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
- Jonathan I Bisson, professor of psychiatry,
- Sarah Cosgrove, public representative,
- Catrin Lewis, research psychologist,
- Neil P Roberts, consultant clinical psychologist
- 1Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- 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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