What is it?
Post-traumatic stress disorder (PTSD) develops after exposure to a traumatic event involving actual or threatened death, serious injury, or sexual violence. PTSD affects approximately 6% of adults in the United States at some point in their lives, with women roughly twice as likely to develop the condition (VA National Center for PTSD).
PTSD is defined by four symptom clusters: intrusive re-experiencing (flashbacks, nightmares, intrusive memories), avoidance of trauma-related stimuli, negative alterations in cognition and mood, and hyperarousal (exaggerated startle, hypervigilance, sleep disturbance, irritability).
Clinical presentation
The majority of PTSD cases involve civilian trauma: motor vehicle accidents, sexual assault, physical assault, childhood abuse, witnessing violence, and medical trauma. Adults frequently present with symptoms that do not immediately suggest trauma: chronic insomnia, irritability, concentration difficulties, emotional numbness, and social withdrawal. Many are initially diagnosed with depression or generalized anxiety because the trauma history is not elicited.
Complex PTSD, from prolonged or repeated trauma, presents with additional features including emotional dysregulation, shame, relationship difficulties, and self-perception disturbances. These patients are frequently misdiagnosed with bipolar disorder or personality disorders. The connection between trauma and functional neurological disorder is an area where neuropsychiatric expertise is particularly relevant.
Evaluation
PTSD rarely occurs alone. Most people with PTSD also have at least one other condition, most often depression, another anxiety disorder, or a substance use disorder. Major depression is present in roughly 50% (Rytwinski et al., 2013). Substance use disorders occur in 25% to 50% (VA National Center for PTSD). The overlap between PTSD and traumatic brain injury is particularly important: events that cause TBI frequently also cause psychological trauma, and the two share several symptoms.
Misdiagnosis is common. Patients with PTSD-related emotional dysregulation are frequently diagnosed with bipolar disorder. Patients whose hyperarousal includes concentration difficulty may be diagnosed with ADHD and prescribed stimulants that worsen hypervigilance. Our evaluation identifies these errors and redirects treatment.
Treatment
We use evidence-based pharmacotherapy: SSRIs (sertraline and paroxetine are FDA-approved for PTSD) and SNRIs as first-line agents. Prazosin may be used for trauma-related nightmares. We do not prescribe benzodiazepines for PTSD; evidence suggests they are ineffective and may interfere with trauma processing in therapy.
We coordinate closely with therapists trained in prolonged exposure (PE), cognitive processing therapy (CPT), and EMDR. We view our role as stabilizing symptoms sufficiently for patients to engage productively in therapy, while therapy addresses the trauma itself.
Recognizing PTSD and its overlap with TBI
PTSD is frequently misdiagnosed as depression, anxiety, or bipolar disorder. Our neuropsychiatric evaluation identifies trauma-related disorders that other providers may miss. The overlap between PTSD and TBI is an area of particular expertise: Dr. Lodhi and Dr. Patel both completed neuropsychiatry fellowships at Stanford, and Dr. Lodhi evaluates TBI-related PTSD cases in his forensic practice.
Frequently asked questions
How long after trauma can PTSD develop?
Symptoms typically begin within 3 months but onset can be delayed by months or years. Delayed-onset PTSD is more common with childhood trauma. Evaluation is appropriate regardless of when the trauma occurred.
How is PTSD different from normal stress after trauma?
Most people recover from traumatic stress within weeks. PTSD is diagnosed when symptoms persist beyond one month and include re-experiencing, avoidance, mood changes, and hyperarousal. The distinction is persistence and functional impairment.
Can PTSD be treated without medication?
Yes. Evidence-based trauma therapies including CPT, prolonged exposure, and EMDR are effective alone. Many patients benefit from combining therapy with pharmacotherapy, particularly when symptoms are severe.
Do you treat complex PTSD?
Yes. Complex PTSD requires a comprehensive approach addressing emotional regulation, relational difficulties, and identity disturbance alongside core symptoms. Our evaluation distinguishes complex PTSD from conditions it is frequently confused with, including bipolar disorder.
Requesting a trauma evaluation
An evaluation is appropriate regardless of when the trauma occurred. It takes 60 minutes by secure video, and when treatment includes therapy, we coordinate with therapists trained in prolonged exposure, cognitive processing therapy, or EMDR.
This information is for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Always consult a qualified physician before making medication or treatment decisions. Content reviewed by physicians at Bay Area Neuropsychiatry who are board-certified by the American Board of Psychiatry and Neurology.