Post-Traumatic Stress Disorder (PTSD) is a chronic and functionally impairing psychiatric disorder that develops after exposure to, witnessing, or learning about a traumatic event involving actual or threatened death, serious injury or sexual violence. PTSD is not limited to military personnel or disaster survivors; it can also develop in individuals exposed to experiences such as childhood trauma, domestic violence or sexual abuse. In the DSM-5, the American Psychiatric Association reclassified PTSD under the category of “Trauma- and Stressor-Related Disorders,” distinguishing it from anxiety disorders.

DSM-5 Diagnostic Criteria for PTSD

According to DSM-5, diagnosis of PTSD requires that the individual meet criteria across four symptom clusters:

1. Exposure to Trauma:

Direct exposure to a traumatic event, witnessing the event, learning that a close relative or friend was exposed, or repeated indirect exposure to details of the trauma (for example, police officers investigating child abuse cases).

2. Intrusion Symptoms:

• Recurrent, involuntary and distressing memories of the event
• Trauma-related nightmares
• Psychological distress or physiological reactivity upon exposure to reminders of the trauma
• Dissociative flashbacks (feeling as if the event is recurring)

3. Avoidance:

• Avoiding trauma-related thoughts, feelings or memories
• Avoiding people, places or activities that serve as reminders of the trauma

4. Negative Alterations in Cognition and Mood:

• Inability to recall key aspects of the trauma
• Persistent negative beliefs (for example, “I am bad,” “No one can be trusted”)
• Persistent negative emotions such as fear, anger, guilt or shame
• Diminished interest, detachment, inability to experience positive emotions

5. Alterations in Arousal and Reactivity:

• Irritability or anger outbursts
• Self-destructive or reckless behavior
• Hypervigilance
• Sleep and concentration difficulties

Symptoms must persist for at least one month, cause clinically significant distress or impairment, and not be attributable to substance use or another medical condition.

Symptoms of PTSD

The presentation of PTSD symptoms varies depending on the type and duration of trauma, the individual’s psychological resilience and available support systems.

• Re-experiencing: Flashbacks, nightmares, intrusive recollections
• Avoidance: Avoidance of trauma-related reminders, often leading to isolation
• Emotional Numbing: Reduced emotional responsiveness and inability to feel positive emotions
• Hyperarousal: Irritability, exaggerated startle response, sleep disturbances
• Dissociation: Depersonalization or derealization in some individuals

These symptoms are frequently comorbid with depression, anxiety disorders, substance use and somatic symptom disorders.

Etiology of PTSD

PTSD development is influenced not only by the trauma itself but also by biological and psychosocial factors.

1. Biological Factors:

• Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis associated with increased or paradoxically decreased cortisol levels
• Neuroimaging findings show increased amygdala activity with decreased functioning in the prefrontal cortex and hippocampus, regions critical for emotional regulation and processing traumatic memories
• Imbalances in neurotransmitters such as serotonin, dopamine and norepinephrine contribute to symptom severity

2. Genetic and Epigenetic Factors:

A family history of psychiatric illness increases vulnerability. Epigenetic changes in genes such as FKBP5 have been linked to altered stress responses.

3. Psychosocial Factors:

• Severity, duration and recurrence of trauma
• Lack of post-trauma social support
• Pre-existing psychiatric disorders
• Childhood neglect or abuse

Risk Factors for PTSD

Risk of developing PTSD increases in the presence of:

• Female gender
• Early-life trauma
• Combat exposure during military service
• Sexual violence
• Chronic domestic violence
• Poor social support networks
• Comorbid substance use

Diagnosis of PTSD

Diagnosis relies on the duration, severity and impact of symptoms on functioning. Assessment may include:

• Structured clinical interview based on DSM-5 criteria
• Detailed history of traumatic exposure and its impact
• Comprehensive psychiatric evaluation
• Screening tools such as the Beck Anxiety Inventory and PTSD Checklist for DSM-5 (PCL-5)
• Differential diagnosis to rule out depression, anxiety disorders, substance use, psychotic disorders and dissociative disorders

Symptoms in the immediate aftermath of trauma may represent a normal stress response; persistence and chronicity are key in diagnosis.

Treatment of PTSD

PTSD is treatable with evidence-based interventions that aim to reduce symptoms, improve coping and restore functioning. Treatment plans should be individualized and multidisciplinary.

1. Psychotherapy

Trauma-focused psychotherapies are first-line interventions.

• Cognitive Behavioral Therapy (CBT): Focuses on restructuring trauma-related cognitions and reducing avoidance behaviors
• Eye Movement Desensitization and Reprocessing (EMDR): Processes sensory and cognitive components of trauma to reduce distress
• Narrative Therapy: Encourages integration of traumatic experiences into a coherent personal narrative
• Exposure Therapy: Controlled exposure to trauma-related cues in safe contexts reduces avoidance

2. Pharmacotherapy

Medication is particularly useful in managing comorbid anxiety, depression and sleep disturbances.

• SSRIs: Sertraline and paroxetine are FDA-approved for PTSD
• SNRIs: Venlafaxine is effective for mood and arousal symptoms
• Adjuncts: Atypical antipsychotics (for example, risperidone) or prazosin (for nightmares) may be added in severe cases

3. Family and Social Support

Family involvement reduces stigma, fosters understanding and supports recovery. Social services may be essential in cases involving housing or safety concerns.

Impact on Daily Life

PTSD can significantly impair occupational, academic and social functioning.

• Functional Impairment: Job loss, academic difficulties, interpersonal conflicts
• Physical Health Problems: Chronic pain, hypertension, gastrointestinal issues
• Suicide Risk: Elevated rates of suicidal ideation and attempts, especially with comorbid depression

In the long term, PTSD can reduce quality of life and contribute to the development of comorbid conditions. Early intervention and long-term follow-up are therefore critical.