DxRxHx
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Clinical Condition Guide

Post-Traumatic
Stress Disorder

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.

  • 6-7%
    Prevalence
  • ~23
    Onset Age
  • 2:1
    Ratio
  • 60-70%
    Response Rate

DSM-5-TR Diagnostic Criteria

  • Criterion A: Trauma Exposure

    Exposure to actual or threatened death, serious injury, or sexual violence.

  • Criterion B: Intrusion

    1+ required:

    • • Recurrent distressing memories
    • • Traumatic nightmares
    • • Dissociative reactions (flashbacks)
    • • Psychological distress to cues
    • • Physiological reactions to cues

  • Criterion C: Avoidance

    1+ required:

    • • Avoidance of trauma-related thoughts/feelings
    • • Avoidance of external reminders

  • Criterion D: Negative Mood/Cognitions

    2+ required:

    • • Inability to recall key trauma features
    • • Negative beliefs about self/world
    • • Persistent negative emotional state
    • • Diminished interest in activities
    • • Detachment from others
    • • Inability to experience positive emotions

  • Criterion E: Hyperarousal

    2+ required:

    • • Irritable/aggressive behavior
    • • Reckless/self-destructive behavior
    • • Hypervigilance
    • • Exaggerated startle response
    • • Concentration problems
    • • Sleep disturbance

  • Additional Requirements

    Timing and functional impact

    • • Symptoms persist >1 month
    • • Functional impairment or significant distress
    • • Not attributable to substance use or medical condition

Assessment Protocols

Validated tools for screening and severity tracking

  • PCL-5

    PTSD Checklist for DSM-5-TR

    Criterion-standard 20-item self-report measure corresponding directly to DSM-5-TR symptom criteria.

    Scoring:

    Cutoff ≥33 suggests probable PTSD; symptom cluster scores guide treatment planning

    Time:5-10 minutes

  • CAPS-5

    Clinician-Administered PTSD Scale

    Structured clinical interview providing categorical diagnosis and dimensional symptom severity.

    Scoring:

    Severity ratings 0-4 per symptom; diagnoses PTSD and identifies dissociative subtype

    Time:45-60 minutes

  • PC-PTSD-5

    Primary Care PTSD Screen

    Brief 5-item screener for use in primary care and emergency settings.

    Scoring:

    3+ 'yes' responses suggests need for full PTSD assessment

    Time:1-2 minutes

  • DES

    Dissociative Experiences Scale

    Assesses dissociative symptoms often present with PTSD (derealization, depersonalization).

    Scoring:

    Mean score ≥30 suggests clinically significant dissociation

    Time:10-15 minutes

Causes & Etiology

  • Traumatic Events

    • Combat exposure
    • Sexual assault and intimate partner violence
    • Serious accidents
    • Natural disasters
    • Childhood abuse
    • Witnessing violence or death

  • Neurobiological

    • Amygdala hyperactivity
    • Prefrontal cortex hypoactivity
    • Hippocampal volume reduction
    • HPA axis dysregulation
    • Norepinephrine and serotonin dysregulation

  • Risk Factors

    • 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)

  • Psychological Mechanisms

    • Fear conditioning to trauma cues
    • Impaired fear extinction
    • Negative appraisals of trauma/self
    • Experiential avoidance
    • Memory fragmentation and intrusions

Scientific Sources

Evidence-Based

  • PCL-5 Validation

    Weathers FW, Litz BT, et al. The PTSD Checklist for DSM-5-TR (PCL-5). National Center for PTSD. 2013.

  • DSM-5-TR Criteria

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022.

  • 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.

  • Neurobiology of PTSD

    Pitman RK, Rasmusson AM, et al. Biological studies of post-traumatic stress disorder. Nat Rev Neurosci. 2012;13(11):769-787.

  • 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.

  • Comorbidity Epidemiology

    Kessler RC, Sonnega A, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048-1060.

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