# Post-Traumatic Stress Disorder (PTSD)

> PTSD notes for NEET-PG Psychiatry covering the four symptom clusters, acute stress versus PTSD, adjustment disorder, trauma-focused CBT, EMDR and SSRI treatment.

- Canonical URL: https://prepelephant.com/topics/neet-pg/psychiatry/post-traumatic-stress-disorder
- Exam / course: NEET-PG · Subject: Psychiatry
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Post-Traumatic Stress Disorder (PTSD)", PrepElephant, https://prepelephant.com/topics/neet-pg/psychiatry/post-traumatic-stress-disorder

## 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.