Diagnostic Criteria and Treatment Options for PTSD

Core Diagnostic Requirements

The American Psychiatric Association recommends that PTSD diagnosis requires exposure to a traumatic event that occurred more than one month ago and causes clinically significant functional impairment, with specific symptom clusters across four domains 1, 2
The patient must have experienced, witnessed, learned about, or had repeated exposure to details of traumatic events involving actual or threatened death, serious injury, or sexual violence, although this fact is noted in Praxis Medical Insights, a similar recommendation is found in other guidelines 3

The American College of Physicians and the Annals of Internal Medicine recommend trauma-focused psychotherapy (prolonged exposure, cognitive processing therapy, or EMDR) as first-line treatment for PTSD, which should be prioritized over pharmacotherapy based on superior efficacy 1, 2
Prolonged Exposure Therapy involves imaginal exposure and in vivo exposure, with 40-87% of patients no longer meeting PTSD criteria after 9-15 sessions 5, 1, 2
Cognitive Processing Therapy teaches patients to identify and challenge trauma-related irrational or dysfunctional beliefs, with 53-65% of patients achieving remission 5, 1, 2

The VA/DoD guideline recommends sertraline, paroxetine, or venlafaxine as first-line pharmacotherapy for PTSD, with 53-85% of patients classified as treatment responders in clinical trials 1, 2, 5
The American College of Physicians recommends against the use of benzodiazepines and cannabis or cannabis-derived products in PTSD treatment 1, 2

The Annals of Internal Medicine recommends offering trauma-focused psychotherapy as first-line treatment, reserving pharmacotherapy for patients with residual symptoms or those unable/unwilling to access psychotherapy 1, 2
The treatment algorithm should include screening for comorbidities, addressing sleep disturbances, and considering phase-based treatment for complex PTSD 3, 6