Recognition of circumstances and behaviours that may suggest PTSD

Recognition

Be aware that people with PTSD, including complex PTSD, may present with a range of symptoms associated with functional impairment, including:

• re-experiencing
• avoidance
• hyperarousal (including hypervigilance, anger and irritability)
• negative alterations in mood and thinking
• emotional numbing
• dissociation
• emotional dysregulation
• interpersonal difficulties or problems in relationships
• negative self-perception (including feeling diminished, defeated or worthless)

Be aware of traumatic events associated with the development of PTSD. These could be experiencing or witnessing single, repeated or multiple events and could include, for example:

• serious accidents
• physical and sexual assault abuse, including childhood or domestic abuse
• work-related exposure to trauma, including remote exposure trauma
• related to serious health problems or childbirth experiences (for example, intensive care admission or neonatal death)
• war and conflict
• torture

When assessing for PTSD, ask people specific questions about re-experiencing, avoidance, hyperarousal, dissociation, negative alterations in mood and thinking, and associated functional impairment.

When assessing for PTSD, ask people with symptoms of PTSD if they have experienced 1 or more traumatic events (which may have occurred many months or years before). Give specific examples of traumatic events as listed above.

For people with unexplained physical symptoms who repeatedly attend health services, think about asking whether they have experienced 1 or more traumatic events and provide specific examples of traumatic events (see above).

Reference:

• NICE (December 2018).Post-traumatic stress disorder (NG116)