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Posttraumatic stress disorder: Overview

Key points

  • Primary care providers are often the first to see a client with posttraumatic stress disorder (PTSD).
  • PTSD is an anxiety disorder that is precipitated by severe trauma in which the person experienced, saw or heard physical or mental threats.
  • Symptoms may begin months or years after the traumatic event.
  • People with PTSD often avoid talking about or acknowledging the trauma. Instead, they may seek treatment for physical ailments, low mood, anger, relationship problems, sleep difficulties or sexual dysfunction.

Symptoms

PTSD is an anxiety disorder that follows exposure to a severe traumatic event. Common forms of trauma include the unexpected death of a loved one, sexual assault and seeing someone badly injured or killed. Symptoms may begin long after the event and can last for many years without treatment.

Symptoms may include:

  • flashbacks (sudden, disruptive and vivid re-experiencing of the traumatic event)
  • avoiding reminders of the event
  • always being on guard against danger
  • feeling numb
  • self-harming behaviour
  • spending less time with family and friends
  • losing interest in daily activities
  • shame and guilt
  • nightmares
  • long-term sleeping problems.

Prevalence

  • In Canada, the prevalence rate of lifetime PTSD is about 9%.
  • Traumatic exposure to at least one event sufficient to cause PTSD is common.
  • More women than men experience PTSD. This is likely because women experience more sexual assault and other forms of interpersonal violence.

Causes

There is no one cause of PTSD. It is precipitated by severe trauma, but not everyone who experiences trauma develops the disorder. Both risk factors and protective factors play a role in determining whether a person will develop PTSD.

Risk factors include:

  • family history of mental disorders
  • previous psychiatric illness
  • other life stressors
  • female gender
  • lack of social support
  • young age when exposed to trauma
  • severity of the trauma.

Protective factors include:

  • perceived social support
  • easygoing temperament
  • high intellectual ability
  • sense of control
  • high socio-economic status
  • positive family environment.

Prognosis

  • PTSD symptoms decrease substantially in the first year after the trauma without treatment for most people.
  • Some evidence suggests that combining psychological treatment and pharmacotherapy improves outcomes.
  • Follow-up after treatment is essential.

Evidence summary

Ng, L. (2012). Trauma and posttraumatic stress disorder. In A. Khenti, J. Sapag, S. Mohamound & A. Ravindran (Eds.), Collaborative Mental Health: An Advanced Manual for Primary Care Professionals (pp. 251–272). Toronto, ON: Centre for Addiction and Mental Health.

Swinson, R. (2011). The patient who is anxious. In D. Goldbloom & J. Davine (Eds.), Psychiatry in Primary Care: A Concise Canadian Pocket Guide (pp. 45–60). Toronto, ON: Centre for Addiction and Mental Health.

Van Ameringen, M., Mancini, C., Patterson, B. & Boyle, M.H. (2008). Post-traumatic stress disorder in Canada. CNS Neuroscience & Therapeutics, 14(3), 171–181.


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