Modifiable Factors

Non-Modifiable Factors

 Coping Skills
 Substance Abuse  Previous Traumatic Experiences (Sailing
 Low Self-Esteem Accident)
 Life stressors  Family History of PTSD or Depression
 History of Abuse
 Psychiatric Comorbidities

Traumatic Event

(Death of a loved one, Lack of

control, Feelings of helplessness)

Intense peri-traumatic emotional response

(Fear, helplessness, nightmares)

Post-Traumatic Stress
Disorder / Depression

Neurochemical abnormalities Disrupted cognitive

Changes in cortisol, GABA, Dopamine processes

Emotional Increased Increased reactivity Development of Disruptions to

hyper-arousal Anxiety
in amygdala negative cognitive prefrontal cortex
(Attentional bias and behavioral thought
towards threat cues) patterns suppression
Hyper- Exaggerated Trouble
vigilance startle reflex Concentrating
Re-experiencing the Ruminative and Avoidance and
Insomnia Irritability trauma event worry thought numbing
(Flashbacks, nightmares) patterns (people, places,
feelings)
Low energy and
low appetite Social isolation
and inter-
personal
challenges
Clinically significant distress, or impaired functioning
Causes

Signs and Symptoms

Post-traumatic stress disorder symptoms may start within one month of a traumatic
event, but sometimes symptoms may not appear until years after the event. These
symptoms cause significant problems in social or work situations and in relationships.
They can also interfere with your ability to go about your normal daily tasks.

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance,
negative changes in thinking and mood, and changes in physical and emotional
reactions. Symptoms can vary over time or vary from person to person.

Intrusive memories

Symptoms of intrusive memories may include:

 Recurrent, unwanted distressing memories of the traumatic event

 Reliving the traumatic event as if it were happening again (flashbacks)

 Upsetting dreams or nightmares about the traumatic event

 Severe emotional distress or physical reactions to something that reminds

you of the traumatic event

Avoidance

Symptoms of avoidance may include:

 Trying to avoid thinking or talking about the traumatic event

 Avoiding places, activities or people that remind you of the traumatic event

Negative changes in thinking and mood

Symptoms of negative changes in thinking and mood may include:

 Negative thoughts about yourself, other people or the world

 Hopelessness about the future

 Memory problems, including not remembering important aspects of the

traumatic event

 Difficulty maintaining close relationships

 Feeling detached from family and friends

  Lack of interest in activities you once enjoyed

 Difficulty experiencing positive emotions

 Feeling emotionally numb

Changes in physical and emotional reactions

Symptoms of changes in physical and emotional reactions (also called arousal

symptoms) may include:

 Being easily startled or frightened

 Always being on guard for danger

 Self-destructive behavior, such as drinking too much or driving too fast

 Trouble sleeping

 Trouble concentrating

 Irritability, angry outbursts or aggressive behavior

 Overwhelming guilt or shame

Depression

-Trouble concentrating, remembering details, and making

decisions

 Feelings of guilt, worthlessness, and helplessness

-Insomnia, 

-Low energy, low appetite

-Suicidal thoughts

 Pessimism and hopelessness


Diagnosis

A doctor can rule out other conditions that may cause depression with a

physical examination, a personal interview, and lab tests. The doctor
will also do a complete diagnostic evaluation, discussing any family
history of depression or other mental illness.

After reviewing the information from your appointment, including the

signs and symptoms, patient history, family history, and physician exam
The CAPS is widely considered to be the "gold standard" in PTSD assessment. It is a
structured interview providing a categorical diagnosis, as well as a measure of the severity of
PTSD symptoms as defined by DSM-IV. It can be administered by any trained person and takes
30-60 minutes.

CAPS-5
The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is a standard test used to diagnose
PTSD.3 This is a 30-item questionnaire that clinicians use to better understand the patient’s
experience with PTSD.

The goal of CAPS-5 is to establish whether a person can be diagnosed with PTSD. It is also used to
assess whether this condition has been present throughout a person’s life or within the past month.
Additionally, this assessment is used to assess symptoms as the patient has experienced them over
the previous week. 

Specifically, these questions explore:

 The onset and duration of symptoms

 The impact of symptoms on social relationships and work functioning
 Overall severity of PTSD symptoms
 Presence of dissociative subtype, like depersonalization and derealization

This interview takes roughly an hour to complete, follows a detailed scoring system, and determines
to what extent the severity of the symptoms impacts an individual’s daily life. 

