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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
Symptoms
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
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Table 1. Simple Versus Complicated Trauma |
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Simple Trauma |
Complicated Trauma |
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Involves single event |
Involves several repetitive events |
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Is of brief duration |
Occurs over long time |
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Occurs late in life (after ego development solidified) |
Occurs early in life |
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Contains no violence created by human beings |
Involves violence created by human beings |
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Allows patient active role |
Allows patient only passive role |
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Carries advance warning |
Occurs suddenly, with no advance warning |
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Has time-limited symptoms |
Has long-lasting symptoms; can produce personality or neurophysiologic changes; causes some symptoms that may be irreversible |
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Symptoms resolve spontaneously or with support in the recovery environment |
Professional intervention usually necessary for symptom resolution |
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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