What is PTSD?

Post-Traumatic Stress Disorder (PTSD) is a trauma- and stressor-related disorder that can develop after exposure to actual or threatened death, serious injury, sexual violence, combat, assault, accidents, or disasters.

It involves persistent dysregulation of fear and stress systems, especially in:

Amygdala (hyperactive threat detection)

Hippocampus (memory processing)

Prefrontal cortex (reduced top-down regulation)

DSM-5-TR Core Criteria (Clinical Overview)

A. Exposure to trauma
Direct, witnessed, learned (close other), or repeated exposure (e.g., first responders).

B. Intrusion (≥1)

Flashbacks

Nightmares

Intrusive memories

Intense psychological/physiological distress to cues

C. Avoidance (≥1)

Avoid thoughts/feelings

Avoid reminders

D. Negative alterations in cognition/mood (≥2)

Persistent negative beliefs

Distorted blame

Persistent fear/anger/guilt/shame

Anhedonia

Detachment

E. Arousal/reactivity (≥2)

Hypervigilance

Exaggerated startle

Irritability

Sleep disturbance

Poor concentration

Duration: >1 month
Functional impairment required

Subtypes

With dissociative symptoms (depersonalization/derealization)

With delayed expression

Complex PTSD (ICD-11 term; developmental trauma)

Common Comorbidities

MDD

GAD

Substance use disorders

Chronic pain

Metabolic syndrome

TBI (especially veterans)

Evidence-Based Treatment
🧠 First-Line Psychotherapies

Trauma-Focused CBT

CPT (Cognitive Processing Therapy)

PE (Prolonged Exposure)

EMDR

These are gold standard.

💊 Pharmacologic Treatment

FDA-Approved

Sertraline

Paroxetine

Common Off-Label

Venlafaxine

Prazosin (nightmares)

Mirtazapine (sleep + appetite)

Trazodone (sleep)

Avoid:

Benzodiazepines (generally not recommended long-term)

Veterans have:

High trauma exposure

Moral injury components

Sleep disturbance

Hyperarousal

Substance co-use