PTSD (Post-Traumatic Stress Disorder)

Post-traumatic stress disorder, or PTSD, is a mental health condition that can develop after you experience or witness a traumatic event. These could include war, natural disaster, abuse or sexual assault, among others.

You might have symptoms like having unwanted memories and flashbacks, negative mood changes, feeling on edge or being easily startled. These can last more than a month at a time and may affect your routine, relationships and school or work.

A healthcare provider can help you manage these symptoms.

Types of PTSD

This condition may show up in different ways. Providers recognize several subtypes based on age, timing or specific symptoms:

• Preschool PTSD: This affects children age 6 and younger. Symptoms may show up through play, behavior changes or strong emotional reactions instead of words.
• Dissociative PTSD: This includes symptoms of dissociation, like feeling disconnected from your body or feeling like the world isn’t real.
• PTSD with delayed expression: Full symptoms don’t appear until at least six months after the traumatic event, even though mild symptoms may start earlier.
• Complex PTSD (C-PTSD): This comes from long-term or repeated trauma (especially interpersonal trauma). It includes PTSD symptoms, plus ongoing problems with emotions, self-image and relationships. C-PTSD is recognized in the ICD-11, but it isn’t in the DSM-5-TR. Some providers may still use the term to describe your symptoms.

Knowing the type of PTSD you have helps your provider plan care. They’ll determine the type after reviewing your symptoms and health history.

PTSD symptoms

Symptoms of post-traumatic stress disorder usually fall into four main groups. Each group affects how you think, feel or react after a traumatic event. If symptoms last more than a month or interfere with daily life, talk to a healthcare provider.

Intrusion symptoms

These bring the negative memory back into your mind, even when you don’t want to think about it. You might:

• Have flashbacks, where the event feels like it’s happening again
• Have nightmares about what happened
• Have repeated, unwanted memories of the event

Avoidance symptoms

These involve trying to stay away from reminders of the trauma. You might:

• Avoid people, places, activities or situations that remind you of the event
• Not talk about the event or your feelings about it
• Try not to think about or remember what happened

Changes in thinking and mood

These affect how you feel about yourself, others and the world around you. You might:

• Blame yourself or others for what happened, even when it’s not accurate
• Feel ongoing fear, anger, guilt, shame or horror
• Feel detached or distant from other people
• Find it hard to feel positive emotions
• Have negative thoughts about yourself or others
• Lose interest in activities you once enjoyed
• Not remember important parts of the event

Changes in arousal and reactivity

These affect how alert or reactive your body feels. You may:

• Act in risky or self-destructive ways (like substance use or reckless behavior)
• Feel irritable or have angry outbursts
• Have trouble concentrating or sleeping
• Startle easily
• Stay on high alert or feel overly watchful of your surroundings

Symptoms of PTSD in children

This condition can look different in children. And kids may not have the words to explain how they feel.

Common PTSD symptoms in kids may include:

• Acting restless, fidgety or having trouble paying attention
• Acting unusually fearful, sad or angry
• Avoiding people, places or activities that remind them of what happened
• Being easily startled or always alert
• Having bad dreams or trouble sleeping
• Having strong emotional reactions or frequent temper tantrums
• Pulling away from others or losing interest in play and activities
• Repeating the situation during play

Some symptoms can also look like ADHD, so it’s important to have a mental health specialist evaluate your child. If you notice these symptoms lasting or getting worse, a pediatrician can help determine the next steps for children.

What can trigger symptoms of PTSD?

A trigger is something that reminds you of the trauma and makes symptoms feel more intense.

Triggers can include sights, sounds, smells, places or situations. For example, a loud noise or fireworks may bring back memories from a war zone, or a song may remind you of someone who hurt you. Even certain dates or times of year can cause symptoms to flare. When a trigger happens, symptoms like anxiety, flashbacks or strong emotions may return, even if you were feeling better before.

Triggers are a normal part of this condition. A healthcare provider can help you identify them and manage your reaction.

Causes of PTSD

Exposure to a traumatic event causes post-traumatic stress disorder. Trauma is a situation that feels life-threatening or deeply stressful. Examples of these events include:

• Natural disasters, like tornadoes, earthquakes, fires or floods
• Physical or verbal abuse
• Serious accidents, like car crashes
• Severe injury or sudden illness
• Sexual assault or sexual abuse
• The sudden death of a loved one
• War or military combat

Many people experience these situations, but not everyone develops PTSD. Experts don’t fully understand why people respond differently. Research shows that this condition may involve changes in brain chemicals and how certain parts of your brain work:

• Changes in stress chemicals: This condition may affect chemicals in your brain that control stress and mood. These changes may keep your body in “fight-or-flight” mode. This may raise your heart rate, blood pressure and startle response (like changes in cortisol and norepinephrine signaling).
• Changes in your brain: Areas in your brain that process memory, fear and emotional response may be smaller, overactive or less responsive. It’s not always clear whether these changes existed before the experience or developed afterward. These changes may make it harder to manage fear, stress and emotions (like in the amygdala, hippocampus and prefrontal cortex).

Risk factors

PTSD can affect anyone. But certain factors may raise the risk before, during or after an experience.

