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Post-traumatic stress disorder (PTSD)Template:Efn is a mental disorder that develops from experiencing a traumatic event, such as sexual assault, domestic violence, child abuse, warfare and its associated traumas, natural disaster, traffic collision, or other threats on a person's life or well-being.<ref name="DSM5">Template:Cite book</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response.<ref name="DSM5" /><ref name="NIH2016" /><ref name="Forman-Hoffman_2018">Template:Cite report</ref> These symptoms last for more than a month after the event and can include triggers such as misophonia.<ref name="DSM5" /> Young children are less likely to show distress, but instead may express their memories through play.<ref name="DSM5" />
Most people who experience traumatic events do not develop PTSD.<ref name=BMJ2015/> People who experience interpersonal violence such as rape, other sexual assaults, being kidnapped, stalking, physical abuse by an intimate partner, and childhood abuse are more likely to develop PTSD than those who experience non-assault based trauma, such as accidents and natural disasters.<ref name=Zoladz>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>
Prevention may be possible when counselling is targeted at those with early symptoms, but is not effective when provided to all trauma-exposed individuals regardless of whether symptoms are present.<ref name=BMJ2015/> The main treatments for people with PTSD are counselling (psychotherapy) and medication.<ref name=NIH2016/><ref name=Haa2015>Template:Cite journal</ref> Antidepressants of the SSRI or SNRI type are the first-line medications used for PTSD and are moderately beneficial for about half of people.<ref name="Berger-2009">Template:Cite journal</ref> Benefits from medication are less than those seen with counselling.<ref name=BMJ2015/> It is not known whether using medications and counselling together has greater benefit than either method separately.<ref name=BMJ2015>Template:Cite journal</ref><ref name="pmid20614457">Template:Cite journal</ref> Medications, other than some SSRIs or SNRIs, do not have enough evidence to support their use and, in the case of benzodiazepines, may worsen outcomes.<ref name=Gui2015>Template:Cite journal</ref><ref name=Hos2015>Template:Cite journal</ref>
In the United States, about 3.5% of adults have PTSD in a given year, and 9% of people develop it at some point in their life.<ref name=DSM5/> In much of the rest of the world, rates during a given year are between 0.5% and 1%.<ref name=DSM5/> Higher rates may occur in regions of armed conflict.<ref name=BMJ2015/> It is more common in women than men.<ref name=NIH2016>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>Template:Better source needed
Symptoms of trauma-related mental disorders have been documented since at least the time of the ancient Greeks.<ref>Template:Cite book</ref> A few instances of evidence of post-traumatic illness have been argued to exist from the seventeenth and eighteenth centuries, such as the diary of Samuel Pepys, who described intrusive and distressing symptoms following the 1666 Fire of London.<ref>Template:Cite book</ref> During the world wars, the condition was known under various terms, including "shell shock", "war nerves", neurasthenia and 'combat neurosis'.<ref>Template:Cite book</ref><ref>After War: A Conversation with Author Nancy Sherman, by John Waters, Real Clear Defense, 4 June 2015</ref> The term "post-traumatic stress disorder" came into use in the 1970s, in large part due to the diagnoses of U.S. military veterans of the Vietnam War.<ref>Template:Cite book</ref> It was officially recognized by the American Psychiatric Association in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).<ref>Template:Cite journal</ref> Template:TOC limit
Signs and symptomsEdit
Template:See also Symptoms of PTSD generally begin within the first three months after the inciting traumatic event, but may not begin until years later.<ref name="DSM-5-TR"> Template:Cite book </ref><ref name="NIH2016" /> In the typical case, the individual with PTSD persistently avoids either trauma-related thoughts and emotions or discussion of the traumatic event and may even have amnesia of the event (dissociative amnesia).<ref name="DSM5" /> However, the event is commonly relived by the individual through intrusive, recurrent recollections, dissociative episodes of reliving the trauma ("flashbacks"), and nightmares (50 to 70%).<ref name="Waltman_2018"/><ref name=DSM4>Template:Cite bookTemplate:Page needed;</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> While it is common to have symptoms after any traumatic event, these must persist to a sufficient degree (i.e., causing dysfunction in life or clinical levels of distress) for longer than one month after the trauma to be classified as PTSD (clinically significant dysfunction or distress for less than one month after the trauma may be acute stress disorder).<ref name=DSM5 /><ref name="Rothschild 2000">Template:Cite bookTemplate:Page needed</ref><ref>Template:Cite bookTemplate:Page needed</ref><ref name="surgeon4">Template:Cite book</ref> Some following a traumatic event experience post-traumatic growth.<ref>Template:Cite journal</ref>
Associated medical conditionsEdit
Trauma survivors often develop depression, anxiety disorders, and mood disorders in addition to PTSD.<ref>Template:Cite journal</ref> More than 50% of those with PTSD have co-morbid anxiety, mood, or substance use disorders.<ref name="Shalev 2017" />
Substance use disorder, such as alcohol use disorder, commonly co-occur with PTSD.<ref name="Maxmen2002-348">Template:Cite book</ref> Recovery from post-traumatic stress disorder or other anxiety disorders may be hindered, or the condition worsened, when substance use disorders are comorbid with PTSD. Resolving these problems can bring about improvement in an individual's mental health status and anxiety levels.<ref name="Cohen-1995">Template:Cite journal</ref><ref>Template:Cite journal</ref>
PTSD has a strong association with tinnitus,<ref name="Cima et al. (2019)">Template:Cite journal</ref> and speculation exists that PTSD may cause some tinnitus seen in association with the condition.<ref name="Mazurek et al. (2022)">Template:Cite journal</ref>
PTSD is also associated with a number of physical health comorbidities that involve inflammatory processes and immune system dysregulation.<ref>Template:Cite journal</ref>
In children and adolescents, there is a strong association between emotional regulation difficulties (e.g., mood swings, anger outbursts, temper tantrums) and post-traumatic stress symptoms, independent of age, gender, or type of trauma.<ref>Template:Cite journal</ref>
Moral injury, the feeling of moral distress such as a shame or guilt following a moral transgression, is associated with PTSD but is distinguished from it. Moral injury is associated with shame and guilt, while PTSD is associated with anxiety and fear.<ref>Template:Cite journal</ref>Template:Rp
Risk factorsEdit
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Persons considered at risk for developing PTSD include combat military personnel, survivors of natural disasters, concentration camp survivors, and survivors of violent crime. Persons employed in occupations that expose them to violence (such as soldiers) or disasters (such as emergency service workers) are also at risk.<ref name="ASD-PTSD">Template:Cite journal</ref> Other occupations at an increased risk include police officers, firefighters,<ref>Mascarelli, Amanda interview of Stanley, Ian H., Acute stress and early signs of PTSD are common in firefighters and other first responders − here’s what to watch out for, The Conversation, January 17, 2025 — note link to free PTSD Coach and to National Center for PTSD</ref> first responders, ambulance personnel, health care professionals, train drivers, divers, journalists, and sailors, as well as people who work at banks, post offices, or in stores.<ref>Template:Cite journal</ref> The intensity of the traumatic event is also associated with a subsequent risk of developing PTSD, with experiences related to witnessed death, or witnessed or experienced torture, injury, bodily disfigurement, traumatic brain injury being highly associated with the development of PTSD. Similarly, experiences that are unexpected or in which the victim cannot escape are also associated with a high risk of developing PTSD.<ref name="Shalev 2017" />
TraumaEdit
{{#invoke:Labelled list hatnote|labelledList|Main article|Main articles|Main page|Main pages}} Template:See alsoPTSD has been associated with a wide range of traumatic events. The risk of developing PTSD after a traumatic event varies by trauma type<ref>Template:Cite journal</ref><ref>Template:Cite book</ref> and is the highest following exposure to sexual violence (11.4%), particularly rape (19.0%).<ref name="Kessler_2017">Template:Cite journal</ref> Men are more likely to experience a traumatic event (of any type), but women are more likely to experience the kind of high-impact traumatic event that can lead to PTSD, such as interpersonal violence and sexual assault.<ref name="UK20052">Template:Cite book</ref>
Motor vehicle collision survivors, both children and adults, are at an increased risk of PTSD.<ref name="Lin_2018">Template:Cite journal</ref><ref name="Dai_2018">Template:Cite journal</ref> Globally, about 2.6% of adults are diagnosed with PTSD following a non-life-threatening traffic accident, and a similar proportion of children develop PTSD.<ref name="Kessler_2017" /> Risk of PTSD almost doubles to 4.6% for life-threatening auto accidents.<ref name="Kessler_2017" /> Females were more likely to be diagnosed with PTSD following a road traffic accident, whether the accident occurred during childhood or adulthood.<ref name="Lin_2018" /><ref name="Dai_2018" />
Post-traumatic stress reactions have been studied in children and adolescents.<ref>Template:Cite journal</ref> The rate of PTSD might be lower in children than adults, but in the absence of therapy, symptoms may continue for decades.<ref name="UK2005">Template:Cite book</ref> One estimate suggests that the proportion of children and adolescents having PTSD in a non-wartorn population in a developed country may be 1% compared to 1.5% to 3% of adults.<ref name="UK2005" /> On average, 16% of children exposed to a traumatic event develop PTSD, with the incidence varying according to type of exposure and gender.<ref name="AlisicZalta2014">Template:Cite journal</ref> Similar to the adult population, risk factors for PTSD in children include: female gender, exposure to disasters (natural or man-made), negative coping behaviors, or lacking proper social support systems.<ref>Template:Cite journal</ref>
