General signs and symptoms

This category includes the evidence on the signs and symptoms of PTSD.

Click on the tabs below to access the information, or browse and search via the section on the left.

Image: tashatuvango – stock.adobe.com

Anger and aggression

How is anger and aggression related to PTSD? Excessive anger is often observed in people with PTSD and anxiety-related disorders. In PTSD, a propensity towards excessive anger may be apparent before exposure to a trauma, for example as a personality trait, or it could be a result of exposure to the trauma itself and a symptom of PTSD. Elevated anger in people with PTSD has clinical implications as it may be a barrier to effective treatment outcomes. Therefore, anger and aggression are key targets for improvement early in the treatment process. What is the evidence for anger and aggression in…

Anxiety symptoms

How are anxiety symptoms related to PTSD? Many people with PTSD experience symptoms of anxiety, such as worrying, fear, and sleep problems. This topic concentrates on the occurrence of anxiety symptoms rather than anxiety disorders in people with PTSD (also see the anxiety disorders topic under co-occurring conditions). What is the evidence for anxiety in people with PTSD? Moderate to high quality finds a medium-sized correlation between increased PTSD symptoms and increased levels of anxiety. There is also a medium-sized correlation between increased PTSD symptoms and increased anxiety sensitivity (fear of sensations related to anxiety). August 2021 Image: ©Rocketclips inc…

Avoidance

What is avoidance? Avoidance is a core symptom of PTSD, with at least one avoidance symptom being required for a diagnosis. People often try to cope with the trauma and escape painful or difficult emotions by avoiding the distressing memories, thoughts, or feelings associated with the event. Avoidance may be effective in the short-term but in the long run, it may be associated with increased severity of symptoms. What is the evidence for avoidance in people with PTSD? Moderate to low quality evidence finds three clusters of avoidance symptoms; avoidance of thoughts and feelings, activity, and memory. Thoughts/feelings avoidance items…

Depressive symptoms

What are depressive symptoms in PTSD? Depression is characterised by a depressed mood or a loss of interest or pleasure in activities. Symptoms of depression may include changes in appetite, weight, sleep, or psychomotor activity, 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 the occurrence of depressive symptoms rather than depressive disorders. Please see the co-occurring conditions topic for rates of comorbid depressive disorders in people with PTSD. What is…

Dissociation

How is dissociation related to PTSD? Dissociation is described as disruption or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, or behaviour. Common dissociative experiences include mild forms of absorption, such as daydreaming. Less common and more severe dissociative experiences include amnesia, derealisation, depersonalisation, and fragmentation of identity. Trait dissociation is a proposed stable characteristic that exists both pre- and post-trauma and is thought to be a vulnerability factor for PTSD. In contrast, state dissociation is suggested to occur in response to situations. Peritraumatic dissociation is a form of state dissociation and refers…

Distress

How is distress related to PTSD? Peritraumatic distress consists of negative emotions experienced during or shortly after a traumatic event. Responses of fear, helplessness, and horror represent a subset of peritraumatic distress reactions that currently define trauma exposure in the DSM, along with life threat. It is unclear if peritraumatic distress modulates the development or persistence of PTSD symptoms across time. What is the evidence for distress in people with PTSD? Moderate to high quality evidence found increased severity of PTSD symptoms was related to increased feelings of distress. There may be declines in distress over time, in particular before…

Hyperarousal

What is hyperarousal? Hyperarousal is a core symptom of PTSD, with at least two avoidance symptoms being required for a diagnosis. Hyperarousal symptoms include irritability or aggression, risky or destructive behavior, hypervigilance, heightened startle reaction, difficulty concentrating, and difficulty sleeping. What is the evidence for hyperarousal in people with PTSD? Moderate to low quality evidence finds five clusters of hyperarousal symptoms; irritability/anger, difficulty concentrating, hypervigilance, startle, and sleep difficulty. Items relating to irritability/anger include; I lost my cool and exploded over minor everyday things, I lost my temper, little things made me angry, I felt irritable, I had angry outbursts,…

Intrusions

What are intrusions? Intrusions are a core symptom of PTSD, with at least one intrusion symptom being required for a diagnosis. Intrusion symptoms include unwanted and upsetting memories, nightmares, flashbacks, and emotional distress and/or physical reactivity after exposure to reminders. What is the evidence for intrusions in people with PTSD? Moderate to low quality evidence finds five clusters of intrusion symptoms; distressing memories, distressing dreams, flashbacks, emotional cue distress, and physiological cue reactivity. Items relating to distressing memories include; disturbing memories kept coming into my mind, I found myself remembering bad things that happened to me, upsetting thoughts kept coming…

Negative alterations in cognition and mood

What are negative alterations in cognition and mood? According to the DSM-5, at least two “negative alterations in cognitions and mood” are required for a diagnosis of PTSD. These include negative thoughts or feelings that began or worsened after the trauma, an inability to recall key features of the trauma, overly negative thoughts and assumptions about oneself or the world, exaggerated blame of self or others for causing the trauma, negative affect (e.g., fear, horror, anger, guilt, or shame), decreased interest in activities, feeling isolated, and difficulty experiencing positive affect. What is the evidence for negative alterations in cognition and…

Perceptions of defeat and entrapment

How are perceptions of defeat and entrapment related to PTSD? Perceptions of defeat and entrapment have been linked to the development and maintenance of various psychiatric disorders. Perceived defeat involves a perception of powerlessness resulting from the loss or significant disruption of social status, identity, or hierarchical goals. Examples of events that may induce perceptions of defeat include a failure to attain, or loss of, valued social and material resources, social put-downs or attacks from others, and internal perceptions of self-criticism, worthlessness, and incompetence. Perceived entrapment occurs when the usual motivation to escape threat or stress is blocked because of…

Personality and temperament

How are personality and temperament related to PTSD? Personality and temperament are thought to be relatively stable over time. One of the main personality models includes five traits of; 1) neuroticism: vulnerability to emotional instability and self-consciousness, 2) extraversion: predisposition towards sociability, assertiveness, and social interaction, 3) openness: cognitive disposition to new experiences, creativity, and aesthetics, 4) agreeableness: tendency towards being sympathetic, trusting, and altruistic, and 5) conscientiousness: tendency towards dutifulness and competence. A maladaptive combination of personality and temperament traits may constitute a risk factor for the development of psychological dysfunctions. Moreover, temperament traits are considered one of the…

NeuRA Libraries

Title Colour Legend:
Green - Topic summary is available.
Orange - Topic summary is being compiled.
Red - Topic summary has no current systematic review available.