Treatment-Outcome Post Traumatic Stress Disorder Scale

(TOP-8)
The TOP-8 is also an interview-based assessment tool that uses the DSM-5 to understand and
evaluate symptoms. This scale includes eight questions drawn from the core symptom groups
associated with PTSD, which include intrusion, avoidance, and numbing. 
PTSD Symptom Scale Interview (PSS-I and PSS-I-5)
The PSS-I is a 17-item assessment tool that asks patients to identify a singular traumatic event that
they believe is causing their symptoms. Symptoms from the past two weeks are identified and
assessed as they relate to the DSM-5 diagnosis criteria.

The PSS-I-5 contains 24 questions, with 20 focusing on symptoms and four focusing on symptom
distress, interference, onset, and duration.

The Davidson Trauma Scale (DTS)

The Davidson Trauma Scale (DTS) is a self-assessment that people can use to screen themselves for
PTSD. This test uses a four-item scale called SPAN that looks at four key areas involved in PTSD:
startle, physiological arousal, anger, and emotional numbness. This test has 17 items and asks the
person taking it to rate the severity of each symptom across the SPAN categories.

PTSD Checklist for DSM-5 (PCL-5)

Patients can also use the PTSD Checklist for DSM-5, or PCL-5, to assess their
symptoms.4 Composed of 20 questions, this report was created by the National Center for PTSD of
the Department of Veterans Affairs and is used widely because it can offer support throughout a
person’s PTSD journey.

In addition to supporting self-assessment with PTSD, it can also be used after a diagnosis to monitor
symptoms. Therefore, it acts both as a tool for diagnosis and one for assessing symptoms to
understand improvement.

Short PTSD Rating Interview (SPRINT)

The Short PTSD Rating Interview, or SPRINT, can be used to assess main PTSD symptoms. 5 It looks
at eight proven PTSD symptom categories, including intrusion, avoidance, numbing, arousal, somatic
malaise, stress vulnerability, and role and social impairment.

This assessment is best used when a person is first interested in seeking care for PTSD, and it is
considered a more preliminary approach for people who aren’t sure whether they have PTSD. The
test uses a five-point scale, asking patients to rank their symptoms from 0 to 4. If a person’s results
are positive, meaning they rated at least one question above 0, they need further assessment by a
professional.

Beck Depression Inventory

The Beck Depression Inventory (BDI) is made up of 21 self-reported depression

questions. They are designed to help mental health professionals assess the
mood, symptoms, and behaviors of people who are depressed. Each answer is
given a score of zero through three to indicate severity of symptoms.
Hamilton Depression Rating Scale

The Hamilton Depression Rating Scale (HDRS) is a questionnaire designed to

help healthcare professionals determine the severity of depression in people who
have already been diagnosed. It also consists of 21 questions. Each relates to a
particular sign or symptom of depression. Multiple-choice answers are given a
score of zero through four. Higher total scores indicate more severe depression.

Treatment

Post-traumatic stress disorder treatment can help you regain a sense of control over
your life. The primary treatment is psychotherapy, but can also include medication.
Combining these treatments can help improve your symptoms by:

 Teaching you skills to address your symptoms

 Helping you think better about yourself, others and the world

 Learning ways to cope if any symptoms arise again

 Treating other problems often related to traumatic experiences, such as

depression, anxiety, or misuse of alcohol or drugs

Psychotherapy
Several types of psychotherapy, also called talk therapy, may be used to treat children
and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:

 Cognitive therapy. This type of talk therapy helps you recognize the ways
of thinking (cognitive patterns) that are keeping you stuck — for example,
negative beliefs about yourself and the risk of traumatic things happening
again. For PTSD, cognitive therapy often is used along with exposure
therapy.

 Exposure therapy. This behavioral therapy helps you safely face both

situations and memories that you find frightening so that you can learn to
cope with them effectively. Exposure therapy can be particularly helpful for
flashbacks and nightmares. One approach uses virtual reality programs that
allow you to re-enter the setting in which you experienced trauma.
  Eye movement desensitization and reprocessing (EMDR). EMDR
combines exposure therapy with a series of guided eye movements that
help you process traumatic memories and change how you react to them.

Medications
Several types of medications can help improve symptoms of PTSD:

 Antidepressants. These medications can help symptoms of depression and

anxiety. They can also help improve sleep problems and concentration. The
selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and
paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for
PTSD treatment.

 Anti-anxiety medications. These drugs can relieve severe anxiety and related

problems. Some anti-anxiety medications have the potential for abuse, so they are
generally used only for a short time.

 Prazosin. While several studies indicated that prazosin (Minipress) may reduce or

suppress nightmares in some people with PTSD, a more recent study showed no
benefit over placebo. But participants in the recent study differed from others in
ways that potentially could impact the results. Individuals who are considering
prazosin should speak with a doctor to determine whether or not their particular
situation might merit a trial of this drug.
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