History

The diagnosis of posttraumatic stress disorder (PTSD) is based on evidence of having experienced a serious threat of physical injury or a sexual assault followed by the symptoms of PTSD. Because of the frequent comorbidities, providers should also ask about the following:

Depressive symptoms
Anxiety symptoms
Substance abuse
Suicidal ideation
Relationship problems

Physical Examination

Patients may display physiological arousal (e.g., tremor, sweating, agitation) when they are discussing their trauma. Individuals may also present with physical injuries related to the trauma (e.g., traumatic amputation from an explosion or bruises in victims of ongoing domestic abuse). Those who have experienced a head injury should be checked for evidence of neurological impairment.

Autonomic arousal in the immediate aftermath of the traumatic events indicates an increased risk of PTSD.^[16]

Mental Status Examination

Factors discovered during the mental status examination may help confirm the diagnosis of PTSD. These may include:

Behavioral factors
- Increased vigilance
- Increased startle response
- Physiological arousal or emotional distress when discussing the trauma
- Inability to engage with providers
Cognitive factors
- Amnesia for parts of the traumatic events
- Distorted thoughts of self, others, and the world
- Distorted thoughts about the cause or consequences of the trauma
- Problems with concentration
Emotional factors
- Decreased range of positive emotions
- Persistent negative emotional states

Complications

Psychiatric and medical comorbidities are common with PTSD. Among individuals with PTSD there are increased rates of:

Mood disorders
Panic and other anxiety disorders
Substance abuse disorders^{[17, 18, 19, 20]}
Neurological conditions (e.g., headaches, dementia)^[21]

Substance abuse is a particular problem for individuals with PTSD. Studies have found that up to 51.9% of men with PTSD concomitantly misuse alcohol. In one study, men with PTSD reported an earlier age of onset of alcohol dependence, greater alcohol use intensity and craving, and more severe legal problems due to alcohol use. In the same study, PTSD more often preceded alcohol dependence in women than men and women were more likely to test positive for cocaine upon entering treatment.^[17]Use of analgesic medications (opiate and non-opiate) may be raised among individuals with PTSD.^[18]

Differential Diagnoses

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