Predictor models have consistently found that childhood trauma, chronic adversity, neurobiological differences, and familial stressors are associated with risk for PTSD after a traumatic event in adulthood.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> It has been difficult to find consistently aspects of the events that predict, but peritraumatic dissociation has been a fairly consistent predictive indicator of the development of PTSD.<ref name="Skelton 2012 628–637" /> Proximity to, duration of, and severity of the trauma make an impact. It has been speculated that interpersonal traumas cause more problems than impersonal ones,<ref>Template:Cite bookTemplate:Page needed</ref> but this is controversial.<ref>Template:Cite journal</ref> The risk of developing PTSD is increased in individuals who are exposed to physical abuse, physical assault, or kidnapping.<ref name="Kessler95" /><ref>Template:Cite journal</ref> Women who experience physical violence are more likely to develop PTSD than men.<ref name="Kessler95" />
Intimate partner and sexual violenceEdit
{{#invoke:Labelled list hatnote|labelledList|Main article|Main articles|Main page|Main pages}}Template:See alsoAn individual that has been exposed to domestic violence is predisposed to the development of PTSD. There is a strong association between the development of PTSD in mothers that experienced domestic violence during the perinatal period of their pregnancy.<ref>Template:Cite journal</ref>
Those who have experienced sexual assault or rape may develop symptoms of PTSD.<ref name="Hoffman20162">Template:Cite book</ref><ref name="Suris20042">Template:Cite journal</ref> The likelihood of sustained symptoms of PTSD is higher if the rapist confined or restrained the person, if the person being raped believed the rapist would kill them, the person who was raped was very young or very old, and if the rapist was someone they knew. The likelihood of sustained severe symptoms is also higher if people around the survivor ignore (or are ignorant of) the rape or blame the rape survivor.<ref>Template:Cite journal</ref>
Edit
Template:See also Military service in combat is a risk factor for developing PTSD.<ref name="Shalev 2017">Template:Cite journal</ref> Around 22% of people exposed to combat develop PTSD; in about 25% of military personnel who develop PTSD, its appearance is delayed.<ref name="Shalev 2017" />
Refugees are also at an increased risk for PTSD due to their exposure to war, hardships, and traumatic events. The rates for PTSD within refugee populations range from 4% to 86%.<ref>Template:Cite journal</ref> While the stresses of war affect everyone involved, displaced persons have been shown to be more so than others.<ref>Template:Cite journal</ref>
Challenges related to the overall psychosocial well-being of refugees are complex and individually nuanced. Refugees have reduced levels of well-being and a high rate of mental distress due to past and ongoing trauma. Groups that are particularly affected and whose needs often remain unmet are women, older people, and unaccompanied minors.<ref name="UNESCO_2018">Template:Cite book</ref> Post-traumatic stress and depression in refugee populations also tend to affect their educational success.<ref name="UNESCO_2018" />
Unexpected death of a loved oneEdit
Sudden, unexpected death of a loved one is the most common traumatic event type reported in cross-national studies.<ref name="Kessler_2017"/><ref name="Atwoli_2017">Template:Cite journal</ref> However, the majority of people who experience this type of event will not develop PTSD. An analysis from the WHO World Mental Health Surveys found a 5.2% risk of developing PTSD after learning of the unexpected death of a loved one.<ref name="Atwoli_2017" /> Because of the high prevalence of this type of traumatic event, unexpected death of a loved one accounts for approximately 20% of PTSD cases worldwide.<ref name="Kessler_2017" />
Life-threatening or severe illnessEdit
Medical conditions associated with an increased risk of PTSD include cancer,<ref name="cancer.gov">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> heart attack,<ref>Template:Cite journal</ref> and stroke.<ref>Template:Cite journal</ref> 22% of cancer survivors present with lifelong PTSD like symptoms.<ref>Template:Cite journal</ref> Intensive-care unit (ICU) hospitalization is also a risk factor for PTSD.<ref>Template:Cite journal</ref> Some women experience PTSD from their experiences related to breast cancer and mastectomy.<ref name="ArnaboldiRiva2017">Template:Cite journal</ref><ref name="Liu e0177055">Template:Cite journal</ref><ref name="cancer.gov"/> Loved ones of those who experience life-threatening illnesses are also at risk for developing PTSD, such as parents of a child with chronic illnesses.<ref>Template:Cite journal</ref>
Psychosis spectrum conditionsEdit
Research exists which demonstrates that survivors of psychotic episodes, which exist in diseases such as schizophrenia, schizoaffective disorder, bipolar I disorder, and others, are at greater risk of developing PTSD. This is often due to the experiences one may have during and after psychosis. Such traumatic experiences include, but are not limited to, experiences in psychiatric hospitals, police interactions, social stigma, and embarrassment due to psychotic behavior, suicidal behavior and attempts, distressing delusions and hallucinations, and the fear of losing control or actual loss of control. The incidence of PTSD in survivors of psychosis may be as low as 11% and as high at 67%.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>
CancerEdit
Prevalence estimates of cancer‐related PTSD range between 7% and 14%,<ref>Template:Cite journal</ref> with an additional 10% to 20% of patients experiencing subsyndromal post-traumatic stress symptoms (PTSS).<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Both PTSD and PTSS have been associated with increased distress and impaired quality of life,<ref>Template:Cite journal</ref> and have been reported in newly diagnosed patients as well as in long‐term survivors.<ref>Template:Cite journal</ref>
The PTSD Field Trials for the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV), revealed that 22% of cancer survivors present with lifetime cancer-related PTSD (CR-PTSD), endorsing cancer diagnosis and treatment as a traumatic stressor.<ref>Template:Cite journal</ref>
Therefore, as the number of people diagnosed with cancer increases and cancer survivorship improves, cancer-related PTSD becomes a more prominent issue, and thus, providing for cancer patients' physical and psychological needs becomes increasingly important.<ref>Template:Cite journal</ref>
Edit
{{#invoke:Labelled list hatnote|labelledList|Main article|Main articles|Main page|Main pages}} Women who experience miscarriage are at risk of PTSD.<ref name=Christiansen2017>Template:Cite journal</ref><ref name="kirs2">Template:Cite journal</ref><ref>Template:Cite journal</ref> Those who experience subsequent miscarriages have an increased risk of PTSD compared to those experiencing only one.<ref name="Christiansen2017" /> PTSD can also occur after childbirth and the risk increases if a woman has experienced trauma prior to the pregnancy.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Prevalence of PTSD following normal childbirth (that is, excluding stillbirth or major complications) is estimated to be between 2.8 and 5.6% at six weeks postpartum,<ref name="Olde20062">Template:Cite journal</ref> with rates dropping to 1.5% at six months postpartum.<ref name="Olde20062" /><ref name="Alder20062">Template:Cite journal</ref> Symptoms of PTSD are common following childbirth, with prevalence of 24–30.1%<ref name="Olde20062"/> at six weeks, dropping to 13.6% at six months.<ref>Template:Cite journal</ref> Emergency childbirth is also associated with PTSD.<ref>Template:Cite book</ref>
Natural disastersEdit
GeneticsEdit
{{#invoke:Labelled list hatnote|labelledList|Main article|Main articles|Main page|Main pages}} There is evidence that susceptibility to PTSD is hereditary. Approximately 30% of the variance in PTSD is caused from genetics alone.<ref name="Skelton 2012 628–637" /> For twin pairs exposed to combat in Vietnam, having a monozygotic (identical) twin with PTSD was associated with an increased risk of the co-twin's having PTSD compared to twins that were dizygotic (non-identical twins).<ref>Template:Cite journal</ref> Women with a smaller hippocampus might be more likely to develop PTSD following a traumatic event based on preliminary findings.<ref>Template:Cite journal</ref> Research has also found that PTSD shares many genetic influences common to other psychiatric disorders. Panic and generalized anxiety disorders and PTSD share 60% of the same genetic variance. Alcohol, nicotine, and drug dependence share greater than 40% genetic similarities.<ref name="Skelton 2012 628–637" /> Neuroscientist Dr. Rachel Yehuda researched how psychological trauma can travel across generations, specifically focusing on trans-generational trauma with Holocaust survivors and their offspring. The researchers in her study focused on a stress gene called FKBP5 that is linked to PTSD. The results of this study underscore the genetic components of PTSD as they showed an effect on methylation of the FKBP5 gene both on the parents who experienced trauma in concentration camps, as well as their offspring.<ref>Template:Cite journal</ref>
PathophysiologyEdit
NeuroendocrinologyEdit
PTSD symptoms may result when a traumatic event causes an over-reactive adrenaline response, which creates deep neurological patterns in the brain. These patterns can persist long after the event that triggered the fear, making an individual hyper-responsive to future fearful situations.<ref name="Rothschild 2000" /><ref name="secret">Template:Cite AV media</ref> During traumatic experiences, the high levels of stress hormones secreted suppress hypothalamic activity that may be a major factor toward the development of PTSD.<ref name="PTSD fact and fiction">Template:Cite journal</ref>
PTSD causes biochemical changes in the brain and body, that differ from other psychiatric disorders such as major depression. Individuals diagnosed with PTSD respond more strongly to a dexamethasone suppression test than individuals diagnosed with clinical depression.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>
Most people with PTSD show a low secretion of cortisol and high secretion of catecholamines in urine,<ref>Template:Cite journal</ref> with a norepinephrine/cortisol ratio consequently higher than comparable non-diagnosed individuals.<ref>Template:Cite journal</ref> This is in contrast to the normative fight-or-flight response, in which both catecholamine and cortisol levels are elevated after exposure to a stressor.<ref>Template:Cite journal</ref>
Brain catecholamine levels are high,<ref>Template:Cite journal</ref> and corticotropin-releasing factor (CRF) concentrations are high.<ref>Template:Cite journal</ref><ref>Template:Cite book</ref> Together, these findings suggest abnormality in the hypothalamic-pituitary-adrenal (HPA) axis.
