Posttraumatic stress disorder (PTSD) (synonyms: posttraumatic stress disorder; posttraumatic stress syndrome; psychotraumatic stress disorder; basal psychotraumatic stress syndrome or posttraumatic stress disorder (English, abbreviated PTSD); F43.1) represents a delayed psychological response to one or more stressful events of particular severity or catastrophic magnitude. The experiences (traumas) may be of longer or shorter duration.
Trauma is defined according to the WHO (World Health Organization) ICD-10 classification (international statistical classification of diseases and related health problems) as: “A stressful event or situation of shorter or longer duration, of exceptional threat or catastrophic magnitude, that would cause deep distress in almost anyone (e.g., natural disaster or human catastrophe). E.g., natural or man-made disaster – man-made disaster – combat deployment, serious accident, witnessing the violent death of others, or being a victim of torture, terrorism, rape, or other crime).”
Post-traumatic stress disorder (PTSD) develops as a possible consequence to the traumatic event.
PTSD is characterized by intrusions (intrusive thoughts and ideas rushing into consciousness), avoidance, and hyperarousal (overexcitement usually occurring under stress).
Posttraumatic stress disorder is classified by event type (see classification below for details):
- Type I trauma: one-time/short-term (e.g., accident).
- Type II trauma: multiple/long-term (war experience; domestic, sexual violence).
Complex post-traumatic stress disorder (KPTBS) was added to ICD-11 as a stand-alone diagnosis in mid-2018. This is a disorder that occurs as a result of repetitive or prolonged traumatic events. In addition to the symptoms of PTSD, PTSD is characterized by affect regulation disorders, negative self-perception, and relationship disturbances.
Sex ratio: males to females is 1: 2-3; with males experiencing trauma more frequently, except for sexual trauma
One-month prevalence (frequency of illness) is 1.3-1.9% in those under 60 and 3.4% in those over 60 (in Germany).
Course and prognosis: The courses are very variable. Initially, severe symptom development is possible. Within days to weeks, there is a reduction of symptoms or remission (regression). Most traumatized persons do not develop PTSD, but show spontaneous recovery. Note: Both diagnosis and therapy must take into account the high proportion of comorbid disorders (see below) as well as the stability of the patient.
Chronicity occurs in approximately 20-30% of patients with PTSD.
Comorbidities (concomitant disorders): Post-traumatic stress disorder is associated with mental disorders (anxiety disorders, panic disorder, dependency disorders, borderline personality disorder, somatization disorders, psychoses, dissociative identity disorders) and somatic disorders (after accidents: e.g. pain syndromes). In elementary school children, PTSD is associated with oppositional defiant disorder, separation anxiety, and specific phobias, in addition to ADHD (attention-deficit/hyperactivity disorder), depression, and social behavior disorders; in adolescents, anxiety disorders, depression, and social behavior disorders may be joined by self-injury, suicidal ideation, and substance dependence.
