Editing Post-traumatic stress disorder (section)

== Signs and symptoms ==
[[Image:Art of War, Service members use art to relieve PTSD symptoms DVIDS579803.jpg|thumb|Service members use art to relieve PTSD symptoms.]]
{{See also|Psychological stress and sleep}}
Symptoms of PTSD generally begin within the first three months after the inciting traumatic event, but may not begin until years later.<ref name="DSM-5-TR">
{{cite book |title=APA Releases Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) |date=March 2022 |page=683 |edition=5th |url=https://archive.org/details/dsm-5-tr/page/n683/ |access-date=2025-01-12 |quote=Symptoms usually begin within the first 3 months after the trauma, although there may be a delay of months, or even years, before full criteria for the diagnosis are met. There is abundant evidence for what DSM-IV called "delayed onset" but is now called "delayed expression," with the recognition that some symptoms typically appear immediately and that the delay is in meeting full criteria.}}
</ref><ref name="NIH2016" /> In the typical case, the individual with PTSD persistently avoids either trauma-related thoughts and emotions or discussion of the traumatic event and may even have amnesia of the event ([[dissociative amnesia]]).<ref name="DSM5" /> However, the event is commonly relived by the individual through intrusive, recurrent recollections, dissociative episodes of reliving the trauma ("[[Flashback (psychology)|flashbacks]]"), and nightmares (50 to 70%).<ref name="Waltman_2018"/><ref name=DSM4>{{cite book |author=American Psychiatric Association |title=Diagnostic and statistical manual of mental disorders: DSM-IV |publisher=[[American Psychiatric Association]] |location=Washington, DC |year=1994 |isbn=978-0-89042-061-4 |url=https://archive.org/details/diagnosticstati00amer}}{{page needed|date=January 2014}};</ref><ref>{{cite web | vauthors = Rebecca C |title=The primary care PTSD screen (PC-PTSD): development and operating characteristics. |url=https://depts.washington.edu/fammed/improvingopioidcare/wp-content/uploads/sites/12/2018/02/Prins-2003.pdf |website=Washington University |publisher=Primary Care Psychiatry |access-date=19 November 2022}}</ref> While it is common to have symptoms after any traumatic event, these must persist to a sufficient degree (i.e., causing dysfunction in life or clinical levels of distress) for longer than one month after the trauma to be classified as PTSD (clinically significant dysfunction or distress for less than one month after the trauma may be [[acute stress disorder]]).<ref name=DSM5 /><ref name="Rothschild 2000">{{cite book |vauthors=Rothschild B |title=The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment |year=2000 |publisher=[[W.W. Norton & Company]] |location=New York |isbn=978-0-393-70327-6}}{{page needed|date=January 2014}}</ref><ref>{{cite book |vauthors=Kaplan HI, Sadock BJ |title=Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences, clinical psychiatry |edition=7th |veditors=Grebb JA |publisher=[[Williams & Williams]] |year=1994 |location=Baltimore |pages=606–609}}{{page needed|date=January 2014}}</ref><ref name="surgeon4">{{cite book |year=1999 |chapter=Chapter 4 |vauthors=Satcher D |author-link=David Satcher |title=Mental Health: A Report of the Surgeon General |publisher=[[Surgeon General of the United States]] |chapter-url=http://www.surgeongeneral.gov/library/mentalhealth/toc.html#chapter4 |url-status=live |archive-url=https://web.archive.org/web/20100702092029/http://www.surgeongeneral.gov/library/mentalhealth/toc.html#chapter4 |archive-date=2010-07-02}}</ref> Some following a traumatic event experience [[post-traumatic growth]].<ref>{{cite journal |vauthors=Bernstein M, [[Betty Pfefferbaum|Pfefferbaum B]] |s2cid=21721645 |title=Posttraumatic Growth as a Response to Natural Disasters in Children and Adolescents |journal=[[Current Psychiatry Reports]] |volume=20 |issue=5 |pages=37 |date=May 2018 |pmid=29766312 |doi=10.1007/s11920-018-0900-4}}</ref>

=== Associated medical conditions ===
Trauma survivors often develop depression, anxiety disorders, and mood disorders in addition to PTSD.<ref>{{cite journal |vauthors=O'Donnell ML, Creamer M, Bryant RA, Schnyder U, Shalev A |title=Posttraumatic disorders following injury: an empirical and methodological review |journal=[[Clinical Psychology Review]] |volume=23 |issue=4 |pages=587–603 |date=July 2003 |pmid=12788111 |doi=10.1016/S0272-7358(03)00036-9}}</ref> More than 50% of those with PTSD have co-morbid [[anxiety disorder|anxiety]], [[mood disorders|mood]], or [[substance use disorder]]s.<ref name="Shalev 2017" />

