Posttraumatic Stress Disorder (PTSD)

Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a mental health condition that can develop after exposure to a traumatic event.[1] Many individuals with PTSD repeatedly re-experience the ordeal as flashback episodes, memories, nightmares, or frightening thoughts, especially when exposed to events that remind them of the trauma. Other symptoms of PTSD include persistent avoidance of stimuli, negative alterations in cognitions and mood, and marked alterations in arousal and reactivity all associated with the traumatic event.[2] PTSD is often comorbid with and shares symptoms common to other conditions, such as substance use disorders, depression, anxiety, chronic health conditions, and sleep difficulties.

Symptoms usually develop following a traumatic event, though “delayed expression” PTSD can occur where full diagnosis is not met until at least six months after the trauma.[3] In DoD, eight to 20 percent of the more than 2.6 million service members who deployed in support of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn have or may develop symptoms of PTSD.*** [4] PTSD is treatable and many service members recover with appropriate treatment.

PTSD can develop after experiencing, witnessing or learning the details of a traumatic event, such as:

  • Threat of injury or death
  • Serious accident
  • Combat
  • Terrorist attack
  • Sexual assault
  • Physical assault
  • Natural disaster
  • Childhood sexual
  • Physical abuse

A diagnosis of PTSD requires exposure to a trauma and the presence of symptoms from four different categories:

Intrusions

  • Intrusive thoughts
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

Avoidance

  • Trauma-related thoughts or feelings
  • Trauma-related reminders

Negative Thoughts

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect

Arousal or Reactivity

  • Irritability or aggression
  • Risky or destructive behavior
  • Hypervigilance
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping

PTSD Factors

Per the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) and the VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder (Version 3.0)

Pre-traumatic
Factors

  • Childhood adversity
  • Exposure to prior trauma
  • Ongoing life stress
  • Lack of social support
  • Pre-existing or family history of psychiatric disorders
  • Young age at time of trauma
  • Female gender
  • Lower socioeconomic status; lower education; lower intelligence; minority racial/ethnic status

Peri-traumatic
Factors

  • High perceived life threat
  • Community (mass) trauma
  • Being a perpetrator, witnessing atrocities, or killing the enemy
  • Combat exposure – frequency and intensity of direct exposure
  • Type/magnitude of trauma (interpersonal traumas, such as torture, rape or assault have higher risk of PTSD)
  • Peri-trauma disassociation
  • Severe trauma

Post-traumatic
Factors

  • Development of acute stress disorder
  • Ongoing life stress or adverse events
  • Lack of positive social support/negative social support (e.g., negative reactions from others)
  • Bereavement
  • Significant loss of resources
Between 2000-2015, 153,000 active-duty service members were diagnosed with PTSD in the Military System, 124,000 of those were diagnosed following a deployment of 30 days or more.  5,000 active-duty service members
Source: Armed Forces Health Survelliance Center.

PTSD Support for Providers

Click on the buttons below to learn about what providers need to know in caring for patients who may have PTSD.

*** These numbers vary widely depending on sampling procedures.

References

  1. Institute of Medicine. (2014). Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment. Washington, DC: The National Academies Press.

  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.