Post-Traumatic Stress Disorder (PTSD)

What is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition that some people develop after experiencing or witnessing a shocking, frightening or dangerous event. It is a recognized, treatable condition — not a sign of weakness.

Symptoms

PTSD symptoms are generally grouped into four categories:

• Re-experiencing: intrusive memories, flashbacks or nightmares.
• Avoidance: staying away from reminders, or avoiding thinking about the event.
• Negative changes in thinking and mood: persistent fear, guilt, shame, feeling detached, or losing interest in activities.
• Arousal and reactivity: being easily startled, feeling on edge, irritability, difficulty sleeping or concentrating.

These symptoms can occur with PTSD, but only a qualified professional can provide a diagnosis.

Causes and risk factors

Anyone can develop PTSD. Factors associated with higher risk include the severity of the trauma, previous trauma, a history of mental health conditions, a lack of social support after the event, and additional stress afterward.

Diagnosis

A clinician diagnoses PTSD through a careful interview about the event and your symptoms, often using validated questionnaires. Symptoms must last more than a month and cause significant distress or impairment.

Treatment

• Trauma-focused psychotherapy is generally recommended as a first-line treatment. Approaches with strong evidence include cognitive processing therapy (CPT), prolonged exposure (PE), trauma-focused CBT and eye movement desensitization and reprocessing (EMDR). See trauma therapy.
• Medication: certain antidepressants may help some people, particularly when therapy isn’t available or preferred.

Trauma-focused therapy can be done online. Platforms such as BetterHelp and Sesame list therapists who treat PTSD; look for training in approaches such as CPT, prolonged exposure or EMDR.

The four groups of PTSD symptoms

Clinicians usually describe PTSD in terms of four groups of symptoms that last for more than a month after a traumatic event and cause significant distress or difficulty functioning:

1. Intrusion: unwanted, distressing memories, nightmares, flashbacks, or intense distress and physical reactions when reminded of the event.
2. Avoidance: staying away from people, places, conversations or thoughts that bring the trauma to mind.
3. Negative changes in thinking and mood: persistent blame of oneself or others, feeling detached, losing interest in activities, difficulty feeling positive emotions, or memory gaps about the event.
4. Arousal and reactivity: being easily startled, constantly on guard, irritable, having trouble sleeping or concentrating, or reckless behavior.

These symptoms can occur with PTSD, but only a qualified healthcare professional can provide a diagnosis. Many people have some of them in the days and weeks after a traumatic event, and most gradually recover without developing PTSD.

Complex PTSD

Some people who experienced prolonged or repeated trauma, particularly in childhood or in situations where escape was difficult, can develop what is called complex PTSD. In addition to the core symptoms, it involves persistent difficulties regulating emotions, a negative sense of self and problems in relationships. It is recognized in the World Health Organization’s international classification of diseases, and treatment often takes longer and may involve a staged approach that starts with safety and stabilization.

Who is affected

Anyone can develop PTSD after experiencing, witnessing or learning of a threat to life, serious injury or sexual violence, including combat, accidents, disasters, assault, medical emergencies, childbirth complications and the sudden death of a loved one. Emergency responders and health professionals can develop it through repeated exposure. Not everyone exposed to trauma develops PTSD: factors such as the severity and duration of the trauma, previous trauma, lack of social support and other mental health conditions affect risk.

Treatments with strong evidence

Trauma-focused psychological therapies are recommended as first-line treatments in clinical guidelines. They include:

• Trauma-focused CBT, including prolonged exposure and cognitive processing therapy. See exposure therapy and CBT.
• Eye movement desensitization and reprocessing (EMDR), which combines recalling trauma memories with guided eye movements or other bilateral stimulation.
• Other approaches, such as narrative exposure therapy, which are used in certain populations.

Some medications, such as certain antidepressants, can help with PTSD symptoms or co-occurring depression and anxiety, and are chosen with a prescriber; see antidepressants. Nightmares and sleep problems can be addressed too; see sleep and mental health. Our page on trauma therapy explains what to expect and how to find a trained therapist.

What to expect from trauma therapy

Trauma therapy is not about reliving the worst moments without support. Good therapists build safety and coping skills first, move at a pace you can handle and make sure you understand what each step involves. Symptoms can feel more intense for a short time as you start to process memories; tell your therapist if it feels overwhelming, because the pace can be adjusted. Many people notice significant improvement within a few months.

Supporting someone with PTSD

• Listen without pressing for details of the trauma.
• Respect their need for space and their triggers, and ask what helps.
• Keep routines and offer practical support.
• Encourage professional help, and offer to help find a therapist.
• Be patient, and look after yourself; family and friends are affected too.
• Don’t take irritability or withdrawal personally.

When to seek help

Consider seeking help if distressing symptoms last more than a few weeks, interfere with daily life, or if you are using alcohol or drugs to cope. If you have thoughts of suicide or feel unsafe, reach out right away; see Get Help Now for emergency numbers and crisis lines. PTSD often occurs with depression, anxiety and substance use, and these can be treated together.

Self-care

Stay connected with people you trust, keep regular routines, be gentle with yourself about recovery timelines, and limit alcohol. Grounding techniques can help during distressing memories — see our guide to calming an overwhelmed mind.