Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is a mental health condition triggered by extremely stressful or frightening events. While most people experience distress after trauma, some develop persistent symptoms that can significantly affect their daily lives—but effective treatments are available that can help people recover.
Table of contents
- What is post-traumatic stress disorder?
- What causes PTSD?
- Who is more likely to develop PTSD?
- Symptoms of PTSD
- When to seek medical help
- How PTSD is diagnosed
- Treatment options
- Living with PTSD and coping strategies
What is post-traumatic stress disorder?
Post-traumatic stress disorder is a mental health condition that can develop after experiencing or witnessing a traumatic event. The traumatic event may be life-threatening or pose a significant threat to physical, emotional or spiritual well-being.[1] PTSD affects people of all ages.[5]
People with PTSD have intense and intrusive thoughts and feelings related to the traumatic experience that last long after the event has ended.[5] These symptoms may include flashbacks (feeling as if the traumatic event is happening again), nightmares, severe anxiety and uncontrollable thoughts about the event.[1]
It’s normal to experience upsetting and confusing thoughts after a traumatic event. Most people who go through traumatic events may have a hard time adjusting and coping for a short time, but with time and by taking good care of themselves, they usually get better naturally.[1][3] However, if the symptoms get worse, last for months or years, and affect the ability to function daily, a person may have PTSD.[1]
What causes PTSD?
PTSD may develop at least one month after a qualifying traumatic event—specifically, an event that involves the threat of death or harm to physical integrity.[14] Any situation that a person finds traumatic can cause PTSD.[3] Trauma doesn’t have to happen directly to you—you could witness a traumatic event or learn that a traumatic event happened to a loved one.[5]
Examples of traumatic events include:
- Serious accidents, such as car accidents[3][5]
- Violent personal assaults, such as sexual assault, mugging or robbery[3]
- War and military combat[5]
- Natural disasters, such as tornadoes, earthquakes, fires or floods[5]
- Physical, verbal or sexual abuse[5]
- Bullying[5]
- Serious health problems or childbirth experiences[3]
- The sudden death of a loved one[5]
Around 70% of people globally will experience a potentially traumatic event during their lifetime.[6] However, most people exposed to potentially traumatic events do not develop PTSD.[6]
Who is more likely to develop PTSD?
An estimated 3.9% of the world population has experienced PTSD at some point in their lives.[6] PTSD is estimated to affect about 1 in every 3 people who have a traumatic experience, but it’s not clear exactly why some people develop the condition and others do not.[3] PTSD develops in 5% to 10% of people who have experienced trauma.[5]
Women are more likely to develop PTSD than men. Women are twice as likely to receive a diagnosis compared with men.[14] Up to 40% of people with PTSD recover within one year.[6]
Several risk factors may affect whether someone develops PTSD after a traumatic event. These include:
- Gender—women are more likely to develop PTSD[8]
- Having had trauma in childhood[8]
- Feeling horror, helplessness, or extreme fear during the event[8]
- Going through a traumatic event that lasts a long time[8]
- Having little or no social support after the event[8]
- Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home[8]
- Having a history of mental illness or substance use[8]
Feeling supported by family, friends or other people following the potentially traumatic event can reduce the risk of developing PTSD.[6] The likelihood of developing PTSD varies depending on the type of traumatic event experienced. For example, rates of PTSD are more than three times higher (15.3%) among people exposed to violent conflict or war.[6] PTSD rates are especially high following sexual violence, with up to 40% of people affected.[6]
Military personnel exposed to combat in a war zone are especially vulnerable. About 11% to 20% of veterans who served in Iraq or Afghanistan have PTSD.[15]
Symptoms of PTSD
Post-traumatic stress disorder symptoms may start within the first three months after a traumatic event. But sometimes symptoms may not appear until years after the event.[1] PTSD can develop immediately after someone experiences a disturbing event, or it can occur weeks, months or even years later.[3]
To receive a PTSD diagnosis, symptoms must last for more than a month and must cause significant distress or issues in daily functioning.[5] These symptoms last more than one month and cause major problems in social or work situations and how well you get along with others. They also can affect the ability to do usual daily tasks.[1]
Generally, PTSD symptoms are grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.[1]
Intrusive memories
Symptoms of intrusive memories may include:
- Unwanted, distressing memories of a traumatic event that come back over and over again[1]
- Reliving a traumatic event as if it were happening again, also known as flashbacks[1]
- Upsetting dreams or nightmares about the traumatic event[1]
- Intrusive thoughts, such as repeated, involuntary memories[5]
