Intended for healthcare professionals

Practice Easily Missed?

Post-traumatic stress disorder

BMJ 2012; 344 doi: (Published 25 June 2012) Cite this as: BMJ 2012;344:e3790
  1. Ruth V Reed, specialty registrar in child and adolescent psychiatry1,
  2. Mina Fazel, NIHR postdoctoral research fellow2,
  3. Lorna Goldring, general practitioner3
  1. 1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, UK
  2. 2Oxford University Department of Psychiatry, Warneford Hospital, Oxford
  3. 3Portobello Surgery, Edinburgh EH15 2AW
  1. Correspondence to: R V Reed ruth.reed{at}
  • Accepted 7 March 2012

A 37 year old woman presented to her general practitioner with a two month history of low mood, poor sleep, and irritability. She was initially treated for depression with sertraline. Her mood improved slightly over six weeks, but, because of continued insomnia and irritability, her medication was changed to citalopram, with no further improvement. Through regular review and the building of a trusting relationship with her doctor, the patient felt able to disclose that she was experiencing intrusive images of past domestic violence. She was diagnosed with post-traumatic stress disorder and referred for trauma-focused cognitive behavioural therapy; over 15 sessions, this led to a substantial reduction in her symptoms.

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is a severe, prolonged, and impairing psychological reaction to a distressing event. The precipitating incident must be “exceptionally threatening or catastrophic”1 and can range from interpersonal violence and combat to accidents and natural disasters; sexual violence is a particularly potent cause.2 Serious illnesses or medical interventions can also precipitate PTSD if the individual perceived their own or someone else’s health or life to be under threat. The individual repeatedly relives the event through intrusive imagery, bodily re-experiencing, nightmares, and flashbacks. Irritability, insomnia, and other symptoms related to increased arousal also occur. Sufferers usually have difficulty remembering aspects of the event and avoid reminders of it (see box of diagnostic criteria). Children may act out the traumatic event through repetitive play, drawings, and stories, and have frightening dreams without recognisable content.3 Adolescents with PTSD can show aggressive or withdrawn behaviour and can find it difficult to relate to their peers.

Diagnostic criteria for post-traumatic stress disorder (ICD-10 (international classification of diseases, 10th revision) classification of mental and behavioural disorders1)

  • A. Exposure to a …

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