Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a chronic, disabling disorder that affects 8%–9% of the population at some point in their lifetime. The disorder is associated with significant morbidity and functional impairment, affecting both patients and family members, and its costs are similar to those of other severe mental disorders. The pathophysiology of PTSD involves a complex interplay between trauma-related factors and the neurobiological and psychosocial influences that determine individual differences in resilience and vulnerability. Despite its wide prevalence, PTSD remains an underrecognized disorder, with proper diagnosis complicated by a variety of factors, including stigma, comorbidity and symptom overlap, and high diagnostic thresholds. Through careful assessment of trauma and PTSD in all patients, health care providers may more readily identify individuals at risk of PTSD and in need of interventions early on, thereby improving outcome and potentially limiting the chronic and disabling course of the illness. Recent research demonstrates efficacy for both pharmacologic and psychosocial interventions in treating PTSD. First-line pharmacotherapeutic options are the selective serotonin reuptake inhibitors. Among the most effective psychosocial interventions are cognitive behavioral approaches that use exposure and cognitive restructuring techniques.