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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

September 2013

Recognizing Post-traumatic Stress Disorder in the Primary Care Setting 


When violence occurs, it can leave lasting scars not only physically, but also emotionally. The National Institute of Mental Health estimates that post-traumatic stress disorder (PTSD) affects about 7.7 million American adults, with women more likely to develop the disorder than men. PTSD may result from experiencing a terrifying ordeal directly or from witnessing a traumatic event. According to the National Center for PTSD, a variety of traumatic events may lead to PTSD, including wartime violence, rape, child abuse, acts of terrorism, natural disasters, or car, train, or airplane crashes. Symptoms of PTSD typically begin within three months of an incident, though on occasion they manifest themselves years later. Not every person involved in a trauma develops PTSD, and it’s unclear why some individuals develop the condition, while others do not. However, the following factors may influence how susceptible an individual is:

  • Degree of intensity of the traumatic event
  • Whether a loved one was lost or hurt
  • Proximity to the event
  • How much control the person perceived they had over or during the event
  • Support and assistance received after the trauma

Initially, a person who experienced a traumatic event may feel only numbness and shock. As time goes on, however, other feelings emerge, and many individuals with PTSD replay the event over and over in their minds, creating different scenarios about what they could have done differently. Often, they can’t forget the feelings of terror, helplessness, and the loss of control they felt at the time. Common symptoms after a traumatic event may include:

  • Emotional symptoms: depression, helplessness, fear, anxiety, anger, frustration, or grief
  • Behavioral symptoms: social withdrawal, loss of interest in activities, increased use of alcohol or drugs
  • Cognitive symptoms: poor concentration, poor job performance, confusion, or forgetfulness  
  • Physical symptoms: changes in appetite, headaches, insomnia, nightmares, fatigue, tension

Deliberate violence, such as acts of terrorism or rape, often creates longer lasting mental health effects than do natural disasters, such as earthquakes or hurricanes. The effect of acts of terrorism may be widespread, creating a mass trauma and affecting those directly and indirectly involved. 

Keep in mind that a patient with PTSD may first report physical symptoms such as sleeplessness or indigestion. If a Harvard Pilgrim member is displaying symptoms of PTSD, our behavioral health partner can help with diagnosis and treatment.

How Optum/United Behavioral Health (Optum/UBH) can help your patients—For complex clinical situations, Optum/UBH is available to provide consultative assistance. Practitioners can call the Optum/UBH Physicians Consultation Service at (800) 292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call Optum/UBH at (888) 777-4742.

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