Posttraumatic stress disorder (PTSD) may develop after severe or prolonged life-threatening events, such as those caused by war, accidents, and other traumas (e.g., fires, assault, near-drowning) (12). Persons with PTSD often relive their traumatic event in flashbacks and/or nightmares (13, 14). Individuals with PTSD also may experience severe anxiety when exposed to scenarios reminiscent of the original trauma and often avoid anything (mentally or physically) that reminds them of the trauma they experienced (12). Additional symptoms of PTSD include persistent alertness and mental hyperarousal, insomnia, irritability, hypervigilance, and low concentration, as well as reckless and self-destructive behaviors (e.g., illicit drug use, risky sexual behaviors, deliberate self-harm) (1214). In PTSD, the trauma-related episodes are typically followed by distressing physiological responses that result in cognitive and behavioral avoidance, a coping mechanism aimed at reducing psychological distress and physiological hyperarousal (15). However, this avoidance only reinforces fear and thwarts adaptive processing of traumatic memories, thus perpetuating PTSD symptoms (15, 16)
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