Post Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a mental health condition that arises following exposure to an event perceived as deeply distressing or life-threatening. Such events may include sexual assault, domestic violence, child abuse, armed conflict, natural disasters, serious traffic collisions, or other incidents that threaten personal safety or wellbeing. Although many individuals experience traumatic events during their lives, only a minority develop PTSD, and the condition varies considerably in its presentation, severity, and long-term implications.

Definition and Core Characteristics

PTSD is characterised by the persistence of symptoms for more than one month following exposure to trauma. Its core features include intrusive recollections such as disturbing thoughts, flashbacks, or nightmares; avoidance of trauma-related cues; negative alterations in thoughts and mood; and heightened physiological arousal, often manifesting as hypervigilance or an exaggerated startle response. Emotional or physical distress when exposed to reminders of the trauma is common. In some individuals, specific sensory triggers such as certain sounds may provoke acute reactions. Children may not articulate distress in a typical manner and instead re-enact traumatic experiences through play, demonstrating behavioural expression rather than verbal recall.
The onset of symptoms usually occurs within the first three months following the traumatic incident, yet delayed onset is also well documented, with some individuals developing symptoms years later. Many trauma survivors experience short-term psychological reactions, but these do not always progress to PTSD unless they become persistent and disruptive.

Historical Background

Historical accounts indicate that trauma-related mental disturbances have been observed since ancient times. Writings from classical Greek sources describe symptoms that mirror modern understandings of intrusive recollections and heightened fear responses. During the seventeenth century, diarist Samuel Pepys documented emotional and psychological disturbances following the Great Fire of London in 1666, often cited as an early depiction of trauma-related illness.
Terminology evolved significantly during the twentieth century, especially in relation to wartime experiences. During the First and Second World Wars, the condition was described variously as “shell shock”, “war neurosis”, “neurasthenia”, or “combat stress reaction”. The modern term post-traumatic stress disorder emerged in the 1970s as clinicians recognised consistent patterns of psychological disturbance among United States veterans returning from the Vietnam War. This led to its formal inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, marking its official recognition as a distinct psychiatric condition.

Epidemiology and Prevalence

PTSD occurs worldwide but varies significantly by region, gender, and exposure type. In the United States, approximately 3.5 per cent of adults experience PTSD in a given year, and around 9 per cent will develop it at some point in their lives. In many other regions, annual prevalence estimates range between 0.5 and 1 per cent, although higher rates are found in areas affected by armed conflict or chronic violence.
Women are more likely than men to develop PTSD despite men experiencing a greater number of traumatic events overall. This disparity is linked largely to the higher likelihood of women being exposed to interpersonal traumas such as sexual violence and intimate partner abuse, which are associated with elevated risk.

Types of Trauma and Associated Risks

A wide variety of traumatic events may precipitate PTSD; however, the probability of developing the disorder varies significantly according to trauma type. Interpersonal violence—particularly sexual assault and rape—carries the highest risk. Many studies indicate that the likelihood of PTSD following rape may exceed that of any other single traumatic event.
Non-interpersonal traumas, such as natural disasters or accidents, also present risks but generally at lower rates. Nonetheless, severe motor vehicle collisions can lead to PTSD in both adults and children. Globally, an estimated one quarter of adults exhibit PTSD symptoms following non-life-threatening traffic accidents, and the risk nearly doubles when the accident is life-threatening.
Occupational exposure to trauma also increases vulnerability. Military personnel, emergency service workers, police officers, firefighters, ambulance crews, healthcare staff, journalists in conflict zones, and others working in high-risk environments demonstrate greater rates of trauma-related disorders. Repeated exposure to distressing experiences may amplify risk, particularly when accompanied by lack of control or inability to escape the traumatic event.
Children display different patterns of risk. Approximately 1 per cent of children in non-war-affected regions develop PTSD, compared with slightly higher rates among adults. However, where trauma exposure is substantial, childhood rates can rise to 16 per cent or more. Predictive factors include female gender, limited social support, negative coping styles, chronic adversity, and previous exposure to trauma.

Psychological and Medical Comorbidities

PTSD frequently coexists with other mental health conditions. More than half of affected individuals develop comorbid anxiety disorders, depression, or mood disorders. Substance use disorders, particularly alcohol misuse, commonly emerge alongside PTSD and can significantly hinder recovery. Addressing substance use is often a prerequisite for successful psychological treatment, as drug or alcohol dependence can intensify symptoms and impede therapeutic progress.
Physical health associations are increasingly recognised. Evidence suggests links between PTSD and tinnitus, potentially arising from neurological alterations associated with prolonged stress responses. Additionally, immune system dysregulation and inflammatory processes appear more common among individuals with chronic PTSD. In children and adolescents, impaired emotional regulation—manifested as anger outbursts, mood instability, or behavioural dysregulation—is strongly associated with trauma-related symptoms.
Moral injury, while distinct from PTSD, frequently co-occurs. It refers to psychological distress caused by perceived violations of moral or ethical values, often involving shame or guilt. Although moral injury relates more to internal conflict, while PTSD centres on fear-based reactions, the two can overlap.

Predictive and Contributory Factors

A number of factors influence an individual’s likelihood of developing PTSD. Key predictors include:

• Intensity and duration of the trauma, with greater severity correlating with increased risk.
• Degree of perceived threat, especially when escape is impossible or the event is unexpected.
• Exposure to physical injury, disfigurement, or traumatic brain injury.
• Interpersonal nature of trauma, as events involving deliberate harm generally carry greater psychological impact.
• Peritraumatic dissociation, where individuals feel detached or unreal during the event, a consistent predictor of later symptom development.
• Proximity to the traumatic event, with closer exposure associated with higher risk.

Gender differences remain significant; women are more likely to develop PTSD following physical violence or sexual assault compared with men. Chronic adversity in childhood, such as neglect or familial instability, also increases the likelihood of PTSD in adulthood.

Prevention Approaches

Preventive strategies focus on early identification and targeted intervention. Trauma-focused cognitive behavioural therapy (TF-CBT) delivered to individuals exhibiting early symptoms can reduce the progression to full PTSD. However, evidence shows that offering such interventions indiscriminately to all trauma-exposed individuals, regardless of symptoms, is not effective and may not be beneficial.
Public awareness, early assessment in high-risk occupations, and support systems following traumatic events play crucial roles in mitigating long-term psychological consequences.

Treatment Modalities

Management of PTSD typically involves a combination of psychological therapies and pharmacological treatments. Counselling and psychotherapy—particularly trauma-focused cognitive behavioural therapy and eye-movement desensitisation and reprocessing (EMDR)—are considered first-line interventions and demonstrate the greatest benefit for most individuals.
Antidepressants, predominantly selective serotonin reuptake inhibitors (SSRIs) and serotonin–noradrenaline reuptake inhibitors (SNRIs), are widely used and offer moderate benefit for about half of patients. Other classes of medication lack sufficient supportive evidence. Benzodiazepines are generally discouraged due to risk of dependency and evidence suggesting poorer outcomes.
Whether the combination of psychotherapy and medication is superior to either treatment alone remains unclear, with research showing mixed results. Treatment must often be tailored to individual needs, especially in the presence of comorbid conditions or ongoing stressors.