PTSD in Primary Care: A Physician’s Guide to Dealing with War-Induced PTSD

Posttraumatic stress disorder (PTSD), as defined in DSM IV-TR, is the most common and conspicuous psychiatric problem associated with the stress experienced by soldiers in combat yet it is often misunderstood even by frontline primary care providers. Diagnosis of PTSD requires exposure to a traumatic event that involves experiencing, witnessing, or being confronted by death or serious injury to self or others; a response of intense fear, helplessness, or horror; and development of a set of symptoms that persist for at least a month and cause significant impairment of functioning (American Psychiatric Association, 2000). Some factor analytic studies have demonstrated four basic dimensions of PTSD symptoms (e.g., King, Leskin, King, & Weathers, 1998): reexperiencing (e.g., nightmares, flashbacks), avoidance (e.g., efforts to avoid thinking about the trauma), numbing of general responsiveness (e.g., restricted range of affect), and hyperarousal (e.g., exaggerated startle response), but some suggest other complex relationships between symptoms (McWilliams, Cox, & Asmundson, 2005). Most individuals who develop chronic PTSD experience immediate distress that then persists over time (Buckley, Blanchard, & Hickling, 1996). However, a small but significant number of individuals reports increases in PTSD symptoms over time (delayed onset PTSD; Gray, Bolton, & Litz, 2004).