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Post-traumatic stress disorder — Overview

TL;DR — PTSD is a trauma- and stressor-related disorder, not a synonym for trauma exposure. DSM-5 and ICD-11 select overlapping but non-identical cases; ICD-11 uses a narrower six-symptom core and recognizes complex PTSD separately (Cloitre 2018, PMID 30178492) (Brewin 2017, PMID 29029837). Trauma-focused psychotherapies have the strongest comparative evidence, but certainty is usually moderate-to-low and dropout is part of real-world effectiveness (Mavranezouli 2020, PMID 32063234) (Lewis 2020, PMID 32284821). Medication effects are smaller and sleep-targeted treatment illustrates heterogeneity: the 304-person prazosin re-test was null despite earlier positive trials (Raskind 2018, PMID 29414272). MDMA-assisted therapy had two positive phase 3 trials but the FDA rejected the initial application in 2024 and required another phase 3 trial (Mitchell 2021, PMID 33972795) (Mitchell 2023, PMID 37709999) (Wolfgang 2025, PMID 39741438).

What the diagnosis denotes

A qualifying exposure is necessary but not sufficient. The diagnosis additionally requires a defined pattern of intrusion/re-experiencing, avoidance, threat/arousal and—under DSM-5—negative cognition/mood symptoms, persistence and impairment. CAPS-5 is the structured reference interview; its initial veteran evaluation reported inter-rater κ 0.78–1.00 depending on scoring rule (Weathers 2018, PMID 28493729). PCL-5 is self-report: initial work found α=.94 and test–retest r=.82, while veteran validation found α=.96 and r=.84 (Blevins 2015, PMID 26606250) (Bovin 2016, PMID 26653052). Screening and diagnosis therefore must not be collapsed.

Two nosologies

ICD-11 deliberately simplified PTSD and created complex PTSD (CPTSD) by adding disturbances in self-organisation—affect dysregulation, negative self-concept and relational disturbance—to the PTSD core (Maercker 2022, PMID 35780794). The ITQ was developed as a 12-item self-report instrument for those constructs in community (n=1,051) and clinical (n=247) samples (Cloitre 2018, PMID 30178492). Latent-profile studies in veterans, refugees and clinical services often recover separable profiles, but profile recovery is not proof of different causes or differential treatment response (Karatzias 2017, PMID 27723542) (Folke 2021, PMID 34249244) (Vang 2019, PMID 31984942) (Kazlauskas 2018, PMID 33680347).

Burden and conditional risk

PTSD is uncommon relative to trauma exposure: conditional risk varies sharply by trauma type, sex/gender, prior adversity and social context. Child and adolescent interview studies estimated 15.9% (95% CI 11.5–21.5) after trauma, not population prevalence (Alisic 2014, PMID 24785767). Global estimates must retain survey instrument, trauma definition, age range and time horizon; pooled ‘anxiety disorder’ figures are not PTSD figures (Yildiz 2017, PMID 27865585) (Ayers 2016, PMID 26878223).

Treatment map

A 90-trial, 6,560-participant network meta-analysis found EMDR (SMD −2.07, 95% CrI −2.70 to −1.44) and trauma-focused CBT (SMD −1.46, 95% CrI −1.87 to −1.05) superior to waitlist at treatment end, with moderate-to-low certainty (Mavranezouli 2020, PMID 32063234). Against active comparators, differences narrow: a 65-study exposure meta-analysis found large effects versus waitlist/usual care, a small effect versus non-trauma-focused treatment, and negligible differences versus other trauma-focused therapies or medication (McLean 2022, PMID 34954460).

Prevention and the negative anchor

Single-session psychological debriefing should not be treated as prevention. Across 11 trials it did not reduce distress or PTSD; the pooled short-term PTSD OR was 1.22 (95% CI 0.60–2.46), and one trial found higher one-year risk (OR 2.88, 95% CI 1.11–7.53) (Rose 2002, PMID 12076399). Selective early trauma-focused CBT for symptomatic/high-risk people is a different intervention and has supportive evidence (Bryant 2007, PMID 21352105).

