Snapshot A 32-year-old male presents with difficulty sleeping. The patient states that these symptoms began approximately 3 months ago, when he lost his close friend while they were both in combat. He re-experiences this loss during the day and in his dreams. The patient reports anxiety and depression. Introduction Anxiety disorder secondary to traumatic event which can be experienced or observed examples of traumatic events: war exposure from the perspective of a civilian or a combatant physical assault physical abuse of a child robbery sexual violence leading to psychological distress when exposed to triggers that remind them of traumatic event Presentation Clinical features intrusive thoughts nightmares sleep disturbances flashbacks hypervigilance results in avoidance of stimuli associated with the traumatic event causes significant distress/impaired functioning including onset > 1 month after event with symptoms persisting > 1 month Differential Diagnosis Acute stress disorder clinical presentation the same as PTSD ≥ 3 days to 1 month after being exposed to the traumatic event Treatment Pharmacotherapy selective serotonin reuptake inhibitors (SSRIs) first-line examples: paroxetine, sertraline prazosin can help reduce nightmares related to PTSD Psychotherapy cognitive behavioral therapy (CBT) exposure therapy