LEARNING OUTCOME AND OBJECTIVES:  Upon completion of this course, you will have increased your understanding of posttraumatic stress disorder and your ability to intervene appropriately in the assessment, diagnosis, treatment, and prevention of the disorder. Specific learning objectives to address potential knowledge gaps include:

• Define posttraumatic stress disorder (PTSD).
• Summarize the epidemiology and etiology of PTSD.
• Identify risk factors for developing PTSD.
• Identify the symptoms and diagnostic criteria.
• Discuss appropriate assessment and diagnosis of patients with suspected PTSD.
• Describe current interventions and outcome goals for patients.

INTRODUCTION

PTSD has been known in the past as “shell shock” during World War I and “combat fatigue” during World War II. But PTSD does not just happen to combat veterans. PTSD occurs in people of any ethnicity, nationality, or culture, and at any age.

Definition

PTSD is classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an anxiety and “trauma and stressor-related disorder.”

The Encyclopedia of Mental Disorders (EMD, 2023) defines posttraumatic stress disorder as “a complex disorder in which the affected person’s memory, emotional responses, intellectual processes, and nervous system have been disrupted by one or more traumatic experiences. It is sometimes summarized as a normal reaction to abnormal events.”

PTSD can impact all aspects of a person’s functioning and well-being. It has been associated with a greater likelihood of comorbid substance use disorder, mood disorder, anxiety disorder, and personality disorder. PTSD is also associated with poorer perceived physical health, increased morbidity, and greater healthcare utilization for physical problems.

Types of PTSD

According to the DSM-5, there are five potential classifications of PTSD.

• Uncomplicated PTSD: PTSD as outlined in DSM-5
• Complex PTSD: Severe psychological symptoms due to chronic repeat trauma over long periods of time
• PTSD with dissociative symptoms: PTSD with the presence of persistent derealization or depersonalization
• PTSD with delayed expression: Full PTSD diagnostic criteria occurring 6 months or longer after the experience of trauma
• Comorbid PTSD: PTSD diagnosis coinciding with another mental health condition, such as depression
  (APA, 2013)

Etiology

Harmful or life-threatening events that individuals find traumatic can vary from person to person, and these may include:

• Interpersonal violence: Childhood physical abuse, witnessing interpersonal violence, physical assault, or being threatened by violence
• Sexual violence: Rape, childhood sexual abuse, intimate partner violence
• Interpersonal-network traumatic experiences: An unexpected death of a loved one, life-threatening illness of a child, or other traumatic event of a loved one
• Exposure to organized violence: Being a refuge, kidnapping victim, or civilian in a war zone
• Participation in organized violence: Military combat exposure or exposure to gang violence, witnessing death or serious injury, discovering dead bodies, accidentally or purposefully causing death or serious injury to others
• Mass conflict and displacement: Torture, cumulative exposure to potentially traumatic events
• Being a victim of harassment or bullying, including racism, sexism, homophobia, biphobia, transphobia, or other types of abuse targeting the person’s identity
• Other life-threatening traumatic events: Life-threatening motor vehicle or train accidents, gas explosions, fires, infectious disease epidemics, radiation, mass casualties, natural disasters, or being diagnosed with a life-threatening condition
  (Sareen, 2023; APA, 2013)

Factors that increase vulnerability to PTSD include:

• Experiencing repeated trauma
• Being physically injured or feeling pain
• Prior history of anxiety or depression
• Having little or no support from friends, family, or professionals
• Dealing with added stress such as bereavement, seeking asylum, homelessness, or being incarcerated
  (Mind, 2023)