The maintenance of fear has been shown to include the HPA axis, the locus coeruleus-noradrenergic systems, and the connections between the limbic system and frontal cortex. The HPA axis that coordinates the hormonal response to stress,<ref name="Radley 2011 481–497">Template:Cite journal</ref> which activates the LC-noradrenergic system, is implicated in the over-consolidation of memories that occurs in the aftermath of trauma.<ref name="Pitman 1989">Template:Cite journal</ref> This over-consolidation increases the likelihood of one's developing PTSD. The amygdala is responsible for threat detection and the conditioned and unconditioned fear responses that are carried out as a response to a threat.<ref name="Skelton 2012 628–637" />
The HPA axis is responsible for coordinating the hormonal response to stress.<ref name="Skelton 2012 628–637">Template:Cite journal</ref> Given the strong cortisol suppression to dexamethasone in PTSD, HPA axis abnormalities are likely predicated on strong negative feedback inhibition of cortisol, itself likely due to an increased sensitivity of glucocorticoid receptors.<ref>Template:Cite journal</ref>
PTSD has been hypothesized to be a maladaptive learning pathway to fear response through a hypersensitive, hyperreactive, and hyperresponsive HPA axis.<ref>Template:Cite journal</ref>
Low cortisol levels may predispose individuals to PTSD: Following war trauma, Swedish soldiers serving in Bosnia and Herzegovina with low pre-service salivary cortisol levels had a higher risk of reacting with PTSD symptoms, following war trauma, than soldiers with normal pre-service levels.<ref>Template:Cite journal</ref> Because cortisol is normally important in restoring homeostasis after the stress response, it is thought that trauma survivors with low cortisol experience a poorly contained—that is, longer and more distressing—response, setting the stage for PTSD.
It is thought that the locus coeruleus-noradrenergic system mediates the over-consolidation of fear memory. High levels of cortisol reduce noradrenergic activity, and because people with PTSD tend to have reduced levels of cortisol, it has been proposed that individuals with PTSD cannot regulate the increased noradrenergic response to traumatic stress.<ref name="PTSD fact and fiction"/> Intrusive memories and conditioned fear responses are thought to be a result of the response to associated triggers. Neuropeptide Y (NPY) has been reported to reduce the release of norepinephrine and has been demonstrated to have anxiolytic properties in animal models. Studies have shown people with PTSD demonstrate reduced levels of NPY, possibly indicating their increased anxiety levels.<ref name="Skelton 2012 628–637" />
Other studies indicate that people with PTSD have chronically low levels of serotonin, which contributes to the commonly associated behavioral symptoms such as anxiety, ruminations, irritability, aggression, suicidality, and impulsivity.<ref name="Olszewski 2005 40">Template:Cite journal</ref> Serotonin also contributes to the stabilization of glucocorticoid production.
Dopamine levels in a person with PTSD can contribute to symptoms: low levels can contribute to anhedonia, apathy, impaired attention, and motor deficits; high levels can contribute to psychosis, agitation, and restlessness.<ref name="Olszewski 2005 40" />
Studies have also described elevated concentrations of the thyroid hormone triiodothyronine in PTSD.<ref name="Chatzitomaris_2017">Template:Cite journal</ref> This kind of type 2 allostatic adaptation may contribute to increased sensitivity to catecholamines and other stress mediators.
Hyperresponsiveness in the norepinephrine system can also be caused by continued exposure to high stress. Overactivation of norepinephrine receptors in the prefrontal cortex can be connected to the flashbacks and nightmares frequently experienced by those with PTSD. A decrease in other norepinephrine functions (awareness of the current environment) prevents the memory mechanisms in the brain from processing the experience, and emotions the person is experiencing during a flashback are not associated with the current environment.<ref name="Olszewski 2005 40" />
There is considerable controversy within the medical community regarding the neurobiology of PTSD. A 2012 review showed no clear relationship between cortisol levels and PTSD. The majority of reports indicate people with PTSD have elevated levels of corticotropin-releasing hormone, lower basal cortisol levels, and enhanced negative feedback suppression of the HPA axis by dexamethasone.<ref name="Skelton 2012 628–637" /><ref>Template:Cite journal</ref>
NeuroimmunologyEdit
Studies on the peripheral immune have found dysfunction with elevated cytokine levels and a higher risk of immune-related chronic diseases among individuals with PTSD.<ref name="y574">Template:Cite journal</ref> Neuroimmune dysfunction has also been found in PTSD, raising the possibility of a suppressed central immune response due to reduced activity of microglia in the brain in response to immune challenges. Individuals with PTSD, compared to controls, have lower increase in a marker of microglial activation (18-kDa translocator protein) following lipopolysaccharide administration.<ref name="m591">Template:Cite journal</ref> This neuroimmune suppression is also associated with greater severity of anhedonic symptoms. Researchers suggest that treatments aimed at restoring neuroimmune function could be beneficial for alleviating PTSD symptoms.<ref name="m591" />
NeuroanatomyEdit
A meta-analysis of structural MRI studies found an association with reduced total brain volume, intracranial volume, and volumes of the hippocampus, insula cortex, and anterior cingulate.<ref>Template:Cite journal</ref> Much of this research stems from PTSD in those exposed to the Vietnam War.<ref>Template:Cite book</ref><ref>Template:Cite journal</ref>
People with PTSD have decreased brain activity in the dorsal and rostral anterior cingulate cortices and the ventromedial prefrontal cortex, areas linked to the experience and regulation of emotion.<ref>Template:Cite journal</ref>
The amygdala is strongly involved in forming emotional memories, especially fear-related memories. During high stress, the hippocampus, which is associated with placing memories in the correct context of space and time and memory recall, is suppressed. According to one theory, this suppression may be the cause of the flashbacks that can affect people with PTSD. When someone with PTSD undergoes stimuli similar to the traumatic event, the body perceives the event as occurring again because the memory was never properly recorded in the person's memory.<ref name="Skelton 2012 628–637" /><ref>Template:Cite journal</ref>
The amygdalocentric model of PTSD proposes that the amygdala is very much aroused and insufficiently controlled by the medial prefrontal cortex and the hippocampus, in particular during extinction.<ref name="Milad">Template:Cite journal</ref> This is consistent with an interpretation of PTSD as a syndrome of deficient extinction ability.<ref name="Milad" /><ref name="Stein">Template:Cite journal</ref>
The basolateral nucleus (BLA) of the amygdala is responsible for the comparison and development of associations between unconditioned and conditioned responses to stimuli, which results in the fear conditioning present in PTSD. The BLA activates the central nucleus (CeA) of the amygdala, which elaborates the fear response, (including behavioral response to threat and elevated startle response). Descending inhibitory inputs from the medial prefrontal cortex (mPFC) regulate the transmission from the BLA to the CeA, which is hypothesized to play a role in the extinction of conditioned fear responses.<ref name="Skelton 2012 628–637" />
While as a whole, amygdala hyperactivity is reported by meta analysis of functional neuroimaging in PTSD, there is a large degree of heterogeniety, more so than in social anxiety disorder or phobic disorder. Comparing dorsal (roughly the CeA) and ventral (roughly the BLA) clusters, hyperactivity is more robust in the ventral cluster, while hypoactivity is evident in the dorsal cluster. The distinction may explain the blunted emotions in PTSD (via desensitization in the CeA) as well as the fear related component.<ref>Template:Cite book</ref>
In a 2007 study, Vietnam War combat veterans with PTSD showed a 20% reduction in the volume of their hippocampus compared with veterans who did not have such symptoms.<ref>Template:Cite book</ref> This finding was not replicated in chronic PTSD patients traumatized at an air show plane crash in 1988 (Ramstein, Germany).<ref name="Jatzko">Template:Cite journal</ref>
Evidence suggests that endogenous cannabinoid levels are reduced in PTSD, particularly anandamide, and that cannabinoid receptors (CB1) are increased in order to compensate.<ref name="ECS_PTSD">Template:Cite journal</ref> There appears to be a link between increased CB1 receptor availability in the amygdala and abnormal threat processing and hyperarousal, but not dysphoria, in trauma survivors.
