Mental Health

Post-traumatic stress disorder

A trauma-related disorder characterised by re-experiencing, avoidance, threat arousal and negative changes in mood or thinking that impair recovery and daily functioning.

In a nutshell

PTSD combines trauma-linked re-experiencing, avoidance, threat arousal and negative changes in mood or thinking with clinically important impairment. NICE prioritises trauma-focused psychological therapy, with age- and timing-specific pathways; medication is not routine prevention or first-line treatment.

Classic presentation

After a serious accident, assault, abuse, disaster or other trauma, a person develops flashbacks or nightmares, avoids reminders, becomes hypervigilant and sleeps poorly, with persistent distress or functional impairment.

Key points

Ask directly about re-experiencing, avoidance, hyperarousal, dissociation, negative mood or thinking and functional impairment after trauma.
Within the first month, less severe symptoms may be actively monitored; adults with clinically important symptoms or acute stress disorder should be offered trauma-focused CBT.
After 1 month, individual trauma-focused CBT is first-line for adults; EMDR is offered after 3 months for non-combat trauma and considered earlier when preferred.
Children and young people need developmentally adapted trauma-focused CBT with appropriate parent or carer involvement; NICE does not recommend drug treatment under 18 years.
Do not offer single-session psychological debriefing or medication to prevent PTSD.
For adults who prefer medication, consider an SSRI or venlafaxine and review regularly; specialist antipsychotic augmentation is reserved for disabling, refractory symptoms.
Assess ongoing danger, suicide risk, self-harm, substance misuse, dissociation, depression and safeguarding throughout care.

First-line investigation

Trauma-focused clinical assessment covering re-experiencing, avoidance, hyperarousal, negative mood or thinking, dissociation, timing, impairment and risk; use a validated measure as an adjunct and investigate physical differentials selectively.

Management

Make the present safe

Assess ongoing danger, suicide, self-harm, harm to others, dissociation, severe comorbidity and safeguarding before routine trauma-focused work; agree practical support and a safety plan.^1,2

Use the timing-appropriate early pathway

Use active monitoring for less severe early symptoms, offer adults with clinically important symptoms or acute stress disorder within 1 month individual trauma-focused CBT, and do not offer single-session debriefing.¹

Treat established adult PTSD psychologically

Offer manual-based individual trauma-focused CBT after 1 month; offer EMDR after 3 months for non-combat trauma and consider supported computerised trauma-focused CBT only for suitable, safe, non-severe presentations.^1,2

Adapt treatment for children and young people

Use developmentally adapted trauma-focused CBT with appropriate parent or carer involvement; consider EMDR after 3 months only when CBT has not worked or has not been engaged with, and do not offer drug treatment under 18 years.¹

Use medication and specialist care selectively

For adults who prefer medication, consider an SSRI or venlafaxine with regular review; reserve specialist antipsychotic augmentation for disabling symptoms or behaviours that have not responded to psychological and drug treatment.^1,3

Exam traps

Symptoms in the first month are not automatically PTSD; distinguish normal acute responses, acute stress disorder and clinically important symptoms.
Single-session psychological debriefing is not recommended for prevention or treatment of PTSD.
Medication is not first-line when trauma-focused psychological therapy is suitable, and drugs should not be used to prevent PTSD.
EMDR timing and trauma type matter: NICE offers it after 3 months for non-combat-related adult trauma and only considers it earlier in selected adults.
Children and young people should not be offered routine drug treatment for PTSD.

Illustrations

Trauma memory encoding versus ordinary memoryDiagram contrasting ordinary contextualised recall with the vivid, trigger-linked re-experiencing and threat response described in PTSD models.PassFinals · original

The avoidance-maintenance cycleDiagram showing how avoiding trauma reminders can reduce distress briefly while maintaining fear, isolation and functional impairment.PassFinals · original

PTSD symptom domainsSummary diagram of re-experiencing, avoidance, hyperarousal and negative changes in mood or thinking, with dissociation and complex PTSD features shown separately.PassFinals · original

Key sources

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.