Post-traumatic stress disorder

Context

Post-traumatic stress disorder (PTSD) develops after a stressful event or situation of an exceptionally threatening or catastrophic nature. It is a disorder that can affect people of any age. Around 25–30% of people experiencing a traumatic event go on to develop PTSD.

PTSD can present with a range of symptoms. In adults the most common of these are vivid, distressing memories of the event or flashbacks, known as intrusive symptoms. Another prominent symptom is avoidance of trauma-related reminders or general social contact. People with PTSD often try to push memories of the event out of their mind and avoid thinking or talking about it in detail. On the other hand, people may also reflect excessively on questions that prevent them from coming to terms with the event – for example, why it happened to them, how it could have been prevented, or how they could take revenge. People with PTSD often have nightmares related to the trauma that affect their sleep.

Symptoms of PTSD often develop immediately after the traumatic event but in some people (fewer than 15%) onset is delayed. People may not present for treatment for months or years despite experiencing considerable distress. PTSD is a treatable disorder, even for people who present many years later, but assessment can be challenging because many people avoid talking about their problems even when presenting with associated complaints.

Children, particularly those aged under 8 years, may not complain directly of PTSD symptoms such as re‑experiencing or avoidance. Instead, symptoms may take the form of re‑enacting the experience, repetitive play or frightening dreams with no recognisable content.

It is common for people with PTSD to have other problems such as depression. If people have had repeated or multiple traumas, or have other significant mental health problems, their presentation of PTSD may be complex and adjustments may be needed to the way in which treatment is delivered.

Effective treatment of PTSD can only take place if the disorder is recognised. Opportunities for recognition usually come during routine healthcare, for example during physical treatment after an assault or an accident, or when a person discloses domestic violence or a history of childhood sexual abuse. Many people attending for medical services in hospital have experienced traumatic events, particularly in emergency departments, and orthopaedic and plastic surgery clinics. Up to 30% of children who attend an emergency department for a traumatic injury go on to develop PTSD. Identifying PTSD in children presents particular problems, but is improved by asking children directly about their experiences.

This guideline updates NICE's 2005 guidance on PTSD. It covers children, young people and adults (aged 18 years and over) who are at risk of PTSD or have a diagnosis of PTSD, and their families and carers. It also covers people with comorbid conditions including drug and alcohol misuse and common mental health conditions.

The guideline covers all NHS and social care-commissioned services that provide care for people with PTSD.