title: Post-traumatic stress disorder--a diagnostic and therapeutic challenge.
abstract: BACKGROUND
  In Germany, the one-month prevalence of post-traumatic stress disorder (PTSD) is in the range of 1% to 3%. Soldiers, persons injured in accidents, and victims of domestic violence increasingly seek medical help for symptoms of emotional stress. Days lost from work and monetary compensation for emotional disturbances are markedly on the rise. The term "PTSD" is commonly used uncritically and imprecisely, with too little regard for the existing diagnostic criteria. It is at risk of turning into a nonspecific collective term for emotional stress of any kind.
  
  
  METHODS
  We selectively reviewed the literature in the PubMed database and pertinent journals, with additional consideration of the recommendations and guidelines of medical societies from Germany and abroad.
  
  
  RESULTS
  The characteristic types of reactions seen in PTSD are nightmares and an intense, repetitive, intrusive "reliving" of the traumatic event(s). Emotional traumatization manifests itself not only as PTSD but also through major effects on other mental and somatic diseases. An early, trauma-focused behavioral therapeutic intervention involving several sessions, generally on an outpatient basis, can prevent the development of PTSD. The most important components of effective treatment are a focus on the particular trauma experienced and confrontation with the patient's memories of the trauma. The best existing evidence is for cognitive therapy, behavioral therapy according to the exposure paradigm of Foa, and eye movement desensitization and reprocessing therapy. The most recent meta-analysis reveals effect strengths of g = 1.14 for all types of psychotherapy and g = 0.42 for all types of pharmacotherapy taken together (with considerable differences among psychotherapeutic methods and among drugs). The efficacy of psychodynamic therapy, systemic therapy, body-oriented therapy, and hypnotherapy has not been adequately documented in randomized controlled trials.
  
  
  CONCLUSIONS
  PTSD can be precisely diagnosed and effectively treated when the diagnostic criteria and guideline recommendations are taken into account. Referral for trauma-focused psychotherapy should be considered if the acute symptoms persist for several weeks.
authors.affiliation: MediClin Klinik an der Lindenhöhe. Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Offenburg, Department of Psychiatry and Psychotherapy, University Hospital of Freiburg.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Frommberger
authors.forename: Jörg
authors.initials: J
authors.lastname: Angenendt
authors.forename: Mathias
authors.initials: M
authors.lastname: Berger
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D006801:Humans; D026441:Mind-Body Therapies / Q000379:methods*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*