Post-traumatic stress disorder

1.1 Recognition of post-traumatic stress disorder

1.1.1Be aware that people with post-traumatic stress disorder (PTSD), including complex PTSD, may present with a range of symptoms associated with functional impairment, including:

  • re-experiencing
  • avoidance
  • hyperarousal (including hypervigilance, anger and irritability)
  • negative alterations in mood and thinking
  • emotional numbing
  • dissociation
  • emotional dysregulation
  • interpersonal difficulties or problems in relationships
  • negative self-perception (including feeling diminished, defeated or worthless). [2005, amended 2018]

1.1.2Be aware of traumatic events associated with the development of PTSD. These could be experiencing or witnessing single, repeated or multiple events and could include, for example:

  • serious accidents
  • physical and sexual assault
  • abuse, including childhood or domestic abuse
  • work-related exposure to trauma, including remote exposure
  • trauma related to serious health problems or childbirth experiences (for example, intensive care admission or neonatal death)
  • war and conflict
  • torture. [2005, amended 2018]

1.1.3When assessing for PTSD, ask people specific questions about re‑experiencing, avoidance, hyperarousal, dissociation, negative alterations in mood and thinking, and associated functional impairment. [2005, amended 2018]

1.1.4When assessing for PTSD, ask people with symptoms in recommendation 1.1.1 if they have experienced 1 or more traumatic events (which may have occurred many months or years before). Give specific examples of traumatic events as listed in recommendation 1.1.2. [2005, amended 2018]

1.1.5For people with unexplained physical symptoms who repeatedly attend health services, think about asking whether they have experienced 1 or more traumatic events and provide specific examples of traumatic events (see recommendation 1.1.2). [2005, amended 2018]

Specific recognition issues for children

1.1.6Do not rely solely on the parent or carer for information when it is developmentally appropriate to directly and separately question a child or young person about the presence of PTSD symptoms. [2005, amended 2018]

1.1.7When a child who has been involved in a traumatic event is treated in an emergency department, emergency staff should explain to their parents or carers about the normal responses to trauma and the possibility of PTSD developing. Briefly describe the possible symptoms (for example, nightmares, repetitive trauma-related play, intrusive thoughts, avoiding things related to the event, increased behavioural difficulties, problems concentrating, hypervigilance, and difficulties sleeping), and suggest they contact their GP if the symptoms persist beyond 1 month. [2005, amended 2018]

Screening of people involved in a major disaster, refugees and asylum seekers

1.1.8For people at high risk of developing PTSD after a major disaster, those responsible for coordinating the disaster plan should think about the routine use of a validated, brief screening instrument for PTSD at 1 month after the disaster. [2005, amended 2018]

1.1.9For refugees and asylum seekers at high risk of PTSD, think about the routine use of a validated, brief screening instrument for PTSD as part of any comprehensive physical and mental health screen. [2005, amended 2018]

1.2 Assessment and coordination of care

1.2.1For people with clinically important symptoms of PTSD presenting in primary care, GPs should take responsibility for assessment and initial coordination of care. This includes determining the need for emergency physical or mental health assessment. [2005, amended 2018]

1.2.2Assessment of people with PTSD should be comprehensive, including an assessment of physical, psychological and social needs and a risk assessment. [2005, amended 2018]

1.2.3Where management is shared between primary and secondary care, healthcare professionals should agree who is responsible for monitoring people with PTSD. Put this agreement in writing (if appropriate, using the Care Programme Approach) and involve the person and, if appropriate, their family or carers. [2005, amended 2018]

Supporting transitions between services

1.2.4To support transitions when people with PTSD are moving between services:

  • give the person information about the service they are moving to, including the setting and who will provide their care
  • ensure there is effective sharing of information between all services involved
  • involve the person and, if appropriate, their family or carers in meetings to plan the transition
  • address any worries the person has, for example about changes to their routine or anxiety about meeting new people. [2018]

1.2.5Provide additional support:

1.2.6During transitions between services for people with PTSD who need ongoing care, the referring team should not discharge the person before a care plan has been agreed in the new service. [2018]

For a short explanation of why the committee made the 2018 recommendations and how they might affect practice, see the rationale and impact section on supporting transitions between services .

Full details of the evidence and the committee’s discussion are in evidence review J: care pathways for adults, children and young people with PTSD.

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