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# Post-traumatic stress disorder (PTSD) and acute stress disorder

A disorder that can follow a terrifying event, with intrusive memories, avoidance and constant alertness. Trauma-focused therapy works well.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Amygdala](https://durgical.com/en/anatomy/amygdaloid-body/)
- [Hippocampus](https://durgical.com/en/anatomy/hippocampus/)
- [Frontal lobe](https://durgical.com/en/anatomy/superior-frontal-gyrus/)
- [Cingulate gyrus](https://durgical.com/en/anatomy/cingulate-gyrus/)
- [Insula](https://durgical.com/en/anatomy/insula/)
- [Hypothalamus](https://durgical.com/en/anatomy/hypothalamus/)
- [Pituitary gland](https://durgical.com/en/anatomy/pituitary-gland/)

## Why it happens

- [The HPA axis and its circadian rhythm](https://durgical.com/en/physiology/the-hpa-axis-and-its-circadian-rhythm/)
- [The limbic system, emotion and reward](https://durgical.com/en/physiology/the-limbic-system-emotion-and-reward/)
- [Learning and memory](https://durgical.com/en/physiology/learning-and-memory/)

## What it is

A mental disorder that may develop after exposure to an extremely threatening or horrific event (violence, war, sexual assault, disasters, serious accidents). It combines intrusive re-experiencing, avoidance, negative changes in mood and thinking, and hyperarousal lasting more than a month. When the same picture lasts from 3 days to 1 month after the trauma, it is called acute stress disorder.

## Who gets it

Most people exposed to trauma do not develop PTSD, but it affects a significant share of those exposed, more often women. In Colombia, decades of armed conflict, forced displacement and violence have left millions of registered victims, and PTSD, depression and anxiety are frequent among them; the national psychosocial care programme for victims (PAPSIVI) responds to this burden. Violence against women and children and urban violence are other common causes in the region.

## Causes

- Direct exposure to actual or threatened death, serious injury or sexual violence
- Witnessing trauma to others or learning that it happened to a close person
- Repeated exposure to traumatic details (first responders, health workers)
- Armed conflict, kidnapping, forced displacement, torture and community violence

## Risk factors

- Severity, duration and interpersonal nature of the trauma (assault, torture)
- Previous trauma, especially in childhood
- Female sex and pre-existing mental illness
- Lack of social support after the event
- Acute stress disorder or dissociation at the time of the trauma
- Ongoing stressors: displacement, poverty, loss of family members

## Pathophysiology

Fear memories are encoded too strongly and fail to extinguish. The [amygdala](https://durgical.com/en/anatomy/amygdaloid-body/) becomes hyper-responsive, while the medial prefrontal cortex that normally damps it is underactive and the [hippocampus](https://durgical.com/en/anatomy/hippocampus/), which places memories in context, works less well and may be smaller. The stress [axis](https://durgical.com/en/anatomy/axis/) ([hypothalamus](https://durgical.com/en/anatomy/hypothalamus/) –pituitary–adrenal) and the noradrenergic system are dysregulated, which sustains hyperarousal and nightmares.

## Classification

- Acute stress disorder: symptoms from 3 days to 1 month after the trauma
- PTSD: symptoms for more than 1 month; may have delayed expression (onset 6 months or more later)
- Complex PTSD (ICD-11): PTSD plus problems with emotion regulation, self-concept and relationships, usually after prolonged or repeated trauma

## Symptoms and signs

- Intrusions: unwanted memories, nightmares and flashbacks in which the event feels as if it were happening again
- Intense distress or bodily reactions to reminders
- Avoidance of thoughts, places, people or activities linked to the trauma
- Negative mood and thinking: guilt, shame, blame, detachment, loss of interest, inability to feel positive emotions, memory gaps
- Hyperarousal: hypervigilance, exaggerated startle, irritability, poor concentration and insomnia
- Risky or self-destructive behaviour

## Red flags

- Suicidal thoughts or self-harm
- Ongoing danger (domestic violence, threats from armed groups) requiring protection
- Severe dissociation or psychotic symptoms
- Heavy alcohol or drug use to cope
- Children with marked regression, withdrawal or traumatic play

## Diagnosis

**Clinical**
Clinical diagnosis with DSM-5-TR or ICD-11 criteria after a careful, trauma-informed interview that avoids forcing details. Screening tools such as the PC-PTSD-5 and the PCL-5 checklist help detect and follow symptoms. Assessment of suicide risk, substance use, depression and current safety is essential.