[[Substance use disorder]], such as [[alcohol use disorder]], commonly co-occur with PTSD.<ref name="Maxmen2002-348">{{cite book |title=Psychotropic drugs: fast facts |vauthors=Maxmen JS, Ward NG |publisher=[[W.W. Norton & Company]] |year=2002 |isbn=978-0-393-70301-6 |edition=3rd |place=New York |page=348}}</ref> Recovery from post-traumatic stress disorder or other anxiety disorders may be hindered, or the condition worsened, when substance use disorders are [[comorbid]] with PTSD. Resolving these problems can bring about improvement in an individual's mental health status and anxiety levels.<ref name="Cohen-1995">{{cite journal |vauthors=Cohen SI |title=Alcohol and benzodiazepines generate anxiety, panic and phobias |journal=[[Journal of the Royal Society of Medicine]] |volume=88 |issue=2 |pages=73–7 |date=February 1995 |pmid=7769598 |pmc=1295099}}</ref><ref>{{cite journal |vauthors=Spates R, Souza T |year=2007 |title=Treatment of PTSD and Substance Abuse Comorbidity |url=http://www.baojournal.com/BAT%20Journal/VOL-9/BAT%209-1.pdf |journal=The Behavior Analyst Today |volume=9 |issue=1 |pages=11–26 |doi=10.1037/h0100643 |archive-url=https://web.archive.org/web/20141106235005/http://www.baojournal.com/BAT%20Journal/VOL-9/BAT%209-1.pdf |archive-date=6 November 2014}}</ref>

PTSD has a strong association with [[tinnitus]],<ref name="Cima et al. (2019)">{{cite journal|vauthors=Cima R, Mazurek B, Haider H, Kikidis D, Lapira A, Noreña A, Horare D|year=2019|title=A multidisciplinary European guideline for tinnitus: diagnostics, assessment, and treatment|journal=HNO|volume=67|issue=Suppl 1 |pages=10–42 |doi=10.1007/s00106-019-0633-7|pmid=30847513 |s2cid=71145857 |doi-access=free}}</ref> and speculation exists that PTSD may cause some tinnitus seen in association with the condition.<ref name="Mazurek et al. (2022)">{{cite journal|vauthors=Mazurek B, Haupt H, Olze H, Szczepeck A|year=2022|title=Stress and tinnitus—from bedside to bench and back|journal= Frontiers in Systems Neuroscience|volume=6|issue=47|page=47 |doi=10.3389/fnsys.2012.00047|pmid=22701404 |pmc=3371598 |doi-access=free }}</ref>

In children and adolescents, there is a strong association between emotional regulation difficulties (e.g., mood swings, anger outbursts, [[Tantrum|temper tantrums]]) and post-traumatic stress symptoms, independent of age, gender, or type of trauma.<ref>{{cite journal |vauthors=Villalta L, Smith P, Hickin N, Stringaris A |s2cid=4731753 |title=Emotion regulation difficulties in traumatized youth: a meta-analysis and conceptual review |journal=[[European Child & Adolescent Psychiatry]] |volume=27 |issue=4 |pages=527–544 |date=April 2018 |pmid=29380069 |doi=10.1007/s00787-018-1105-4 |url=https://kclpure.kcl.ac.uk/portal/files/87273928/Emotion_regulation_difficulties_in_VILLALTA_Publishedonline27January2018_GREEN_AAM.pdf}}</ref>

[[Moral injury]], the feeling of moral distress such as a shame or guilt following a moral transgression, is associated with PTSD but is distinguished from it. Moral injury is associated with shame and guilt, while PTSD is associated with anxiety and fear.<ref>{{cite journal |vauthors=Hall NA, Everson AT, Billingsley MR, Miller MB |title=Moral injury, mental health and behavioural health outcomes: A systematic review of the literature |journal=[[Clinical Psychology & Psychotherapy]] |volume=29 |issue=1 |pages=92–110 |date=January 2022 |pmid=33931926 |doi=10.1002/cpp.2607 |s2cid=233471425}}</ref>{{Rp|page=2,8,11}}