Perspectives

Posttraumatic Stress Disorder 101

Authors: Raymond Pary, MD, Steven Lippmann, MD

Abstract

Treatment of veterans at the Louisville Veterans Administration (VA) Medical Center during the past 46 years motivated this summary of key points from the literature regardingposttraumatic stress disorder (PTSD). News reports from the coronavirus disease 2019 pandemic, a building collapse in Miami, hurricanes off the coast of Florida, and fires in the western US states prompted writing interest on this topic. This article was
designed to improve understanding about PTSD and its various treatment options.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Kessler RC, Rose S, Koenen KC, et al. How well can post-traumatic stress disorder be predicted from pre-trauma risk factors? An exploratory study in the WHO World Mental Health Surveys. World Psychiatry 2014;13: 265–274.
 
2. Koenen KC, Ratanatharathorn A, Ng L, et al. Posttraumatic stress disorder in the world mental health surveys. Psychol Med 2017;47:2260–2274.
 
3. Resnick HS, Kilpatrick DG, Dansky BS, et al. Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol 1993;61:984–991.
 
4. van der Kolk BA, Pelcovitz D, Roth S, et al. Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma. Am J Psychiatry 1996;153:83–93.
 
5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
 
6. Herzog S, Fogle BM, Harpaz-Rotem I, et al. Understanding dissociative symptoms in trauma exposed veterans: prevalence, comorbidities, and suicidality. J Affect Disord 2020;272:138–145.
 
7. McLaughlin KA, Koenen KC, Friedman MJ, et al. Subthreshold posttraumatic stress disorder in the World Health Organization world mental health surveys. Biol Psychiatry 2015;77:375–338.
 
8. Dyb G, Jensen TK, Nygaard E, et al. Post-traumatic stress reactions in survivors of the 2011 massacre on Utøya Island, Norway. Br J Psychiatry 2014;204:361–367.
 
9. Blackmore R, Gray KM, Boyle JA, et al. The prevalence of mental illness in child and adolescent refugees and asylum seekers. J Am Acad Child Adolesc Psychiatry 2020;59:705–714.
 
10. Stein MD, Jang KL, Taylor S, et al. Genetic and environmental influences on trauma exposure and posttraumatic stress disorder symptoms: a twin study. Am J Psychiatry 2002;159:1675–1681.
 
11. Childress JE, McDowell EJ, Venkata VK, et al. Hippocampal volumes in patients with chronic combat-related posttraumatic stress disorder: a systematic review. J Neuropsychiatry Clin Neurosci 2013;25:12–25.
 
12. Shin LM, Rauch SL, Pitman RK, et al. Amygdala, medial prefrontal cortex and hippocampal function in PTSD. Ann N Y Acad Sci 2006;1071:67–79.
 
13. Sperry L. Trauma, neurobiology, and personality dynamics: a primer. J Individ Psychol 2016;72:161–167.
 
14. Boscarino JA. Posttraumatic stress disorder; exposure to combat, and lower plasma cortisol among Vietnam veterans: findings and clinical implications. J Consult Clin Psychol 1996;64:191–201.
 
15. Yehuda R, Lowry MT, Southwick SM, et al. Lymphocyte glucocorticoid receptor number in posttraumatic stress disorder. Am J Psychiatry 1991; 148:499–504.
 
16. Duncan LE, Cooper BN, Shen H. Robust findings from 25 years of PTSD genetics research. Curr Psychiatry Rep 2018;20:115.
 
17. Eraly SA, Nievergelt CM, Mailhoefer AX, et al. Assessment of plasma C-reactive protein as a biomarker of posttraumatic stress disorder risk. JAMA Psychiatry 2014;71:423–431.
 
18. Price M, van Stolk-Cooke K. Examination of the interrelations between the factors of PTSD, major depression, and generalized anxiety disorder in a heterogeneous trauma-exposed sample using DSM 5 criteria. J Affect Disord 2015;186:149–155.
 
19. Grieger TA, Cozza SJ, Ursano RJ, et al. Posttraumatic stress disorder and depression in battle-injured soldiers. Am J Psychiatry 2006;163:1777–1783.
 
20. Menon DK, Schwab K, Wright DW, et al. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil 2010;91:1637–1640.
 
21. Cnossen MC, Scholten AC, Lingsma HF, et al. Predictors of major depression and posttraumatic stress disorder following traumatic brain injury: a systematic review and meta-analysis. J Neuropsychiatry Clin Neurosci 2017;29:206–224.
 
22. Yurgil KA, Barkauskas DA, Vasterling J, et al. Association between traumatic brain injury and risk of posttraumatic stress disorder in activeduty marines. JAMA Psychiatry 2014;71:149–157.
 
23. Benedict TM, Keenan PG, Nitz AJ, et al. Posttraumatic stress disorder symptoms contribute to worse pain and health outcomes in veterans with PTSD compared to those without: a systematic review with meta-analysis. Mil Med 2020;185:e1481–e1491.
 
24. Kang B, Xu H, McConnell ES. Neurocognitive and psychiatric comorbidities of posttraumatic stress disorder among older veterans: a systematic review. Int J Geriatr Psychiatry 2019;34:522–538.
 
25. Roberts AL, Agnew JC, Spiegelman D, et al. Posttraumatic stress disorder and incidence of type 2 diabetes mellitus in a sample of women a 22-year longitudinal study. JAMA Psychiatry 2015;72:203–210.
 
26. Kessler RC, Sonnega A, Bromet E, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995:52:1048–1060.
 
27. Bremner JD, Southwick SM, Darnell A, et al. Chronic PTSD in Vietnam combat veterans: course of illness and substance abuse. Am J Psychiatry 1996;153:369–375.
 
