Post-traumatic stress disorder

For clarity recommendation 1.1.1 has been split to separate awareness of symptoms from assessment.

Functional impairment has been added and symptoms updated compared with 2005 in light of new classification systems.

Reference to complex PTSD and the additional symptoms of complex PTSD (interpersonal difficulties or problems in relationships, negative self-perception, and emotional dysregulation) have been included after the publication of ICD-11 and the new diagnostic classification of complex PTSD.

Substance misuse has been removed as although this is a commonly coexisting condition it is not a core symptom of PTSD like all other bullet points in this recommendation.

Recommendation 1.1.2 has been broadened to all settings so 'primary care' has been removed.

Examples of types of traumatic events have been extended and clarified.

Traumatic childbirth has been broadened to include serious health problems and childbirth experiences.

In recommendation 1.1.3, symptoms have been updated in line with recommendation 1.1.1.

Recommendation 1.1.4 has been broadened to all settings so 'primary care' has been removed.

'Traumatic experience' has been amended to '1 or more traumatic events' because of the possibility of multiple/repeated trauma.

Recommendation 1.1.5 has been broadened to all care settings. To reduce repetition, examples of traumatic events have been replaced by a cross reference to recommendation 1.1.2.

In recommendation 1.1.7, symptoms have been updated compared with 2005 in light of new classification systems. The normal responses to trauma has been added based on the opinion of the committee that it is helpful to 'normalise' the presence of some symptoms in the first few weeks as they can manifest but diminish as part of 'natural' recovery.

The committee added that the screening instrument should be validated to recommendation 1.1.8.

Programme refugees has been changed to 'refugees' and 'validated' added to recommendation 1.1.9 for clarification.

Recommendation 1.2.1 has been updated to reflect that, before assessment, people with clinically important symptoms of PTSD will not have a diagnosis so it is not meaningful to talk about people with PTSD in this recommendation.

Competence has been removed from recommendation 1.2.2 as this is a general expectation of the NHS and is not specific to PTSD or to assessment.

In recommendation 1.2.3, 'Share it with' has been replaced by 'involve' to reflect that the person (and family if appropriate) would have a more active role in this process.

A cross reference to NICE guidance published since 2005 has been added to recommendation 1.5.1 to provide further detail.