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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Post-traumatic stress disorder

Psychiatry · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Trauma-related crisis with immediate danger

Suicidal intent, violent danger, ongoing abuse, trafficking, severe dissociation with unsafe wandering, psychosis, inability to care for dependants or acute intoxication or withdrawal requires immediate safety action before routine trauma processing.

Action: Establish current location and threat, use ABCDE for injury or intoxication, assess suicide and access to means, and create a risk-management and safeguarding plan. Involve emergency, crisis and specialist services and trusted supports as appropriate without requiring a detailed trauma narrative during crisis.

Synopsis

Recognise post-traumatic re-experiencing, avoidance, threat and negative mood changes, assess complex needs and risk, and sequence active monitoring, trauma-focused CBT, EMDR and preference-based medication according to timing and presentation.

  • Name the diagnostic framework: ICD-11 PTSD follows an extremely threatening or horrific event and requires re-experiencing in the present, deliberate avoidance and persistent current threat for at least several weeks with impairment; DSM-5 uses broader symptom clusters lasting more than one month after qualifying trauma.
  • Ask about flashbacks, nightmares, bodily reliving, trauma reminders, avoidance, shame, guilt, detachment, sleep, startle and hypervigilance without forcing a detailed account at the first contact.
  • Within one month, actively monitor subthreshold symptoms with follow-up within one month; offer individual trauma-focused CBT to adults with acute stress disorder or clinically important PTSD symptoms.
  • After one month, offer individual trauma-focused CBT; NICE also offers EMDR after more than three months for non-combat trauma and considers it at one to three months when preferred.
  • Trauma-focused CBT is usually eight to twelve sessions and includes psychoeducation, arousal and flashback strategies, memory and meaning processing, overcoming avoidance, safety planning and functional recovery.
  • Do not offer psychologically focused debriefing and do not use medication, including benzodiazepines, to prevent PTSD after trauma.
  • For an adult who prefers drug treatment for established PTSD, consider venlafaxine or an SSRI such as sertraline while continuing safety, social and substance care.

Key red flags

A current suicide plan, recent high-lethality attempt, severe hopelessness or access to weapons requires urgent crisis assessment and means-safety action.

Ongoing domestic abuse, exploitation, stalking, trafficking or unsafe housing means present danger must be addressed rather than treating all hypervigilance as a memory problem.

Severe dissociation, amnesia, collapse, seizure, psychosis or substance withdrawal requires medical and psychiatric differential assessment before trauma-focused work.

A child or dependent exposed to violence, neglect or an acutely unwell caregiver requires proportionate safeguarding and coordinated family support.

Investigation priorities

01
Trauma-informed clinical assessmentFirst step

Define exposure, symptom clusters, timing, triggers, meanings, impairment and current safety.

Management branches

First monthMatch early care to symptom severity

A person presents within one month of a traumatic event.

  1. Provide practical and emotional support, assess current danger and risk, normalise common reactions without predicting either inevitable disorder or rapid recovery.
  2. Use active monitoring with follow-up within one month for subthreshold symptoms and provide a clear route back if symptoms or safety worsen.
  3. Offer individual trauma-focused CBT to an adult with acute stress disorder or clinically important PTSD symptoms and do not use debriefing or preventive medication.

Key medicines

Sertraline oralFor licensed adult PTSD treatment, give 25 mg by mouth once daily for one week, then 50 mg once daily; increase by 50 mg at intervals of at least one week to a maximum of 200 mg daily if needed.Monitor activation, akathisia, suicidal thinking, mania, hyponatraemia, bleeding, sexual dysfunction and serotonergic interactions; it does not prevent PTSD after trauma and should be tapered gradually when discontinued.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NICE NG116 PTSD recommendationsAssessment, early monitoring, trauma-focused CBT, EMDR, medication and debriefing recommendations.
  • NHS post-traumatic stress disorder overviewCurrent UK patient information on symptoms, urgent risk and available treatments.
  • Sertraline tablets summary of product characteristicsLicensed adult PTSD dose, titration, maximum and safety information.
  • NICE NG116 rationale and impactEvidence reasoning for active monitoring, debriefing and trauma-focused interventions.
  • WHO ICD-11 clinical descriptions and diagnostic requirementsCurrent ICD-11 PTSD and complex PTSD core features, duration and functional-impairment requirements.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom