Post-traumatic stress disorder (PTSD) is a maladaptive and debilitating psychiatric disorder, characterized by re-experiencing, avoidance, negative emotions and thoughts, and hyperarousal in the months and years following exposure to severe trauma. PTSD has a prevalence of approximately 6–8% in the general population, although this can increase to 25% among groups who have experienced severe psychological trauma, such as combat veterans, refugees and victims of assault. The risk of developing PTSD in the aftermath of severe trauma is determined by multiple factors, including genetics — at least 30–40% of the risk of PTSD is heritable — and past history, for example, prior adult and childhood trauma. Many of the primary symptoms of PTSD, including hyperarousal and sleep dysregulation, are increasingly understood through translational neuroscience. In addition, a large amount of evidence suggests that PTSD can be viewed, at least in part, as a disorder that involves dysregulation of normal fear processes. The neural circuitry underlying fear and threat-related behaviour and learning in mammals, including the amygdala–hippocampus–medial prefrontal cortex circuit, is among the most well-understood in behavioural neuroscience. Furthermore, the study of threat-responding and its underlying circuitry has led to rapid progress in understanding learning and memory processes. By combining molecular–genetic approaches with a translational, mechanistic knowledge of fear circuitry, transformational advances in the conceptual framework, diagnosis and treatment of PTSD are possible. In this Review, we describe the clinical features and current treatments for PTSD, examine the neurobiology of symptom domains, highlight genomic advances and discuss translational approaches to understanding mechanisms and identifying new treatments and interventions for this devastating syndrome.

创伤后应激障碍（PTSD）是一种适应不良和使人衰弱的精神疾病，其特征是在遭受严重创伤后的数月和数年内重新经历、回避、消极情绪和想法以及过度警觉。 PTSD 在普通人群中的患病率约为 6-8%，尽管在经历过严重心理创伤的群体中，如退伍军人、难民和袭击受害者，这一比例可能会上升至 25%。严重创伤后发生 PTSD 的风险由多种因素决定，包括遗传（至少 30-40% 的 PTSD 风险是可遗传的）和既往史，例如之前的成人和儿童创伤。转化神经科学越来越多地了解创伤后应激障碍（PTSD）的许多主要症状，包括过度警觉和睡眠失调。此外，大量证据表明，创伤后应激障碍（PTSD）至少可以部分地被视为一种涉及正常恐惧过程失调的疾病。哺乳动物中与恐惧和威胁相关的行为和学习背后的神经回路，包括杏仁核-海马体-内侧前额叶皮层回路，是行为神经科学中最容易理解的神经回路之一。此外，对威胁响应及其底层电路的研究使人们在理解学习和记忆过程方面取得了快速进展。通过将分子遗传学方法与恐惧回路的转化机制知识相结合，创伤后应激障碍的概念框架、诊断和治疗方面的变革性进展是可能的。 在这篇综述中，我们描述了 PTSD 的临床特征和当前的治疗方法，检查了症状领域的神经生物学，强调了基因组进展，并讨论了理解机制和确定这种破坏性综合症的新治疗方法和干预措施的转化方法。