Traumatic
Disorders

Trauma- and stressor-related disorders are unusual in psychiatry: an identifiable event is part of the diagnosis rather than background to it. DSM-5 moved PTSD out of the anxiety disorders into its own chapter for exactly this reason, alongside acute stress disorder, adjustment disorders, and — since 2022 — prolonged grief disorder.

What separates them is largely timing. Acute stress disorder covers the window from three days to one month after exposure. Beyond a month, the diagnosis becomes PTSD. Adjustment disorder describes symptoms beginning within three months of a stressor that was difficult rather than traumatic. Prolonged grief disorder requires at least twelve months since a death in adults. Getting the timeline right is most of the diagnostic work, and it determines what treatment is appropriate and how long it should reasonably take.

ICD-11 recognises complex PTSD as a separate diagnosis for prolonged or repeated trauma — the core PTSD features plus persistent difficulties with emotional regulation, self-concept, and relationships. DSM-5-TR does not include it as a distinct disorder, which is worth knowing if you've been given the label: it's a real and useful clinical description, and which manual your clinician works from affects how it gets recorded.

Most people exposed to trauma do not develop a disorder. NIMH estimates past-year PTSD at 3.6% of U.S. adults and lifetime prevalence at 6.8%, with rates roughly three times higher in women than men, and 36.6% of past-year cases classed as seriously impairing.

On treatment the guidance is unusually clear, and worth stating because it is regularly reversed in practice. The 2023 VA/DoD clinical practice guideline makes a strong recommendation for specific manualized psychotherapies — prolonged exposure, cognitive processing therapy, and EMDR — over pharmacotherapy. Where medication is used, paroxetine, sertraline and venlafaxine are recommended, with sertraline and paroxetine the two carrying FDA indications for PTSD. The same guideline makes strong recommendations against benzodiazepines and against cannabis and its derivatives.

That last point matters, because benzodiazepines remain among the most commonly prescribed medications for trauma symptoms. They don't treat PTSD, they interfere with the learning that trauma-focused therapy depends on, and they carry dependence risk in a population with elevated substance-use rates. If you're already taking one, that's a conversation about a planned taper rather than a reprimand.

Co-occurring conditions — depression, substance use, chronic pain, insomnia — are the rule rather than the exception, and the guideline is explicit that their presence should not exclude anyone from recommended treatment. Dr. Farkas brings MD/PhD neuroscience training, NIH research center experience, and board-certified psychiatric practice to this work.

A new patient evaluation with Dr. Farkas runs 30–60 minutes. It covers when symptoms began relative to what happened, which symptom clusters are present now, sleep, what you avoid, alcohol and substance use, prior treatment including therapy, and every medication tried.

You will not be asked to narrate an event in detail. You'll leave with a specific diagnosis, a clear account of which therapy is indicated and a referral for it, and an honest explanation of medication's role. Telehealth is available throughout South Carolina and New York. In-person appointments are available at the Bluffton, SC office.