Posttraumatic stress disorder: from diagnosis to prevention

Overview

This review covers posttraumatic stress disorder across the full clinical continuum, from diagnosis and understanding of mechanisms to treatment and prevention. It is written for clinicians in mental health, primary care and trauma services who meet people exposed to traumatic events.

Diagnosis and mechanisms

The review describes the core symptom clusters of PTSD: intrusive re-experiencing, avoidance, negative changes in mood and thinking, and hyperarousal. It explains how the major classification systems differ, including the concept of complex PTSD. It discusses risk factors related to the trauma itself, the individual and the social environment. It summarises neurobiological models such as altered fear conditioning and extinction and dysregulation of stress-response systems. Structured assessment and screening instruments are described as aids to careful clinical evaluation, not as a replacement for it.

Treatment

Trauma-focused psychological therapies, such as trauma-focused cognitive behavioural approaches and eye movement desensitisation and reprocessing, are presented as the main evidence-based treatments. Pharmacological treatment is discussed as an option when psychological therapy is unavailable, declined or only partly effective. The review also stresses attention to comorbid depression, substance use and physical health.

Prevention

The review looks at early responses after trauma. It supports practical and psychological first aid and watchful monitoring, and it notes that the evidence does not support routine single-session debriefing for everyone exposed. Early targeted intervention for people with persistent acute stress symptoms is described as more promising.

Implications for practice

The practical messages are to recognise PTSD accurately, to offer trauma-focused therapy as the core treatment and to put prevention effort into people at highest risk.