[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"condition-ptsd":3},{"id":4,"title":5,"abbr":6,"assessments":7,"bgClass":36,"body":37,"category":6,"comorbidities":44,"description":74,"dsmCriteria":75,"etiology":120,"extension":162,"heroSubtitle":163,"heroTitle":164,"icdCode":165,"icon":166,"iconClass":167,"labelClass":6,"lastReviewed":6,"meta":168,"name":191,"navigation":192,"onsetAge":193,"path":194,"prevalence":195,"ratio":196,"responseRate":197,"seo":198,"slug":199,"sources":200,"stem":223,"takeaways":6,"tools":6,"treatments":224,"__hash__":259},"conditions\u002Fconditions\u002Fptsd.md","PTSD Clinical Guide: PCL-5, CAPS-5 and Trauma-Focused CBT",null,[8,15,22,29],{"name":9,"fullName":10,"description":11,"scoring":12,"timeframe":13,"icon":14},"PCL-5","PTSD Checklist for DSM-5-TR","Criterion-standard 20-item self-report measure corresponding directly to DSM-5-TR symptom criteria.","Cutoff ≥33 suggests probable PTSD; symptom cluster scores guide treatment planning","5-10 minutes","ph:clipboard-text",{"name":16,"fullName":17,"description":18,"scoring":19,"timeframe":20,"icon":21},"CAPS-5","Clinician-Administered PTSD Scale","Structured clinical interview providing categorical diagnosis and dimensional symptom severity.","Severity ratings 0-4 per symptom; diagnoses PTSD and identifies dissociative subtype","45-60 minutes","ph:user-circle",{"name":23,"fullName":24,"description":25,"scoring":26,"timeframe":27,"icon":28},"PC-PTSD-5","Primary Care PTSD Screen","Brief 5-item screener for use in primary care and emergency settings.","3+ 'yes' responses suggests need for full PTSD assessment","1-2 minutes","ph:first-aid",{"name":30,"fullName":31,"description":32,"scoring":33,"timeframe":34,"icon":35},"DES","Dissociative Experiences Scale","Assesses dissociative symptoms often present with PTSD (derealization, depersonalization).","Mean score ≥30 suggests clinically significant dissociation","10-15 minutes","ph:eye-closed","bg-rose-500\u002F10",{"type":38,"value":39,"toc":40},"minimark",[],{"title":41,"searchDepth":42,"depth":42,"links":43},"",2,[],[45,50,55,60,65,69],{"condition":46,"prevalence":47,"note":48,"icon":49},"Major Depressive Disorder","30-50%","Often secondary to trauma; anhedonia and numbing overlap with PTSD","ph:cloud-rain",{"condition":51,"prevalence":52,"note":53,"icon":54},"Substance Use Disorders","30-60%","Self-medication hypothesis; used to manage hyperarousal","ph:pill",{"condition":56,"prevalence":57,"note":58,"icon":59},"Panic Disorder","10-30%","Panic attacks triggered by trauma reminders","ph:warning-circle",{"condition":61,"prevalence":62,"note":63,"icon":64},"Generalized Anxiety Disorder","15-30%","Chronic worry extends beyond trauma-related content","ph:warning",{"condition":66,"prevalence":47,"note":67,"icon":68},"Chronic Pain","Bidirectional relationship; trauma can sensitize pain pathways","ph:lightning",{"condition":70,"prevalence":71,"note":72,"icon":73},"Traumatic Brain Injury","15-40%","Common in combat\u002Faccident trauma; complicates diagnosis","ph:brain","Clinical guide to PTSD: assessment protocols (PCL-5, CAPS-5), diagnostic criteria, comorbidities, and treatment including trauma-focused CBT and EMDR.",[76,80,89,94,104,113],{"title":77,"subtitle":78,"items":79},"Criterion A: Trauma Exposure","Exposure to actual or threatened death, serious injury, or sexual violence.",[],{"title":81,"subtitle":82,"items":83},"Criterion B: Intrusion","1+ required:",[84,85,86,87,88],"Recurrent distressing memories","Traumatic nightmares","Dissociative reactions (flashbacks)","Psychological distress to cues","Physiological reactions to cues",{"title":90,"subtitle":82,"items":91},"Criterion C: Avoidance",[92,93],"Avoidance of trauma-related thoughts\u002Ffeelings","Avoidance of external reminders",{"title":95,"subtitle":96,"items":97},"Criterion D: Negative Mood\u002FCognitions","2+ required:",[98,99,100,101,102,103],"Inability to recall key trauma features","Negative beliefs about self\u002Fworld","Persistent negative emotional state","Diminished interest in activities","Detachment from others","Inability to experience positive emotions",{"title":105,"subtitle":96,"items":106},"Criterion E: Hyperarousal",[107,108,109,110,111,112],"Irritable\u002Faggressive behavior","Reckless\u002Fself-destructive behavior","Hypervigilance","Exaggerated startle response","Concentration problems","Sleep disturbance",{"title":114,"subtitle":115,"items":116},"Additional Requirements","Timing and functional impact",[117,118,119],"Symptoms persist >1 month","Functional impairment or significant distress","Not attributable to substance use or medical condition",[121,132,141,152],{"category":122,"factors":123,"icon":130,"color":131},"Traumatic Events",[124,125,126,127,128,129],"Combat exposure","Sexual assault