Posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to one or more terrifying events that threatened or caused grave physical harm.
It is a severe and ongoing emotional reaction to an extreme psychological trauma. This stressor may involve someone's actual death, a threat to the patient's or someone else's life, serious physical injury, or threat to physical or psychological integrity, overwhelming psychological defenses.
In some cases it can also be from profound psychological and emotional trauma, apart from any actual physical harm. Often, however, the two are combined.
PTSD is a condition distinct from traumatic stress, which has less intensity and duration, and combat stress reaction, which is transitory. PTSD has also been recognized in the past as railway spine, shell shock, battle fatigue, traumatic war neurosis, or post-traumatic stress syndrome (PTSS).
Diagnostic symptoms include reexperience such as flashbacks and nightmares, avoidance of stimuli associated with the trauma, increased arousal such as difficulty falling or staying asleep, anger and hypervigilance. Per definition, the symptoms last more than 6 months and cause significant impairment in social, occupational, or other important areas of functioning (e.g. problems with work and relationships.)

Many forms of psychotherapy have been advocated for trauma-related problems such as PTSD. Basic counseling for PTSD includes education about the condition and provision of safety and support.
Cognitive therapy shows good results, and group therapy may be helpful in reducing isolation and social stigma. The psychotherapy programs with the strongest demonstrated efficacy include cognitive behavioral programs, variants of exposure therapy, stress inoculation training (SIT), variants of cognitive therapy (CT), eye movement desensitization and reprocessing (EMDR), and many combinations of these procedures. Psychodynamic psychotherapy, while widely employed, has not been well tested as a treatment for PTSD.
Exposure involves assisting trauma survivors to therapeutically confront distressing trauma-related memories and reminders in order to facilitate habituation and successful emotional processing of the trauma memory. Most exposure therapy programs include both imaginal confrontation with the traumatic memories and real-life exposure to trauma reminders.
Indeed, the success of exposure-based therapies has raised the question of whether exposure is a necessary ingredient in the treatment of PTSD. Some organizations have endorsed the need for exposure. Yet other approaches, particularly involving social supports, may also be important.
A recent open trial of interpersonal psychotherapy reported high rates of remission from PTSD symptoms without using exposure. An ongoing trial is testing interpersonal psychotherapy in relation to exposure and relaxation therapies at New York State Psychiatric Institute