People with PTSD have repeated and unwanted recollections of the traumatic event, which make them feel as if the event is happening all over again. These memories are accompanied by intense fear or horror. They may be experienced as images or sounds.[6]
Avoidance
Avoidance symptoms occur when a person tries to avoid situations or people that trigger memories of the traumatic event. This may cause them to:
- Stay away from places, events, or objects that are reminders of the traumatic experience. For example, if you were in a car accident, you might stop driving[5]
- Avoid remembering or thinking about the traumatic event[5]
- Avoid talking about what happened or how you feel about it[5]
Changes in thinking and mood
Negative changes in beliefs and feelings may include:
- Ongoing fear, horror, anger, guilt or shame[5]
- Memory loss of important aspects of the traumatic event[5]
- Ongoing negative and distorted thoughts and feelings about yourself or others[5]
- Distorted thoughts about the cause or effects of the event that lead to wrongly blaming yourself or others[5]
- Feeling detached from others[5]
- No longer enjoying activities you once did[5]
- Being unable to experience positive emotions[5]
- Feelings of isolation and irritability[3]
Changes in arousal and reactivity
These symptoms may cause a person to be jittery or be on the lookout for danger. They include:
- Being easily startled[5]
- Feeling tense or “on edge”[5]
- Having difficulty sleeping[5]
- Irritability and angry outbursts[5]
- Problems sleeping, such as insomnia[3]
- Finding concentrating difficult[3]
These symptoms are often severe and persistent enough to have a significant impact on a person’s day-to-day life.[3]
Complex PTSD
People who repeatedly experience traumatic situations, such as severe neglect, abuse or violence, may be diagnosed with complex PTSD (also called CPTSD).[3] 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.[5]
Complex PTSD can cause similar symptoms to PTSD and may not develop until years after the event. It’s often more severe if the trauma was experienced early in life, as this can affect a child’s development.[3] People with CPTSD typically have PTSD symptoms in addition to extensive issues with emotion regulation, sense of self and relationships.[5]
When to seek medical help
It’s normal to experience upsetting and confusing thoughts after a traumatic event, but most people improve naturally over a few weeks.[3] You should see a doctor if you or your child are still having problems about 4 weeks after the traumatic experience, or if the symptoms are particularly troublesome.[3]
If problems last longer than four weeks, cause great distress, or interfere with work or home life, you might have PTSD.[8] Getting treatment after PTSD symptoms arise can be very important to ease symptoms and help people function better.[1]
How PTSD is diagnosed
A health care provider who has experience helping people with mental illnesses can diagnose PTSD.[8] To diagnose post-traumatic stress disorder, your healthcare professional likely will do a physical exam to check for medical problems that may be causing your symptoms, as well as a mental health evaluation that includes talking about your symptoms and the trauma that led up to them.[9]
You also may fill out questionnaires asking about your experiences and symptoms.[9] Before having treatment for PTSD, a detailed assessment of your symptoms will be carried out to ensure treatment is tailored to your individual needs.[10]
A diagnosis of PTSD means a person has gone through an event that involved an actual or possible threat of death, violence or serious injury. That can happen in one or more of these ways:
- You directly experienced a traumatic event[9]
- You witnessed, in person, a traumatic event happening to others[9]
- You learned that someone close to you had a traumatic event[9]
- You’re exposed to graphic details of traumatic events over and over again, as is the case for first responders[9]
You may have PTSD if the problems you have after this exposure last for more than a month and greatly affect your ability to function in social and work settings and how you get along with others.[9]
Treatment options
PTSD can be successfully treated, even when it develops many years after a traumatic event.[3] Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The main treatment is psychotherapy (talk therapy), but treatment also can include medicine.[9]
There are effective treatments for PTSD, yet only 1 in 4 people with PTSD in low- and middle-income countries report seeking any form of treatment.[6] Treatment depends on the severity of symptoms and how soon they occur after the traumatic event.[3]
Psychotherapy
Psychotherapy is more effective than medication and has fewer adverse side effects.[15] Several types of psychotherapy are used to treat PTSD. The most effective approaches are trauma-focused therapies.[12]
Trauma-focused cognitive behavioral therapy (CBT) uses a range of psychological techniques to help you come to terms with the traumatic event. For example, your therapist may ask you to face your traumatic memories by describing aspects of your experience in detail. During this process, your therapist helps you cope with any distress you feel while identifying any beliefs you have about the experience that may be unhelpful.[10]
