Post-Traumatic Stress Disorder (PTSD)

🔍 When to Suspect

History of trauma with symptoms (≥1 month) of re-experiencing (flashbacks, nightmares), avoidance, negative mood/cognition, and hyperarousal

From the full topic in The Ocean Library: Post-Traumatic Stress Disorder (PTSD)

🧭 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) and 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 present instead with insomnia, irritability, low mood, chronic pain or unexplained physical symptoms, or rising alcohol use, and often will not mention the trauma unless asked. Onset may be immediate or delayed by months or even years.

Ask directly about traumatic experiences – giving concrete examples – in anyone with persistent anxiety, sleep disturbance, or unexplained somatic symptoms who repeatedly attends. 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), and 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

---