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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
  • 49-70%
    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

Common Comorbidities

  • Major Depressive Disorder

    ~50%

    About half of people with current PTSD have current MDD; anhedonia and numbing overlap

  • Substance Use Disorders

    30-60%

    Self-medication hypothesis; used to manage hyperarousal

  • Panic Disorder

    Elevated

    Panic attacks can be triggered by trauma reminders

  • Generalized Anxiety Disorder

    Elevated

    Chronic worry extends beyond trauma-related content

  • Chronic Pain

    Common

    Frequent, especially in veterans; bidirectional links with pain proposed

  • Traumatic Brain Injury

    15-40%

    Rates come mainly from military and injury samples; complicates diagnosis

Evidence-Based Treatments

  • Prolonged Exposure (PE)

    First-line

    Gradual confrontation with trauma memories and avoided situations through imaginal and in-vivo exposure.

    Evidence

    Large effect vs control (g 1.08); no difference from CPT or EMDR in meta-analysis

    In practice

    8-15 sessions; requires tolerance for emotional distress during processing

  • Cognitive Processing Therapy (CPT)

    First-line

    Addresses stuck points in trauma processing; challenges maladaptive cognitions about safety, trust, control.

    Evidence

    Comparable to PE; 49-70% meaningful improvement in military trials

    In practice

    12 sessions; Socratic questioning; written trauma account optional

  • EMDR

    First-line

    Eye Movement Desensitization and Reprocessing. Bilateral stimulation during trauma recall facilitates processing.

    Evidence

    Effective vs control; no consistent difference from PE in head-to-head trials

    In practice

    6-12 sessions; mechanism debated but efficacy established

  • SSRIs (Sertraline, Paroxetine)

    First-line

    Pharmacotherapy (FDA-approved); reduces hyperarousal, intrusions, and avoidance.

    Evidence

    Small effect vs placebo (SMD 0.23 for SSRIs)

    In practice

    Often combined with psychotherapy

  • Prazosin

    Adjunct

    Alpha-1 antagonist reduces nightmares and sleep disturbance in PTSD.

    Evidence

    Mixed evidence; some benefit for nightmare frequency

    In practice

    Titrated to effect; monitor blood pressure

  • DBT Skills Training

    Adjunct

    Distress tolerance and emotion regulation skills for affect dysregulation in complex PTSD.

    Evidence

    Improves emotion regulation; prepares for trauma processing

    In practice

    Used in some phased or combined approaches (e.g., DBT with PE)

Try it with one client

Send a PHQ-9 or GAD-7 by secure link and read the scored result before the session.

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Post-Traumatic Stress Disorder questions

  • What is Post-Traumatic Stress Disorder?

    Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder defined in DSM-5-TR (ICD-10 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.

  • 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.

  • 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) is one of the most widely used 20-item self-report measures; against the CAPS-5 in veterans, scores of 31 to 33 were the most efficient cutoff for probable PTSD. 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.

  • What causes PTSD?

    PTSD requires exposure to a Criterion A traumatic event, but only a minority 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. Interpersonal violence, especially rape and other sexual assault, carries the highest risk, along with combat and childhood abuse.

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.