Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) can develop in people of any age following a traumatic event, for example, a major disaster or childhood sexual abuse. It encompasses what became known as 'shell shock' following the first world war. One of the DSM-IV diagnostic criteria is that symptoms have been present for more than one month.

Features

• re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images
• avoidance: avoiding people, situations or circumstances resembling or associated with the event
• hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
• emotional numbing - lack of ability to experience feelings, feeling detached

from other people

• depression
• drug or alcohol misuse
• anger
• unexplained physical symptoms

Management

• following a traumatic event single-session interventions (often referred to as debriefing) are not recommended
• watchful waiting may be used for mild symptoms lasting less than 4 weeks
• military personnel have access to treatment provided by the armed forces
• trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases
• drug treatments for PTSD should not be used as a routine first-line treatment for adults. If drug treatment is used then venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried. In severe cases, NICE recommends that risperidone may be used