Post Traumatic Stress Disorder

About Post Traumatic Stress Disorder

Post traumatic stress disorder can develop after exposure to actual or threatened death, serious injury or sexual violence. Most people exposed to trauma do not develop PTSD, and risk is higher after interpersonal violence such as assault or combat than after natural disasters or accidents. DSM-5 groups symptoms into four clusters: intrusion, such as involuntary memories, flashbacks and nightmares; avoidance of reminders; negative changes in thoughts and mood, such as persistent negative beliefs, guilt, detachment and difficulty feeling positive emotions; and changes in arousal and reactivity, such as hypervigilance, an exaggerated startle response, irritability, poor concentration and sleep problems. Symptoms must last more than a month. Research has linked PTSD with heightened amygdala responses, reduced prefrontal regulation of fear, and changes in stress hormone systems. Trauma focused psychotherapies are considered first line, including prolonged exposure, cognitive processing therapy and eye movement desensitization and reprocessing, and they work in part by supporting fear extinction and revising unhelpful beliefs. The SSRIs sertraline and paroxetine are approved for PTSD in the United States. Prazosin has been used for trauma related nightmares, with mixed evidence. MDMA assisted therapy has been studied in clinical trials, but the US Food and Drug Administration declined to approve it in 2024.