© Copyright 2000 Physicians Postgraduate Press, Inc. One personal copy may be printed 60 J Clin Psychiatry 2000;61 (suppl 5) Ballenger et al. osttraumatic stress disorder (PTSD) is an important anxiety disorder because it is common, chronic, and and the legal profession in particular. There is a unique in- terface between PTSD and the legal system, rooted in insurance claims and unfortunate skepticism about the concept of PTSD. 2 Despite extensive research, no test has emerged to confirm that an individual has the disorder. PTSD remains a clinical diagnosis. By definition, PTSD differs from other anxiety disorders because its onset depends on exposure to a traumatic ex- perience. The current behavior of sufferers is psychologi- cally organized around, and dominated by, a traumatic experience. This may relate to a single event, as in an acci- dent, or a series of related events, as in persistent sexual abuse. Extreme anxiety and recurrent “reexperiencing” of the trauma are stimulated by reminders of the event, and these flashbacks are one of the core features of PTSD. Suf- ferers often report that experiencing flashbacks is extremely distressing because any sense of control or choice of be- havior is removed in the memory. PTSD was the subject of the fourth meeting of the Inter- national Consensus Group on Depression and Anxiety. As in our earlier consensus meetings, our objective was to pro- vide clinicians with a better understanding of the condition by identifying what is known in the field and what requires Discussed at the meeting “Focus on Posttraumatic Stress Disorder,” April 29–30, 1999, in Montecatini, Italy, held by the International Consensus Group on Depression and Anxiety. The Consensus Meeting was supported by an unrestricted educational grant from SmithKline Beecham Pharmaceuticals. Reprint requests to: James C. Ballenger, M.D., Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 171 Ashley Ave., Charleston, SC 29425- 0742. P disabling in many ways, impairing the functionality and physical health of sufferers and imposing an enormous burden on society. Recent assessment of the cost of anxi- ety disorders in the United States estimates the annual cost at $63 billion in 1998 dollars, 1 with PTSD and panic disor- der identified as the anxiety disorders with the highest rates of service use and work limitation. PTSD is underrecognized in clinical practice, by pri- mary care physicians and psychiatrists alike, but the need to disseminate information about PTSD extends beyond the medical profession to the community at large, employers, Consensus Statement on Posttraumatic Stress Disorder From the International Consensus Group on Depression and Anxiety James C. Ballenger, M.D.; Jonathan R. T. Davidson, M.D.; Yves Lecrubier, M.D.; and David J. Nutt, D.M., M.R.C.P., F.R.C.Psych. (International Consensus Group on Depression and Anxiety); and Edna B. Foa, Ph.D.; Ronald C. Kessler, Ph.D.; Alexander C. McFarlane, M.D.; and Arieh Y. Shalev, M.D. Objective: To provide primary care clinicians with a better understanding of management issues in posttraumatic stress disorder (PTSD) and guide clinical practice with recommendations on the appro- priate management strategy. Participants: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Other faculty invited by the chair were Edna B. Foa, Ronald C. Kessler, Alexander C. McFarlane, and Arieh Y. Shalev. Evidence: The consensus statement is based on the 6 review ar- ticles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. Consensus process: Group meetings were held over a 2-day period. On day 1, the group discussed the review articles and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. Conclusion: PTSD is often a chronic and recurring condition associated with an increased risk of developing secondary comorbid disorders, such as depression. Selective serotonin reuptake inhibitors are generally the most appropri- ate choice of first-line medication for PTSD, and effective therapy should be continued for 12 months or longer. The most appropriate psychotherapy is exposure therapy, and it should be continued for 6 months, with follow-up therapy as needed. (J Clin Psychiatry 2000;61[suppl 5]:60–66)