Quantitative anchors

Measure Estimate Population/method Source
Adult psychotherapy NMA 90 trials; n=6,560 PTSD-specific (Mavranezouli 2020, PMID 32063234)
Manualized psychotherapy review 114 RCTs; n=8,171 PTSD-specific (Lewis 2020, PMID 32284821)
Exposure meta-analysis 65 articles; n=4,929 PTSD-specific (McLean 2022, PMID 34954460)
Pediatric NMA 70 RCTs; n=5,528 PTSD/subthreshold PTSD ≤19 years (Hoppen 2025, PMID 39630422)
MDMA phase 3, first n=90; CAPS-5 d=0.91 Severe PTSD (Mitchell 2021, PMID 33972795)
MDMA phase 3, confirmatory n=104; CAPS-5 d=0.70 Moderate–severe PTSD (Mitchell 2023, PMID 37709999)
Prazosin re-test n=304; three primary outcomes null Veterans with chronic PTSD/nightmares (Raskind 2018, PMID 29414272)

Evidence ledger

The ledger lists the live-retrieved records used to bound this page. Inclusion does not make every record equally probative; design, population and comparator remain decisive.

PMID Year Evidence contribution Scope caution
30178492 2018 The International Trauma Questionnaire: development of a self-report measure of ICD-11 PTSD and complex PTSD. PTSD-specific record; inspect design and population
29029837 2017 A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Synthesis: preserve included-population and certainty limits
35780794 2022 Complex post-traumatic stress disorder. PTSD-specific record; inspect design and population
28493729 2018 The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. PTSD-specific record; inspect design and population
26606250 2015 The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. PTSD-specific record; inspect design and population
26653052 2016 Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans. PTSD-specific record; inspect design and population
27723542 2017 Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ). PTSD-specific record; inspect design and population
34249244 2021 PTSD and complex PTSD in treatment-seeking Danish soldiers: a replication of Folke et al. (2019) using the International Trauma Questionnaire. PTSD-specific record; inspect design and population
31984942 2019 Testing the validity of ICD-11 PTSD and CPTSD among refugees in treatment using latent class analysis. PTSD-specific record; inspect design and population
33680347 2018 The structure of ICD-11 PTSD and complex PTSD in Lithuanian mental health services. PTSD-specific record; inspect design and population
24785767 2014 Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. Synthesis: preserve included-population and certainty limits
27865585 2017 The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. Synthesis: preserve included-population and certainty limits
26878223 2016 The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Synthesis: preserve included-population and certainty limits
32063234 2020 Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Synthesis: preserve included-population and certainty limits
32284821 2020 Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. Synthesis: preserve included-population and certainty limits
34954460 2022 Exposure therapy for PTSD: A meta-analysis. Synthesis: preserve included-population and certainty limits
39630422 2025 Psychological Interventions for Pediatric Posttraumatic Stress Disorder: A Systematic Review and Network Meta-Analysis. Synthesis: preserve included-population and certainty limits
12076399 2002 Psychological debriefing for preventing post traumatic stress disorder (PTSD). PTSD-specific record; inspect design and population
21352105 2007 Early intervention for post-traumatic stress disorder. PTSD-specific record; inspect design and population
29451967 2018 Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Synthesis: preserve included-population and certainty limits
29414272 2018 Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans. PTSD-specific record; inspect design and population
12562588 2003 Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study. PTSD-specific record; inspect design and population
17069768 2007 A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. PTSD-specific record; inspect design and population
33972795 2021 MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. PTSD-specific record; inspect design and population
37709999 2023 MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. PTSD-specific record; inspect design and population
39741438 2025 MDMA and MDMA-Assisted Therapy. PTSD-specific record; inspect design and population
32813696 2020 Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis. Synthesis: preserve included-population and certainty limits
26574151 2016 Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Synthesis: preserve included-population and certainty limits

