Post-traumatic stress disorder

Overview

Post-traumatic stress disorder (PTSD) develops after exposure to actual or threatened death, serious injury or sexual violence, and produces persistent intrusion, avoidance, negative mood-cognition change and hyperarousal lasting more than one month. DSM-5 moved it out of the anxiety disorders into a new chapter, Trauma- and Stressor-Related Disorders. The move signals that a traumatic precipitant, not shared phenomenology with anxiety, defines the family of conditions that includes acute stress disorder and the adjustment disorders.^[12]

The disorder is common in the population the GP serves. Australian lifetime prevalence is 7.1%, with projected lifetime risk of 9.6%; women carry higher risk than men (projected 12.3% vs 6.4%).^[50] In general practice the yield is higher still. A Valencia primary-care survey found lifetime PTSD in 14% and current PTSD in 9% of attenders who reported any traumatic event.^[6] An English waiting-room survey of 1058 patients across 11 practices found probable PTSD in 15.1% (PC-PTSD score 3 or more), concentrated in deprived areas, and more than half of those screening positive wanted help with it.^[34]

Internationally, among recent trauma survivors recruited in emergency settings, 11.8% met criteria for PTSD at follow-up (9.2% of men, 16.4% of women).^[30] Comorbidity is the rule rather than the exception. Australians with PTSD have roughly six-fold adjusted odds of any anxiety disorder and nearly five-fold odds of any mood disorder compared with those without PTSD.^[50] This comorbidity profile drives most of the presenting picture in general practice: depression, insomnia, anger, somatic complaints and substance misuse bring the patient to the desk long before anyone names the trauma.

References52ShowHide

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