Office management of posttraumatic stress disorder. A clinician's guide to a pervasive problem

Primary care physicians are often called on to help patients and families struggling with posttraumatic stress disorders. The characteristic clusters of symptoms, namely, reexperiencing, avoidance, and hyperarousal, are easily confused with other disorders, particularly since symptoms can occur months or even years after the initial trauma. Treatment includes drug therapy and clinical office techniques to stabilize symptoms, such as interrupting traumatic flashbacks, educating family members about effective home care, and redirecting unhealthy self-blame and aggression. Nonetheless, some patients need psychiatric referral for further processing of traumatic perceptions and adaptive integration of the trauma into a self-view and world-view.