Interpretation guardrails

  • Trauma exposure, post-traumatic symptoms, acute stress disorder, DSM-5 PTSD, ICD-11 PTSD and ICD-11 complex PTSD are not interchangeable populations.
  • A mixed-anxiety or transdiagnostic estimate is labelled as such; only a source’s PTSD stratum can be treated as a PTSD effect.
  • Comorbid depression is measured separately and cross-linked to the depression condition; it is not absorbed into PTSD.
  • Waitlist, treatment-as-usual, attention control and active treatment answer different causal questions.
  • Registration, statistical significance and diagnostic loss do not respectively prove completion, clinical importance or functional recovery.
  • This page synthesizes research and does not provide individual medical advice.

Minimum extraction frame for studies on this topic

Field What must be retained Why it changes interpretation
Diagnostic system DSM version, ICD version, full/subthreshold Case mix is not interchangeable
Diagnostic method Structured interview, clinician judgment, self-report cutoff Screening is not diagnosis
Index trauma Type, timing, repetition, direct/indirect/occupational Conditional risk and phenotype differ
Population Civilian, veteran, refugee, child/adolescent, mixed Transportability is empirical
Baseline severity Mean, SD, range and exclusion threshold Ceiling and floor effects alter change
CPTSD status ITQ/ICD-11 definition and DSO score Complexity cannot be inferred from trauma count
Comorbidity Depression, GAD, SUD, pain, TBI measured separately Shared symptoms can distort effects
Comparator Waitlist, usual care, attention, active treatment The estimand changes with comparator
Treatment dose Sessions offered/attended, duration, homework Assignment is not exposure
Outcome Symptoms, diagnosis, response, function, sleep Outcomes are not interchangeable
Time point End point and prespecified follow-up windows Acute benefit may not persist
Missing data Denominator, reasons, imputation and estimand Attrition can bias rank and magnitude
Adverse events Definitions, ascertainment and arm-level counts Absence of reporting is not absence of harm
Therapist/context Training, fidelity, allegiance, setting Delivery is part of the intervention
Funding/conflicts Sponsor role and analytic independence Especially material for proprietary packages

Claims this page does not make

  • It does not infer PTSD from trauma exposure alone.
  • It does not treat a self-report cutoff as equivalent to a structured diagnosis.
  • It does not convert a pooled anxiety-disorder effect into a PTSD effect.
  • It does not convert a depression outcome in a comorbid sample into a PTSD outcome.
  • It does not infer superiority from a statistically significant within-group change.
  • It does not infer equivalence from a non-significant between-group test.
  • It does not infer effectiveness from trial registration or mechanistic plausibility.
  • It does not assume military, civilian, refugee and pediatric estimates transport unchanged.
  • It does not average conflicting estimates that use different definitions.
  • It does not treat lack of adverse-event reporting as evidence of safety.

Evidence-updating triggers

Trigger Required response
New diagnostic revision Recalculate which populations prior estimates represent
New head-to-head RCT Compare against active treatment, not only waitlist
New individual-participant synthesis Revisit effect modifiers and transportability
Registry status change Verify results and linked publication before changing conclusions
Guideline update Separate evidence review from panel recommendation
Regulatory decision Record decision date and source; do not infer from efficacy papers
Safety signal Re-extract denominator, ascertainment and exposure time by arm
Contradictory replication Display estimates side by side; do not average definitions

Evidence updates should preserve the prior estimate and explain why the new study changes—or does not change—the inference.

