PTSD — Post-Traumatic Stress Disorder

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 client — 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 client relives the event. During a flashback, orient the client 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 client 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.