Clinical Review

Post-traumatic stress disorder

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6161 (Published 26 November 2015) Cite this as: BMJ 2015;351:h6161
  1. Jonathan I Bisson, professor of psychiatry,
  2. Sarah Cosgrove, public representative,
  3. Catrin Lewis, research psychologist,
  4. Neil P Roberts, consultant clinical psychologist
  1. 1Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
  1. Correspondence to: J I Bisson BissonJI{at}cardiff.ac.uk

What you need to know

  • Individual reactions to traumatic events vary greatly and most people do not develop a mental disorder after exposure to trauma

  • PTSD should be considered in any patient exposed to a major traumatic event

  • Up to 3% of adults has PTSD at any one time. Lifetime prevalence rates are between 1.9% and 8.8%

  • Psychological treatments, particularly trauma focused psychological therapies, can be effective

  • Although the effect sizes are not as high as for psychological therapies, drug treatments can be effective

  • Patients with complex PTSD should receive specialist multidisciplinary care

What is post-traumatic stress disorder (PTSD)?

PTSD is a mental disorder that may develop after exposure to exceptionally threatening or horrifying events. Many people show remarkable resilience and capacity to recover following exposure to trauma.1 PTSD can occur after a single traumatic event or from prolonged exposure to trauma, such as sexual abuse in childhood. Predicting who will go on to develop PTSD is a challenge.2

Examples of the many different trajectories of PTSD symptoms after exposure to trauma

Sources and selection criteria

We identified Cochrane and other relevant systematic reviews and meta-analyses, and supplemented these with additional searches and our knowledge of the subject. Wherever possible, we used evidence from recent meta-analyses of randomised trials.

Patients with PTSD are at increased risk of experiencing poor physical health, including somatoform, cardiorespiratory, musculoskeletal, gastrointestinal, and immunological disorders.3 4 It is also associated with substantial psychiatric comorbidity,5 increased risk of suicide,6 and considerable economic burden.7 8

PTSD is a widely accepted diagnosis9 but some believe that the term medicalises understandable responses to catastrophic events and further disempowers those who are already disempowered.10

How common is PTSD?

About 3% of the adult population has PTSD at any one time.11 Lifetime prevalence is between 1.9%12 and 8.8%,7 but this rate doubles in populations affected by conflict13 and reaches …

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