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Table of Contents

Magill’s Medical Guide, 9th Edition

Post-traumatic stress disorder

by Shuba Samuel, , PhD

Category: Disease/Disorder

Also known as: Shell shock, combat neurosis, battle fatigue

Anatomy or system affected: Psychic-emotional system

Specialties and related fields: Psychiatry, psychology

Definition: A maladaptive condition resulting from exposure to events beyond the realm of normal human experience and characterized by persistent difficulties involving emotional numbing, intense fear, helplessness, horror, reexperiencing of trauma, avoidance, and arousal.

CAUSES AND SYMPTOMS

Posttraumatic stress disorder (PTSD) is said to occur when a person experiences symptoms such as intense fear, helplessness, or horror following exposure to a traumatic event (an event outside the range of normal human experiences).

Trauma is a condition in which the biological fear system fails to deactivate even after the threat that triggered subsides. Complex trauma is the result of a chronic failure of fear system deactivation and of the dysfunctional impact of this failure, over time, on a network of biological, emotional, behavioral, cognitive, and social systems.

The traumatic event may involve threatened death, serious injury, or other threat to physical integrity; witnessing the death of or threat to another person; or learning about the death of or threat to a family member or close friend. Events such as natural disasters (earthquakes, mudslides, fires, floods, tsunamis, tornados), war, domestic violence, crime, accidents, and medical procedures may trigger the development of PTSD. PTSD is the only disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) with a cited etiology.

PTSD involves reexperiencing the trauma, avoidance of things that remind the person of the trauma, and an uncomfortable state of arousal usually connected to readiness to avoid reexperiencing a trauma. Reexperiencing includes recurrent and intrusive thoughts, recurrent distressing dreams, feeling as if the event is happening again, intense psychological distress at exposure to any reminders (internal or external) of the event, or intense physical reactivity to any reminders of the event. Persistent avoidance includes anything associated with the event, as well as a numbing of general responsiveness. Such numbing may be indicated by several of the following: avoiding thoughts, feelings, or conversations associated with the event; avoiding activities, places, or people that remind one of the event; forgetting an important aspect of the event; experiencing markedly diminished interest or participation in significant activities; feeling detached or estranged from others; having a restricted range of feelings, such as not being able to love; or feeling that the future is foreshortened. Increased arousal includes at least two of the following: difficulty with sleep; irritability or outbursts of anger; difficulty concentrating; hypervigilance; or exaggerated startle response. The reexperiencing, avoidance, and arousal start after the traumatic event, last more than one month, and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The course of the disorder varies, with some individuals not experiencing symptoms until years later, but most individuals experience symptoms within three months of the initial trauma. If the trauma occurs early in life, it may have profound effects on stress response throughout the individual’s lifetime.

Persons with PTSD may describe painful guilt feelings about surviving when others did not, or about what they had to do to survive. Their phobic avoidance of situations or activities that resemble or symbolize the original trauma may interfere with interpersonal relationships and lead to marital conflict, divorce, or job loss.

The likelihood of developing PTSD increases as intensity and physical proximity to the event increase. Recent immigrants from countries where there is considerable social unrest and civil conflict may have elevated rates of PTSD. The disorder may occur at any age. Women are more likely to develop PTSD than men; this gender difference is thought to exist in part because some traumatic events that women experience occur directly to their persons.

Not everyone who experiences a significant trauma will develop PTSD. Individual differences in terms of immediate posttrauma assistance and support, long-term social support, stress response, physical health, and other biological factors may explain a lack of occurrence in some individuals.

TREATMENT AND THERAPY

Treatments for PTSD include individual therapy, group therapy, antianxiety and antidepressant drugs, and eye movement desensitization and reprocessing (EMDR). Combinations of therapies can also be effective. In general, the sooner the victim of PTSD receives treatment, the greater are the chances of complete recovery. It is important to note, however, that complex techniques such as trauma debriefing and critical incident debriefing should be attempted only by well-trained persons. Discussing traumatic events in a way that is not sensitive to the experience of the victim may retraumatize them, so caution is advised. For untrained persons, the best way to help someone affected by a trauma is to help them get to a qualified treatment professional as quickly as possible. This is especially important because research has suggested that treatment delivered soon after the trauma may reduce the overall negative impacts of the trauma.

Psychotherapy can help the person come to grips with the traumatic event. Different approaches are used, including exposure (or imaginal) therapy, anxiety management/relaxation training, cognitive therapy, and supportive psychotherapy. Also, hypnosis, journaling (such as thought diaries and grief letters), creative arts, and a critical-incident stress debriefing may be used in treating PTSD, either alone or in conjunction with psychotherapy.

Group therapy, in which victims of PTSD can share their experiences and gain support from others, is especially helpful. Groups are typically small (six to eight persons) and are often composed of individuals who have undergone similar experiences. Also, marital and family therapy or parent training may be used in treating PTSD.

