This page has moved. Click here to view.


Posttramatic Stress Disorder

Posttrumatic stress disorder is a psychiatric sequela of trauma. It results from a traumatic event and consists of three clusters of symptoms: reexperiencing, avoidance, and hyperarousal. The traumatic events can be triggered by human acts (eg, rape, robbery, bombings) or by nature (eg, floods, hurricanes, earthquakes), posttraumatic stress disorder, post traumatic, post-traumatic, tramatic, posttramatic, postraumatic.

Nearly 40% of a sample of 1,007 working men and women (mean age, 26 years) in Detroit and its suburbs reported having experienced a major traumatic event, such as rape, fire, flood, a serious traffic accident, or

Rates of trauma-related symptoms vary widely. For example, 23.6% of the trauma-exposed Detroit residents experienced related psychiatric disorders, compared with 17.9% of the national sample of women. In a review of studies investigating the psychiatric effects of childhood sexual abuse, a surprising 43% (13) of 30 studies found


Posttramatic stress disorder is the best-known psychiatric sequela of trauma. It was established as a diagnosis in 19806 and consists of three clusters of symptoms: reexperiencing, avoidance, and

Reexperiencing may involve vivid recurring dreams or nightmares, unwanted and relentless thoughts about the event that are difficult or impossible to "turn off," or a sudden overwhelming flood of the

Avoidance symptoms involve feeling numb (as if the event is happening to someone else), "fuzzy-headed" or spacey (with poor concentration and difficulty remembering what was said just a few minutes before), or

Avoidance symptoms also include withdrawing from social activities, particularly from events, places, or people associated with the trauma. A carefully taken history that documents the timing of symptom onset

Hyperarousal symptoms include sleep disturbances, hyperirritability, increased angry outbursts, exaggerated startle response, and hypervigilance. Also, various somatic complaints may be related to

Complicating factors

Diagnosis of posttramatic stress disorder can be complicated by several factors. First, symptoms can occur months or years after the event: For example, 18 to 20 months after the Persian Gulf War, military

Second, symptoms can persist for years after the event. For example, mothers of infants requiring newborn intensive care report distressing memories years after the event. Assessment of the child's developmental

Simple versus complicated trauma

The prognosis for posttraumatic stress disorder depends on a number of factors, one of the most important being whether the disorder is considered simple or complicated. These categories represent two ends of a

Table 1. Simple Versus Complicated Trauma

Simple Trauma

Complicated Trauma

Involves single event

Involves several repetitive events

Is of brief duration

Occurs over long time

Occurs late in life (after ego development solidified)

Occurs early in life

Contains no violence created by human beings

Involves violence created by human beings

Allows patient active role

Allows patient only passive role

Carries advance warning

Occurs suddenly, with no advance warning

Has time-limited symptoms

Has long-lasting symptoms; can produce personality or neurophysiologic changes; causes some symptoms that may be irreversible

Symptoms resolve spontaneously or with support in the recovery environment

Professional intervention usually necessary for symptom resolution

If professional intervention is necessary, it typically is brief

Professional intervention can be lengthy, requiring changes in capacity for trust, long-standing defensive styles, and identity formation

Impact on the Family

Primary care physicians have an important role in helping families deal with trauma, whether related to an event that affects the entire family, such as a boating accident that occurs on a family vacation, or brought

Treatment guidelines

Primary care physicians can help patients with posttraumatic stress disorder by providing appropriate drug therapy, clinical office management, and referral to outside consultants.

Drug treatment

Specific guidelines based on an ever-expanding empirical database have been developed for pharmacologic treatment of post-traumatic stress disorder. In clinical practice, the brief use of benzodiazepines (eg, clonazepam [Klonopin], 0.5 to 4 mg/day) or clonidine hydrochloride (Catapres), 0.2 to 0.4 mg/day, is

A number of studies have shown that tricyclic antidepressants (eg, imipramine hydrochloride [Tofranil], 50 to 150 mg/day) and selective serotonin reuptake inhibitors (eg, fluoxetine hydrochloride [Prozac], 20 to 60

Clinical office management

Shock and disbelief at the time of a traumatic event create a unique psychological state of heightened focus and suggestibility. The family's personal physician is in a unique and privileged position to intervene after the