A 2020 study found no evidence for conclusions from prior research that suggested low IQ is a risk factor for developing PTSD.<ref>Template:Cite journal</ref>
DiagnosisEdit
PTSD can be difficult to diagnose, because of:
- the subjective nature of most of the diagnostic criteria (although this is true for many mental disorders);
- the potential for over-reporting, e.g., while seeking disability benefits, or when PTSD could be a mitigating factor at criminal sentencing<ref>Template:Cite journal</ref>
- the potential for under-reporting, e.g., stigma, pride, fear that a PTSD diagnosis might preclude certain employment opportunities;
- symptom overlap with other mental disorders such as obsessive compulsive disorder and generalized anxiety disorder;<ref>Template:Cite book</ref>
- association with other mental disorders such as major depressive disorder and generalized anxiety disorder;
- substance use disorders, which often produce some of the same signs and symptoms as PTSD; and
- substance use disorders can increase vulnerability to PTSD or exacerbate PTSD symptoms or both; and
- PTSD increases the risk for developing substance use disorders.<ref>Template:Cite journal</ref>
- the differential expression of symptoms culturally (specifically with respect to avoidance and numbing symptoms, distressing dreams, and somatic symptoms)<ref>Template:Citation</ref>
ScreeningEdit
There are a number of PTSD screening instruments for adults, such as the PTSD Checklist for DSM-5 (PCL-5)<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="PCL-5">Template:Cite journal</ref> and the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5).<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The 17 item PTSD checklist is also capable of monitoring the severity of symptoms and the response to treatment.<ref name="Shalev 2017" />
There are also several screening and assessment instruments for use with children and adolescents. These include the Child PTSD Symptom Scale (CPSS),<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>Template:Cite journal</ref> Child Trauma Screening Questionnaire,<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>Template:Cite journal</ref> and UCLA Post-traumatic Stress Disorder Reaction Index for DSM-IV.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>Template:Cite journal</ref>
In addition, there are also screening and assessment instruments for caregivers of very young children (six years of age and younger). These include the Young Child PTSD Screen,<ref name="Scheeringa Tulane">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> the Young Child PTSD Checklist,<ref name="Scheeringa Tulane" /> and the Diagnostic Infant and Preschool Assessment.<ref>Template:Cite journal</ref>
AssessmentEdit
Evidence-based assessment principles, including a multimethod assessment approach, form the foundation of PTSD assessment.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite book</ref>Template:Rp Those who conduct assessments for PTSD may use various clinician-administered interviews and instruments to provide an official PTSD diagnosis.<ref>Template:Cite journal</ref> Some commonly used, reliable, and valid assessment instruments for PTSD diagnosis, in accordance with the DSM-5, include the Clinician-Administered PTSD Scale for the DSM-5 (CAPS-5), PTSD Symptom Scale Interview (PSS-I-5), and Structured Clinical Interview for DSM-5 – PTSD Module (SCID-5 PTSD Module).<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite book</ref>
In the DSM and ICDEdit
PTSD was classified as an anxiety disorder in the DSM-IV, but has since been reclassified as a "trauma- and stressor-related disorder" in the DSM-5.<ref name="DSM5" /> The DSM-5 diagnostic criteria for PTSD include four symptom clusters: re-experiencing, avoidance, negative alterations in cognition/mood, and alterations in arousal and reactivity.<ref name="DSM5" /><ref name="NIH2016" />
The International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) classifies PTSD under "Reaction to severe stress, and adjustment disorders."<ref name="World Health Organization">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The ICD-10 criteria for PTSD include re-experiencing, avoidance, and either increased reactivity or inability to recall certain details related to the event.<ref name="World Health Organization" />
The ICD-11 diagnostic description for PTSD contains three components or symptom groups (1) re-experiencing, (2) avoidance, and (3) heightened sense of threat.<ref>Template:Cite news</ref><ref name="Brewin_2017">Template:Cite journal</ref> ICD-11 no longer includes verbal thoughts about the traumatic event as a symptom.<ref name="Brewin_2017" /> There is a predicted lower rate of diagnosed PTSD using ICD-11 compared to ICD-10 or DSM-5.<ref name="Brewin_2017" /> ICD-11 also proposes identifying a distinct sub-group with Complex Post-Traumatic Stress Disorder (CPTSD), who have more often experienced several or sustained traumas and have greater functional impairment than those with PTSD.<ref name="Brewin_2017" />
Differential diagnosisEdit
A diagnosis of PTSD requires that the person has been exposed to an extreme stressor. Any stressor can result in a diagnosis of adjustment disorder and it is an appropriate diagnosis for a stressor and a symptom pattern that does not meet the criteria for PTSD.
The symptom pattern for acute stress disorder must occur and be resolved within four weeks of the trauma. If it lasts longer, and the symptom pattern fits that characteristic of PTSD, the diagnosis may be changed.<ref name=DSM4 />
Obsessive–compulsive disorder (OCD) may be diagnosed for intrusive thoughts that are recurring but not related to a specific traumatic event.<ref name=DSM4 />
In extreme cases of prolonged, repeated traumatization where there is no viable chance of escape, survivors may develop complex post-traumatic stress disorder.<ref name="Herman1992">Template:Cite journal</ref> This occurs as a result of layers of trauma rather than a single traumatic event, and includes additional symptomatology, such as the loss of a coherent sense of self.<ref name="Herman1997">Template:Cite book</ref>
PreventionEdit
Template:See also Modest benefits have been seen from early access to cognitive behavioral therapy. Critical incident stress management has been suggested as a means of preventing PTSD, but subsequent studies suggest the likelihood of its producing negative outcomes.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> A 2019 Cochrane review did not find any evidence to support the use of an intervention offered to everyone, and that "multiple session interventions may result in worse outcome than no intervention for some individuals."<ref name="Roberts_2019">Template:Cite journal</ref> The World Health Organization recommends against the use of benzodiazepines and antidepressants in for acute stress (symptoms lasting less than one month).<ref name=WHO2013>Template:Cite book</ref> Some evidence supports the use of hydrocortisone for prevention in adults, although there is limited or no evidence supporting propranolol, escitalopram, temazepam, or gabapentin.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>
Psychological debriefingEdit
Trauma-exposed individuals often receive treatment called psychological debriefing in an effort to prevent PTSD, which consists of interviews that are meant to allow individuals to directly confront the event and share their feelings with the counselor and to help structure their memories of the event.<ref name=AHRQ2013/> However, several meta-analyses find that psychological debriefing is unhelpful, is potentially harmful and does not reduce the future risk of developing PTSD.<ref name="Shalev 2017" /><ref name=AHRQ2013>Template:Cite book</ref><ref name=Feldner2007>Template:Cite journal</ref><ref>Template:Cite journal</ref> This is true for both single-session debriefing and multiple session interventions.<ref name="Roberts_2019" /> As of 2017 the American Psychological Association assessed psychological debriefing as No Research Support/Treatment is Potentially Harmful.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Early interventionEdit
Trauma focused intervention delivered within days or weeks of the potentially traumatic event has been found to decrease PTSD symptoms.<ref>Template:Cite journal</ref> Similar to psychological debriefing, the goal of early intervention is to lessen the intensity and frequency of stress symptoms, with the aim of preventing new-onset or relapsed mental disorders and further distress later in the healing process.<ref>Template:Cite journal</ref>
Risk-targeted interventionsEdit
Template:For Risk-targeted interventions are those that attempt to mitigate specific formative information or events. It can target modeling normal behaviors, instruction on a task, or giving information on the event.<ref name=Wiseman2013Rev>Template:Cite journal</ref><ref name=Kassam-Adams2013Rev>Template:Cite journal</ref>
ManagementEdit
Reviews of studies have found that combination therapy (psychological and pharmacotherapy) is no more effective than psychological therapy alone.<ref name="pmid20614457" />
CounsellingEdit
The approaches with the strongest evidence include behavioral and cognitive-behavioral therapies such as prolonged exposure therapy,<ref>Template:Cite journal</ref> cognitive processing therapy (CBT), and eye movement desensitization and reprocessing (EMDR).<ref>Template:Cite book</ref><ref name="pmid23266601">Template:Cite journal</ref><ref>Template:Cite book</ref><ref>Template:Cite report</ref> There is some evidence for brief eclectic psychotherapy (BEP), narrative exposure therapy (NET), and written exposure therapy.<ref>Template:Cite book</ref><ref>Template:Cite book</ref>
A 2019 Cochrane review evaluated couples and family therapies compared to no care and individual and group therapies for the treatment of PTSD.<ref name="Suomi_2019">Template:Cite journal</ref> There were too few studies on couples therapies to determine if substantive benefits were derived, but preliminary RCTs suggested that couples therapies may be beneficial for reducing PTSD symptoms.<ref name="Suomi_2019" />
A meta-analytic comparison of EMDR and CBT found both protocols indistinguishable in terms of effectiveness in treating PTSD; however, "the contribution of the eye movement component in EMDR to treatment outcome" is unclear.<ref>Template:Cite journal</ref> A meta-analysis in children and adolescents also found that EMDR was as efficacious as CBT.<ref name=MetaNSUE>Template:Cite journal</ref>
Children with PTSD are far more likely to pursue treatment at school (because of its proximity and ease) than at a free clinic.<ref>Template:Cite journal</ref>
Cognitive behavioral therapyEdit
{{#invoke:Labelled list hatnote|labelledList|Main article|Main articles|Main page|Main pages}}
CBT seeks to change the way a person feels and acts by changing the patterns of thinking or behavior, or both, responsible for negative emotions. Results from a 2018 systematic review found high strength of evidence that supports CBT-exposure therapy efficacious for a reduction in PTSD and depression symptoms, as well as the loss of PTSD diagnosis.<ref name="Forman-Hoffman_2018"/> CBT has been proven to be an effective treatment for PTSD and is currently considered the standard of care for PTSD by the United States Department of Defense.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>Template:Cite news</ref>
In CBT, individuals learn to identify thoughts that make them feel afraid or upset and replace them with less distressing thoughts. The goal is to understand how certain thoughts about events cause PTSD-related stress.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> A study assessing an online version of CBT for people with mild-to-moderate PTSD found that the online approach was as effective as, and cheaper than, the same therapy given face-to-face.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> A 2021 Cochrane review assessed the provision of CBT in an Internet-based format found similar beneficial effects for Internet-based therapy as in face-to-face. However, the quality of the evidence was low due to the small number of trials reviewed.<ref>Template:Cite journal</ref>
Exposure therapy is a type of cognitive behavioral therapy<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> that involves assisting trauma survivors to re-experience distressing trauma-related memories and reminders in order to facilitate habituation and successful emotional processing of the trauma memory. Most exposure therapy programs include both imaginal confrontation with the traumatic memories and real-life exposure to trauma reminders; this type of CBT has shown benefit in the treatment of PTSD.<ref name="McLean 2022">Template:Cite journal</ref><ref name="Shalev 2017" />
Some organizationsTemplate:Which have endorsed the need for exposure.<ref name="pmid15617511">Template:Cite journal</ref><ref>Template:Cite bookTemplate:Page needed</ref> The U.S. Department of Veterans Affairs has been actively training mental health treatment staff in prolonged exposure therapy<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> and cognitive processing therapy<ref>Template:Cite journal</ref> in an effort to better treat U.S. veterans with PTSD.
