Overview
Definition
A psychiatric disorder that develops after exposure to a traumatic event, characterized by intrusive symptoms, avoidance, negative alterations in cognition/mood, and hyperarousal, lasting for more than 1 month.
Epidemiology
Lifetime prevalence ~7-8%. Highest rates among combat veterans and survivors of sexual assault.
Etiology & Risk Factors
- Traumatic conditioning, fear extinction failure, and hyperactive amygdala with hypoactive prefrontal cortex
Clinical Symptoms
- Intrusion: Recurrent flashbacks, nightmares, or distressing memories of the trauma
- Avoidance: Avoiding thoughts, feelings, or external reminders of the event
- Negative alterations in mood/cognitions: Amnesia for trauma details, distorted blame, detachment, anhedonia
- Hyperarousal/Reactivity: Hypervigilance, exaggerated startle response, irritability, sleep disturbance
- *Note: Symptoms must last > 1 month (if < 1 month, diagnosis is Acute Stress Disorder)*
Clinical Approach
Diagnosis
- DSM-5 criteria based on exposure to actual or threatened death, serious injury, or sexual violence + specific symptom clusters for > 1 month
Management
- Trauma-focused psychotherapy: Prolonged Exposure (PE) therapy, Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR)
- Pharmacotherapy: SSRIs (Sertraline, Paroxetine)
- Prazosin (alpha-1 blocker) for trauma-related nightmares
Complications
- Chronic depression / Anxiety
- Substance use disorders
- Suicide risk