Open questions

  • How should trials report outcomes so remission, functioning, harms and dropout can be compared together? (Mavranezouli 2020, PMID 32063234) (Carpenter 2018, PMID 29451967)
  • Do treatment effects transport between DSM-5 PTSD, ICD-11 PTSD and ICD-11 CPTSD? (Cloitre 2018, PMID 30178492) (Coventry 2020, PMID 32813696)
  • Which baseline features identify the minority who benefits from prazosin after the large null trial? (Raskind 2018, PMID 29414272)

References

  1. Cloitre M, et al. The International Trauma Questionnaire: development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatr Scand. 2018;138(6):536-546. PMID 30178492
  2. Brewin CR, et al. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev. 2017;58:1-15. PMID 29029837
  3. Maercker A, et al. Complex post-traumatic stress disorder. Lancet. 2022;400(10345):60-72. PMID 35780794
  4. Weathers FW, et al. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychol Assess. 2018;30(3):383-395. PMID 28493729
  5. Blevins CA, et al. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. J Trauma Stress. 2015;28(6):489-98. PMID 26606250
  6. Bovin MJ, et al. Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans. Psychol Assess. 2016;28(11):1379-1391. PMID 26653052
  7. Karatzias T, et al. Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ). J Affect Disord. 2017;207:181-187. PMID 27723542
  8. Folke S, et al. PTSD and complex PTSD in treatment-seeking Danish soldiers: a replication of Folke et al. (2019) using the International Trauma Questionnaire. Eur J Psychotraumatol. 2021;12(1):1930703. PMID 34249244
  9. Vang ML, et al. Testing the validity of ICD-11 PTSD and CPTSD among refugees in treatment using latent class analysis. Torture. 2019;29(3):27-45. PMID 31984942
  10. Kazlauskas E, et al. The structure of ICD-11 PTSD and complex PTSD in Lithuanian mental health services. Eur J Psychotraumatol. 2018;9(1):1414559. PMID 33680347
  11. Alisic E, et al. Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. Br J Psychiatry. 2014;204:335-40. PMID 24785767
  12. Yildiz PD, et al. The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. J Affect Disord. 2017;208:634-645. PMID 27865585
  13. Ayers S, et al. The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychol Med. 2016;46(6):1121-34. PMID 26878223
  14. Mavranezouli I, et al. Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychol Med. 2020;50(4):542-555. PMID 32063234
  15. Lewis C, et al. Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. Eur J Psychotraumatol. 2020;11(1):1729633. PMID 32284821
  16. McLean CP, et al. Exposure therapy for PTSD: A meta-analysis. Clin Psychol Rev. 2022;91:102115. PMID 34954460
  17. Hoppen TH, et al. Psychological Interventions for Pediatric Posttraumatic Stress Disorder: A Systematic Review and Network Meta-Analysis. JAMA Psychiatry. 2025;82(2):130-141. PMID 39630422
  18. Rose S, et al. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2002;(2):CD000560. PMID 12076399
  19. Bryant RA Early intervention for post-traumatic stress disorder. Early Interv Psychiatry. 2007;1(1):19-26. PMID 21352105
  20. Carpenter JK, et al. Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depress Anxiety. 2018;35(6):502-514. PMID 29451967
  21. Raskind MA, et al. Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans. N Engl J Med. 2018;378(6):507-517. PMID 29414272
  22. Raskind MA, et al. Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study. Am J Psychiatry. 2003;160(2):371-3. PMID 12562588
  23. Raskind MA, et al. A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry. 2007;61(8):928-34. PMID 17069768
  24. Mitchell JM, et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med. 2021;27(6):1025-1033. PMID 33972795
  25. Mitchell JM, et al. MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. Nat Med. 2023;29(10):2473-2480. PMID 37709999
  26. Wolfgang AS, et al. MDMA and MDMA-Assisted Therapy. Am J Psychiatry. 2025;182(1):79-103. PMID 39741438
  27. Coventry PA, et al. Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis. PLoS Med. 2020;17(8):e1003262. PMID 32813696
  28. Cusack K, et al. Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clin Psychol Rev. 2016;43:128-41. PMID 26574151