**Tests**
No laboratory test confirms PTSD. Tests are used only to exclude contributing medical problems (thyroid function, toxicology) when indicated.

**Imaging**
Not needed for diagnosis. Brain imaging is considered when traumatic brain injury or a neurological cause is suspected.

## Differential diagnosis

- Adjustment disorder
- Major depressive disorder or prolonged grief
- Panic disorder and other anxiety disorders
- Traumatic brain injury (post-concussive syndrome)
- Psychotic disorders and dissociative disorders
- Substance-induced disorders

## Goal of treatment

Ensure safety, reduce intrusive symptoms, avoidance and hyperarousal, restore functioning and relationships, and treat coexisting depression and substance use.

## Treatment

**Conservative**
Trauma-focused psychotherapy is first-line: trauma-focused CBT, cognitive processing therapy, prolonged exposure and EMDR (eye movement desensitisation and reprocessing).

**Medical**
SSRIs (such as sertraline or paroxetine) or the SNRI venlafaxine are the medicines with the best evidence, alone or with psychotherapy.

**Medical**
Prazosin may be considered for trauma nightmares in some patients; benzodiazepines are avoided because they do not help core symptoms and may hinder recovery.

**Conservative**
Early after trauma: psychological first aid, practical support and safety; routine single-session debriefing is not recommended. Community and psychosocial programmes support conflict victims.

**Follow-up**
Nursing care: a calm, predictable, trauma-informed environment, asking consent before touch or procedures, suicide-risk monitoring and sleep support.

## Complications

- Major depression and suicide
- Alcohol and drug use disorders
- Chronic pain, cardiovascular disease and other physical illness
- Family conflict, violence and loss of work
- Intergenerational effects on children

## Prognosis

About half of people recover within months, but a substantial share have chronic symptoms for years. Trauma-focused therapy leads to large improvements in many patients; ongoing danger, lack of support and repeated trauma predict a worse course.

## Prevention

- Social support and psychological first aid after trauma
- Early detection in high-risk groups (victims of violence, displaced people, first responders)
- Protection from further violence

## Test yourself

Think of the answer, then tap the question to see it.

## What is the time criterion that separates acute stress disorder from PTSD?

Acute stress disorder lasts 3 days to 1 month after the trauma; PTSD lasts more than 1 month.

## What are the four symptom clusters of PTSD in DSM-5?

Intrusion, avoidance, negative changes in cognition and mood, and changes in arousal and reactivity.

## What is the first-line treatment for PTSD?

Trauma-focused psychotherapy (such as CPT, prolonged exposure, trauma-focused CBT or EMDR); SSRIs or venlafaxine are first-line medicines.

## Why are benzodiazepines avoided in PTSD?

They do not treat core symptoms, may hinder fear extinction and carry a risk of dependence, especially with coexisting substance use.

## Which brain structure is typically hyper-responsive in PTSD?

The amygdala, with reduced control from the medial prefrontal cortex.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/post-traumatic-stress-disorder-and-acute-stress-disorder/)

## Related conditions

- [Panic disorder](https://durgical.com/en/conditions/panic-disorder/)
- [Opioid use disorder, overdose and withdrawal](https://durgical.com/en/conditions/opioid-use-disorder-overdose-and-withdrawal/)
- [Alcohol withdrawal and delirium tremens](https://durgical.com/en/conditions/alcohol-withdrawal-and-delirium-tremens/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Post-traumatic stress disorder](https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder) (World Health Organization (WHO), 2026).

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Source: https://durgical.com/en/conditions/post-traumatic-stress-disorder-and-acute-stress-disorder/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/post-traumatic-stress-disorder-and-acute-stress-disorder/