and intimate partner violence","Serious accidents","Natural disasters","Childhood abuse","Witnessing violence or death","ph:warning-octagon","primary",{"category":133,"factors":134,"icon":73,"color":140},"Neurobiological",[135,136,137,138,139],"Amygdala hyperactivity","Prefrontal cortex hypoactivity","Hippocampal volume reduction","HPA axis dysregulation","Norepinephrine and serotonin dysregulation","secondary",{"category":142,"factors":143,"icon":150,"color":151},"Risk Factors",[144,145,146,147,148,149],"Prior trauma exposure (cumulative effect)","Lack of social support post-trauma","Peritraumatic dissociation","Pre-existing anxiety or depression","Female sex (2x higher prevalence)","Genetic vulnerability (30-40% heritability)","ph:shield-warning","accent",{"category":153,"factors":154,"icon":160,"color":161},"Psychological Mechanisms",[155,156,157,158,159],"Fear conditioning to trauma cues","Impaired fear extinction","Negative appraisals of trauma\u002Fself","Experiential avoidance","Memory fragmentation and intrusions","ph:lightbulb","info","md","A psychiatric disorder that develops after exposure to traumatic events involving actual or threatened death, serious injury, or sexual violence. Characterized by intrusive memories, avoidance, negative mood changes, and hyperarousal.","Post-Traumatic \u003Cbr \u002F> \u003Cspan class='text-gradient-flow'>Stress Disorder\u003C\u002Fspan>","F43.10","ph:shield-slash","text-rose-500",{"faqs":169},[170,173,176,179,182,185,188],{"question":171,"answer":172},"What is Post-Traumatic Stress Disorder?","Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder defined in DSM-5-TR (ICD-11 code F43.10) that develops after exposure to actual or threatened death, serious injury, or sexual violence, either through direct experience, witnessing, learning of an event happening to a loved one, or repeated indirect exposure (as in first responders). Symptoms must persist for more than 1 month and produce clinically significant distress or functional impairment. Symptoms appearing in the first month meet criteria for Acute Stress Disorder rather than PTSD.",{"question":174,"answer":175},"What are the symptoms of PTSD?","DSM-5-TR organizes PTSD symptoms into four clusters. Intrusion symptoms include unwanted distressing memories, nightmares, dissociative flashbacks, and intense psychological or physiological reactions to trauma reminders. Avoidance includes efforts to avoid trauma-related thoughts, feelings, or external reminders. Negative alterations in cognition and mood include amnesia for trauma details, persistent negative beliefs, distorted blame, persistent negative emotional state, diminished interest, detachment, and inability to experience positive emotions. Alterations in arousal and reactivity include irritability, reckless behavior, hypervigilance, exaggerated startle, concentration problems, and sleep disturbance.",{"question":177,"answer":178},"How is PTSD diagnosed?","Diagnosis is made by a clinician using DSM-5-TR criteria, supported by validated assessment tools. The PCL-5 (PTSD Checklist for DSM-5-TR) is the most widely used 20-item self-report measure; a score of 31 to 33 or above is the provisional cutoff for probable PTSD with 76 to 81% sensitivity. The CAPS-5 (Clinician-Administered PTSD Scale) is the criterion-standard structured interview. The PC-PTSD-5 is a 5-item primary care screener. A full clinical evaluation distinguishes PTSD from Acute Stress Disorder, Adjustment Disorder, dissociative disorders, and complicated grief.",{"question":180,"answer":181},"What causes PTSD?","PTSD requires exposure to a Criterion A traumatic event, but only about 7 to 8 percent of people who experience trauma develop PTSD. Risk factors that increase vulnerability include prior trauma history, female gender, lower socioeconomic status, lack of social support, peri-traumatic dissociation, and severity and duration of trauma exposure. Genetic heritability is estimated at 30 to 40 percent. Neurobiologically, PTSD involves amygdala hyperactivity, hippocampal volume reduction, prefrontal cortex hypoactivity, and HPA axis dysregulation. Combat trauma, sexual assault, childhood abuse, and interpersonal violence carry the highest rates of post-trauma PTSD.",{"question":183,"answer":184},"How is PTSD treated?","First-line treatments are trauma-focused psychotherapies: Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and Eye Movement Desensitization and Reprocessing (EMDR). All three produce 60 to 80 percent response rates and are designated first-line by the VA, DoD, APA, and NICE. SSRIs (sertraline, paroxetine) and SNRIs (venlafaxine) have FDA approval and produce moderate effect sizes; pharmacotherapy is typically combined with trauma-focused therapy. Prazosin reduces