- Jonathan I Bisson, clinical senior lecturer in psychiatry
- Cardiff University, University Hospital of Wales, Cardiff CF14 4XW
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.
I consulted recent systematic searches used to prepare Cochrane reviews and BMJ Clinical Evidence on prevention and treatment of post-traumatic stress disorder, as well as those used to prepare the National Institute for Health and Clinical Excellence (NICE) guidelines for post-traumatic stress disorder. I searched PubMed using the terms “epidemiology”, “neurobiology”, and “neuroimaging” in conjunction with “post-traumatic stress disorder”. I also used a personal archive of references.
What is post-traumatic stress disorder?
Box 1 shows the characteristic features of the disorder. It occurs after a traumatic event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.4 For the DSM classification, the person must also have experienced intense fear, helplessness, or horror when the event occurred. The symptoms must have been present for at least one month (the one month criterion does not apply in the ICD-10 classification) and, crucially, they must also cause clinically significant distress or impairment in social, occupational, or other important areas of …