Recent research on contextually based third-generation behavior therapies suggests that they may produce results comparable to some of the better validated therapies.<ref>Template:Cite journal</ref> Many of these therapy methods have a significant element of exposure<ref name="Hassija 2007">Template:Cite journal</ref> and have demonstrated success in treating the primary problems of PTSD and co-occurring depressive symptoms.<ref>Template:Cite journal</ref>
Eye movement desensitization and reprocessingEdit
{{#invoke:Labelled list hatnote|labelledList|Main article|Main articles|Main page|Main pages}} Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy developed and studied by Francine Shapiro.<ref name="Shapiro F 1989 199–223">Template:Cite journal</ref> She had noticed that, when she was thinking about disturbing memories herself, her eyes were moving rapidly. When she brought her eye movements under control while thinking, the thoughts were less distressing.<ref name="Shapiro F 1989 199–223" />
In 2002, Shapiro and Maxfield published a theory of why this might work, called adaptive information processing.<ref>Template:Cite journal</ref> This theory proposes that eye movement can be used to facilitate emotional processing of memories, changing the person's memory to attend to more adaptive information.<ref name=VAguideline>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The therapist initiates voluntary rapid eye movements while the person focuses on memories, feelings or thoughts about a particular trauma.<ref name=UK2005/><ref name=CochraneGilliesKids>Template:Cite journal</ref> The therapist uses hand movements to get the person to move their eyes backward and forward, but hand-tapping or tones can also be used.<ref name=UK2005/> EMDR closely resembles cognitive behavior therapy as it combines exposure (re-visiting the traumatic event), working on cognitive processes and relaxation/self-monitoring.<ref name=UK2005/> However, exposure by way of being asked to think about the experience rather than talk about it has been highlighted as one of the more important distinguishing elements of EMDR.<ref name="Jeffries/Davis">Template:Cite journal</ref>
Several scientific studies have evaluated the efficacy of EMDR in adults<ref name="AHRQtreat92">Template:Cite book</ref> as well as children and adolescents.<ref name="CochraneGilliesKids" /> There is moderate strength of evidence to support the efficacy of EMDR "for reduction in PTSD symptoms, loss of diagnosis, and reduction in depressive symptoms" according to a 2018 systematic review update.<ref name="Forman-Hoffman_2018" />
In children and adolescents, a recent meta-analysis of randomized controlled trials found that EMDR was at least as efficacious as CBT, and superior to waitlist or placebo.<ref name=MetaNSUE/> There was some evidence that EMDR might prevent depression.<ref name="AHRQtreat92" /> Adverse effects were largely unstudied.<ref name="AHRQtreat92" /> The benefits were greater for women with a history of sexual assault compared with people who had experienced other types of traumatizing events (such as accidents, physical assaults and war).
The eye movement component of the therapy may not be critical for benefit.<ref name="UK2005" /><ref name="VAguideline" />
Interpersonal psychotherapyEdit
Other approaches, in particular involving social supports,<ref name="Brewin">Template:Cite journal</ref><ref name=Ozer>Template:Cite journal</ref> may also be important. An open trial of interpersonal psychotherapy reported high rates of remission from PTSD symptoms without using exposure.<ref>Template:Cite journal</ref>
MedicationEdit
Four antidepressants (sertraline, fluoxetine, paroxetine, and venlafaxine) have been shown to have a small to modest benefit over placebo.<ref name="Hos2015"/>
AntidepressantsEdit
Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) may have some benefit for PTSD symptoms.<ref name=Hos2015/><ref name=Jeffreys-2012>Template:Cite journal</ref><ref>Template:Cite journal</ref> Tricyclic antidepressants are equally effective, but are less well tolerated.<ref>Template:Cite journal</ref> Evidence provides support for a small or modest improvement with sertraline, fluoxetine, paroxetine, and venlafaxine.<ref name=Hos2015/><ref>Template:Cite journal</ref> Thus, these four medications are considered to be first-line medications for PTSD.<ref name=Jeffreys-2012/><ref name="Berger-2009"/> The SSRIs paroxetine and sertraline are approved by the U.S. Food and Drug Administration (FDA) approved for the treatment of PTSD.<ref name="Shalev 2017" />
BenzodiazepinesEdit
Benzodiazepines are not recommended for the treatment of PTSD due to a lack of evidence of benefit and risk of worsening PTSD symptoms.<ref name="pmid22302333">Template:Cite journal</ref> Some authors believe that the use of benzodiazepines is contraindicated for acute stress, as this group of drugs can cause dissociation.<ref name="pmid23062450">Template:Cite journal</ref> Nevertheless, some use benzodiazepines with caution for short-term anxiety and insomnia.<ref name="Kapfhammer-2008">Template:Cite journal</ref><ref name="autogenerated1">Template:Cite book</ref><ref name="Maxmen2002-349">Template:Cite book</ref> While benzodiazepines can alleviate acute anxiety, there is no consistent evidence that they can stop the development of PTSD and may actually increase the risk of developing PTSD 2–5 times.<ref name=Gui2015/> Benzodiazepines should not be used in the immediate aftermath of a traumatic event as they may increase symptoms related to PTSD.<ref name="Shalev 2017" />
Benzodiazepines may reduce the effectiveness of psychotherapeutic interventions, and there is some evidence that benzodiazepines may actually contribute to the development and chronification of PTSD. For those who already have PTSD, benzodiazepines may worsen and prolong the course of illness, by worsening psychotherapy outcomes, and causing or exacerbating aggression, depression (including suicidality), and substance use.<ref name=Gui2015/> Drawbacks include the risk of developing a benzodiazepine dependence, tolerance (i.e., short-term benefits wearing off with time), and withdrawal syndrome; additionally, individuals with PTSD (even those without a history of alcohol or drug misuse) are at an increased risk of abusing benzodiazepines.<ref name="Berger-2009" /><ref name="Martényi-2005">Template:Cite journal</ref>
Due to a number of other treatments with greater efficacy for PTSD and fewer risks, benzodiazepines should be considered relatively contraindicated until all other treatment options are exhausted.<ref name=Haa2015/><ref name="VA/DoD_2010"/>
Benzodiazepines also carry a risk of disinhibition (associated with suicidality, aggression and crimes) and their use may delay or inhibit more definitive treatments for PTSD.<ref name="Berger-2009"/><ref name="VA/DoD_2010">Template:Cite book</ref><ref>Template:Cite journal</ref>
PrazosinEdit
Prazosin, an alpha-1 adrenergic antagonist, has been used in veterans with PTSD to reduce nightmares. Studies show variability in the symptom improvement, appropriate dosages, and efficacy in this population.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref name="Waltman_2018">Template:Cite journal</ref>
GlucocorticoidsEdit
Glucocorticoids may be useful for short-term therapy to protect against neurodegeneration caused by the extended stress response that characterizes PTSD, but long-term use may actually promote neurodegeneration.<ref>Template:Cite journal</ref>
CannabinoidsEdit
Template:See also Cannabis is not recommended as a treatment for PTSD because scientific evidence does not currently exist demonstrating treatment efficacy for cannabinoids.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>Template:Efn However, use of cannabis or derived products is widespread among U.S. veterans with PTSD.<ref>Template:Cite journal</ref>
The cannabinoid nabilone is sometimes used for nightmares in PTSD. Although some short-term benefit was shown, adverse effects are common and it has not been adequately studied to determine efficacy.<ref name=CADTH-Nabilone-2015>Template:Cite journal</ref> An increasing number of states permit and have legalized the use of medical cannabis for the treatment of PTSD.<ref>Template:Cite news</ref>
OtherEdit
Exercise, sport and physical activityEdit
Physical activity can influence people's psychological<ref name=CR-Lawrence>Template:Cite journal</ref> and physical health.<ref name=VA-Jankowski>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The U.S. National Center for PTSD recommends moderate exercise as a way to distract from disturbing emotions, build self-esteem and increase feelings of being in control again. They recommend a discussion with a doctor before starting an exercise program.<ref name=VA-Lifestylerecs>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Play therapy for childrenEdit
Play is thought to help children link their inner thoughts with their outer world, connecting real experiences with abstract thought.<ref name=Wethington2008>Template:Cite journal</ref> Repetitive play can also be one way a child relives traumatic events, and that can be a symptom of trauma in a child or young person.<ref name=Fletcher2003>Template:Cite book</ref> Although it is commonly used, there have not been enough studies comparing outcomes in groups of children receiving and not receiving play therapy, so the effects of play therapy are not yet understood.<ref name=UK2005/><ref name=Wethington2008 />
Military programsEdit
