AssessmentsPost-traumatic stress disorder
Post-traumatic stress disorder
USMLE® Step 1 style questions USMLE
A 23-year-old woman comes to her primary care physician to evaluate recurrent nightmares. The patient was sexually assaulted two weeks ago, and since that time, reports recurrent nightmares surrounding the event. She states, “Ever since the incident, I can’t return to campus. The thought of being back at school after what happened is unbearable.” The patient avoids thinking about the incident and feels depressed, irritable, and distracted throughout the day. The patient has not had any suicidal ideation or thoughts. The patient has no past medical history. Which of the following is the most likely diagnosis?
Content Reviewers:Rishi Desai, MD, MPH
Contributors:Tanner Marshall, MS
Post-traumatic stress disorder, also called PTSD, happens when some memory of a past traumatic event—like war or sexual assault—causes recurrent mental and physical distress.
Now the Diagnostic and Statistical Manual 5th edition or the DSM 5 categorizes PTSD as a “trauma-and-stressor-related-disorder” that happens when the symptoms of an acute stress response persist for over a month.
The main symptoms are psychological ones, for example someone might re-experience their trauma through nightmares, flashbacks, and intrusive thoughts, but these can lead to behavioral changes as well.
Somebody might start to avoid environments and situations that remind them of their trauma and feel a sense of hypervigilance where they are constantly on guard or hyperarousal where they have this exaggerated startle response to the smallest of triggers.
Not surprisingly, all of these thoughts and behaviours can lead to trouble sleeping and general irritability, which can lead to angry outbursts.
Interestingly, this pattern is different for young children who are less likely to show distress, but instead they might use play to express their memories, sometimes acting out scenes that trouble them.
Whether or not someone develops PTSD in response to trauma is determined by a number of different factors.
In addition, people that go through extreme trauma as children are more likely to develop PTSD in response to other traumas faced in their adult life.
Having said that, if someone manages to develop effective coping strategies for trauma including having a social support network, then that can help with future traumas as well.
As far as causes go, there are some clues about biological factors related to development of PTSD.
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