Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a mental disorder that develops from experiencing a traumatic event. Examples include sexual assault, domestic violence, child abuse, warfare along its associated traumas, natural disaster, bereavement, traffic collision, or other traumatic events on a person's life or well-being. 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. These symptoms last for more than a month after the event and can include triggers such as misophonia. Young children are less likely to show distress, but instead may express their memories through play. Most people who experience traumatic events do not develop PTSD. 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. 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 lives. In much of the rest of the world, rates during a given year are between 0.5% and 1%. Higher rates may occur in regions of armed conflict. It is more common in women than men. A recent systematic review and meta-analysis reported that the pooled prevalence rates for ICD-11 PTSD and complex PTSD were 2% and 4%, respectively, among adults in non-war-exposed/economically developed countries/regions; they increased to 6% and 15%, respectively, in war-exposed/less economically developed countries/regions. Prevention may be possible when counselling is necessary for those with early symptoms, but is not effective when provided to all trauma-exposed individuals regardless of whether symptoms are present. The main treatments for people with PTSD are counselling (psychotherapy) and medication. Most combination therapy (psychotherapy and pharmacotherapy) does not seem to be more effective than psychotherapy alone, except for possibly MDMA-assisted psychotherapy. Benefits from medication are less than those seen with counselling. Antidepressants of the SSRI or SNRI type are the first-line medications used for PTSD and are moderately beneficial for about half of people. 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. Symptoms of trauma-related mental disorders have been documented since at least the time of the ancient Greeks. 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. During the world wars, the condition was known under various terms, including "shell shock", "war nerves", neurasthenia and 'combat neurosis'. 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. 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). alongside a growing body of clinical literature on Vietnam War veterans.

Signs and symptoms

Symptoms of PTSD generally begin within the first three months after the inciting traumatic event, but may not begin until years later. 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). 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%). 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). Some following a traumatic event experience post-traumatic growth. The social interactions of people experiencing trauma may influence their PTSD symptoms, including critical comments by partners making the victim feel guilty.

Associated medical conditions Trauma survivors often develop depression, anxiety disorders, and mood disorders in addition to PTSD. More than 50% of those with PTSD have co-morbid anxiety, mood, or substance use disorders. Substance use disorders, such as alcohol use disorder, commonly co-occur with PTSD. 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. PTSD has a strong association with tinnitus, and speculation exists that PTSD may cause some tinnitus seen in association with the condition. PTSD is also associated with several physical health comorbidities that involve inflammatory processes and immune system dysregulation. 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. Moral injury, the feeling of moral distress, such as 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.

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