GPAtlas🧭 When to suspect
Post-traumatic stress disorder (PTSD) is a treatable mental health condition that can develop after experiencing or witnessing a traumatic event – one involving actual or threatened death, serious injury, or sexual violence.
The core picture is four symptom clusters:
• Re-experiencing (flashbacks, nightmares, intrusive images)
• Avoidance of reminders
• Hyperarousal (hypervigilance, exaggerated startle, irritability, sleep disturbance, poor concentration)
• Negative alterations in mood and thinking (fear, guilt, shame, emotional numbing, detachment)
To meet the diagnosis, symptoms must persist for more than one month and cause functional impairment.
The central challenge in primary care is recognition: PTSD is common (around 1 in 3 people exposed to major trauma) yet frequently missed, because patients rarely present saying they have PTSD.
They often will not mention the trauma unless asked, and present instead with:
• Insomnia
• Irritability
• Low mood
• Chronic pain or unexplained physical symptoms
• Rising alcohol use
Onset may be immediate or delayed by months or even years.
Ask directly about traumatic experiences – giving concrete examples – in anyone who repeatedly attends with:
• Persistent anxiety
• Sleep disturbance
• Unexplained somatic symptoms
Relevant traumas include:
• Serious accidents
• Physical or sexual assault
• Childhood or domestic abuse
• Work-related or remote exposure (emergency services, armed forces)
• Serious health events or traumatic childbirth (intensive care admission, neonatal death)
• War, conflict or torture
| Condition | Onset relative to trauma | Distinguishing feature |
|---|---|---|
| Acute stress reaction | • Minutes to hours • Settles within days |
Transient, expected response to trauma – not a disorder |
| Acute stress disorder (DSM-5) | The first month (3 days to 1 month) | ≥ 9 symptoms across intrusion, negative mood, dissociation, avoidance and arousal |
| PTSD | Symptoms persist > 1 month (may be delayed) | Re-experiencing + avoidance + hyperarousal + negative mood/cognition, with functional impairment |
| Complex PTSD (ICD-11) | After prolonged or repeated trauma | All PTSD features plus affect dysregulation, negative self-concept and relationship difficulties |
| Adjustment disorder | Soon after an identifiable stressor | • Distress and impairment not meeting full PTSD criteria • Stressor need not be “traumatic” |
Source: NICE NG116 · NHS
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