BMJ  2007;334:789-793 (14 April), doi:10.1136/bmj.39162.538553.80

Clinical Review

Post-traumatic stress disorder

Cardiff University, University Hospital of Wales, Cardiff CF14 4XW

The first 150 words of the full text of this article appear below.

Vivid descriptions of reactions to traumatic events span many centuries, although their nature has changed over time.¹ Post-traumatic stress disorder was first recognised as a diagnosable psychiatric disorder in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III)^w1 and ICD-10 (International Classification of Diseases, 10th edition).² Its very existence continues to attract debate, with several authors arguing that culturally determined, understandable emotions to traumatic events are being pathologised.^w2 However, even its most ardent critics are more concerned by overdiagnosis than by whether post-traumatic stress disorder should be used as a label for the severe mental health problems some people experience after traumatic events.³ This article provides an overview of our current understanding of the disorder, who it affects, and the best approaches to its prevention and management.

Methods

I consulted recent systematic searches used to prepare Cochrane reviews and BMJ Clinical Evidence on prevention and treatment . . . [Full text of this article]

What is post-traumatic stress disorder?

Box 1 Characteristic symptoms of post-traumatic stress disorder (adapted from DSM-IV⁴)
Re-experiencing phenomena (at least one required)
Avoidance and numbing (at least three required)
Increased arousal (at least two required)

Psychological models of the disorder

Biological models of the disorder

Who is affected?

Box 2 Factors associated with post-traumatic stress disorder^{15 16}
Pretraumatic factors
Peritraumatic factors
Post-traumatic factors

Immediate reactions after trauma

Detecting the disorder

Box 3 Items on trauma screening questionnaire^w13
Re-experiencing
Hyperarousal

Preventing the disorder

Box 4 Trauma focused psychological treatments
Exposure therapy
Trauma focused cognitive therapy
Eye movement desensitisation and reprocessing

Managing chronic post-traumatic stress disorder

Psychological treatment
Unanswered questions

Drug treatment

Tips for general practitioners

Management guidelines for the chronic disorder

Summary points

Prognosis

Additional educational resources
Resources for healthcare professionals
Information resources for patients

Children and adolescents

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