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This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
Key points
- Develops after exposure to a traumatic event (actual/threatened death, serious injury, sexual violence) — direct or witnessed
- Four symptom clusters: re-experiencing (flashbacks, nightmares), avoidance, negative cognitions/mood, hyperarousal
- Symptoms must persist >1 month and cause significant distress/impairment. <1 month = acute stress reaction
- First-line treatment: trauma-focused CBT (TF-CBT) or EMDR (eye movement desensitisation and reprocessing)
- Do NOT offer debriefing, benzodiazepines, or non-trauma-focused CBT (NICE NG116)
- Drug treatment: NOT first-line. Consider venlafaxine or SSRI (sertraline, paroxetine) only if trauma-focused therapy declined/unavailable
Overview
Post-traumatic stress disorder (PTSD) is a condition that can develop after exposure to an exceptionally threatening or horrific event. Qualifying traumas include actual or threatened death, serious injury, or sexual violence — experienced directly, witnessed, or learned about happening to a close person. PTSD is characterised by four symptom clusters: re-experiencing (intrusive memories, flashbacks, nightmares), avoidance (of reminders of the trauma), negative alterations in cognitions and mood (emotional numbing, guilt, detachment), and hyperarousal (hypervigilance, exaggerated startle, insomnia, irritability). Symptoms must persist for >1 month. Complex PTSD (ICD-11) additionally includes affect dysregulation, negative self-concept, and interpersonal difficulties, typically following prolonged/repeated trauma.
Epidemiology
PTSD has a lifetime prevalence of approximately 3–4% in the UK general population, though this is much higher in at-risk groups: military veterans (~5–17%), refugees (~30%), survivors of sexual assault (~50%), and emergency service personnel. It is approximately twice as common in women. Onset is usually within 3 months of the trauma but can be delayed (delayed-onset PTSD: >6 months after trauma). Risk factors for developing PTSD include severity and duration of trauma, female sex, pre-existing mental health conditions, lack of social support, and previous trauma exposure. Not everyone exposed to trauma develops PTSD — individual resilience factors are protective.
Clinical Features
Symptoms
Re-experiencing: intrusive memories, vivid flashbacks (reliving the event as if happening now), distressing nightmares
Avoidance: deliberate avoidance of reminders (places, people, thoughts, conversations) related to the trauma
Emotional numbing: feeling detached, restricted affect, loss of interest, inability to experience positive emotions
Negative cognitions: persistent distorted blame of self or others, guilt, shame, "the world is completely dangerous"
Hyperarousal: hypervigilance, exaggerated startle response, difficulty concentrating
Sleep disturbance: insomnia, nightmares, night terrors
Irritability, angry outbursts, reckless or self-destructive behaviour
Suicidal ideation or self-harm
Dissociative symptoms: derealisation, depersonalisation, dissociative flashbacks
Signs
Hypervigilance: scanning environment, sitting with back to wall, startling at sudden noises
Emotional reactivity to trauma reminders — distress, autonomic arousal
Flat affect, emotional constriction
Evidence of self-harm, substance misuse
Investigations
First-line
Clinical diagnosisBased on detailed trauma history + four symptom clusters persisting >1 month + functional impairment
PCL-5 or IES-RPTSD Checklist for DSM-5 (PCL-5) or Impact of Event Scale-Revised — validated screening and severity measures
Risk assessmentAssess for suicidal ideation, self-harm, substance misuse, and safeguarding concerns
Second-line
Screen for comorbiditiesDepression (PHQ-9), anxiety (GAD-7), substance misuse (AUDIT/DAST), dissociative symptoms
Specialist
Specialist trauma assessmentIf complex PTSD, delayed onset, diagnostic uncertainty, or significant comorbidity
1
Acute stress reaction (<1 month)
- Active monitoring — most people recover naturally with social support
- Do NOT offer formal psychological debriefing (may worsen outcomes)
- If symptoms persist at 1 month → treat as PTSD
2
First-line: trauma-focused psychological therapy
- Trauma-focused CBT (TF-CBT): individually delivered, 8–12 sessions
- OR EMDR (eye movement desensitisation and reprocessing): 8–12 sessions
- Both involve processing the traumatic memory in a safe therapeutic environment
- Do NOT offer non-trauma-focused CBT, relaxation therapy, or supportive counselling alone
3
Drug treatment (not first-line)
- Consider if patient declines or cannot engage with trauma-focused therapy
- Venlafaxine (SNRI) 75–225 mg or SSRI (sertraline or paroxetine)
- Review at 4–6 weeks; continue for ≥12 months if effective
- Do NOT offer benzodiazepines for PTSD (NICE NG116) — risk of dependence and may impair trauma processing
4
Complex PTSD and treatment-resistant cases
- Stabilisation phase before trauma processing — address dissociation, affect dysregulation, safety
- May require longer treatment duration and specialist trauma service
- Address comorbid substance misuse, depression, and personality difficulties
Complications
- Depression: Comorbid in ~50% of PTSD cases
- Substance misuse: Self-medication with alcohol/drugs is very common
- Suicide: Significantly elevated risk — always assess
- Relationship breakdown: Emotional numbing, irritability, and avoidance strain relationships
- Chronic pain and somatisation: Physical symptoms are common in PTSD
- Complex PTSD: Following prolonged/repeated trauma — includes affect dysregulation, negative self-concept, interpersonal difficulties
UKMLA Exam Tips
- 1PTSD symptoms >1 month after trauma. Acute stress reaction = <1 month. Adjustment disorder = not a qualifying trauma
- 2Four clusters: RE-EXPERIENCING + AVOIDANCE + NEGATIVE COGNITIONS/MOOD + HYPERAROUSAL
- 3Flashbacks are RELIVING the event as if it is happening NOW — not simply remembering it
- 4Do NOT offer debriefing, benzodiazepines, or non-trauma-focused therapies (NICE NG116)
- 5TF-CBT and EMDR are equally effective first-line treatments
- 6Delayed-onset PTSD (>6 months after trauma) exists — do not dismiss late presentations
- 7Complex PTSD (ICD-11): PTSD + affect dysregulation + negative self-concept + interpersonal difficulties
practicetest your knowledge on Post-Traumatic Stress DisorderApply what you've learnt with UKMLA-style questions from the iatroX Q-Bank — Psychiatry and beyond.
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Post-Traumatic Stress Disorder: guidance by region
Recommendations, thresholds and pathways can differ. Open the page written for the jurisdiction you need.
United StatesPTSD assessment and evidence-based treatmentMental health · reviewed 2026-08-20CanadaPost-traumatic stress disorder (PTSD) — recognition and managementMental health · reviewed 2026-08-20AustraliaPost-traumatic stress disorder (PTSD) — recognition and managementMental health · reviewed 2026-08-20