Ptsd definition
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Understanding PTSD: Definition and Key Characteristics
Definition of PTSD: DSM-5 and ICD-11 Perspectives
Post-traumatic stress disorder (PTSD) is a psychiatric condition that arises after exposure to traumatic events. It is characterized by symptoms such as re-experiencing the trauma, avoidance of trauma-related stimuli, negative changes in thoughts and mood, and heightened arousal and reactivity1 3. The definition of PTSD has evolved since its formal introduction in the DSM-III in 1980, and it remains a subject of debate. The DSM-5 and ICD-11 offer differing definitions, reflecting ongoing disagreements about whether PTSD should encompass a broad range of psychological responses to trauma or focus more narrowly on trauma memory phenomena1.
Complex PTSD: Prolonged and Repeated Trauma
Complex PTSD, also known as Disorders of Extreme Stress Not Otherwise Specified (DESNOS), is a proposed subtype of PTSD that occurs in survivors of prolonged and repeated trauma, such as captivity or chronic abuse. This form of PTSD includes a wider array of symptoms that are not fully captured by the traditional PTSD diagnosis, highlighting the need for a more nuanced understanding of trauma's psychological impact2.
Symptoms and Physiological Impact
PTSD is marked by a variety of symptoms, including hyperarousal, increased startle responses, intrusive memories, flashbacks, emotional numbing, and avoidance behaviors3 4. These symptoms can lead to significant impairments in social and emotional functioning, affecting the individual's ability to predict and understand others' emotions and thoughts, which is known as social cognition7.
Biological and Neurological Underpinnings
Recent research has expanded our understanding of the biological and neurological aspects of PTSD. Studies have identified various physiological disturbances, including neuroendocrine, cardiovascular, gastrointestinal, and immune system dysfunctions3. Neuroimaging studies have revealed alterations in brain regions responsible for stress and emotion regulation, such as the amygdala, hippocampus, and frontal cortex6 9. Additionally, increased levels of inflammatory cytokines have been observed in individuals with PTSD, suggesting a link between inflammation and the disorder6 9.
Treatment and Management
Despite advances in understanding PTSD, effective treatment remains a challenge. Trauma-focused cognitive behavior therapy (CBT) is the most validated treatment, yet only about two-thirds of patients respond adequately1. Pharmacological treatments are limited, with only two FDA-approved medications, paroxetine and sertraline, both of which are selective serotonin reuptake inhibitors (SSRIs)8. The high prevalence of psychiatric comorbidities often necessitates polypharmacy and off-label prescriptions8.
Conclusion
PTSD is a complex and multifaceted disorder with significant psychological, physiological, and social implications. While definitions and diagnostic criteria continue to evolve, understanding the broad spectrum of symptoms and underlying biological mechanisms is crucial for developing more effective treatments. Addressing the barriers to accessing evidence-based care, especially in low- and middle-income countries, remains a critical challenge in the management of PTSD1.
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Most relevant research papers on this topic
Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges
Trauma-focused cognitive behavior therapy is the best treatment for PTSD, but only two-thirds of patients respond adequately, and access to evidence-based treatment is often limited, especially in low- and middle-income countries.
Literature Review
Highly CitedComplex PTSD: A syndrome in survivors of prolonged and repeated trauma.
Prolonged, repeated trauma is a complex form of post-traumatic disorder, with potential for inclusion in the DSM-IV under the name DESNOS.
Highly CitedPTSD and stress sensitisation: A tale of brain and body Part 1: Human studies
PTSD is a complex psychiatric disorder characterized by hyperarousal, re-experiencing of traumatic events, and various physiological disturbances, with potential links to individual traits and disability.
Literature ReviewHighly CitedA cognitive action theory of post-traumatic stress disorder
This paper proposes a hierarchical network view of cognition and action, identifying PTSD symptoms as adaptive structures acquired during combat that now lead to inappropriate actions in a civilian environment.
Highly CitedBiological studies of post-traumatic stress disorder
PTSD is a complex biological phenomenon involving physiological, cellular, and molecular responses to environmental events, with a known cause and a growing understanding of its impact.
Highly CitedInflammation in Post-Traumatic Stress Disorder (PTSD): A Review of Potential Correlates of PTSD with a Neurological Perspective
Elevated levels of serum proinflammatory cytokines and neuroimaging studies show inflammation in brain regions responsible for stress and emotion regulation.
Systematic Review
Rigorous JournalHighly CitedSocial cognition in post-traumatic stress disorder: A systematic review.
Social cognition is significantly impaired in PTSD patients, leading to functional disability and highlighting the need for individualized cognitive remediation based on empathy and the emotional component of Theory of Mind.
Systematic ReviewAre There Effective Psychopharmacologic Treatments for PTSD?
PTSD treatment with SSRIs, paroxetine, and sertraline is effective, but more research is needed to optimize response and reduce off-label prescriptions.
Systematic ReviewNeuroinflammation in Post-Traumatic Stress Disorder
PTSD is linked to increased inflammation, which may contribute to its pathogenesis and treatment possibilities.
Literature ReviewRigorous JournalDifferent neural modifications underpin PTSD after different traumatic events: an fMRI meta-analytic study
PTSD has a consistent neural network, but specific brain areas are affected differently after different traumatic events, potentially related to specific aspects of the trauma.
Meta-Analysis
Very Rigorous JournalHighly Cited