Many veterans of the wars in Iraq and Afghanistan have faced significant physical, emotional, and relational disruptions. In response, the United States Marine Corps has instituted programs to assist them in re-adjusting to civilian life, especially in their relationships with spouses and loved ones, to help them communicate better and understand what the other has gone through.<ref name=Marriagetherapy>Template:Cite news</ref> Walter Reed Army Institute of Research (WRAIR) developed the Battlemind program to assist service members avoid or ameliorate PTSD and related problems. Wounded Warrior Project partnered with the US Department of Veterans Affairs to create Warrior Care Network, a national health system of PTSD treatment centers.<ref>Template:Cite news</ref><ref>Template:Cite news</ref>
NightmaresEdit
In 2020, the United States Food and Drug Administration granted marketing approval for an Apple Watch app call NightWare. The app aims to improve sleep for people suffering from PTSD-related nightmares, by vibrating when it detects a nightmare in progress based on monitoring heart rate and body movement.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
EpidemiologyEdit
There is debate over the rates of PTSD found in populations, but, despite changes in diagnosis and the criteria used to define PTSD between 1997 and 2013, epidemiological rates have not changed significantly.<ref name="Brunet2">Template:Cite journal</ref><ref>Template:Cite journal</ref> Most of the current reliable data regarding the epidemiology of PTSD is based on DSM-IV criteria, as the DSM-5 was not introduced until 2013.
The United Nations' World Health Organization publishes estimates of PTSD impact for each of its member states; the latest data available are for 2004. Considering only the 25 most populated countries ranked by overall age-standardized Disability-Adjusted Life Year (DALY) rate, the top half of the ranked list is dominated by Asian/Pacific countries, the US, and Egypt.<ref name=WHO2004>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Ranking the countries by the male-only or female-only rates produces much the same result, but with less meaningfulness, as the score range in the single-sex rankings is much-reduced (4 for women, 3 for men, as compared with 14 for the overall score range), suggesting that the differences between female and male rates, within each country, is what drives the distinctions between the countries.<ref name=WHO2004f>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name=WHO2004m>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
As of 2017, the cross-national lifetime prevalence of PTSD was 3.9%, based on a survey where 5.6% had been exposed to trauma.<ref name="Koenen_2017">Template:Cite journal</ref> The primary factor impacting treatment-seeking behavior, which can help to mitigate PTSD development after trauma was income, while being younger, female, and having less social status (less education, lower individual income, and being unemployed) were all factors associated with less treatment-seeking behavior.<ref name="Koenen_2017" />
| Region | Country | PTSD DALY rate, overall<ref name=WHO2004 /> |
PTSD DALY rate, females<ref name=WHO2004f /> |
PTSD DALY rate, males<ref name=WHO2004m /> |
|---|---|---|---|---|
| Asia / Pacific | Thailand | 59 | 86 | 30 |
| Asia / Pacific | Indonesia | 58 | 86 | 30 |
| Asia / Pacific | Philippines | 58 | 86 | 30 |
| Americas | USA | 58 | 86 | 30 |
| Asia / Pacific | Bangladesh | 57 | 85 | 29 |
| Africa | Egypt | 56 | 83 | 30 |
| Asia / Pacific | India | 56 | 85 | 29 |
| Asia / Pacific | Iran | 56 | 83 | 30 |
| Asia / Pacific | Pakistan | 56 | 85 | 29 |
| Asia / Pacific | Japan | 55 | 80 | 31 |
| Asia / Pacific | Myanmar | 55 | 81 | 30 |
| Europe | Turkey | 55 | 81 | 30 |
| Asia / Pacific | Vietnam | 55 | 80 | 30 |
| Europe | France | 54 | 80 | 28 |
| Europe | Germany | 54 | 80 | 28 |
| Europe | Italy | 54 | 80 | 28 |
| Asia / Pacific | Russian Federation | 54 | 78 | 30 |
| Europe | United Kingdom | 54 | 80 | 28 |
| Africa | Nigeria | 53 | 76 | 29 |
| Africa | Dem. Republ. of Congo | 52 | 76 | 28 |
| Africa | Ethiopia | 52 | 76 | 28 |
| Africa | South Africa | 52 | 76 | 28 |
| Asia / Pacific | China | 51 | 76 | 28 |
| Americas | Mexico | 46 | 60 | 30 |
| Americas | Brazil | 45 | 60 | 30 |
United StatesEdit
PTSD affects about 5% of the US adult population each year.<ref>Template:Cite news</ref> The National Comorbidity Survey Replication has estimated that the lifetime prevalence of PTSD among adult Americans is 6.8%, with women (9.7%) more than twice as likely as men<ref name="Olszewski 2005 40" /> (3.6%) to have PTSD at some point in their lives.<ref name=Kessler95>Template:Cite journal</ref> More than 60% of men and more than 60% of women experience at least one traumatic event in their life. The most frequently reported traumatic events by men are rape, combat, and childhood neglect or physical abuse. Women most frequently report instances of rape, sexual molestation, physical attack, being threatened with a weapon and childhood physical abuse.<ref name="Olszewski 2005 40" /> 88% of men and 79% of women with lifetime PTSD have at least one comorbid psychiatric disorder. Major depressive disorder, 48% of men and 49% of women, and lifetime alcohol use disorder or dependence, 51.9% of men and 27.9% of women, are the most common comorbid disorders.<ref>Template:Cite journal</ref>
Military combatEdit
The United States Department of Veterans Affairs estimates that 830,000 Vietnam War veterans had symptoms of PTSD.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The National Vietnam Veterans' Readjustment Study (NVVRS) found 15% of male and 9% of female Vietnam veterans had PTSD at the time of the study. Life-time prevalence of PTSD was 31% for males and 27% for females. In a reanalysis of the NVVRS data, along with analysis of the data from the Matsunaga Vietnam Veterans Project, Schnurr, Lunney, Sengupta, and Waelde found that, contrary to the initial analysis of the NVVRS data, a large majority of Vietnam veterans had PTSD symptoms (but not the disorder itself). Four out of five reported recent symptoms when interviewed 20–25 years after Vietnam.<ref name="autogenerated2">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
A 2011 study from Georgia State University and San Diego State University found that rates of PTSD diagnosis increased significantly when troops were stationed in combat zones, had tours of longer than a year, experienced combat, or were injured. Military personnel serving in combat zones were 12.1 percentage points more likely to receive a PTSD diagnosis than their active-duty counterparts in non-combat zones. Those serving more than 12 months in a combat zone were 14.3 percentage points more likely to be diagnosed with PTSD than those having served less than one year.<ref name="Journalistsresource.org">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Experiencing an enemy firefight was associated with an 18.3 percentage point increase in the probability of PTSD, while being wounded or injured in combat was associated with a 23.9 percentage point increase in the likelihood of a PTSD diagnosis. For the 2.16 million U.S. troops deployed in combat zones between 2001 and 2010, the total estimated two-year costs of treatment for combat-related PTSD are between $1.54 billion and $2.69 billion.<ref name="Journalistsresource.org"/>
As of 2013, rates of PTSD have been estimated at up to 20% for veterans returning from Iraq and Afghanistan.<ref name="VAscreen">Template:Cite book</ref> As of 2013 13% of veterans returning from Iraq were unemployed.<ref>Template:Cite news</ref>
Human-made disastersEdit
The September 11 attacks took the lives of nearly 3,000 people, leaving 6,000 injured.<ref name="Lowell_2018">Template:Cite journal</ref> First responders (police, firefighters, and emergency medical technicians), sanitation workers, and volunteers were all involved in the recovery efforts. The prevalence of probable PTSD in these highly exposed populations was estimated across several studies using in-person, telephone, and online interviews and questionnaires.<ref name="Lowell_2018" /><ref name="Perrin_2007">Template:Cite journal</ref><ref name="Stellman_2008">Template:Cite journal</ref> Overall prevalence of PTSD was highest immediately following the attacks and decreased over time. However, disparities were found among the different types of recovery workers.<ref name="Lowell_2018" /><ref name="Perrin_2007" /> The rate of probable PTSD for first responders was lowest directly after the attacks and increased from ranges of 4.8–7.8% to 7.4–16.5% between the 5–6 year follow-up and a later assessment.<ref name="Lowell_2018" />
When comparing traditional responders to non-traditional responders (volunteers), the probable PTSD prevalence 2.5 years after the initial visit was greater in volunteers with estimates of 11.7% and 17.2% respectively.<ref name="Lowell_2018" /> Volunteer participation in tasks atypical to the defined occupational role was a significant risk factor for PTSD.<ref name="Perrin_2007" /> Other risk factors included exposure intensity, earlier start date, duration of time spent on site, and constant, negative reminders of the trauma.<ref name="Lowell_2018" /><ref name="Perrin_2007" />
