Exploring the landscape of PTSD
PTSD is often underdiagnosed or misdiagnosed as other mental health conditions
The symptoms of PTSD can make it difficult to diagnose.
According to the APA, patients with PTSD are 80% more likely than those without PTSD to have symptoms that meet diagnostic criteria for at least 1 other mental disorder (e.g., depressive, bipolar, anxiety, or substance use disorders).1 And some symptoms such as negative thoughts about oneself, feelings of shame, and avoidance—particularly of social interactions—may be conceptually related to self-stigma, which contributes to underdiagnosis.2
Surprisingly, in a review of 592 primary care patient medical records, 62% were diagnosed with a mental illness3*
*Based on a secondary data analysis of 592 adult patients with PTSD interviewed in 2003-2004 for which the prior 12 months of electronic medical records were assessed for mental health diagnoses and treatments.
Across both primary care and secondary care mental health settings, <50% of PTSD cases are correctly diagnosed4-6†
†Based on a secondary data analysis of 509 adult patients with PTSD interviewed in 2003-2004 for which the prior 12 months of electronic medical records were assessed for mental health diagnoses and treatments, as well as an analysis of medical records from 1980 to 2016 of 6,412 patients in secondary care health settings with a mental illness diagnosis who were screened for PTSD.
An Expert’s Insights
Dr. Javanbakht discusses current challenges in PTSD
PTSD Treatment Landscape
US guidelines from the VA, APA, and APoA recommend psychotherapy as first-line treatment. First-line pharmacologic treatment recommendations include certain SSRIs for patients requiring medications.1,7,8
VA=Veterans Affairs; APA=American Psychiatric Association; American Psychological Association; APoA=American Psychologic Association.
Psychotherapies
Trauma-focused cognitive behavioral therapy
Eye movement desensitization and reprocessing
Prolonged exposure therapy
~60% of patients with PTSD do not recover from PTSD following a course of psychotherapy treatment alone, suggesting the majority of patients require additional intervention.12,13
Based on a report from Improving Access to Psychological Therapy (IAPT) services of 48,111 patients treated between December 1 to December 31, 2020. On average, 40% of PTSD patients meet IAPT criteria for recovery at discharge, which included recovery on self- report measures of both PTSD and depression.
Pharmacological treatments
Selective serotonin reuptake inhibitors (SSRIs)
Limited FDA-approved options
The FDA has approved 2 treatments for PTSD, both of which are SSRIs. US guidelines recommend both treatments as the first-line pharmacotherapy option for the treatment of PTSD.1,7,8,14
No new drug has received FDA approval for PTSD treatment in 20 years15,16
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Inside PTSD
Journey into the
pathophysiology
Explore the science
Beyond the trauma
Navigating the symptoms and course of PTSD
See the symptoms
Behind the numbers
Understanding the impact
of PTSD
Explore the impact
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1.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. DSM-5™. American Psychiatric Publishing; 2013.
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2.
Benfer N, et al. Self-stigma and PTSD: conceptualization and implications for research and treatment [published online ahead of print, March 20, 2023]. Psychiatr Serv. 2023;
appi.ps.20220397. -
3.
Meltzer EC, et al. Discrepancy in diagnosis and treatment of post-traumatic stress disorder (PTSD): treatment for the wrong reason. J Behav Health Serv Res. 2012;
39:190-201. -
4.
Liebschutz J, et al. PTSD in urban primary care: high prevalence and low physician recognition. J Gen Intern Med. 2007;
22:719-726. -
5.
Zammit S, et al. Undetected post-traumatic stress disorder in secondary-care mental health services: systematic review. Br J Psychiatry. 2018;
212:11-18. -
6.
Greene T, et al. Prevalence, detection and correlates of PTSD in the primary care setting: a systematic review. J Clin Psychol Med Settings. 2016;
23:160-180. -
7.
American Psychological Association. Clinical Practice Guideline for the Treatment of PTSD. 2017. https://www.apa.org/ptsd-guideline/ptsd.pdf
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8.
The Management of Posttraumatic Stress Disorder Work Group. VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder 2023. Version 4.0. US Department of Veterans Affairs, US Department of Defense; 2023. Accessed February 19, 2024. https://www.healthquality.va.gov/guidelines/MH/ptsd/VA-DoD-CPG-PTSD-Full-CPGAug242023.pdf
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9.
Yehuda R, et al. Post-traumatic stress disorder. Nat Rev Dis Primers. 2015;
1:15057. -
10.
Mavranezouli I, et al. Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychol Med. 2020;
50:542-555. -
11.
Lee DJ, et al. Psychotherapy versus pharmacotherapy for posttraumatic stress disorder: systemic review and meta-analyses to determine first-line treatments. Depress Anxiety. 2016;
33:792-806. -
12.
Murray H, et al. Ten misconceptions about trauma-focused CBT for PTSD. Cognitive Behav Ther. 2022;
15(e33):1-15. -
13.
National Institute for Health and Care Excellence (2018). Posttraumatic stress disorder. NICE guideline [NG116]. NHS Digital (2021). Psychological therapies: reports on the use of IAPT services, England – December 2020 Final. Accessed March 2023. https://digital.nhs.uk/data-and-information/publications/statistical/psychological-therapies-report-on-the-use-of-iapt-services
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14.
Davidson JR, et al. A new treatment algorithm for posttraumatic stress disorder. Psychiatr Ann. 2005;
35(11):887-900. -
15.
FDA approval letter. 1999. Accessed January 29, 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019839S74S86S87_20990S35S44S45lbl.pdf
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16.
FDA approval letter. 2001. Accessed January 29, 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020031s067,020710s031.pdf