Your therapist can help you gain control of your fear and distress by reviewing with you any conclusions you have drawn about your experience (for example, feeling you’re to blame for what happened, or fear that it may happen again). You may also be encouraged to gradually restart any activities you have avoided since your experience, such as driving a car if you had an accident.[10] You’ll usually have 8 to 12 weekly sessions of trauma-focused CBT, although fewer may be needed. Sessions usually last for around 60 to 90 minutes.[10]
Eye movement desensitization and reprocessing (EMDR) is a psychological treatment that’s been found to reduce the symptoms of PTSD. It involves recalling the traumatic incident in detail while making eye movements, usually by following the movement of your therapist’s finger. Other methods may include the therapist tapping their finger or playing sounds.[10] It’s not clear exactly how EMDR works, but it may help you change the negative way you think about a traumatic experience.[10]
Other trauma-focused therapies such as Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE) are also considered the current gold standard for treatment.[12]
Medications
Pharmacotherapy (medication treatment) is useful for patients who have residual symptoms after psychotherapy or are unable or unwilling to access psychotherapy.[14] The medications recommended to treat PTSD in adults are selective serotonin reuptake inhibitors (SSRIs), such as paroxetine and sertraline, and the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine.[10][14]
These medicines will only be used if you choose not to have trauma-focused psychological treatment, psychological treatment would not be effective because there’s an ongoing threat of further trauma, or you have gained little or no benefit from a course of trauma-focused psychological treatment.[10]
The addition of other pharmacotherapy, such as atypical antipsychotics or certain other medications, may be helpful for residual symptoms.[14] Patients with PTSD often have sleep disturbance related to hyperarousal or nightmares, and certain medications can be effective for the treatment of PTSD-related sleep disturbance.[14]
Special avoidance of benzodiazepines (anti-anxiety drugs) or other sedative hypnotic medications is recommended, as these can cause increased intrusive and dissociative symptoms over time.[12]
Other treatment approaches
Any of the following treatment options may be recommended:
- Watchful waiting – monitoring your symptoms to see whether they improve or get worse without treatment[3]
- Antidepressants – such as paroxetine or sertraline[3]
- Talking therapies – such as trauma-focused cognitive behavioral therapy (CBT) or eye movement desensitization and reprocessing (EMDR)[3]
Combining treatments can make symptoms better by teaching skills to manage symptoms, helping you think better about yourself, others and the world, learning ways to cope if any symptoms arise again, and treating other problems often related to traumatic experiences, such as depression, anxiety, or misuse of alcohol or drugs.[9]
Related conditions
Psychiatric comorbidities (co-occurring mental health conditions), particularly mood disorders and substance use, are common in PTSD and are best treated concurrently.[14] Although comorbid behavioral health disorders (such as depression and substance use) are common in patients with PTSD, the diagnosis of additional disorders should not preclude treatment of PTSD.[14]
Living with PTSD and coping strategies
If an unwanted memory or thought comes to mind, remind yourself that it is only a memory. Recognize that feelings of fear or panic (and even flashbacks or nightmares) are common after trauma. They are also temporary and will pass soon.[19]
Once you’ve calmed yourself, try to refocus your mind and concentrate on coping techniques. In many cases, doing something different for just 10 to 15 minutes can help minimize the effects of triggering events.[19]
Here are some strategies that can help reduce stress:
- Distract yourself with positive activities. Call a friend, read a book, watch your favorite TV show or take a walk outside. Consciously switching activities, or changing your environment, can help shift your mind away from negative thought patterns.[19]
- Get moving. Exercise is good for the body and the mind. It helps distract from distressing thoughts, gets you connected with your body and releases positive hormones that help manage stress and anxiety.[19]
- Try mindfulness and relaxation. Observe your surroundings; list what you see and how you’re feeling. Send yourself soothing messages that help you relax. You can also use guided meditation or progressive relaxation exercises that are available online.[19]
Support from family, friends or other people can be important for recovery. There are a number of organizations that provide peer support and advice for PTSD, including charities that specialize in helping specific groups such as veterans, survivors of sexual violence, or people who have experienced bereavement.[10]
PTSD doesn’t just affect the person who is suffering but also their families and sometimes their entire communities.[15] If you or someone you know has symptoms of PTSD, effective treatment can make a positive impact. Different types of therapy, and sometimes medication, can help you get back to enjoying life.[19]
