title: Post-traumatic stress disorder.
abstract: Post-traumatic stress disorder (PTSD) occurs in 5-10% of the population and is twice as common in women as in men. Although trauma exposure is the precipitating event for PTSD to develop, biological and psychosocial risk factors are increasingly viewed as predictors of symptom onset, severity and chronicity. PTSD affects multiple biological systems, such as brain circuitry and neurochemistry, and cellular, immune, endocrine and metabolic function. Treatment approaches involve a combination of medications and psychotherapy, with psychotherapy overall showing greatest efficacy. Studies of PTSD pathophysiology initially focused on the psychophysiology and neurobiology of stress responses, and the acquisition and the extinction of fear memories. However, increasing emphasis is being placed on identifying factors that explain individual differences in responses to trauma and promotion of resilience, such as genetic and social factors, brain developmental processes, cumulative biological and psychological effects of early childhood and other stressful lifetime events. The field of PTSD is currently challenged by fluctuations in diagnostic criteria, which have implications for epidemiological, biological, genetic and treatment studies. However, the advent of new biological methodologies offers the possibility of large-scale approaches to heterogeneous and genetically complex brain disorders, and provides optimism that individualized approaches to diagnosis and treatment will be discovered.
authors.affiliation: James J. Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, New York, New York 10468, USA.|Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Yehuda
authors.affiliation: Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Hoge
authors.affiliation: Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: McFarlane
authors.affiliation: Military Mental Health Research Center, Ministry of Defense, Utrecht, The Netherlands.|Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.|Arq Psychotrauma Expert Group, Diemen, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: Vermetten
authors.affiliation: Department of Psychiatry, Western University of Canada, London, Ontario, Canada.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Lanius
authors.affiliation: Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA.|VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, La Jolla, California, USA.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Nievergelt
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Stevan E
authors.initials: SE
authors.lastname: Hobfoll
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health and Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.|The Stanley Center, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.
authors.forename: Karestan C
authors.initials: KC
authors.lastname: Koenen
authors.affiliation: Department of Psychiatry, University of California San Francisco, San Francisco, California, USA.|Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
authors.affiliation: The Stanley Center, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.|Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Hyman
mesh_terms: D000223:Adaptation, Psychological; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D013312:Stress, Physiological