Post-traumatic stress disorder

Disease Description (Causes and Symptoms)

• Disease name: Post-traumatic stress disorder (PTSD) — a medically valid term.
• Cause: Occurs after directly experiencing or witnessing a traumatic event that threatens life or causes severe physical or psychological shock (war, violence, rape, traffic accidents, natural disasters, etc.). In addition to the trauma itself, a combination of factors such as genetic vulnerability, childhood trauma, personality factors, lack of social support, and excessive alcohol consumption may be involved.
• Pathophysiology (summary): Abnormalities in stress-related neurotransmitters (norepinephrine, dopamine, serotonin) and the HPA axis, as well as associations with benzodiazepine receptors, have been reported. Abnormal fixation of traumatic memories and hyperarousal are key pathophysiological elements.
• Main symptoms (core diagnostic clusters):
  1. Re-experiencing the trauma (nightmares, intrusive memories and recollections, flashbacks)
  2. Avoidance of or emotional numbness toward trauma-related stimuli (avoiding places, people, or thoughts; emotional blunting)
  3. Hyperarousal (irritability, excessive alertness, sleep disturbance, impaired concentration, being easily startled)
• Diagnostic criteria (overview): The symptom clusters above (including re-experiencing, avoidance, and hyperarousal) must appear after exposure to trauma, persist for at least 1 month, and cause significant impairment in daily functioning. Diagnostic support tools include PCL-5 (self-administered questionnaire) and CAPS-5 (structured clinical interview).

Treatment Methods

• Psychotherapy (first-line recommendation)
  • Trauma-focused cognitive behavioral therapy (TF-CBT), exposure-based therapy (long-term, controlled exposure), EMDR (eye movement desensitization and reprocessing), and other trauma-focused treatments are preferred. The number and duration of sessions are adjusted according to symptoms and response.
  • Crisis intervention and supportive counseling are important for initial stabilization. Strengthening family and social support is recommended.
• Medication treatment
  • First-line: Selective serotonin reuptake inhibitors (SSRIs) — e.g., sertraline, paroxetine (considering approval in Korea).
  • Alternative/adjunctive: Efficacy has been reported with some medications, including SNRIs (e.g., venlafaxine).
  • Symptom management: Short-term sleeping medication or low-dose anxiolytics may be considered for insomnia and anxiety, but long-term use of benzodiazepines is not recommended (due to concerns about dependence and worsening of symptoms).
  • Treatment duration: Use for at least 8–12 weeks is recommended to observe efficacy; if there is a response, continuation for generally 6–12 months or longer may be considered.
• Other interventions
  • In cases of severe treatment resistance or comorbid conditions (e.g., severe depression or risk of self-harm), inpatient treatment or multidisciplinary intervention may be necessary.
  • Complementary approaches: Exercise, sleep hygiene, and stress management (relaxation training, mindfulness, etc.).
• Precautions (during treatment and self-care)
  • If signs of self-harm or suicide risk (such as thoughts or plans for self-harm) occur, contact a professional immediately or visit an emergency room.
  • Discontinuation of alcohol or drug abuse is recommended because it can worsen symptoms.
  • Symptoms may temporarily worsen during exposure-based therapy — the therapist must establish a safety plan and a gradual approach.
• Risk of complications
  • Major depressive disorder, other anxiety disorders, substance abuse, impairment in interpersonal relationships and occupational functioning, and reduced quality of life due to chronicity.

Outpatient Visit Checklist (Including Example Questions)

• Materials and information to provide
  • A list of currently used medications (including prescription drugs, OTC medications, herbal medicines, and supplements)
  • Previous psychiatric and internal medicine diagnoses and treatment records, as well as records of previous medication responses and side effects
  • The time symptoms began (including the date of the trauma), symptom patterns and a log of changes (number of nightmares, frequency of recollections, situations avoided, etc.)
  • Sleep patterns, history of alcohol and drug use, whether there are thoughts of self-harm or suicide, and recent safety status
  • Social support (family and work circumstances) and sources of life stress
• Questions to think about in advance for the outpatient visit (examples)
  • When did your symptoms worsen recently, and what triggered them?
  • Have there been any recent changes in your sleep, eating, or medication use?

Examples of General Questions to Ask the Doctor

• "What is the expected treatment duration for this condition, and which treatment will we start with?"
• "Considering the medication I am taking (or my existing conditions), which medications are safe for me? What side effects can occur?"
• "Can symptoms temporarily worsen during treatment? If so, how should I cope with this?"
• "What actions should I take if there are signs of self-harm or suicide risk?"

Examples of Condition-Specific Questions

• "Is exposure-based psychotherapy (e.g., TF-CBT or EMDR) appropriate for my case? What are the expected benefits and risks?"
• "Could you recommend medications or non-medication approaches that are particularly helpful for sleep disturbances and hyperarousal symptoms?"