Posttraumatic stress disorder - challenges and priorities

Abstract

Posttraumatic stress disorder (PTSD) was only recently introduced in the classification of mental disorders. PTSD definition is based on clinical evidence, neurobiology and neuroimagery studies and prospective populational studies leading to a consensus regarding the framing of this disorder. PTSD outlines an enduring dysfunctional pattern of affective, cognitive and behavioral reactions directly caused by exposure to specific (intense, catastrophic, threatening) traumatic events. PTSD symptoms (intrusive reexperiencing of trauma, avoidance, psycho-physiological hyperreactivity, detachment and numbing), regardless of how they are clustered into diagnostic criteria, are in direct relationship with the traumatic events and contexts evoking it. PTSD affects all functioning domains, including sleep and imagination, and divides individual development in two stages, before and after traumatic exposure. Although the rate of exposure to trauma intense enough to warrant PTSD diagnosis is relatively increased and diverse, most persons exposed do not develop PTSD. This reality confirmed by epidemiology studies, associated with the priority of emergency medical and social interventions after trauma exposure, lead to a lack of assessment of the psychological impact of trauma. The danger and costs of not identifying clinical or subclinical PTSD entail preventable suicidal behaviors and complications/co-morbidities which add to the burden of healthcare and welfare systems and affect community in general.