Risk factors include:

• Being a first responder or military service member, living in a war zone or forced to migrate because of conflict
• Living through adverse childhood experiences or a negative or severe past event
• Having little social support before or after a negative event
• Feeling intense fear, panic or numbness during the event
• Living with ongoing stress, like financial hardship or discrimination
• Having anxiety, depression or a family history of mental health conditions

Having one or more risk factors doesn’t mean you’ll develop PTSD, but it may make managing this condition more difficult without support.

Complications

PTSD may affect more than your emotions. Over time, symptoms may lead to other mental health, physical and life challenges if they aren’t treated. Complications may include:

• Anxiety disorders
• Depression and other mood disorders
• Problems at work or school
• Risky or self-destructive behaviors
• Sleep problems
• Substance use disorder (including alcohol or drug use)
• Suicidal thoughts or suicide attempts
• Trouble with relationships

In children and teens, complications may also include:

• Behavioral problems, like irritability or aggression
• Social withdrawal or difficulty with peers
• Trouble at school or falling behind developmentally

If you or a loved one is thinking about suicide, call or text 988 to reach the Suicide and Crisis Lifeline. Someone is available to help you 24/7.

How doctors diagnose PTSD

There’s no single test to diagnose PTSD. Instead, a mental health specialist makes the diagnosis by talking with you about your symptoms, your medical and mental health history, and any trauma you’ve experienced. It can all be hard to talk about, so you may want to bring a trusted person with you for support.

In some cases, your provider may order blood tests to rule out other medical causes of your symptoms. There are no lab tests that can diagnose PTSD directly. They may also use questionnaires or interviews to better understand how your life experiences affect you.

Your provider may also check for related conditions like depression, anxiety or substance use, as these may occur alongside PTSD.

PTSD DSM-5 criteria

To diagnose this condition, a mental health provider compares your symptoms to criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). The criteria include:

• You had exposure to a traumatic event, either directly, by witnessing it, learning it happened to a loved one or through repeated exposure at work.
• You have symptoms from four groups: intrusion, avoidance, negative changes in mood or thinking and arousal or reactivity.
• You have symptoms that last longer than one month.
• Symptoms cause serious problems in your daily life, like work, school or relationships.
• Symptoms aren’t caused by substances, medications or another medical condition.

PTSD treatment

PTSD treatment often includes therapy and medications. Many people benefit from using both together. Your provider will work with you to choose what fits your symptoms, needs and comfort level.

PTSD therapy

Therapy is usually the first choice for treating this condition. There are different types to help you process negative experiences and build coping skills:

• Trauma-focused cognitive behavioral therapy (CBT): This helps you notice unhelpful thoughts linked to the experience and replace them with healthier ones. This includes approaches like cognitive processing therapy (CPT). It also teaches coping and stress-management skills.
• Exposure therapy: This helps you slowly and safely face reminders. One common type is prolonged exposure therapy. Over time, it may reduce fear and stress.
• Eye movement desensitization and reprocessing (EMDR): This uses guided eye movements while you think about bad memories. It may make memories feel less intense.
• Supportive therapy: This focuses on emotional support and coping. It may help early on or when symptoms feel overwhelming.
• Group therapy: This lets people who’ve had similar experiences share their thoughts and feelings in a supportive, nonjudgmental setting. Family therapy may also help, as PTSD can affect your loved ones.

PTSD medications

Medications may help you manage symptoms, especially when therapy feels hard to start.

• SSRIs and SNRIs: These antidepressants help balance brain chemicals. The U.S. Food and Drug Administration (FDA) approves SSRIs, like sertraline and paroxetine, for PTSD. They may reduce anxiety, low mood and intrusive thoughts.
• Prazosin: This may reduce nightmares and sleep problems. It’s often used off-label, and results may vary from person to person.
• Second-generation antipsychotics: Providers may use these in some cases when symptoms are severe or don’t improve with other treatments. These are usually added to other medications rather than used alone.

Your provider can adjust your treatment plan as your needs change.

Alternative therapies

Alternative therapies are nontraditional approaches that may support PTSD treatment. Providers often recommend them alongside therapy and medications to help manage stress and other symptoms.

Options may include:

• Acupuncture
• Mindfulness and meditation
• Service animals
• Yoga

When should I see my healthcare provider?

Reach out to a provider if you:

• Have symptoms that last more than one month
• Notice symptoms affecting work, school or relationships
• Have flashbacks, nightmares or avoid reminders of the event
• Feel anxious, can’t sleep or struggle to focus
• Feel depressed, use substances to cope or have thoughts of self-harm or suicide

If you feel at immediate risk of harming yourself, seek emergency help right away or call or text 988 to reach the Suicide and Crisis Lifeline.

What can I expect if I have PTSD?

PTSD doesn’t have a quick cure, but it can be managed. Some days may feel harder, especially during stress or reminders. Progress often isn’t a straight line, and ups and downs are common.

This condition doesn’t define who you are, but it may change your routines, relationships and energy for a while. With support, you might find ways to reconnect with work, relationships and activities that matter most to you.

Finding the right treatment can take time. Your provider may adjust your plan as your needs change. Improvement often happens gradually. Even when symptoms don’t fully disappear, they may feel less disruptive over time.

Can PTSD be prevented?

You can’t prevent all causes. But certain steps after trauma may lower the risk and support your recovery. You may try:

• Staying connected with supportive friends or family
• Seeking professional help early if symptoms don’t improve after a few weeks
• Waiting until you’re ready to talk about the trauma
• Returning to daily routines, like work or school, when it’s safe to do so
• Using healthy coping skills instead of addictive substances