28. Elbogen EB, Johnson SC, Wagner HR, et al. Violent behavior and posttraumatic stress disorder in US Iraq and Afghanistan veterans. Br J Psychiatry 2014;204:368–375.
 
29. Kubzansky LD, Bordelois P, Jun HJ, et al. The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women. JAMA Psychiatry 2014;71:44–51.
 
30. Reynolds K, Pietrrazk RH, Mackenzie CS, et al. Traumatic stress disorder across the life span: findings from a nationally representative survey. Am J Geriatr Psychiatry 2016;24:81–93.
 
31. Bardhoshi G, Erford BT, Duncan K, et al. Choosing assessment instruments for posttraumatic stress disorder screening and outcome research. J Couns Dev 2016;94:184–195.
 
32. Eisen SV, Schultz MR, Ni P, et al. Development and validation of a without computerized-adaptive test for PTSD (P-CAT). Psychiatr Serv 2016;67:1116–1123.
 
33. Merz J, Schwarzer G, Gerger H. Efficacy and acceptability of pharmacological, psychotherapeutic, and combination treatments in adults with posttraumatic stress disorder: a network meta-analysis. JAMA Psychiatry 2019;76:904–913.
 
34. US Department of Veterans Affairs/Department of Defense. VA/DoD clinical practice guidelines. Management of posttraumatic stress disorder and acute stress reaction 2017. https://www.healthquality.va.gov/guidelines/MH/ptsd/. Published 2017. Accessed September 4, 2022.
 
35. Rauch SA, Cigrang J, Austern D, et al. Expanding the reach of effective PTSD treatment into primary care: prolonged exposure for primary care. Focus 2017;15:406–410.
 
36. Powers MB, Halpern JM, Ferenschak MP, et al. A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Focus 2013;11:428–436.
 
37. Goenijian AK, Steinberg AM, Walling D, et al. 25-year follow-up of treated and not-treated adolescents after the Spitak earthquake: course and predictors of PTSD and depression. Psychol Med 2021;51:976–988.
 
38. Monson CM, Schnurr PP, Resnick PA, et al. Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. J Consult Clin Psychol 2006;74:898–907.
 
39. Resnick PA, Wachen JS, Dondanville KA, et al. Effect of group vs individual cognitive processing therapy in active-duty military seeking treatment for posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry 2017;74:28–36.
 
40. Kearney DJ, Malte CA, Storms M, et al. Loving-kindness meditation vs cognitive processing therapy for posttraumatic stress disorder among veterans: a randomized clinical trial. JAMA Netw Open 2021;4:e216604.
 
41. Jackson S, Baity MR, Bobb K, et al. Stress inoculation training outcomes among veterans with PTSD and TBI. Psychol Trauma 2019;11:842–850.
 
42. Fernandez CA, Choi KW, Marshall DL, et al. Assessing the relationship between psychosocial stressors and psychiatric resilience among Chilean disaster survivors. Br J Psychiatry 2020;217:630–637.
 
43. Lely JC, Knipscheer JW, Moeerbeek M, et al. Randomised controlled trial comparing narrative exposure therapy with present-centred therapy for older patients with post-traumatic stress disorder. Br J Psychiatry 2019; 214:369–377.
 
44. Held P, Klassen BJ, Zalta AK, et al. Understanding the impact and treatment of moral injury among military service members. Focus 2017;15:399–405.
 
45. Sornborger J, Fann A, Serpa JG, et al. Integrative therapy approaches for posttraumatic stress disorder: a special focus on treating veterans. Focus 2017;15:390–398.
 
46. Puetz TW, Youngstedt SD, Herring MP. Effects of pharmacotherapy on combat-related PTSD, anxiety, and depression: a systematic review and meta-regression analysis. PLoS ONE 2015;10:e0126529.
 
47. Hoskins M, Pearce J, Bethell A, et al. Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis. Br J Psychiatry 2015; 206:93–100.
 
48. Zoeliner LA, Roy-Byne PP, Mavissakalian M, et al. Doubly randomized preference trial of prolonged exposure versus sertraline for treatment of PTSD. Am J Psychiatry 2019;176:287–296.
 
49. Spangler PT, West JC, Dempsey CL, et al. Randomized controlled trial of riluzole augmentation for posttraumatic stress disorder: efficacy of a glutamatergic modulator for antidepressant-resistant symptoms. J Clin Psychiatry 2020;81:20 m13233.
 
50. Villarreal G, Hamner MB, Canive JM, et al. Efficacy of quetiapine monotherapy in posttraumatic stress disorder: a randomized, placebocontrolled trial. Am J Psychiatry 2016;173:1205–1212.
 
51. Feder A, Costi S, Rutter SB, et al. A randomized controlled trial of repeated ketamine administration for chronic posttraumatic stress disorder. Am J Psychiatry 2021;178:193–202.
 
52. Khachatryan D, Groll D, Booij L, et al. Prazosin for treating sleep disturbances in adults with posttraumatic stress disorder: a systematic review and meta-analysis of randomized controlled trials. Gen Hosp Psychiatry 2016;39:46–52.
 
53. Raskind MA, Peterson K, Williams T, et al. A trial of prazosin for combat trauma. PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan. Am J Psychiatry 2013;170:1003–1010.
 
54. Tucker P, Trautman RP, Wyatt DB, et al. Efficacy and safety of topiramate monotherapy in civilian posttraumatic stress disorder: a randomized, doubleblind, placebo-controlled study. J Clin Psychiatry 2007;68:201–206. 55. Yeh MS, Mari JJ, Costa MC, et al. A double-blind randomized controlled trial to study the efficacy of topiramate in a civilian sample of PTSD. CNS Neurosci Ther 2011;17:305–310.