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Posttraumatic stress disorder
Background
Overview
Definition
PTSD is a mental disorder resulting from exposure to a traumatic experience, which is typically characterized by intrusive, involuntary, and/or distressing recollection or re-experience of the traumatic events.
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Pathophysiology
PTSD is caused by traumatic exposure to death, injury, sexual assault, torture, or bodily disfigurement.
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Epidemiology
In the US, the estimated prevalence of PTSD, based on the Same Event definition of DSM-V for lifetime, past 12 months, and past 6 months, is 8.3%, 4.7%, and 3.8%, respectively.
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Disease course
The psychological impact of trauma leads to abnormalities in fear learning, threat detection, executive function, emotion regulation, and contextual processing. These neuroendocrine changes are linked to altered activity in the amygdala. PTSD is associated with mood, anxiety, substance abuse disorders, or suicidal ideation leading to serious disability, medical illness, and premature death. The relative risk of suicidal ideation in PTSD is similar to the relative risk of generalized anxiety disorder or alcohol dependence; however, is lower than that of depression.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of posttraumatic stress disorder are prepared by our editorial team based on guidelines from the American Psychological Association (APA 2025), the Canadian Expert Group on Cannabinoids Use in Chronic Pain (CCP-CEG 2023), the United States Department of Defense (DoD/VA 2023), the World Health Organization (WHO 2023), the Ontario Neurotrauma Foundation (ONF ...
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Screening and diagnosis
Indications for screening: as per DoD/VA 2023 guidelines, consider using the Primary Care PTSD Screen for DSM-5 for screening for PTSD.
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Diagnosis
Medical management
General principles
As per DoD/VA 2023 guidelines:
Offer individual psychotherapy over pharmacologic interventions for the treatment of PTSD.
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Avoid precluding psychotherapies from the treatment of PTSD in patients with comorbid substance use disorder and/or other disorders.
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Antidepressants
Antipsychotics
Anticonvulsants
Alpha-blockers
Other medications
Combination therapy
Nonpharmacologic interventions
Psychotherapy
As per APA 2025 guidelines:
Offer the following psychological interventions in patients with PTSD:
cgnitive processing therapy
prolonged exposure
trauma-focused CBT
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Consider offering the following psychological interventions in patients with PTSD:
cognitive therapy
eye movement desensitization and reprocessing
narrative exposure therapy
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Technology-based interventions
Alternative and complementary therapies
Therapeutic procedures
Specific circumstances
Patients with substance use disorder: as per APA 2025 guidelines, offer the following trauma-focused treatments plus usual treatment for substance use disorder in patients with PTSD and comorbid substance use disorder:
trauma-focused CBT (concurrent treatment of PTSD and substance use)
disorders using prolonged exposure (prolonged exposure plus usual treatment for substance use disorder, trauma-focused CBT plus usual treatment for substance use disorder).
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Patients after traumatic brain injury