Anxiety disorders are a group of mental disorders characterised by excessive fear or worrying. Anxiety disorders include generalised anxiety disorder, which is characterised by continuous and excessive worrying for six months or more. Specific phobias are characterised by anxiety provoked by a feared object/situation, resulting in avoidance. Social phobia is anxiety provoked by social or performance situations. Agoraphobia is anxiety about situations where escape may be difficult or help might not be available. Panic disorder is characterised by a panic attack, which is a distinct episode where a person experiences sudden apprehension and fearfulness where they may experience shortness of breath, palpitations, chest pain, or choking.

What is the evidence for anxiety disorders in people with PTSD?

Moderate quality evidence finds the rate of anxiety disorders in veterans with PTSD is between 13% and 19%. One small study reported prevalence as high as 59% in veterans. Moderate to low quality evidence finds a medium-sized increase in generalised anxiety disorder in prisoners with PTSD compared to prisoners without PTSD. Rates were highest in males and in adult prisoners, and in prisoners with any lifetime rather than a current diagnosis of PTSD.

August 2021

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Attention deficit hyperactivity disorder is a behavioural disorder characterised by inattention, hyperactivity, and impulsivity. The estimated prevalence in children under 18 years in the general population is around 5%. It can persist into adulthood with an estimated prevalence of 2.5% in the adult general population.

What is the evidence for attention deficit hyperactivity disorder?

Moderate quality evidence finds a small increase in the rate of attention deficit hyperactivity disorder in people with PTSD compared to people without PTSD. The rate of PTSD was also higher in people with attention deficit hyperactivity disorder compared to people without attention deficit hyperactivity disorder. The onset of attention deficit hyperactivity disorder was earlier than the onset of PTSD in these samples.

August 2021

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Bipolar disorders are a group of disorders characterised by episodes of mania or hypomania and depression. In between episodes, mild symptoms of mania and/or depression may, or may not, be present. The bipolar disorders include bipolar I, bipolar II, and cyclothymic disorder. Bipolar I disorder is characterised by mania, while bipolar II disorder is characterised by less severe hypomania. Cyclothymic disorder is the mildest of the bipolar disorders.

A major depressive episode is at least two weeks of at least five of the following symptoms. Intense sadness or despair; feelings of helplessness, hopelessness or worthlessness; loss of interest in activities once enjoyed; feelings of guilt, restlessness or agitation; sleeping too little or too much; slowed speech or movements; changes in appetite; loss of energy; difficulty concentrating, remembering or making decisions; and/or thoughts of death or suicide.

A manic episode is at least one week of extremely high spirits or irritableness most of the time. A manic episode involves changes in normal behaviour. These include exaggerated self-esteem, less sleep, talking a lot and loudly, being easily distracted, doing many activities at once, risky behaviour, uncontrollable racing thoughts, and quickly changing ideas or topics. These changes in behaviour are significant and clear to friends and family and are severe enough to cause major dysfunction. A hypomanic episode is similar to a manic episode but less severe and need only last four days. Hypomanic symptoms do not lead to major dysfunction that mania often causes.

What is the evidence for rates of bipolar disorders in people with PTSD?

Moderate quality evidence finds current bipolar disorder in people with PTSD ranges between 4% for bipolar II disorder and 19% for bipolar I disorder. For any lifetime diagnosis, the rate ranges between 20% for bipolar II disorder and 35% for bipolar I disorder.

August 2021

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Cancer is a broad group of diseases involving abnormal cell growth such that cells divide and grow forming malignant tumours. These may spread through the lymphatic system or blood stream. Not all tumours are malignant – some remain benign and do not invade other organs. Lifestyle, genetic factors and environmental pollutants increase a persons’ risk of developing cancer. Cancer can affect people of all ages. The most common cancers include lung cancer (22% of all cancers), bowel cancer (12%), breast cancer (8-23%) and prostate cancer (7%). Cancer may be measured by incidence or mortality rates. Incidence is the number of new cases in a specific population. Mortality refers to the rate of deaths due to cancer in a specific population.

What is the evidence for PTSD in cancer patients?

Moderate to high quality evidence finds more severe PTSD symptoms in cancer patients were associated with more depression, anxiety, distress, and post-traumatic growth. They were also associated with less social support and quality of life. There were no significant associations with age, gender, or time since cancer diagnosis.

August 2021

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Chronic fatigue syndrome is a widely accepted medical condition characterised by extreme fatigue. The fatigue lasts for at least six months, worsens with physical or mental activity, and does not improve with rest. The fatigue cannot be explained by an underlying medical condition. The causes of chronic fatigue syndrome are still being investigated, but may include viral infection and/or exposure to psychological stress.

