Post-Traumatic Stress Disorder

By Seedat, S. | South African Journal of Psychiatry, August 2013 | Go to article overview

Post-Traumatic Stress Disorder


Seedat, S., South African Journal of Psychiatry


1. Introduction

Post-traumatic stress disorder (PTSD) is among the most prevalent anxiety disorders, both in terms of lifetime and 12-month prevalence rates documented in epidemiological studies worldwide. The National Comorbidity Survey Replication (NCS-R) study conducted in the USA, for example, found the lifetime prevalence of PTSD to be 6.8% while the 12-month prevalence was 3.5%. [1,2] The South African Stress and Health Study (SASH) documented lower lifetime (2.3%) and 12-month (0.6%) rates, although PTSD was among the anxiety disorders with the highest proportion of severe cases (36% of all individuals diagnosed with PTSD were severely ill). [3] High rates of PTSD (19.9%) have also been documented among South African patients attending primary healthcare clinics. [4]

2. Diagnosis and clinical characteristics

The disorder represents a pathological response to a traumatic event, characterised by symptoms of recurrent and intrusive distressing recollections of the event (e.g. nightmares, a sense of reliving the experience with illusions, hallucinations, or dissociative flashback episodes, intense psychological or physiological distress at exposure to cues that resemble the traumatic event); avoidance of stimuli associated with the trauma (e.g. inability to recall important aspects of the trauma, loss of interest, estrangement from others); and increased arousal (sleep disturbances, irritability, difficulty concentrating, hypervigilance, and exaggerated startle response). [5] These symptoms cut across three recognised symptom clusters (re-experiencing, avoidance or numbing and hyperarousal), produce distress and impairment for individuals, and form the essential targets for treatment. The Diagnositic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) includes an additional cluster of symptoms characterised by negative alterations in cognition and mood. The full symptom picture must be present for more than 1 month for the diagnosis to be made. [6] PTSD is classified in the category of trauma- and stressor-related disorders, and separate from the anxiety disorders, in the DSM-V. Risk factors that increase the likelihood of PTSD include severity of the traumatic exposure, history of past trauma or previous psychiatric disorder, female gender, experience of further stressful events and lack of social support.

3. Assessment

As a general rule, a comprehensive review of the differential diagnosis of the anxiety symptoms should be done, ruling out or treating other psychiatric diagnoses and medical causes. Thus, as part of the initial diagnostic assessment, and after each subsequent treatment trial, should response to treatment be unsatisfactory, it is important to evaluate symptoms associated with PTSD (e.g. insomnia, aggression, nightmares, suicidality, psychotic symptoms). Other considerations include comorbid diagnoses (including depression, other anxiety disorders, substance abuse, bipolar disorder), other issues such as concurrent medical illness especially that which may be undiagnosed (e.g. thyroid disease), ongoing trauma, and legal/compensation issues, ongoing use of anxiety-producing substances (e.g. caffeine, other stimulants), pregnancy, and poor adherence to treatment. [7] Those with PTSD, with and without depression, are at increased risk for suicidality, and it is important to assess suicide risk both at the initial evaluation and subsequent follow-up visits. [7]

Longitudinal studies indicate that PTSD is a disorder of chronicity in that symptoms appear shortly after the traumatic event, subside in many individuals, but can persist in as many as 40% in the form of chronic PTSD. [5] Given that a significant number of cases of PTSD are undiagnosed and undertreated, it is important to inquire about exposure to trauma, and to maintain a high index of suspicion and a high level of awareness of the disorder. Patients with PTSD are frequent users of general medical and psychiatric services, have high rates of coexisting psychiatric (e.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Post-Traumatic Stress Disorder
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.