CLINICAL SYNTHESISFull Access
Quick Reference for Posttraumatic Stress Disorder
Differential Diagnosis of Posttraumatic Stress DisorderDepression after trauma (numbing and avoidance may be present, but not hyperarousal or intrusive symptoms) |
Panic disorder (if panic attacks are not limited to reminders or triggers of the trauma) |
Generalized anxiety disorder (may have symptoms similar to PTSD hyperarousal) |
Agoraphobia (if avoidance is not directly trauma related) |
Specific phobia (if avoidance is not directly trauma related) |
Adjustment disorder (usually has less severe stressor and different symptoms) |
Acute stress disorder (if less than 1 month has elapsed since trauma) |
Dissociative disorders (if prominent dissociative symptoms are present) |
Factitious disorders or malingering (especially is secondary gain is apparent) |
Differential Diagnosis of Posttraumatic Stress DisorderEnlarge table Risk Factors for Posttraumatic Stress DisorderPast history of trauma prior to the index trauma |
Past history of PTSD |
Past history of depression |
Past history of anxiety disorders |
Comorbid axis II disorders (predictive of greater chronicity) |
Family history of anxiety (including parental PTSD) |
Disrupted parental attachments |
Severity of exposure to trauma (more predictive of acute symptoms) |
Course and Prognosis of Posttraumatic Stress DisorderCoursea |
4/5 of patients: longer than 3 months |
3/4 of patients: longer than 6 months |
1/2 of patients: 2 years’ duration |
Minority of patients: symptomatic for many years or for decades |
Predictors of worse outcome |
Greater number of PTSD symptoms |
Psychiatric history of other anxiety and mood disorders |
Higher degree of numbing or hyperarousal to stressors |
Comorbid medical illnesses |
Female sex |
Childhood trauma |
Alcohol abuse |
Course and Prognosis of Posttraumatic Stress DisorderEnlarge table Biological Models of Posttraumatic Stress DisorderHeightened physiologic responses to traumatic stimuli |
Noradrenergic activation |
Highly sensitized hypothalamic-pituitary-adrenal axis |
Endogenous opioid dysregulation |
Dysregulated serotonergic modulation |
Hippocampal toxicity, decreased volumes |
Limbic hyperactivity (amygdala, cingulate) and cortical hyporesponsivity (prefrontal, Broca’s area) to traumatic stimuli |