Psychiatry/Behavioral · PANCE / PANRE

Post-Traumatic Stress Disorder (PTSD)

Trauma exposure plus intrusion, avoidance, negative cognition/mood, and arousal symptoms >1 month.

Also known as: PTSD, post-traumatic stress disorder, trauma response

Overview

A trauma- and stressor-related disorder developing after exposure to actual or threatened death, serious injury, or sexual violence (directly experienced, witnessed, learned about a close person, or repeated indirect exposure), characterized by intrusion, avoidance, negative alterations in cognition/mood, and alterations in arousal/reactivity persisting >1 month with functional impairment.

Epidemiology

Lifetime prevalence ~6-8% in the US; ~10% in women, ~4% in men. Higher in combat veterans (~10-20%), sexual assault survivors, refugees. Conditional probability after exposure varies by trauma type (highest for interpersonal violence).

🔒 Free preview limit reached

Keep reading — start your free trial

You've read your 2 free diagnosis previews. Create your free account to unlock the full Post-Traumatic Stress Disorder (PTSD) outline — plus all 514 diagnoses, 3,500+ board-style questions, flashcards, and an AI tutor. Your 7-day free trial includes everything, and there's no credit card required.

Start your 7-day free trial → Sign in

Free to start · No credit card · Cancel anytime

Risk factors

Pre-trauma: prior psychiatric illness, childhood adversity, female sex, lower SES, family history
Peri-trauma: severity, perceived life threat, peritraumatic dissociation, interpersonal violence
Post-trauma: lack of social support, additional life stressors, ongoing threat

Pathophysiology

Dysregulated fear learning and extinction with amygdala hyperreactivity, reduced ventromedial prefrontal control, and hippocampal volume reduction. Elevated noradrenergic tone, altered HPA-axis with paradoxically low cortisol in some patients.

Clinical presentation

Symptoms

Intrusion: recurrent intrusive memories, distressing dreams, flashbacks, intense distress or physiological reactivity to cues
Avoidance: of trauma-related thoughts/feelings or external reminders
Negative cognition/mood: inability to recall key aspects, persistent negative beliefs, distorted blame, persistent negative emotional state, anhedonia, detachment, inability to experience positive emotions
Arousal/reactivity: irritability/anger, reckless or self-destructive behavior, hypervigilance, exaggerated startle, concentration problems, sleep disturbance
Dissociative subtype: depersonalization or derealization

Signs / physical exam

Hyperarousal observable as exaggerated startle, scanning behavior, irritability in interview
PCL-5 score >=33 supports probable PTSD

Differential diagnosis

Acute stress disorder — Same symptom clusters within first 3 days to 1 month after trauma
Adjustment disorder — Stressor not meeting PTSD trauma criterion; subthreshold symptoms
Major depressive disorder — May coexist; PTSD requires trauma exposure and intrusion phenomena
Panic disorder — Spontaneous panic attacks not tied to trauma cues
Complex PTSD (ICD-11) — Prolonged interpersonal trauma plus disturbances in self-organization (affect dysregulation, negative self-concept, relational disturbance)
TBI — Confounding cognitive symptoms; can co-occur
Substance-induced mood/anxiety — Symptoms in context of use or withdrawal

Diagnostic workup

Diagnostic criteria

DSM-5-TR: (A) Trauma exposure as defined; (B) >=1 intrusion symptom; (C) >=1 avoidance symptom; (D) >=2 negative cognition/mood symptoms; (E) >=2 arousal symptoms; (F) Duration >1 month; (G) Significant distress/impairment; (H) Not attributable to substance/medical condition. Specify dissociative subtype or delayed expression (>=6 months after event).

Labs

TSH, CBC, BMP; urine drug screen if substance use suspected
Sleep evaluation for nightmares and insomnia

Imaging

Not routinely indicated

Diagnostic algorithm

Cluster	Min #	Examples
B Intrusion	1	Flashbacks, nightmares, distress on cues
C Avoidance	1	Avoiding thoughts, places, people
D Negative cognition/mood	2	Negative beliefs, anhedonia, detachment
E Arousal/reactivity	2	Hypervigilance, startle, sleep disturbance

DSM-5-TR PTSD symptom clusters and minimum thresholds.

Treatment

First-line

Trauma-focused psychotherapy — prolonged exposure (PE), cognitive processing therapy (CPT), or eye movement desensitization and reprocessing (EMDR)
SSRI — sertraline and paroxetine (FDA-approved), fluoxetine, escitalopram
SNRI — venlafaxine XR
Combine medication with trauma-focused therapy in moderate-to-severe symptoms

Second-line / adjunct

Prazosin — alpha-1 antagonist for trauma-related nightmares (mixed evidence in recent VA trials but still widely used)
Mirtazapine, nefazodone for sleep and depressive overlap
Atypical antipsychotic augmentation (risperidone, quetiapine) for refractory cases or psychotic features
AVOID benzodiazepines — worsen PTSD trajectory, interfere with extinction learning, dependence risk

Complications

Suicide — substantially elevated risk, particularly with comorbid depression
Substance use disorders (alcohol, opioids, cannabis)
Comorbid depression, panic disorder, chronic pain
Relationship and occupational disruption
Cardiovascular morbidity

PANCE pearls

Trauma criterion (A) is specific — vague life stressors (divorce, job loss) do not qualify; consider adjustment disorder instead.
Benzodiazepines are contraindicated in PTSD per VA/DoD guidelines — they impair fear extinction and worsen long-term outcomes.
Single-session psychological debriefing immediately after trauma does NOT prevent PTSD and may be harmful — avoid.
Screen veterans and survivors of interpersonal violence routinely with PC-PTSD-5 or PCL-5.

References

VA/DoD 2023 — VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder (2023)
APA 2017 — American Psychological Association Clinical Practice Guideline for the Treatment of PTSD in Adults (2017)
DSM-5-TR — American Psychiatric Association. DSM-5-TR (2022)

Practice Psychiatry/Behavioral questions on FirstPassPA

Turn this outline into retention. 3,500+ board-style questions with an AI tutor that explains every answer — free to start, no card required.

Start studying free → Browse all 514 diagnoses

Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants.