The key to establishing the diagnosis of PTSD lies in the history of exposure to a perceived or actual life-threatening event, serious injury, or sexual violence. This can include serious medical illnesses, and the prevalence of PTSD is higher in people who have experienced serious illnesses such as cancer. The symptoms of PTSD include intrusive thoughts (eg, flashbacks, nightmares), avoidance (eg, withdrawal), negative thoughts and feelings, and increased reactivity. Patients with PTSD can experience physiologic hyperarousal, including startle reactions, illusions, overgeneralized associations, sleep problems, nightmares, dreams about the precipitating event, impulsivity, difficulties in concentration, and hyperalertness. The symptoms may be precipitated or exacerbated by events that are a reminder of the original traumatic event. Symptoms frequently arise after a long latency period (eg, child abuse can result in later-onset PTSD). DSM-5 includes the requirement that the symptoms persist for at least 1 month. In some individuals, the symptoms fade over months or years, and in others they may persist for a lifetime.