Additional research has been performed to understand the social consequences of the September 11 attacks. Alcohol consumption was assessed in a cohort of World Trade Center workers using the cut-annoyed-guilty-eye (CAGE) questionnaire for alcohol use disorder. Almost 50% of World Trade Center workers who self-identified as alcohol users reported drinking more during the rescue efforts.<ref name="Stellman_2008" /> Nearly a quarter of these individuals reported drinking more following the recovery.<ref name="Stellman_2008" /> If determined to have probable PTSD status, the risk of developing an alcohol problem was double compared to those without psychological morbidity.<ref name="Stellman_2008" /> Social disability was also studied in this cohort as a social consequence of the September 11 attacks. Defined by the disruption of family, work, and social life, the risk of developing social disability increased 17-fold when categorized as having probable PTSD.<ref name="Stellman_2008" />
AnthropologyEdit
Template:More citations needed section Cultural and medical anthropologists have questioned the validity of applying the diagnostic criteria of PTSD cross-culturally.<ref name="Moghimi_2012"/>
Trauma (and resulting PTSD) is often experienced through the outermost limits of suffering, pain and fear. The images and experiences relived through PTSD often defy easy description through language. Therefore, the translation of these experiences from one language to another is problematic, and the primarily Euro-American research on trauma is necessarily limited.<ref>Template:Cite journal</ref> The Sapir-Whorf hypothesis suggests that people perceive the world differently according to the language they speak: language and the world it exists within reflect back on the perceptions of the speaker.<ref>Template:Cite journal</ref>
For example, ethnopsychology studies in Nepal have found that cultural idioms and concepts related to trauma often do not translate to western terminologies: piDaa is a term that may align to trauma/suffering, but also people who suffer from piDaa are considered paagal (mad) and are subject to negative social stigma, indicating the need for culturally appropriate and carefully tailored support interventions.<ref name="search.ebscohost.com">Template:Cite journal</ref> More generally, different cultures remember traumatic experiences within different linguistic and cultural paradigms. As such, cultural and medical anthropologists have questioned the validity of applying the diagnostic criteria of PTSD cross-culturally, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III),Template:Update inline and constructed through the Euro-American paradigm of psychology.<ref name="Moghimi_2012">Template:Cite journal</ref>
There remains a dearth of studies into the conceptual frameworks that surround trauma in non-Western cultures.<ref name="Moghimi_2012" /> There is little evidence to suggest therapeutic benefit in synthesizing local idioms of distress into a culturally constructed disorder of the post-Vietnam era, a practice anthropologist believe contributes to category fallacy.Template:Clarify<ref name="Moghimi_2012"/> For many cultures there is no single linguistic corollary to PTSD, psychological trauma being a multi-faceted concept with corresponding variances of expression.<ref name="search.ebscohost.com"/>
Designating the effects of trauma as an affliction of the spirit is common in many non-Western cultures where idioms such as "soul loss" and "weak heart" indicate a preference to confer suffering to a spirit-body or heart-body diametric. These idioms reflect the emphasis that collectivist cultures place on healing trauma through familial, cultural and religious activities while avoiding the stigma that accompanies a mind-body approach.<ref name="Moghimi_2012"/> Prescribing PTSD diagnostics within these communities is ineffective and often detrimental.Template:Citation needed For trauma that extends beyond the individual, such as the effects of war, anthropologists believe applying the term "social suffering" or "cultural bereavement" to be more beneficial.<ref>Template:Cite journal</ref>
Every facet of society is affected by conflict; the prolonged exposure to mass violence can lead to a 'continuous suffering' among civilians, soldiers, and bordering countries.<ref name="doi.org">Template:Cite book</ref> Entered into the DSM in 1980, clinicians and psychiatrists based the diagnostic criteria for PTSD around American veterans of the Vietnam War.<ref>Template:Cite journal</ref> Though the DSM gets reviewed and updated regularly, it is unable to fully encompass the disorder due to its Americanization (or Westernization).<ref>Template:Cite journal</ref> That is, what may be considered characteristics of PTSD in western society, may not directly translate across to other cultures around the world. Displaced people of the African country Burundi experienced symptoms of depression and anxiety, though few symptoms specific to PTSD were noted.<ref name="Herbert_2010">Template:Cite book</ref>
In a similar review, Sudanese refugees relocated in Uganda were 'concerned with material [effects]' (lack of food, shelter, and healthcare), rather than psychological distress.<ref name="Herbert_2010" /> In this case, many refugees did not present symptoms at all, with a minor few developing anxiety and depression.<ref name="Herbert_2010" /> War-related stresses and traumas will be ingrained in the individual,<ref name="doi.org"/> however they will be affected differently from culture to culture, and the "clear-cut" rubric for diagnosing PTSD does not allow for culturally contextual reactions to take place.Template:Citation needed
VeteransEdit
United StatesEdit
Template:See also The United States provides a range of benefits for veterans that the VA has determined have PTSD, which developed during, or as a result of, their military service. These benefits may include tax-free cash payments,<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> free or low-cost mental health treatment and other healthcare,<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> vocational rehabilitation services,<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> employment assistance,<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> and independent living support.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
United KingdomEdit
In the UK, there are various charities and service organisations dedicated to aiding veterans in readjusting to civilian life. The Royal British Legion and the more recently established Help for Heroes are two of Britain's more high-profile veterans' organisations which have actively advocated for veterans over the years. There has been some controversy that the NHS has not done enough in tackling mental health issues and is instead "dumping" veterans on charities such as Combat Stress.<ref>Template:Cite news Template:Subscription required</ref><ref>Template:Cite news</ref>
CanadaEdit
Veterans Affairs Canada provides assistance to disabled veterans that includes rehabilitation, financial aid, job placement, healthcare, disability compensation, peer support,<ref>{{#invoke:citation/CS1|citation |CitationClass=web }} See also {{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>Template:Cite journal</ref> and family support.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
HistoryEdit
Template:See also Aspects of PTSD in soldiers of ancient Assyria have been identified using written sources from 1300 to 600 BCE. These Assyrian soldiers would undergo a three-year rotation of combat before being allowed to return home, and were reported to have faced immense challenges in reconciling their past actions in war with their civilian lives.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Connections between the actions of Viking berserkers and the hyperarousal of post-traumatic stress disorder have also been drawn.<ref>Template:Cite book</ref>
Psychiatrist Jonathan Shay has proposed that Lady Percy's soliloquy in the William Shakespeare play Henry IV, Part 1 (act 2, scene 3, lines 40–62<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>), written around 1597, represents an unusually accurate description of the symptom constellation of PTSD.<ref>Template:Cite book</ref>
Many historical wartime diagnoses such as railway spine, stress syndrome, nostalgia, soldier's heart, shell shock, battle fatigue, combat stress reaction, and traumatic war neurosis are now associated with PTSD.<ref>Template:Cite book</ref><ref>Template:Cite journal</ref>
The correlations between combat and PTSD are undeniable; according to Stéphane Audoin-Rouzeau and Annette Becker, "One-tenth of mobilized American men were hospitalized for mental disturbances between 1942 and 1945, and, after thirty-five days of uninterrupted combat, 98% of them manifested psychiatric disturbances in varying degrees."<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}, From 14 – 18 Understanding the Great War, by Stéphane Audoin-Rouzeau, Annette BeckerTemplate:Incomplete short citation</ref>
The DSM-I (1952) includes a diagnosis of "gross stress reaction", which has similarities to the modern definition and understanding of PTSD.<ref name="Posttraumatic stress disorder: a history and a critique">Template:Cite journal</ref> Gross stress reaction is defined as a normal personality using established patterns of reaction to deal with overwhelming fear as a response to conditions of great stress.<ref name="DSM-I">Template:Cite book</ref> The diagnosis includes language which relates the condition to combat as well as to "civilian catastrophe".<ref name="DSM-I" />
The addition of the term to the DSM-III was greatly influenced by the experiences and conditions of U.S. military veterans of the Vietnam War.<ref name="AllInTheMind">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> In fact, much of the available published research regarding PTSD is based on studies done on veterans of the war in Vietnam.
