Foa Edna B, Stein Dan J, McFarlane Alexander C
Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA, and the University of Adelaide, Department of Psychiatry, Queen Elizabeth Hospital, Woodville, Australia.
J Clin Psychiatry. 2006;67 Suppl 2:15-25.
A variety of reactions are observed after a major trauma. In the majority of cases these resolve without any long-term consequences. In a significant proportion of individuals, however, recovery may be impaired, leading to long-term pathological disturbances. The most common of these is post-traumatic stress disorder (PTSD), which is characterized by symptoms of reexperiencing the trauma, avoidance and numbing, and hyperarousal. A range of other disorders may also be seen after trauma, and there is considerable overlap between PTSD symptoms and several other psychiatric conditions. Risk factors for PTSD include severe exposure to the trauma, female sex, low socioeconomic status, and a history of psychiatric illness. Although PTSD may resolve in the majority of cases, in some cases risk factors outweigh protective factors, and symptoms may persist for many years. PTSD often coexists with other psychiatric disorders, such as depression, anxiety disorders, and substance abuse, and with physical (somatization) symptoms. There is growing evidence that PTSD does not merely represent a normal response to stress, but rather is mediated by specific neurobiological dysfunctions.
重大创伤后会观察到多种反应。在大多数情况下，这些反应会自行缓解，不会产生任何长期后果。然而，在相当一部分个体中，恢复可能会受到损害，导致长期的病理紊乱。其中最常见的是创伤后应激障碍（PTSD），其特征是再次体验创伤的症状、回避和麻木以及过度警觉。创伤后还可能出现一系列其他障碍，PTSD症状与其他几种精神疾病之间存在相当大的重叠。PTSD的风险因素包括严重暴露于创伤、女性、社会经济地位低以及有精神疾病史。虽然大多数情况下PTSD可能会缓解，但在某些情况下，风险因素超过保护因素，症状可能会持续多年。PTSD常与其他精神障碍共存，如抑郁症、焦虑症和物质滥用，也与身体（躯体化）症状共存。越来越多的证据表明，PTSD不仅仅代表对压力的正常反应，而是由特定的神经生物学功能障碍介导的。
