PTSD
PTSD (post-traumatic stress disorder) develops after exposure to a traumatic event, managed per the 2023 VA/DoD Clinical Practice Guideline.
Symptoms
Intrusive memories or flashbacks, avoidance of trauma reminders, negative changes in mood and thinking, and heightened arousal (hypervigilance, exaggerated startle, sleep disturbance) -- lasting more than a month.
Causes and risk
Exposure to a traumatic event is required for diagnosis, but not everyone exposed develops PTSD; risk is shaped by trauma severity, prior trauma history, and social support, per umbrella review data.
How it is evaluated
Screening tools like the PC-PTSD-5 and PCL-5 aid diagnosis, which requires symptoms lasting more than one month per DSM-5 criteria.
Treatment
Trauma-focused psychotherapies -- prolonged exposure, cognitive processing therapy, and EMDR -- carry the strongest recommendation, above medication, per the VA/DoD guideline, which also recommends sertraline, paroxetine, or venlafaxine and specifically advises against benzodiazepines and cannabis products.
When to seek care
Any thoughts of suicide or self-harm require immediate crisis support -- call 911, the 988 Suicide and Crisis Lifeline, or the Veterans Crisis Line if applicable. Flashbacks with loss of touch with present reality also warrant prompt evaluation.