PTSD (Post-Traumatic Stress Disorder)

What is PTSD?

PTSD (post-traumatic stress disorder) is a mental health condition that some people develop after they experience or witness a traumatic event. The traumatic event may be life-threatening or pose a significant threat to your physical, emotional or spiritual well-being. PTSD affects people of all ages.

People with PTSD have intense and intrusive thoughts and feelings related to the experience that last long after the event. PTSD involves stress responses like:

• Anxiety, depressed mood, or feelings of guilt or shame.
• Having flashbacks or nightmares.
• Avoiding situations, places and activities related to the traumatic event.

These symptoms cause distress and interfere with your daily functioning.

What is a traumatic event?

Trauma or a traumatic event is anything that severely threatens your existence or sense of safety. It doesn’t have to be a single event (like a car accident) — it can be long-term trauma like living through war or frequent abuse. Trauma also doesn’t have to happen directly to you — you could witness a traumatic event. In addition, you could develop PTSD after learning that a traumatic event happened to a loved one.

Examples of traumatic events include (but aren’t limited to):

• Serious accidents, like a car accident.
• Severe injury or sudden illness.
• War and military combat.
• Natural disasters, such as a tornado, earthquake, fire or flood.
• Physical abuse.
• Verbal abuse.
• Sexual assault or abuse.
• Bullying.
• The sudden death of a loved one.

Types of PTSD

Two conditions are closely related to PTSD:

• Acute stress disorder: This is a short-term mental health condition that can occur within the first month after experiencing a traumatic event. Symptoms lasting longer than four weeks may meet the criteria for PTSD.
• Complex PTSD (CPTSD): This is a mental health condition that can develop if you experience chronic (long-term) trauma. Examples of chronic trauma include long-term child physical or sexual abuse, long-term domestic violence and war. People with CPTSD typically have PTSD symptoms in addition to extensive issues with emotion regulation, sense of self and relationships.

How common is PTSD?

PTSD is common. It develops in 5% to 10% of people who have experienced trauma.

What are the symptoms of PTSD?

To receive a PTSD diagnosis, symptoms must last for more than a month and must cause significant distress or issues in your daily functioning. The symptoms of PTSD fall into four categories:

Intrusion:

• Intrusive thoughts, such as repeated, involuntary memories.
• Nightmares.
• Flashbacks of the traumatic event, which can be very vivid and feel real.

Avoidance:

• Avoiding reminders of the traumatic event, like people, places, activities, things and situations.
• Avoiding remembering or thinking about the traumatic event.
• Avoiding talking about what happened or how you feel about it.

Changes in thinking and mood:

• Ongoing fear, horror, anger, guilt or shame.
• Memory loss of important aspects of the traumatic event.
• Ongoing negative and distorted thoughts and feelings about yourself or others.
• Distorted thoughts about the cause or effects of the event that lead to wrongly blaming yourself or others.
• Feeling detached from others.
• No longer enjoying activities you once did.
• Being unable to experience positive emotions.

Changes in arousal and reactivity:

• Irritability and angry outbursts.
• Reckless or self-destructive behavior.
• Being overly watchful of your surroundings (hypervigilance).
• Being easily startled.
• Problems concentrating or sleeping.

Symptoms of PTSD in children

Children with PTSD may have difficulty expressing how they’re feeling or they may have experienced trauma that you don’t know about. They may seem restless, fidgety, or have trouble paying attention and staying organized.

These symptoms can be confused with symptoms of attention-deficit/hyperactivity disorder (ADHD). Because of this, it’s important to take your child to a specialist (like a child psychologist) who has experience in diagnosing PTSD.

Complications of PTSD

The following conditions are common in people with PTSD, which can make PTSD symptoms worse:

• Mood disorders.
• Anxiety disorders.
• Neurological conditions, including dementia.
• Substance use disorder, including alcohol use disorder.

People with PTSD also have an increased risk of suicidal thoughts and attempts.

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.

What causes PTSD?

Approximately 61% to 80% of people experience a traumatic event at some point in their lives. PTSD develops in about 5% to 10% of this population. 

It’s unclear why people respond differently to trauma. But studies show that people with PTSD have abnormal levels of certain neurotransmitters and hormones. They also experience brain changes.

Neurotransmitter and hormone changes

Studies show that people with PTSD have normal to low levels of cortisol (the “stress hormone”) and elevated levels of corticotropin-releasing factor (CRF) despite ongoing stress. CRF triggers the release of norepinephrine, which leads to an increased sympathetic nervous system response. This “fight or flight” response leads to increased:

• Heart rate.
• Blood pressure.
• Awareness and startle response.

In addition, some studies show altered functioning of other neurotransmitter systems, including:

• Gamma-aminobutyric acid (GABA).
• Glutamate.
• Serotonin.

