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Posttraumatic Stress Disorder (PTSD)

Brief Overview: According to UpToDate, “Posttraumatic stress disorder (PTSD) has been described as "the complex somatic, cognitive, affective, and behavioral effects of psychologic trauma". PTSD is characterized by intrusive thoughts, nightmares and flashbacks of past traumatic events, avoidance of reminders of trauma, hypervigilance, and sleep disturbance, all of which lead to considerable social, occupational, and interpersonal dysfunction.”

Prevalence: According to UpToDate, “The lifetime prevalence of posttraumatic stress disorder (PTSD) ranges from 6.1 to 9.2 percent in national samples of the general adult population in the United States and Canada, with one-year prevalence rates of 3.5 to 4.7 percent.”

Etiology:

  • Genetics
  • Exposure to traumatic event(s)
  • Dysregulation of stress-response systems (HPA axis).
  • Altered neurotransmitter activity (serotonin, norepinephrine).
  • Changes in brain regions involved in fear and memory (amygdala, hippocampus).
  • Psychological and biologic vulnerability interacting with trauma exposure.

Types of Trauma:

  • Sexual assault
  • Combat
  • Mass conflict and displacement, exposure to organized violence
  • Participation in organized violence
  • Life-threatening traumatic events
  • Physical injury and medical illness
  • Childhood trauma (ACEs)
  • Interpersonal-network traumatic experiences
  • Interpersonal violence

Risk Factors:

  • History of trauma exposure prior to the index traumatic event
  • Less education
  • Lower socioeconomic status
  • Childhood adversity (including childhood trauma/abuse)
  • Personal and family psychiatric history
  • Gender – females > males
  • Race
  • Poor social support
  • Physical injury (including traumatic brain injury) as part of the traumatic event
  • Initial severity of reaction to the traumatic event
  • History of intimate partner violence or military combat
  • First responders, veterans

Commonly Associated Conditions:

  • Major depressive disorder
  • Generalized anxiety disorder and panic disorder
  • Substance use disorders (alcohol, opioids, stimulants)
  • Chronic pain syndromes
  • Sleep disorders and nightmares
  • Traumatic brain injury (TBI)
  • Cardiovascular disease (association)
  • Functional gastrointestinal disorders

Common Medications:

  • SSRIs: sertraline, escitalopram
  • SNRIs: venlafaxine
  • Alpha-adrenergic receptor blocker: Prazosin (for sleep disturbances, nightmares)

Common Labs, Imaging, and Tests:

  • PTSD checklist (PCL-5)
  • Clinician-Administered PTSD Scale (CAPS)
  • Comprehensive psychiatric assessment

Common Symptoms:

  • Flashbacks or intrusive memories
  • Nightmares
  • Guilt, shame, fear, negative beliefs about self/world
  • Irritability, anger
  • Hypervigilance
  • Exaggerated startle response
  • Sleep disturbances, poor concentration
  • Severe anxiety
  • Dissociative episodes
  • Fleeing
  • Combative behaviors
  • Avoidant behavior, emotional numbing, diminished interest in everyday activities, detachment from others

Common Treatments:

  • Medication (see above)
  • Trauma-focused psychotherapy
  • Sleep-focused interventions
  • Integrated treatment for coexisting depression, anxiety, or substance use
  • Care coordination with behavioral health, psychiatry, and social support services

Physical Findings:

  • Often normal physical exam.
  • May note elevated heart rate, blood pressure, muscle tension.
  • Sleep deprivation or fatigue common.
  • Signs of comorbid conditions (chronic pain, GI symptoms).

Potential Complications and Contraindications:

  • Potential complications if untreated:
    • Depression and suicidality
    • Substance misuse
    • Relationship and occupational impairment
    • Chronic medical illness exacerbation
    • Increased cardiovascular risk
  • Contraindications / cautions:
    • Benzodiazepines (avoid)
    • Monitor antidepressants for activation or mood changes early in treatment
    • Assess suicide risk, especially during symptom exacerbations or medication changes

General Health and Lifestyle Guidance:

  • Encourage consistent therapy attendance and medication adherence.
  • Normalize trauma responses; reduce stigma.
  • Promote sleep hygiene and structured routines.
  • Encourage physical activity and grounding techniques.
  • Limit alcohol and substance use.
  • Emphasize safety planning and crisis resources when needed.

Suggested Questions to Ask Patients:

  • Have you experienced or witnessed a traumatic event in the past?
  • Do you have intrusive memories or nightmares related to that event?
  • Are you avoiding certain places or situations because of past trauma?
  • How are your sleep and energy levels?
  • Do you feel constantly on edge or easily startled?
  • Are you currently receiving counseling or mental health treatment?
  • Are you taking any medications for mood, sleep, or anxiety?
  • Do you feel safe right now?

Suggested Talking Points:

  • PTSD is a common response to trauma and is not a personal weakness.
  • Effective treatments are available and can significantly reduce symptoms.
  • Therapy is the cornerstone of PTSD care; medications can support recovery.
  • Sleep and nightmares are treatable parts of PTSD.
  • You deserve support, and help is available.

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.