Whereas most people who go through traumatic events experience a brief acute response to the stressful situation and never develop an enduring pathological reaction, a smaller proportion of people will develop post-traumatic stress disorder (PTSD), either alone or complicated with comorbid disorders such as depression, generalised anxiety disorder, or substance misuse.[30]Neria Y, Gross R, Olfson M, et al. Posttraumatic stress disorder in primary care one year after the 9/11 attacks. Gen Hosp Psychiatry. 2006 May-Jun;28(3):213-22.
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[33]Kessler RC, Sonnega A, Bromet E, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995 Dec;52(12):1048-60.
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[35]U.S. Department of Veterans Affairs. VA/DOD clinical practice guidelines: management of posttraumatic stress disorder and acute stress disorder 2023 [internet publication].
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The transition from acute to long-term PTSD, and the disease course, are varied and influenced by risk and protective factors. For example, ongoing stress, the presence of mild traumatic brain injury, co-occurring psychopathology, the availability of treatment, social support, and effective coping strategies might influence recovery. Severity of exposure and loss of life and property might be associated with a long and complicated course of illness.[133]Galea S, Ahern J, Resnick H, et al. Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med. 2002 Mar 28;346(13):982-7.
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The average duration of symptoms, if treated, is 36 months, and the average duration of symptoms among those untreated is 64 months. Moreover, although almost 50% of people with PTSD experience a significant reduction in symptoms, more than one third of people never fully remit.[33]Kessler RC, Sonnega A, Bromet E, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995 Dec;52(12):1048-60.
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