is decreased hippocampal volume.
 Therapy/Treatment:
o First-line treatments for PTSD include psychotherapy such as
 Trauma-focused cognitive-behavioral therapy:
 Desensitization/exposure therapy
 Cognitive processing therapy
 Relaxation training
 Supportive and psychodynamic therapy
 Couples/family therapy
Teaching Point | PTSD Date: 12/12/2017

o Either with or without pharmacotherapy with:

 SSRI (e.g. Paroxetine [Paxil], Sertraline [Zoloft], Citalopram [Celexa])
 SNRI (e.g. Venlafaxine [Effexor])
o Prazosin [Minipress] is an α1-adrenergic receptor blocker that can be used to reduce PTSD-
related nightmares and hypervigilance .
 It is often used concurrently with first-line pharmacotherapy (e.g. SSRIs).
o Clonidine [Catapres] is centrally acting α2-adrenergic agonist that can be used to reduce PTSD-
related anxiety.
o In severe cases of PTSD, you may augment with atypical (2nd generation) antipsychotics.

DSM-5 Criteria for PTSD:

 Criterion A (1 required): The person was exposed to: death, threatened death, actual or threatened
serious injury, or actual or threatened sexual violence, in the following way(s):
o Direct exposure
o Witnessing the trauma
o Learning that a relative or close friend was exposed to a trauma
o Indirect exposure to aversive details of the trauma, usually in the course of professional duties
(e.g., first responders, medics)
 Criterion B (1 required): The traumatic event is persistently re-experienced, in the following way(s):
o Intrusive thoughts
o Nightmares
o Flashbacks
o Emotional distress after exposure to traumatic reminders
o Physical reactivity after exposure to traumatic reminders
 Criterion C (1 required): Avoidance of trauma-related stimuli after the trauma, in the following way(s):
o Trauma-related thoughts or feelings
o Trauma-related reminders
 Criterion D (2 required): Negative thoughts or feelings that began or worsened after the trauma, in the
following way(s):
o Inability to recall key features of the trauma
o Overly negative thoughts and assumptions about oneself or the world
o Exaggerated blame of self or others for causing the trauma
o Negative affect
o Decreased interest in activities
o Feeling isolated
o Difficulty experiencing positive affect
 Criterion E (2 required): Trauma-related arousal and reactivity that began or worsened after the trauma,
in the following way(s):
o Irritability or aggression
o Risky or destructive behavior
o Hypervigilance
o Heightened startle reaction
o Difficulty concentrating
o Difficulty sleeping
 Criterion F (required): Symptoms last for more than 1 month.
 Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).
 Criterion H (required): Symptoms are not due to medication, substance use, or other illness.