In general, the goals of psychotherapy include facilitating victims’ emotional engagement with the trauma memory, helping them organize a personal trauma narrative, assisting them in correcting dysfunctional cognitions that often follow trauma, helping them develop increased trust in others, and decreasing their emotional and social isolation. The therapist typically provides empathy, validation, safety, consistency, and sensitivity to cultural and ethnic identity issues.

Antianxiety and antidepressant drugs can relieve the physiological symptoms of PTSD. The major pharmacological agents include benzodiazepines, serotonin receptor partial agonists, tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors. Because of the many biological abnormalities presumed to be associated with PTSD, and because of the overlap between symptoms of PTSD and other comorbid disorders, almost every class of psychotropic agent has been administered to PTSD patients. Whether it includes individual or group therapy, drugs, or some combination of these three, the treatment approach must be tailored to the individual PTSD sufferer and his or her unique situation.

EMDR is a newer therapy for PTSD. It combines many aspects of the other therapies described and works to facilitate reprocessing of traumatic information and experience. Guided discussion and therapeutic work may involve specific eye movements while remembering different aspects of the traumatic event. It is suggested that this type of activity creates an orienting response that facilitates trauma processing. The technique requires a high level of skill and sophistication and should be used only by appropriately trained professionals. EMDR is very highly recommended for trauma and remains a topic of great research interest.

Information on Post-traumatic Stress Disorder

Causes: Exposure to traumatic event

Symptoms: May include recurrent and intrusive thoughts; reliving of traumatic event; intense psychological distress with exposure to reminders of event; recurrent disturbing dreams; difficulty sleeping; irritability or outbursts of anger; detachment; difficulty concentrating; hypervigilance; exaggerated startle response

Duration: Often chronic with acute episodes

Treatments: Individual therapy, group therapy, antianxiety medications, antidepressants

It is important to remember that PTSD, like many other mental health disorders, may not occur in isolation. Comorbidity, or the presence of more than one disorder, is the rule rather than the exception with PTSD. Depressive disorders, substance use disorders, and other anxiety disorders are the disorders most likely to occur with PTSD. Treatment must address the comorbid conditions when they are present. PTSD can be reliably assessed through semistructured interview and self-report measures. Treatment typically occurs on an outpatient basis, but it also may occur on an inpatient basis if the symptoms are severe.

PERSPECTIVE AND PROSPECTS

PTSD was observed in World War I, when some soldiers had intense anxiety reactions to the horrors they were experiencing. At that time, it was called “combat neurosis,” “shell shock,” or “battle fatigue.” It was formally diagnosed as an anxiety-based personality disorder in the 1960s among Vietnam War veterans, but it is no longer considered a personality disorder and is instead seen as an anxiety disorder. It is also now known that traumatic events may include not only war but also violent personal assault, kidnapping, terrorist attacks, torture, natural or human-made disasters, severe automobile accidents, or different aspects of life-threatening illness. For children, sexually traumatic events may include sexual experiences that were developmentally inappropriate, even if no threatened or actual violence occurred. PTSD may be especially severe when the trauma is of human origin (e.g., torture) and directly related to damage to one’s person.

Promising research identifying change to the stress response system in younger persons following trauma, as well as gender differences in trauma response, are expected to fuel greater understanding of the mechanisms of trauma response. Such knowledge will in turn be useful for developing new drug, biological, and interpersonal therapies for children and adults and for both women and men.

See also: Accidents; Antianxiety drugs; Anxiety; Domestic violence; Psychiatric disorders; Psychiatry; Stress; Stress reduction.

For Further Information:

1 

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed., APA, 2013.

2 

Bryant, R. A. “Post-traumatic Stress Disorder: A State-of-the-art Review of Evidence and Challenges.” World Psychiatry, vol. 18, no. 3, 2019, pp. 259-69.

3 

Forbes, D., J. I. Bisson, C. M. Monson, and L. Berliner, editors. Effective Treatments for PTSD. Guilford Publications, 2020.

4 

Guilding, M., S. Nemeckova, D. Brady, et al. “Perspectives on Complex Trauma.” The Journal of the Complex Trauma Institute, vol. 1, no. 1, 2020, pp. 1-74.

5 

“National Center for Posttraumatic Stress Disorder.” US Department of Veterans Affairs, 15 June 2021.

6 

“Post-Traumatic Stress Disorder.” MedlinePlus, 11 Aug. 2016.

7 

“Post-Traumatic Stress Disorder.” National Institute of Mental Health, 2020.

Citation Types

Type
Format
MLA 9th
Samuel, Shuba. "Post-traumatic Stress Disorder." Magill’s Medical Guide, 9th Edition, edited by Anubhav Agarwal,, Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=MMG2022_1094.
APA 7th
Samuel, S. (2022). Post-traumatic stress disorder. In A. Agarwal, (Ed.), Magill’s Medical Guide, 9th Edition. Salem Press. online.salempress.com.
CMOS 17th
Samuel, Shuba. "Post-traumatic Stress Disorder." Edited by Anubhav Agarwal,. Magill’s Medical Guide, 9th Edition. Hackensack: Salem Press, 2022. Accessed September 16, 2025. online.salempress.com.