trauma-related nightmares. Benzodiazepines are not recommended due to evidence of worsening outcomes and dependency risk.",{"question":186,"answer":187},"How long does PTSD last?","Without treatment, approximately one-third of patients with PTSD recover within the first year, another third experience chronic but stable symptoms, and the remaining third experience severe, persistent symptoms that may continue for decades. Combat-related and interpersonal trauma PTSD tend to be more chronic than single-incident PTSD from accidents or natural disasters. With evidence-based trauma-focused therapy, 60 to 80 percent of patients achieve clinically meaningful improvement in 12 to 16 sessions, and a substantial subset achieve full remission. Early intervention, ideally within the first 3 to 6 months after trauma, produces better outcomes.",{"question":189,"answer":190},"Can PTSD be cured?","PTSD can resolve completely with effective treatment, though some patients experience ongoing vulnerability to symptom recurrence under stress. Approximately 60 to 80 percent of patients respond to first-line trauma-focused therapy (CPT, PE, or EMDR), and many achieve sustained remission. Patients with single-incident trauma, intact social support, and early treatment have the strongest prognosis. Complex PTSD (ICD-11 code 6B41), arising from prolonged or repeated trauma, often requires longer phased treatment combining stabilization skills with trauma processing. Comorbid depression, substance use, or chronic pain may need parallel treatment.","Post-Traumatic Stress Disorder",true,"~23","\u002Fconditions\u002Fptsd","6-7%","2:1","60-70%",{"title":5,"description":74},"ptsd",[201,204,208,212,215,219],{"title":202,"citation":203,"icon":14},"PCL-5 Validation","Weathers FW, Litz BT, et al. The PTSD Checklist for DSM-5-TR (PCL-5). National Center for PTSD. 2013.",{"title":205,"citation":206,"icon":207},"DSM-5-TR Criteria","American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022.","ph:book-open",{"title":209,"citation":210,"icon":211},"Prolonged Exposure Efficacy","Powers MB, Halpern JM, et al. A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clin Psychol Rev. 2010;30(6):635-641.","ph:eye",{"title":213,"citation":214,"icon":73},"Neurobiology of PTSD","Pitman RK, Rasmusson AM, et al. Biological studies of post-traumatic stress disorder. Nat Rev Neurosci. 2012;13(11):769-787.",{"title":216,"citation":217,"icon":218},"EMDR Meta-Analysis","Bisson JI, Roberts NP, et al. Psychological therapies for chronic post-traumatic stress disorder in adults. Cochrane Database Syst Rev. 2013;(12):CD003388.","ph:eye-slash",{"title":220,"citation":221,"icon":222},"Comorbidity Epidemiology","Kessler RC, Sonnega A, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048-1060.","ph:intersect","conditions\u002Fptsd",[225,231,236,241,246,253],{"name":226,"type":227,"description":228,"efficacy":229,"notes":230,"icon":211},"Prolonged Exposure (PE)","First-line","Gradual confrontation with trauma memories and avoided situations through imaginal and in-vivo exposure.","60-70% remission rate; large effect sizes (d=1.0-1.4)","8-15 sessions; requires tolerance for emotional distress during processing",{"name":232,"type":227,"description":233,"efficacy":234,"notes":235,"icon":73},"Cognitive Processing Therapy (CPT)","Addresses stuck points in trauma processing; challenges maladaptive cognitions about safety, trust, control.","50-60% remission rate; comparable to PE","12 sessions; written trauma accounts and Socratic questioning",{"name":237,"type":227,"description":238,"efficacy":239,"notes":240,"icon":218},"EMDR","Eye Movement Desensitization and Reprocessing. Bilateral stimulation during trauma recall facilitates processing.","50-60% remission; fewer dropouts than PE in some studies","6-12 sessions; mechanism debated but efficacy established",{"name":242,"type":227,"description":243,"efficacy":244,"notes":245,"icon":54},"SSRIs (Sertraline, Paroxetine)","Pharmacotherapy (FDA-approved); reduces hyperarousal, intrusions, and avoidance.","Modest effect sizes; 40-50% response rate","Often combined with psychotherapy",{"name":247,"type":248,"description":249,"efficacy":250,"notes":251,"icon":252},"Prazosin","Adjunct","Alpha-1 antagonist reduces nightmares and sleep disturbance in PTSD.","Mixed evidence; some benefit for nightmare frequency","Titrated to effect; monitor blood pressure","ph:moon",{"name":254,"type":248,"description":255,"efficacy":256,"notes":257,"icon":258},"DBT Skills Training","Distress tolerance and emotion regulation skills for affect dysregulation in complex PTSD.","Improves emotion regulation; prepares for trauma processing","Often used before PE\u002FCPT in complex presentations","ph:heart","ldxIkXt_IawmczY_-T8fDBXMtprdZ4BAcpTjQZN9OfI"]