Can someone be diagnosed with both Post-Traumatic Stress Disorder (PTSD) and an anxiety disorder?

From the Guidelines

Yes, a person can be diagnosed with both Post-Traumatic Stress Disorder (PTSD) and an anxiety disorder simultaneously, as stated in the 2023 guideline update by the American Society of Clinical Oncology 1. This is called comorbidity, which is common in mental health conditions. PTSD is actually classified as a trauma and stressor-related disorder, while anxiety disorders include conditions like generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias. Many people with PTSD also experience symptoms that meet the criteria for one or more anxiety disorders. For example, someone might have PTSD from a traumatic event and also have generalized anxiety disorder that causes excessive worry about many different aspects of life. Some key points to consider when diagnosing and treating co-occurring PTSD and anxiety disorders include:

• Screening for anxiety disorders, including PTSD, using valid and reliable tools such as the GAD-7 scale 1
• Assessing for symptoms of anxiety, including panic attacks, trembling, sweating, and palpitations, as well as underlying problems or causes 1
• Considering the use of psychotherapy, such as cognitive behavioral therapy, prolonged exposure therapy, or EMDR, and sometimes medications like SSRIs or SNRIs 1
• Focusing on the most distressing symptoms first and developing strategies to manage both conditions over time
• Using secure video teleconferencing to deliver recommended psychotherapy when other options are unavailable 1 It's also important to note that the treatment plan should address both conditions, and therapists should work with patients to develop strategies to manage both conditions over time. In terms of specific treatment recommendations, the 2023 guideline update by the American Society of Clinical Oncology recommends using specific manualized psychotherapies, such as prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy, over pharmacotherapy 1. Additionally, the guideline recommends against the use of benzodiazepines, cannabis, or cannabis-derived products for the treatment of PTSD and anxiety disorders 1. Overall, diagnosing and treating co-occurring PTSD and anxiety disorders requires a comprehensive and patient-centered approach that takes into account the individual's unique needs and circumstances.

From the FDA Drug Label

PTSD, as defined by DSM-III-R/IV, requires exposure to a traumatic event that involved actual or threatened death or serious injury, or threat to the physical integrity of self or others, and a response which involves intense fear, helplessness, or horror Social anxiety disorder, as defined by DSM-IV, is characterized by marked and persistent fear of social or performance situations involving exposure to unfamiliar people or possible scrutiny by others and by fears of acting in a humiliating or embarrassing way Anxiety is a symptom that can occur in various psychiatric disorders, including PTSD and social anxiety disorder.

Key Points:

• PTSD and anxiety disorders are distinct psychiatric conditions with different diagnostic criteria.
• A person can be diagnosed with both PTSD and an anxiety disorder, as these conditions can co-occur.
• The diagnostic criteria for PTSD and anxiety disorders are outlined in the DSM-III-R/IV and DSM-IV, respectively.
• Symptoms of anxiety can be present in both PTSD and social anxiety disorder, among other conditions.

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From the Research

Diagnosis of PTSD and Anxiety Disorders

• PTSD and anxiety disorders are not mutually exclusive, and individuals can be diagnosed with both conditions 3, 4, 5.
• The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition classification no longer considers PTSD as an anxiety-related disorder, but rather as a trauma/stressor-related disorder 3.
• Despite this reclassification, similarities exist in consideration of diagnosis, treatment, and comorbidities with anxiety disorders 3.

Comorbidity of PTSD and Anxiety Disorders

• Studies have shown that PTSD commonly co-occurs with other psychiatric disorders, including anxiety disorders, depressive disorders, and substance use disorders 4, 5.
• The comorbidity of PTSD and depressive disorders is of particular interest, as these are the disorders most likely to co-occur with PTSD 5.
• Anxiety disorders are the most common class of mental conditions and are highly comorbid with other disorders, including PTSD 4.

Treatment of PTSD and Anxiety Disorders

• Treatment approaches for PTSD and anxiety disorders often overlap, with cognitive-behavioral therapy and pharmacologic intervention being commonly used for both conditions 3, 4, 6.
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly used in the treatment of PTSD and anxiety disorders 3, 4, 6.
• Treating sleep disruption, including sleep apnea, nightmares, and insomnia, may improve symptoms of PTSD, as well as improve mood in anxiety disorders 3.

Differential Diagnosis of PTSD and Anxiety Disorders

• Clinicians can distinguish PTSD from other diagnostic categories, including major depressive disorder (MDD) and generalized anxiety disorder (GAD) 7.
• A study found that experienced clinicians could readily distinguish PTSD from MDD and GAD, as well as MDD from GAD, based on a common set of symptom items 7.