What is the evidence for chronic fatigue syndrome in people with PTSD?

Moderate to low quality evidence finds a medium-sized effect of increased rates of chronic fatigue syndrome in people with previous exposure to trauma.

August 2021

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Pain is common in trauma patients, with greater frequency and severity of pain found when compared to people without PTSD. Fibromyalgia is also commonly reported, which is a centralised pain syndrome characterised by the presence of chronic widespread pain in association with fatigue, sleep disturbances, and cognitive dysfunction.

What is the evidence for chronic pain in people with PTSD?

Moderate to high quality evidence finds a small association between increased PTSD symptoms and increased chronic widespread pain. Lower quality evidence found a bidirectional associations between pain and PTSD symptoms within six months post-trauma. There were unidirectional patterns found after six months, either from pain to PTSD symptoms or from PTSD symptoms to pain. Moderate to low quality evidence finds medium-sized increases in fibromyalgia and chronic widespread pain in people previously exposed to any trauma, regardless of a PTSD diagnosis.

August 2021

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Conduct disorder is a repetitive and persistent pattern of behaviour where the basic rights of others or societal norms and rules are violated. Behaviours include aggression to people or animals, destruction of property, theft, and truanting. These behaviours cause impairment in social, academic, and occupational functioning and are often accompanied by a lack of feeling, remorse, concern, or empathy.

To meet a diagnosis of conduct disorder, at least three symptoms need to be present during the past 12 months, with at least one present in the past 6 months. In addition to the individual’s self-report, it is necessary to consider reports by others who have known the individual for extended periods of time in order to obtain an accurate diagnosis.

What is the evidence for conduct disorder?

Moderate quality evidence finds the rate of PTSD in children and adolescents with conduct disorder is around 11%. In adults with conduct disorder, it is around 14%, and in juvenile offenders it is around 32%. These rates are higher than in people without conduct disorder. Females with conduct disorder showed higher rates of PTSD than males with conduct disorder. Conduct disorder symptoms tended to be apparent before trauma exposure and subsequent PTSD symptoms.

August 2021

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Conversion disorder is a mental disorder characterised by symptoms that cannot be explained by any known neurological disease. The condition is often triggered by psychological or physical stress, but this is not always the case. The symptoms include weakness and/or paralysis, non-epileptic seizures, movement disorders, speech or visual impairment, difficulty swallowing, sensory disturbances, or cognitive symptoms. These symptoms can cause significant distress and functioning problems.

What is the evidence for PTSD and conversion disorder?

Moderate quality evidence finds a medium-sized effect of increased rates of PTSD in people with non-epileptic seizures compared to people with epileptic seizures. Review authors suggest traumatic experiences may be a common risk factor for both PTSD and non-epileptic seizures. There were no reviews found that assessed other conversion disorder symptoms.

August 2021

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Dementia is characterised by significant cognitive impairment. Symptoms include memory, executive functioning, language, and movement impairments, and an inability to identify objects, people, sound or smell. Other symptoms may include behavioural disturbances, anxiety, apathy, delirium, and mood and sleep disturbances. Mental disorders are associated with a high prevalence of psychiatric comorbidities, and aging may increase the risk of developing comorbidities such as dementia.

What is the evidence for dementia?

Moderate to low quality evidence finds a small increased risk of dementia in older veterans with PTSD compared to older veterans without the disorder.

August 2021

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Depression is characterised by a depressed mood or a loss of interest or pleasure in activities. Symptoms of depression include changes in appetite, weight, sleep, or psychomotor activity. There is often decreased energy, feelings of worthlessness or guilt, difficulty concentrating or making decisions, and thoughts of death or suicide. Depression may also be associated with increased hopelessness, which is the absence of positive future orientation. This topic concentrates on depressive disorders in PTSD. Please also see the topic on depressive symptoms under signs and symptoms of PTSD.

What is the evidence for depressive disorders?

Moderate to high quality evidence finds around 52% of people with PTSD also have a major depressive disorder. Military samples had higher rates than civilian samples, and people exposed to interpersonal traumas had higher rates than people exposed to natural disasters.

Moderate to low quality evidence finds a medium-sized increase in rates of depressive disorders in prisoners with PTSD compared to those without PTSD. Rates were highest in males, in adult prisoners, and in prisoners with any lifetime diagnosis of PTSD.

August 2021

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