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Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, and diagnosis

Jitender Sareen, MD, FRCPC
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD


Posttraumatic stress disorder (PTSD) has been described as "the complex somatic, cognitive, affective, and behavioral effects of psychological trauma" [1]. PTSD is characterized by intrusive thoughts, nightmares and flashbacks of past traumatic events, avoidance of reminders of trauma, hypervigilance, and sleep disturbance, all of which lead to considerable social, occupational, and interpersonal dysfunction.

The diagnosis of PTSD can be challenging because of the heterogeneity of the presentation and resistance on the part of the patient to discuss past trauma. Another complicating factor is that traumatic events are associated with a range of other psychopathology including depression and other anxiety disorders. Patients exposed to multiple traumatic events may be mistakenly diagnosed with PTSD rather than another primary disorder.

The epidemiology, pathophysiology, clinical manifestations, course, and diagnosis of PTSD are discussed here. Pharmacotherapy and psychotherapy of PTSD are discussed separately. The epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment of PTSD with dissociative features are also discussed separately. The epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment of acute stress disorder are also discussed separately. (See "Pharmacotherapy for posttraumatic stress disorder in adults" and "Psychotherapy for posttraumatic stress disorder in adults" and "Dissociative aspects of posttraumatic stress disorder: Epidemiology, clinical manifestations, assessment, and diagnosis" and "Acute stress disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Treatment of acute stress disorder in adults".)


Many different types of trauma have been found to result in PTSD, including those listed below. Many of these events are common, resulting in a large number of affected individuals. An analysis from a survey of a large, representative community-based sample in 24 countries estimated the conditional probability of PTSD for 29 types of traumatic events [2]:

Sexual relationship violence – 33 percent (eg, rape, childhood sexual abuse, intimate partner violence).


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