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Definition
Post-traumatic stress disorder (PTSD) is a psychiatric condition that some people may develop in response to a traumatic event.
PTSD can develop in response to a single traumatic event, such as a serious car accident or an assault, or a prolonged or multiple-event trauma, such as sustained domestic violence, childhood neglect, or exposure to a war or conflict (NICE, 2023a).
The NHS characterises PTSD as an anxiety disorder (NHS, 2023a) with symptoms normally presenting within the first month after the trauma, although in some people they develop many months or even years later (National Institute for Health and Care Excellence (NICE), 2022a).
Individuals of all ages can develop PTSD in the wake of experiencing trauma first-hand, or after witnessing a traumatic event. Half of the population experience some kind of trauma in their lives and around 20% of those go on to PTSD, which equates to more than 6.5
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Symptoms
There are four different categories or groups of symptoms. An individual may exhibit some or all of them. Symptoms are grouped as follows:
Reliving
The person might relive the whole event or some aspects of it, through nightmares, intrusive memories and thoughts, and experience intense distress at reminders of the trauma. Flashbacks are also common, in which a person may relive aspects of the trauma as if they are happening in the present. This may entail seeing images (as if watching the trauma on video), hearing sounds and experiencing physical sensations and emotions associated with the trauma. Reliving trauma is the most strongly associated symptom of PTSD and the most common (NICE, 2022b).
Avoiding
The person may avoid situations or places that serve as reminders of the trauma. Some people are unable to remember details of the event or describe feeling physically and/or emotionally detached or
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Aetiology
The International Classification of Diseases tenth edition (ICD-10, 2016) outlines PTSD as ‘a delayed or protracted response to a stressful event or situation (of either brief of long duration) of an exceptionally threatening and catastrophic nature, which is likely to cause pervasive distress in almost anyone.’
According to NICE (2022a), the Diagnostic Statistical Manual of Mental Disorders fifth edition (DSM-5) characterises trauma resulting in PTSD as ‘exposure to actual or threatened death, serious injury, or sexual violence.’
Trauma affects everybody differently, various types of events that may cause or trigger PTSD. This includes:
- being in or witnessing a road traffic accident
- experiencing violence, including assault, war, terror attacks
- being the victim of abuse, rape, sexual assault
- experiencing harassment or bullying, including gender-based abuse, transphobia, racism
- seeing other people seriously ill, badly injured or killed, either as a witness or bystander or in the course of the person’s work (e.g.
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Risk factors
Certain factors can predispose a person to developing PTSD. These include:
- physical weakness (asthenia)
- compulsive personality traits
- previous history of depression and anxiety or other neurotic disorders
- repeatedly experiencing trauma
- a lack of psychosocial support
The presence of additional stressors at the time of the trauma can exacerbate the symptoms of PTSD. For example:
- bereavement
- financial worries
- homelessness
- being imprisoned
- being a refugee and/or seeking asylum
- being in foster care
Certain jobs such as working in the police force, ambulance or fire service, armed forces, or as a frontline nurse or emergency care doctor are associated with a higher risk of PTSD. This is because the nature of these professions is more likely to expose a person to trauma.
There is no significant difference in rates of PTSD between males (3.7% of the population) and females (5.1%). Furthermore, women aged 16–24 years are most likely (12.6%) to screen positive for
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Diagnosis
PTSD can sometimes be diagnosed in primary care by a GP or clinician, but usually, they will refer the individual to a specialist mental health service or professional with requisite training and experience in managing PTSD (NICE, 2022b).
The individual’s history and how they describe the trauma, and their symptoms can guide a clinician towards suspecting PTSD. Several screening tools can assist, for example:
Formal criteria
Aside from the screening tools, an individual may be diagnosed with
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Management and treatment
The first-line option is normally a trauma-focused psychological treatment, which can comprise a specific type of cognitive behavioural therapy and exposure therapy (NICE, 2022d). However, PTSD associated with a single-event trauma can also sometimes be managed in primary care through NHS talking therapies. Typically, patients are seen by a specialist team, where treatments and therapies can be discussed.
Another commonly used therapy is eye movement desensitisation and reprocessing (EMDR), which uses eye movements, taps and tones as stimuli while focusing on the event and memories associated with it. EMDR can help the brain to process the misfiled memories and flashbacks. Trauma-focused cognitive behavioural therapy and EMDR are often the best treatments in the first instance (RCPsych, 2021).
Pharmacological treatments including antidepressants e.g. selective serotonin reuptake-inhibitors or venlafaxine, and antipsychotic medications are sometimes offered. They might be helpful in treating people who also have severe depression, or in the cases
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Resources
International Classification of Diseases Tenth Edition. F43.1: Post-traumatic stress disorder. 2016. https://icd.who.int/browse10/2016/en#/F43.1 (accessed 6 March 2023)
Mind. Post-traumatic stress disorder (PTSD). 2021a. https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd-and-complex-ptsd/symptoms/ (accessed 18 January 2023)
Mind. Complex post-traumatic stress disorder (complex PTSD). 2021b. https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd-and-complex-ptsd/complex-ptsd/ (accessed 18 January 2023)
NHS. Overview – Post-traumatic stress disorder. 2023a. https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/overview/ (accessed 18 January 2023)
National Institute of Health and Care Excellence. Post-traumatic stress disorder – Summary. 2022a. https://cks.nice.org.uk/topics/post-traumatic-stress-disorder/ (accessed 18 January 2023)
National Institute of Health and Care Excellence. When should I suspect post-traumatic stress disorder (PTSD)? 2022b. https://cks.nice.org.uk/topics/post-traumatic-stress-disorder/diagnosis/diagnosis/ (accessed 18 January 2023)
National Institute of Health and Care Excellence. Post-traumatic stress disorder: What are the risk factors? 2022c. https://cks.nice.org.uk/topics/post-traumatic-stress-disorder/background-information/risk-factors/ (accessed 18 January 2023)
National Institute of Health and Care Excellence. Post-traumatic stress disorder: Scenario: Management of adults and children with post-traumatic stress disorder. 2022d. https://cks.nice.org.uk/topics/post-traumatic-stress-disorder/management/management/ (accessed 18 January 2023)
Post-Traumatic Stress Disorder UK. Post-traumatic stress disorder explained. 2023a. https://www.ptsduk.org/what-is-ptsd/ptsd-explained/ (accessed 18
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