Quick Reference for Posttraumatic Stress Disorder
| Depression after trauma (numbing and avoidance may be present, but not hyperarousal or intrusive symptoms) |
| Panic disorder (if panic attacks are not limited to reminders or triggers of the trauma) |
| Generalized anxiety disorder (may have symptoms similar to PTSD hyperarousal) |
| Agoraphobia (if avoidance is not directly trauma related) |
| Specific phobia (if avoidance is not directly trauma related) |
| Adjustment disorder (usually has less severe stressor and different symptoms) |
| Acute stress disorder (if less than 1 month has elapsed since trauma) |
| Dissociative disorders (if prominent dissociative symptoms are present) |
| Factitious disorders or malingering (especially is secondary gain is apparent) |
From Hollander E, Simeon D: Concise Guide to Anxiety Disorders. Washington, DC, American Psychiatric Publishing, 2003, p 58
| Past history of trauma prior to the index trauma |
| Past history of PTSD |
| Past history of depression |
| Past history of anxiety disorders |
| Comorbid axis II disorders (predictive of greater chronicity) |
| Family history of anxiety (including parental PTSD) |
| Disrupted parental attachments |
| Severity of exposure to trauma (more predictive of acute symptoms) |
From Hollander E, Simeon D: Concise Guide to Anxiety Disorders. Washington, DC, American Psychiatric Publishing, 2003, p 12
| Coursea |
| 4/5 of patients: longer than 3 months |
| 3/4 of patients: longer than 6 months |
| 1/2 of patients: 2 years’ duration |
| Minority of patients: symptomatic for many years or for decades |
| Predictors of worse outcome |
| Greater number of PTSD symptoms |
| Psychiatric history of other anxiety and mood disorders |
| Higher degree of numbing or hyperarousal to stressors |
| Comorbid medical illnesses |
| Female sex |
| Childhood trauma |
| Alcohol abuse |
a Data from Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P: Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 1998; 55:626–632
From Hollander E, Simeon D: Concise Guide to Anxiety Disorders. Washington, DC, American Psychiatric Publishing, 2003, p 72
| Heightened physiologic responses to traumatic stimuli |
| Noradrenergic activation |
| Highly sensitized hypothalamic-pituitary-adrenal axis |
| Endogenous opioid dysregulation |
| Dysregulated serotonergic modulation |
| Hippocampal toxicity, decreased volumes |
| Limbic hyperactivity (amygdala, cingulate) and cortical hyporesponsivity (prefrontal, Broca’s area) to traumatic stimuli |
From Hollander E, Simeon D: Concise Guide to Anxiety Disorders. Washington, DC, American Psychiatric Publishing, 2003, p 102
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