article · World Psychiatry
Post-traumatic stress disorder understanding has developed considerably since the introduction of initial diagnostic criteria. Emerging evidence identifies post-traumatic reactions across diverse contexts, supported by the recognition of distinct phenotypes such as the dissociative subtype and complex post-traumatic stress disorder. The psychological basis of the condition involves disruptions to memory and identity, which accommodates communal influences and resource loss, while biological research highlights specific genetic and neuroimaging findings. Although preventive measures show limited success, established cases respond to varied interventions. These include trauma-focused cognitive behaviour therapy and eye movement desensitisation and reprocessing, non-trauma-focused therapies, and combined approaches such as MDMA-assisted psychotherapy. Current priorities centre on tailoring these interventions to cultural contexts and resource-limited environments using community-based delivery.
Post-traumatic stress disorder affects individuals and communities across varied situations, including environments not historically recognised as traumatic. Clarifying how trauma alters memory and identity, whilst consolidating evidence for effective therapies, directly guides clinical care. Understanding how to adapt treatments for resource-limited environments and diverse cultural contexts is vital to ensure that effective mental healthcare can be delivered equitably to underserved populations worldwide.
The abstract outlines clinical treatment methodologies rather than commercial products. Applied interventions such as trauma-focused cognitive behaviour therapy, eye movement desensitisation and reprocessing, and community-based programmes are already available for implementation by healthcare providers and non-governmental organisations. Novel combined protocols, specifically MDMA-assisted psychotherapy, represent early-stage to translational clinical applications that require regulated delivery frameworks before widespread adoption in health systems and clinical practices.
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The understanding of responses to traumatic events has been greatly influenced by the introduction of the diagnosis of post-traumatic stress disorder (PTSD). In this paper we review the initial versions of the diagnostic criteria for this condition and the associated epidemiological findings, including sociocultural differences. We consider evidence for post-traumatic reactions occurring in multiple contexts not previously defined as traumatic, and the implications that these observations have for the diagnosis. More recent developments such as the DSM-5 dissociative subtype and the ICD-11 diagnosis of complex PTSD are reviewed, adding to evidence that there are several distinct PTSD phenotypes. We describe the psychological foundations of PTSD, involving disturbances to memory as well as to identity. A broader focus on identity may be able to accommodate group and communal influences on the experience of trauma and PTSD, as well as the impact of resource loss. We then summarize current evidence concerning the biological foundations of PTSD, with a particular focus on genetic and neuroimaging studies. Whereas progress in prevention has been disappointing, there is now an extensive evidence supporting the efficacy of a variety of psychological treatments for established PTSD, including trauma-focused interventions - such as trauma-focused cognitive behavior therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) - and non-trauma-focused therapies, which also include some emerging identity-based approaches such as present-centered and compassion-focused therapies. Additionally, there are promising interventions that are neither psychological nor pharmacological, or that combine a pharmacological and a psychological approach, such as 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. We review advances in the priority areas of adapting interventions in resource-limited settings and across cultural contexts, and of community-based approaches. We conclude by identifying future directions for work on trauma and mental health.
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DOI: 10.1002/wps.21269
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