Recognizing posttraumatic stress disorder in primary care

This chapter summarizes primary care principles for recognizing psychologically traumatized patients and engaging them in treatment. Psychological trauma is a psychiatric injury that occurs in response to severely stressful events and can become chronic if not treated. Trauma-informed clinicians understand how psychological trauma changes how people feel, think, and behave. Recognizing and engaging a psychologically traumatized patient for diagnosis and treatment is one of the most satisfying clinical experiences in primary care, opening doors for both patient and provider. While posttraumatic stress disorder (PTSD) is a common psychiatric disorder, the condition tends to be under-recognized. PTSD recognition is challenging owing to stigma, the variety of presentations, the non-specific nature, and range of severity of PTSD symptoms, and high co-occurrence with other conditions. Patients can be reluctant to seek care, disclose traumatizing events, or remember events. PTSD is more prevalent in people with addictions, chronic physical health conditions, chronic pain, medically unexplained symptoms, other psychiatric disorders, and occupations such as military and public safety personnel. Fourteen diverse case examples demonstrate some of the many faces of PTSD in adults. Barriers and facilitators to recognizing PTSD in primary care and targeted use of screening tools are discussed.