A PMHNP was assigned to a COVID-19 unit during the pandemic. Her assignment was to assist dying patients in saying goodbye to their loved ones via telephone. She facilitated their phone conversations and watched the patients have their last conversations with their family, often crying in agony. More than 2 months after this assignment, during which she assisted hundreds of patients who died, the PMHNP began having nightmares about these experiences. She had flashbacks of some of the memories, often triggered when she received a phone call or looked at her phone. She began avoiding using her phone. She began having difficulty with concentration and often couldn't remember details of her time on the COVID-19 unit. She often felt detached from reality and the world. What diagnosis is most appropriate?

Choice A reason: Major depressive disorder involves persistent low mood, anhedonia, and functional impairment. While some depressive symptoms may occur secondary to trauma, the primary presentation here involves re-experiencing trauma, avoidance, and hyperarousal rather than classic depressive features. Choice B reason: Generalized anxiety disorder is characterized by chronic, excessive worry about multiple life domains, not the trauma-specific intrusive symptoms described. Choice C reason: Acute stress disorder occurs within 3–30 days after a traumatic event and resolves within a month. Symptoms in this scenario persisted for more than 2 months, exceeding the time frame for acute stress disorder. Choice D reason: This is correct. The patient exhibits hallmark features of PTSD, including intrusive memories (nightmares and flashbacks), avoidance (avoiding phone use), negative alterations in cognition and mood (detachment), and hyperarousal. Symptoms have persisted for more than 1 month after exposure to trauma, meeting criteria for PTSD.