Post-traumatic stress disorder 

Clinicians have long noted that traumatic events can lead to severe psychological disturbance. At the end of the nineteenth and the beginning of the twentieth centuries, railway disasters, the World Wars, and the Holocaust prompted systematic descriptions of the symptoms associated with traumatic stress reactions. These include the spontaneous re-experiencing of aspects of the traumatic events, startle responses, irritability, impairment in concentration and memory, disturbed sleep, distressing dreams, depression, phobias, guilt, psychic numbing, and multiple somatic symptoms. A variety of labels were used to describe these reactions including ‘fright neurosis’, ‘combat/war neurosis’, ‘shell shock’, ‘survivor syndrome’, and ‘nuclearism’. This chapter covers clinical features of post-traumatic stress disorder, classification, diagnosis and differential diagnosis, epidemiology, prevalence, comorbidity of PTSD with other disorders, aetiology, course and prognosis, treatment, and finally advice on management.