Post-Traumatic Stress Disorder (PTSD)
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Direct answer
Post-traumatic stress disorder (PTSD) follows exposure to actual or threatened death, serious injury or sexual violence, and requires more than one month of symptoms in four clusters — intrusion, avoidance, negative alterations in cognition and mood, and arousal and reactivity. First-line treatment is trauma-focused psychological therapy; SSRIs are the drug treatment of choice, with sertraline and paroxetine specifically licensed internationally. Symptoms lasting three days to one month after the trauma define acute stress disorder instead.
What you must remember
- The four clusters: intrusion (nightmares, flashbacks, intrusive memories, distress at reminders); avoidance of trauma-related stimuli; negative alterations in cognition and mood (negative beliefs, guilt, detachment, persistent negative emotion); and arousal (hypervigilance, exaggerated startle, insomnia, irritability, concentration problems).
- Duration rule: symptoms more than one month; acute stress disorder occupies three days to one month after trauma exposure.
- Exposure route: directly experiencing, witnessing, learning of it happening to a close person, or repeated aversive exposure (as in professionals removing bodies).
- First-line treatment: trauma-focused cognitive behavioural therapy such as prolonged exposure or cognitive processing therapy, and eye movement desensitisation and reprocessing (EMDR).
- Drug treatment: SSRIs are first-line; sertraline and paroxetine carry specific regulatory approval, though in Indian practice other SSRIs are used equally.
- Prazosin is frequently used for trauma-related nightmares, but larger trials have given mixed results, so it remains an adjunct rather than a routine recommendation.
- Risk factors and comorbidity: trauma severity, prior trauma, peritraumatic dissociation, poor social support and female sex increase risk; depression, substance use and suicide risk commonly follow.
Common confusion
The two boundaries matter most: acute stress disorder versus PTSD is purely a duration question — three days to one month versus beyond one month — while adjustment disorder describes a subthreshold emotional response to an identifiable but usually less catastrophic stressor, resolving within six months of the stressor ending. Also distinguish PTSD flashbacks (re-experiencing of a real event) from hallucinations, and PTSD avoidance from panic-related agoraphobic avoidance, which is driven by fear of attacks rather than trauma reminders. Normal acute distress immediately after trauma is not automatically a disorder.
Exam-focused takeaway
NEET-PG stems describe a survivor of an accident or assault with nightmares, flashbacks, avoidance and startle, and test either the cluster naming or the duration discriminator against acute stress disorder. Treatment answers follow a fixed ladder — trauma-focused CBT or EMDR first, an SSRI when drugs are needed or severity is high, and benzodiazepines explicitly avoided. Watch for the one-month rule as the hinge of many options, the association of peritraumatic dissociation with later PTSD, and debriefing questions, where forced single-session psychological debriefing is not recommended for prevention.
Frequently asked questions
What are the four PTSD symptom clusters?
Intrusion, avoidance, negative alterations in cognition and mood, and marked changes in arousal and reactivity.
How is PTSD distinguished from acute stress disorder?
Duration — acute stress disorder lasts from three days to one month after trauma; PTSD persists beyond one month.
What is the first-line treatment of PTSD?
Trauma-focused cognitive behavioural therapy or EMDR; SSRIs are the first-line drugs, with sertraline and paroxetine specifically approved.
Are benzodiazepines useful in PTSD?
No — they do not prevent or treat PTSD and carry dependence risk, so they are avoided except for very short-term crises.
What is EMDR?
Eye movement desensitisation and reprocessing — a structured trauma-focused therapy pairing recall with guided lateral eye movements.
Which factors predict PTSD after trauma?
Trauma severity, prior trauma, peritraumatic dissociation, limited social support and female sex among others.