Brain changes

PTSD is associated with changes in the functioning and anatomy of your brain:

• The size of your hippocampus (a part of your brain that regulates motivation, emotion, learning and memory) decreases.
• The amygdala (the part of your brain that processes emotions and fear responses) is overly reactive in people with PTSD.
• The medial prefrontal cortex, which partly controls the emotional reactivity of your amygdala, appears to be smaller and less responsive in people with PTSD.

What are the risk factors for PTSD?

There’s no way to predict who will develop PTSD after a traumatic event. But PTSD is more common in people who have experienced:

• Certain types of trauma, particularly military combat or sexual assault.
• Trauma during childhood.
• Injury during the event.
• Horror, helplessness or extreme fear at the time of the event.
• Lack of social support after a traumatic event.
• Long-lasting or repeated trauma.
• Mental health conditions and/or substance use.

How is PTSD diagnosed?

There’s no test to diagnose PTSD. Instead, a healthcare provider makes the diagnosis after asking about your:

• Symptoms.
• Medical history.
• Mental health history.
• Exposure to trauma.

It may be difficult to talk about the trauma. You may want to bring a loved one with you to the appointment for support and to help provide details about your symptoms and behavior changes.

Providers use the diagnostic criteria for PTSD in the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The latest version is the DSM-5-TR (“TR” stands for “text revision”). To get a diagnosis of PTSD, you must have had the following symptoms for at least one month:

• At least one intrusion symptom.
• At least one avoidance symptom.
• At least two thinking and mood symptoms.
• At least two arousal and reactivity symptoms.

Your provider may also perform a physical exam and order certain tests (like blood tests) to see if any physical conditions could be causing some of your symptoms.

How is PTSD treated?

Psychotherapy (talk therapy) is the main treatment for PTSD, especially forms of cognitive behavioral therapy (CBT).

This therapy takes place with a trained, licensed mental health professional, such as a psychologist or psychiatrist. They can provide support, education and guidance to you and/or your loved ones to help you function better and increase your well-being.

Specific forms of CBT for PTSD include:

• Cognitive processing therapy: This therapy was designed specifically to treat PTSD. It focuses on changing painful negative emotions (like shame and guilt) and beliefs due to the trauma. It also helps you confront distressing memories and emotions.
• Eye movement desensitization and reprocessing (EMDR) therapy: This method involves moving your eyes a specific way while you process traumatic memories. EMDR’s goal is to help you heal from trauma or other distressing life experiences. Compared to other therapy methods, EMDR is relatively new. But dozens of clinical trials show this technique is effective and can help a person faster than many other methods.
• Group therapy: This type of therapy encourages survivors of similar traumatic events to share their experiences and feelings in a comfortable and nonjudgmental setting. Family therapy may also help, as challenges of PTSD can affect the entire family.
• Prolonged exposure therapy: This therapy uses repeated, detailed imagining of the trauma or progressive exposures to symptom triggers in a safe, controlled way. This helps you face and gain control of fear and learn to cope.
• Trauma-focused CBT: This therapy involves learning about how your body responds to trauma and stress. You’ll also identify and reframe problematic thinking patterns and learn symptom management skills. It involves exposure therapy, as well.

Medication for PTSD

Currently, there are no medications approved by the U.S. Food and Drug Administration (FDA) to treat PTSD. However, healthcare providers may prescribe certain medications to help certain PTSD symptoms, such as:

• Antidepressants like selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs).
• Anti-anxiety medications.

Can PTSD be prevented?

You can’t necessarily prevent a traumatic event. But some studies show that certain steps may help you prevent PTSD afterward. These are called “protective factors” and include:

• Seeking support from others after the event, such as friends and family. This helps establish a sense of security.
• Joining a support group after a traumatic event.
• Learning to feel positive about your actions in the face of danger.
• Having a healthy coping strategy after the traumatic event.
• Being able to act and respond effectively despite feeling fear.
• Helping other people, especially if it’s a traumatic event that affected several people, like a natural disaster.

What is the prognosis for PTSD?

The prognosis (outlook) for PTSD can vary, but treatment often helps. With treatment, about 30% of people eventually recover from the condition. About 40% of people get better with treatment, but mild to moderate symptoms may remain. For some people, symptoms of PTSD go away over time with the support of loved ones and without professional treatment.

When should I see my healthcare provider?

It’s important to see your medical healthcare provider and/or mental health provider regularly following a traumatic event. If your symptoms get worse, call your provider.

When should I go to the emergency department?

If you’re experiencing thoughts of suicide or self-harm, it’s crucial to contact 911, go to the nearest emergency department or call 988 to reach the Suicide and Crisis Lifeline.