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Post-traumatic stress disorder

Features

  • Exposure to trauma
  • Recurring images of the trauma
  • Distress triggered by similar events
  • Persistent hyperarousal, avoidance of cues
Psychological treatment in primary care
  • Education about the nature of the disorder
  • Hyperventilation control
  • Graded exposure to cues
  • Treatment of comorbid disorders, especially depression
  • Specialist referral to a cognitive behavioural program is recommended
A typical presentation

A 27-year-old man presented six months after having lost his house in a bushfire. He, his wife and children had managed to escape unharmed, but one of his neighbours had died. He stated that he couldn't get the fire out of his mind, was unable to sleep properly and that, when he did sleep, he dreamed about nearly getting caught in the fire. When asked about what happened in the dreams, he stated "We're back in the fire. I can hear the kids screaming, crying, and then I see Joan running towards us, from her house, burning . . . I'm certain we're going to be next, and I wake in a pool of sweat." He also related several instances when similar memories had been triggered, such as hearing fire engine sirens, seeing fires on the news, and when attending a local bonfire. When he experienced these memories, he felt and acted as if the trauma was happening all over again. Since the fire he had felt helpless, hopeless, and was unable to concentrate on much at all. His wife complained that he was not the same person she married, having become withdrawn and emotionally detached.

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