Because of the initial overt focus on PTSD as a combat related disorder when it was first fleshed out in the years following the war in Vietnam, in 1975 Ann Wolbert Burgess and Lynda Lytle Holmstrom defined rape trauma syndrome (RTS) in order to draw attention to the striking similarities between the experiences of soldiers returning from war and of rape victims.<ref>Template:Cite book</ref> This paved the way for a more comprehensive understanding of causes of PTSD.
Early in 1978, the diagnosis term "post-traumatic stress disorder" was first recommended in a working group finding presented to the Committee of Reactive Disorders.<ref name="IHHRT">Template:Cite bookTemplate:Page needed</ref>
A USAF study carried out in 1979 focused on individuals (civilian and military) who had worked to recover or identify the remains of those who died in Jonestown. The bodies had been dead for several days, and a third of them had been children. The study used the term "dysphoria" to describe PTSD-like symptoms.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
After PTSD became an official American psychiatric diagnosis with the publication of DSM-III (1980), the number of personal injury lawsuits (tort claims) asserting the plaintiff had PTSD increased rapidly. However, triers of fact (judges and juries) often regarded the PTSD diagnostic criteria as imprecise, a view shared by legal scholars, trauma specialists, forensic psychologists, and forensic psychiatrists. The condition was termed "posttraumatic stress disorder" in the DSM-III (1980).<ref name="Posttraumatic stress disorder: a history and a critique" /><ref name="IHHRT" />
Professional discussions and debates in academic journals, at conferences, and between thought leaders, led to a more clearly-defined set of diagnostic criteria in DSM-IV (1994), particularly the definition of a "traumatic event".<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The DSM-IV classified PTSD under anxiety disorders. In the ICD-10 (first used in 1994), the spelling of the condition was "post-traumatic stress disorder".<ref name="icd10-2007">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
In 2012, the researchers from the Grady Trauma Project highlighted the tendency people have to focus on the combat side of PTSD: "less public awareness has focused on civilian PTSD, which results from trauma exposure that is not combat related..." and "much of the research on civilian PTSD has focused on the sequelae of a single, disastrous event, such as the Oklahoma City bombing, September 11th attacks, and Hurricane Katrina".<ref>Template:Cite journal</ref> Disparity in the focus of PTSD research affected the already popular perception of the exclusive interconnectedness of combat and PTSD. This is misleading when it comes to understanding the implications and extent of PTSD as a neurological disorder.
The DSM-5 (2013) created a new category called "trauma and stressor-related disorders", in which PTSD is now classified.<ref name="DSM5" />
America's 2014 National Comorbidity Survey reports that "the traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women."<ref name="Kessler95" />
TerminologyEdit
Template:Redirect-distinguish The Diagnostic and Statistical Manual of Mental Disorders does not hyphenate "post" and "traumatic", thus, the DSM-5 lists the disorder as posttraumatic stress disorder.<ref>Template:Cite book</ref> However, many scientific journal articles and other scholarly publications do hyphenate the name of the disorder, viz., "post-traumatic stress disorder".<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Dictionaries also differ with regard to the preferred spelling of the disorder with the Collins English Dictionary – Complete and Unabridged using the hyphenated spelling, and the American Heritage Dictionary of the English Language, Fifth Edition and the Random House Kernerman Webster's College Dictionary giving the non-hyphenated spelling.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Some authors have used the terms "post-traumatic stress syndrome" or "post-traumatic stress symptoms" ("PTSS"),<ref>Template:Cite journal</ref> or simply "post-traumatic stress" ("PTS") in the case of the U.S. Department of Defense,<ref>Template:Cite news</ref> to avoid stigma associated with the word "disorder".
The comedian George Carlin criticized the euphemism treadmill which led to progressive change of the way PTSD was referred to over the course of the 20th century, from "shell shock" in the First World War to the "battle fatigue" in the Second World War, to "operational exhaustion" in the Korean War, to the current "post-traumatic stress disorder", coined during the Vietnam War, which "added a hyphen" and which, he commented, "completely burie[s] [the pain] under jargon". He also stated that the name given to the condition has had a direct effect on the way veteran soldiers with PTSD were treated and perceived by civilian populations over time.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
ResearchEdit
Most knowledge regarding PTSD comes from studies in high-income countries.<ref name="FodorUnterhitzenberger2014">Template:Cite journal</ref>
To recapitulate some of the neurological and neurobehavioral symptoms experienced by the veteran population of recent conflicts in Iraq and Afghanistan, researchers at the Roskamp Institute and the James A Haley Veteran's Hospital (Tampa) have developed an animal model to study the consequences of mild traumatic brain injury (mTBI) and PTSD.<ref name="Ojo2014">Template:Cite journal</ref> In the laboratory, the researchers exposed mice to a repeated session of unpredictable stressor (i.e. predator odor while restrained), and physical trauma in the form of inescapable foot-shock, and this was also combined with a mTBI. In this study, PTSD animals demonstrated recall of traumatic memories, anxiety, and an impaired social behavior, while animals subject to both mTBI and PTSD had a pattern of disinhibitory-like behavior. mTBI abrogated both contextual fear and impairments in social behavior seen in PTSD animals. In comparison with other animal studies,<ref name="Ojo2014" /><ref name="Poulos 2014">Template:Cite journal</ref> examination of neuroendocrine and neuroimmune responses in plasma revealed a trend toward increase in corticosterone in PTSD and combination groups.
Stellate ganglion block is an experimental procedure for the treatment of PTSD.<ref name="StatPearls SGBs">Template:Cite journal</ref>
Researchers are investigating a number of experimental FAAH and MAGL-inhibiting drugs in hopes of finding a better treatment for anxiety and stress-related illnesses.<ref name="ECS_Stress_Related">Template:Cite journal</ref> In 2016, the FAAH-inhibitor drug BIA 10-2474 was withdrawn from human trials in France due to adverse effects.<ref name="BIA_10_2474">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Evidence from clinical trials suggests that MDMA-assisted psychotherapy is an effective treatment for PTSD.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> On August 9, 2024, the FDA issued a letter stating that a further trial was necessary to ascertain that the benefits of MDMA-assisted psychotherapy outweighed the potential harms.<ref>Template:Cite journal</ref> Positive findings in clinical trials of MDMA-assisted psychotherapy might be substantially influenced by expectancy effects given the unblinding of participants.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> To prevent this confounding factor, it has been suggested that future trials compare MDMA against an active placebo.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> There is a lack of trials comparing MDMA-assisted psychotherapy to existent first-line treatments for PTSD, such as trauma-focused psychological treatments, which seems to achieve similar or even better outcomes than MDMA-assisted psychotherapy.<ref>Template:Cite journal</ref>
PsychotherapyEdit
Trauma-focused psychotherapies for PTSD (also known as "exposure-based" or "exposure" psychotherapies), such as prolonged exposure therapy (PE), eye movement desensitization and reprocessing (EMDR), and cognitive-reprocessing therapy (CPT) have the most evidence for efficacy and are recommended as first-line treatment for PTSD by almost all clinical practice guidelines.<ref name="Examining military population and t">Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Exposure-based psychotherapies demonstrate efficacy for PTSD caused by different trauma "types", such as combat, sexual-assault, or natural disasters.<ref name="Examining military population and t"/> At the same time, many trauma-focused psychotherapies evince high drop-out rates.<ref>Template:Cite journal</ref>
Most systematic reviews and clinical guidelines indicate that psychotherapies for PTSD, most of which are trauma-focused therapies, are more effective than pharmacotherapy (medication),<ref>Template:Cite journal</ref> although there are reviews that suggest exposure-based psychotherapies for PTSD and pharmacotherapy are equally effective.<ref>Template:Cite book</ref> Interpersonal psychotherapy shows preliminary evidence of probable efficacy, but more research is needed to reach definitive conclusions.<ref>Template:Cite journal</ref>
See alsoEdit
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NotesEdit
ReferencesEdit
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External linksEdit
Template:Sister project Template:Sister project
- Post traumatic stress disorder information from The National Child Traumatic Stress Network
- Information resources from The University of Queensland School of Medicine
- APA practice parameters for assessment and treatment for PTSD (Updated 2017)
- Resources for professionals from the VA National PTSD Center
Template:Medical condition classification and resources Template:Mental and behavioral disorders Template:Trauma Template:Authority control