Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a clinical diagnosis that develops in some individuals following exposure to a traumatic event. According to the DSM-5, diagnosis requires direct exposure, direct witnessing, learning that the event occurred to a close family member or friend, or repeated exposure to aversive details of the event. Symptoms are grouped into four clusters: intrusion (flashbacks, nightmares, recurrent involuntary memories), avoidance (efforts to avoid memories, thoughts, or external cues), negative alterations in cognition and mood (distorted beliefs about oneself or the world, persistent negative emotions, loss of interest), and hyperarousal (hypervigilance, exaggerated startle response, irritability, sleep disturbance).

Complex PTSD (C-PTSD) was formally recognized by the ICD-11 as a separate diagnosis, incorporating Judith Herman's original proposal. In addition to the classic PTSD symptoms, complex PTSD includes disturbances in self-organization: difficulties in emotional regulation (intense emotional reactions or numbness), negative self-concept (persistent feelings of shame, guilt, or failure), and disturbances in interpersonal relationships (difficulty maintaining close relationships, generalized distrust). Marylène Cloitre and colleagues demonstrated that complex PTSD typically develops in contexts of chronic interpersonal traumatization, especially during childhood, and requires adapted therapeutic approaches that prioritize emotional stabilization.

Therapeutic approaches for PTSD have a solid evidence base. Cognitive processing therapy (CPT), prolonged exposure, and EMDR are first-line treatments recommended by international clinical guidelines. Anke Ehlers and David Clark proposed an influential cognitive model explaining the maintenance of PTSD through excessively negative appraisals of the trauma and its consequences, combined with the fragmented and poorly contextualized nature of traumatic memories. Treatment facilitates the elaboration and contextualization of memories and the modification of problematic appraisals.

The concept of moral injury has emerged as an important dimension in understanding trauma, particularly in military and professional contexts. Moral injury occurs when a person perpetrates, fails to prevent, or witnesses acts that transgress their deeply held moral beliefs, generating feelings of guilt, shame, and betrayal that do not fully fit the classic fear-based PTSD model. This perspective has broadened the understanding of trauma beyond fear responses and has driven the development of specific interventions addressing the moral and existential aspects of post-traumatic suffering.