Posttraumatic Stress Disorder (PTSD)

Posttraumatic stress disorder (PTSD) is a psychiatric condition that develops following exposure to actual or threatened death, serious injury, or sexual violence.
This exposure can occur through direct experience, witnessing the event in person, learning that the event occurred to a close family member or friend, or experiencing extreme, repeated exposure to aversive details of traumatic events.
To meet diagnostic criteria, the disturbance must persist for more than 1 month and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Symptom Domain	Clinical Manifestations
Intrusion Symptoms	Recurrent, involuntary, and intrusive distressing memories; distressing nightmares; dissociative reactions (e.g., flashbacks); and intense psychological or physiologic distress upon exposure to trauma cues.
Avoidance	Persistent avoidance of, or efforts to avoid, distressing memories, thoughts, feelings, or external reminders (e.g., people, places, activities) associated with the trauma.
Negative Cognitions & Mood	Inability to remember key aspects of the event, persistent and exaggerated negative beliefs about oneself or the world, distorted blame, chronic negative emotional states (fear, anger, guilt), diminished interest in activities, and feelings of detachment.
Arousal & Reactivity	Irritable behavior, angry outbursts, reckless or self-destructive behavior, hypervigilance, an exaggerated startle response, impaired concentration, and severe sleep disturbances.

In young children, spontaneous and intrusive memories may not appear overtly distressing and are frequently expressed through trauma-specific play reenactment.
Frightening dreams may occur without recognizable trauma-related content.
Alterations in arousal frequently manifest as extreme temper tantrums, while negative cognitions may present as prominent social withdrawal and a constriction of play.

Psychotherapy: Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is the definitive first-line and most strongly supported treatment for PTSD. It involves trauma education, relaxation, cognitive coping, creating a trauma narrative, and mastering trauma reminders.
Pharmacotherapy: Standard anxiety medications are less effective for core PTSD symptoms, but alpha-agonists (such as clonidine and guanfacine) may be helpful in targeting specific symptoms like sleep disturbances, nightmares, persistent physiologic arousal, and exaggerated startle responses.
Selective Serotonin Reuptake Inhibitors (SSRIs) may be considered if the patient has comorbid conditions responsive to them, such as depression, severe anxiety, or affective numbing.