**4. Clinical overview of PTSD**

A cluster of psychiatric symptoms that persist for more than 1 month following a trauma, causing distress or a decrease in functionality in social, occupational, or other important areas of life is called PTSD [51].

**Trauma content**: There is actual or intimidating death, serious injury, or sexual assault. The person may have experienced this event directly and witnessed it. It may be the death of a family member or friend or learning that he or she has experienced trauma with a high probability of death. Persistent encounter with the adverse consequences of traumatic events (occupational exposure).

**What happens?** Recurrent involuntary distressing memories of traumatic events and recurrent distressing dreams involving these memories. Feeling as if traumatic events are recurring, dissociative reactions. Experiencing excessive or extended distress or physiological responses at exposure to stimuli that symbolize or evoke traumatic events.

**What are the avoidance behaviors?** Efforts to avoid and avoid distressing memories, feelings, and thoughts associated with the traumatic event. Avoidance or efforts to avoid people, places, conversations, activities, objects, and situations that may evoke distressing memories, feelings, and thoughts associated with the traumatic event.

**What is observed in cognitions and mood following the trauma?** Inability to remember the trauma, Negative beliefs, and expectations about self, others, or the world; Blaming self or others about the cause and consequences of the traumatic event, Persistent negative emotional states (e.g., fear, horror, anger, guilt, and shame); Decreased interest and participation in important activities; Feelings of detachment or alienation from others; Inability to constantly experience positive emotions (such as happiness and love).

**What are the changes in arousal and the reactions?** Verbal or non-verbal aggressive, angry behavior toward people or objects, outbursts of anger; Acting without restraint or engaging in self-destructive behavior; being alert all the time; Exaggerated startle response: It occurs in 88% of patients. Increased heart rate, greater skin conductance responses, and slower skin conductance in response to startling stimuli are well-defined findings [51, 52]. Focusing difficulties: The reason for the decrease in attention resources is the basic loss of sensory mechanisms before attention [52]. The dissociative subtype emphasizes a closure or blunted response to traumatic stressors characterized by dissociation [51–53]. The person constantly or recurrently experiences one of the following symptoms in response to the triggering factor:


**What is Delayed Onset PTSD?** If the symptoms are not fully appeared at least 6 months after the traumatic event (even if some symptoms start in a short time), it is called delayed-onset PTSD.
