PTSD: Symptoms, Diagnosis and Treatment

What is PTSD?

PTSD stands for post-traumatic stress disorder, a psychological condition associated with exposure to trauma.  PTSD is listed in the latest diagnostic manual of the American Psychiatric Association, DSM-5, in the chapter, “trauma- and stress-related disorders.”


A patient with PTSD:

To gain a better understanding of what PTSD looks like in real life, let us consider the case of a veteran, a young man who is haunted by the memory of his comrade killed before his eyes during the war.

Sometimes the veteran has nightmares about the tragic incident and wakes up shaking, sweating, and feeling nauseated.  He feels very guilty for surviving the attack that killed his fellow soldier.  Ever since the incident, he can’t help but view the world as dangerous and meaningless, and the future as bleak.

This young man avoids many places and activities because he feels triggered by stimuli directly or indirectly related to the tragic incident.  These triggers include sudden or intense sounds (e.g., a car backfiring, sirens), and other sensory reminders (e.g., smoke, locations that resemble the place where the tragedy occurred).

Even when at home or with friends, the man has trouble relaxing.  He startles easily, is unable to take pleasure in activities he used to enjoy, feels detached from others, has trouble concentrating, and often feels angry and agitated for no reason.

Symptoms of PTSD

As illustrated above, the symptoms of PTSD include intrusive memories, avoidance of reminders or situations related to the trauma, negative views of oneself and the world, memory problems, heightened arousal and reactivity, and emotional difficulties (e.g., persistent anger and guilt).

Though the trauma in the above example was war-related, trauma comes in myriad shapes and forms—rape, natural disaster, animal attack, car accident, etc.  Specifically, trauma involves death, sexual violence, or significant injury, or the threat of such events (e.g., being held at gunpoint).

Therefore, PTSD can result from experiencing or witnessing a trauma, learning about a trauma that occurred to a loved one, or having a lot of exposure to details of traumatic events.

How prevalent is PTSD?  The prevalence is approximately three to five percent.  In an article by Reynolds and colleagues, published in the American Journal of Geriatric Psychiatry, 4.3% of young and 5.2% of middle-aged adults met the criteria for PTSD, compared to only 2.6% of older adults.

PTSD risk factors and treatment

The DSM-5 divides the risk factors for PTSD into pre-traumatic (before the trauma), peri-traumatic (the trauma itself), and post-traumatic (after the trauma):

  • Pre-traumatic: Personal and family history of mental illness, low intelligence, low socioeconomic status, younger age, female gender, childhood adversity and exposure to trauma, cultural factors (e.g., cultural tendencies toward self-blame), minority status, and lack of social support.
  • Peri-traumatic: Severity of the trauma, belief that one’s life is in danger, the occurrence of injury, interpersonal violence (particularly by a parental figure), and the presence of dissociation (i.e. feeling detached from one’s experiences).
  • Post-traumatic: Maladaptive appraisal and coping (e.g., preoccupation with self-blame), exposure to distressing reminders of the trauma, experiencing other unfortunate life events and losses, and a lack of social support.

Common psychological treatments for PTSD include cognitive therapy, cognitive behavioral therapy, prolonged exposure therapy, and cognitive processing therapy.  Duek and colleagues note, in an article in Current Treatment Options in Psychiatry, that drug treatment typically consists of selective serotonin reuptake inhibitors (SSRI) medication, such as fluoxetine and sertraline.  Promising new drug treatment is an anesthetic drug called ketamine; more research is needed to determine ketamine’s safety and effectiveness for PTSD.