Core diagnostic clusters

• Exposure: direct exposure, witnessing, learning of traumatic event to close others, or repeated exposure to aversive details (e.g., first responders).
• Intrusion symptoms: distressing memories, nightmares, flashbacks, intense psychological or physiological reactivity to cues.
• Avoidance: efforts to avoid memories, thoughts or external reminders of the trauma.
• Negative alterations: persistent negative beliefs, distorted cognitions, persistent negative emotional state, diminished interest, detachment.
• Hyperarousal/reactivity: irritability, hypervigilance, exaggerated startle, concentration/sleep disturbance.

Specifiers & variants

• With dissociative symptoms: depersonalisation and/or derealisation prominent during trauma recall.
• With delayed expression: full diagnostic criteria met ≥6 months after the traumatic event.
• Complex PTSD (C‑PTSD): after prolonged, repeated interpersonal trauma — additional features include affect dysregulation, negative self‑concept and relational difficulties (diagnostic constructs vary by classification systems).

Assessment checklist

1. Trauma history: nature of event(s), timing, proximity, ongoing threat and cumulative exposures.
2. Symptom inventory: intrusion, avoidance, negative cognitions, hyperarousal, dissociation, suicidal ideation and substance use.
3. Use validated tools: PCL‑5 (self‑report), CAPS‑5 (clinician‑administered) for diagnosis and severity monitoring; PHQ‑9 and GAD‑7 for comorbidity screening.
4. Risk assessment: suicidality, self‑harm, homicidal ideation, current safety, access to means and protective factors.
5. Physical and forensic considerations: injuries, ongoing legal processes, medico‑legal documentation and liaison with other services as needed.

Differential diagnosis & comorbidity

• Acute stress disorder (symptoms within first month), adjustment disorder, depressive and anxiety disorders, personality disorders, substance‑induced symptoms, TBI and psychosis when severe dissociation present.
• Common comorbidities: depression, anxiety disorders, substance use disorders, chronic pain and somatic complaints.

Evidence‑based psychological treatments

• Trauma‑focused CBT (TF‑CBT): includes cognitive processing therapy (CPT) — targets trauma‑related beliefs, avoidance and processing of memory.
• Prolonged Exposure (PE): graded imaginal exposure to traumatic memory plus in‑vivo exposure to avoided situations — strong evidence base for reducing PTSD symptoms.
• EMDR (Eye Movement Desensitisation & Reprocessing): widely used trauma therapy with evidence for PTSD symptom reduction; requires trained practitioners.
• Choose treatment based on patient preference, availability, comorbidities and clinical expertise; all require adequate preparation and safety planning (grounding, stabilisation) before trauma processing.

Pharmacologic treatments

• First‑line: SSRI antidepressants with evidence for PTSD — sertraline and paroxetine (note: paroxetine has anticholinergic risks) and SNRI venlafaxine have shown benefit for core PTSD symptoms.
• Prazosin for trauma‑related nightmares and sleep disturbance may help some patients; use per specialist guidance.
• Avoid benzodiazepines for PTSD—associated with poor outcomes, dependence and interference with exposure therapies.
• Pharmacotherapy is adjunctive to trauma‑focused psychotherapy and useful when therapy unavailable or as bridge for severe comorbidity.

Acute management & crisis care

• For recent trauma (hours–days): provide psychological first aid — ensure safety, stabilise, provide practical support, normalise reactions and avoid forced debriefing.
• In acute symptomatic crises: manage suicidality with safety planning, brief admission when required, and rapid access to mental health services.
• Address substance misuse and ensure sleep, nutrition and social supports are optimised as part of early care.

Special populations & considerations

• Children & adolescents: TF‑CBT and family‑based trauma therapies are first‑line; adapt interventions developmentally and involve caregivers.
• Perinatal period: assess trauma history as it affects bonding and perinatal mental health—collaborate with obstetric/perinatal mental health teams.
• First responders and military veterans: consider occupational factors, cumulative exposure and tailored group/individual approaches with trauma‑informed occupational support.

Practical tips for clinicians

• Screen at‑risk patients (trauma survivors) routinely with PCL‑5; document trauma history sensitively and offer early referral to trauma‑informed services.
• Use shared decision‑making to choose between trauma‑focused therapy and pharmacotherapy; prepare patients for possible symptom exacerbation during exposure work and ensure safety supports.

Key takeaways

• PTSD is common after traumatic exposure and causes intrusive memories, avoidance, negative cognition/mood changes and hyperarousal — it is treatable.
• First‑line treatments are trauma‑focused psychotherapies (PE, CPT, EMDR); SSRIs (sertraline, paroxetine) and venlafaxine are pharmacologic options when needed.
• Always assess safety, comorbidity and ongoing exposure before initiating trauma processing; escalate urgently for suicidality, severe dissociation or ongoing threat.