PTSD — Post-Traumatic Stress Disorder

A combat veteran flinches at a car backfiring — but not every trauma survivor develops PTSD. The timeline and symptom clusters that cross the diagnostic threshold are highly testable.

Post-traumatic stress disorder develops after exposure to actual or threatened death, serious injury, or sexual violence — either directly experienced, witnessed, or learned about involving a close person. What separates PTSD from a normal stress response is duration and symptom clustering. Symptoms must persist for more than 1 month; anything lasting 3 days to 1 month is acute stress disorder. Four symptom clusters define PTSD: intrusion (flashbacks, nightmares, involuntary distressing memories), avoidance (deliberately steering clear of trauma-related stimuli — places, people, conversations), negative alterations in cognition and mood (persistent guilt, emotional numbing, detachment, inability to recall key trauma details), and arousal/reactivity changes (hypervigilance, exaggerated startle, irritability, sleep disturbance, reckless behavior). PTSD can have delayed expression, with full criteria not met until 6+ months after the event. Nursing priorities center on safety, establishing trust, and creating a predictable environment. Avoid surprising the patient — announce your presence, explain procedures before touching, and offer choices to restore a sense of control. Exposure to trauma cues can trigger dissociative flashbacks where the patient relives the event. During a flashback, orient the patient to the present: use grounding techniques such as naming five visible objects, feeling their feet on the floor, or holding ice. Do not touch the patient without permission during a flashback. SSRIs (sertraline, paroxetine) are first-line pharmacotherapy. Benzodiazepines are generally avoided — they can worsen outcomes and carry addiction risk in this population.

Key Distinctions

Don't confuse PTSD (symptoms > 1 month) with acute stress disorder (3 days to 1 month post-trauma) — the dividing line is duration. Students mix up avoidance in PTSD (avoiding trauma reminders) with the avoidance in phobias (fear of a specific object or situation unrelated to a traumatic event). Hypervigilance in PTSD is trauma-driven scanning for danger, not the generalized free-floating worry seen in GAD.

Clinical Pearl

Think '4 clusters, 1-month rule': Intrusion, Avoidance, Negative cognition/mood, Arousal — if it's under 1 month, it's acute stress disorder, not PTSD.