Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.
Many people who go through traumatic events have difficulty adjusting and coping for a while, but they don't have PTSD — with time and good self-care, they usually get better. But if the symptoms get worse or last for months or even years and interfere with your functioning, you may have PTSD.
Getting effective treatment after PTSD symptoms develop can be critical to reduce symptoms and improve function.
Post-traumatic stress disorder symptoms may start within three months of a traumatic event, but sometimes symptoms may not appear until years after the event. These symptoms cause significant problems in social or work situations and in relationships.
PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, or changes in emotional reactions.
Symptoms of intrusive memories may include:
- Recurrent, unwanted distressing memories of the traumatic event
- Reliving the traumatic event as if it were happening again (flashbacks)
- Upsetting dreams about the traumatic event
- Severe emotional distress or physical reactions to something that reminds you of the event
Symptoms of avoidance may include:
- Trying to avoid thinking or talking about the traumatic event
- Avoiding places, activities or people that remind you of the traumatic event
Negative changes in thinking and mood
Symptoms of negative changes in thinking and mood may include:
- Negative feelings about yourself or other people
- Inability to experience positive emotions
- Feeling emotionally numb
- Lack of interest in activities you once enjoyed
- Hopelessness about the future
- Memory problems, including not remembering important aspects of the traumatic event
- Difficulty maintaining close relationships
Changes in emotional reactions
Symptoms of changes in emotional reactions (also called arousal symptoms) may include:
- Irritability, angry outbursts or aggressive behavior
- Always being on guard for danger
- Overwhelming guilt or shame
- Self-destructive behavior, such as drinking too much or driving too fast
- Trouble concentrating
- Trouble sleeping
- Being easily startled or frightened
Intensity of symptoms
PTSD symptoms can vary in intensity over time. You may have more PTSD symptoms when you're stressed in general, or when you run into reminders of what you went through. For example, you may hear a car backfire and relive combat experiences. Or you may see a report on the news about a sexual assault and feel overcome by memories of your own assault.
When to see a doctor
If you have disturbing thoughts and feelings about a traumatic event for more than a month, if they're severe, or if you feel you're having trouble getting your life back under control, talk to your health care professional. Get treatment as soon as possible to help prevent PTSD symptoms from getting worse.
If you have suicidal thoughts
If you or someone you know is having suicidal thoughts, get help right away through one or more of these resources:
- Reach out to a close friend or loved one.
- Contact a minister, a spiritual leader or someone in your faith community.
- Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.
- Make an appointment with your doctor, mental health provider or other health care professional.
When to get emergency help
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.
If you know someone who's in danger of committing suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you can do so safely, take the person to the nearest hospital emergency room.
You can develop post-traumatic stress disorder when you go through, see or learn about an event involving actual or threatened death, serious injury or sexual violation.
Doctors aren't sure why some people get PTSD. As with most mental health problems, PTSD is probably caused by a complex mix of:
- Inherited mental health risks, such as an increased risk of anxiety and depression
- Life experiences, including the amount and severity of trauma you've gone through since early childhood
- Inherited aspects of your personality — often called your temperament
- The way your brain regulates the chemicals and hormones your body releases in response to stress
People of all ages can have post-traumatic stress disorder. However, some factors may make you more likely to develop PTSD after a traumatic event, such as:
- Experiencing intense or long-lasting trauma
- Having experienced other trauma earlier in life, including childhood abuse or neglect
- Having a job that increases your risk of being exposed to traumatic events, such as military personnel and first responders
- Having other mental health problems, such as anxiety or depression
- Lacking a good support system of family and friends
- Having biological (blood) relatives with mental health problems, including PTSD or depression
Kinds of traumatic events
The most common events leading to the development of PTSD include:
- Combat exposure
- Childhood neglect and physical abuse
- Sexual assault
- Physical attack
- Being threatened with a weapon
Many other traumatic events also can lead to PTSD, such as fire, natural disaster, mugging, robbery, car accident, plane crash, torture, kidnapping, life-threatening medical diagnosis, terrorist attack, and other extreme or life-threatening events.
Post-traumatic stress disorder can disrupt your whole life: your job, your relationships, your health and your enjoyment of everyday activities.
Having PTSD also may increase your risk of other mental health problems, such as:
- Depression and anxiety
- Issues with drugs or alcohol use
- Eating disorders
- Suicidal thoughts and actions
If you think you may have post-traumatic stress disorder, make an appointment with your primary care provider or a mental health provider. Here's some information to help you prepare for your appointment, and what to expect.
What you can do
Before your appointment, make a list of:
- Any symptoms you've been experiencing, and for how long.
- Key personal information, especially events or experiences — even in your distant past — that have made you feel intense fear, helplessness or horror. It will help your doctor to know if there are memories you can't directly access without feeling an overwhelming need to push them out of your mind.
- Your medical information, including other physical or mental health conditions with which you've been diagnosed. Also include any medications or supplements you're taking and the dosages.
Take a trusted family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you.
Make a list of questions to ask so you can make the most of your appointment. For PTSD, some basic questions include:
- What do you believe is causing my symptoms?
- Are there any other possible causes?
- How will you determine my diagnosis?
- Is my condition likely temporary or long term?
- What treatments do you recommend for this disorder?
- I have other health problems. How best can I manage these together with PTSD?
- How soon do you expect my symptoms to improve?
- Does PTSD increase my risk of other mental health problems?
- Do you recommend any changes at home, work or school to encourage recovery?
- Would it help my recovery to tell my teachers or work colleagues about my diagnosis?
- Are there any printed materials on PTSD that I can have? What websites do you recommend?
Don't hesitate to ask questions anytime you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:
- What are your symptoms?
- When did you or your loved ones first notice your symptoms?
- Have you ever experienced or witnessed an event that was life-threatening to you or someone else?
- Have you ever been physically, sexually or emotionally harmed?
- Do you have disturbing thoughts, memories or nightmares of the trauma you experienced?
- Do you ever feel as if you're reliving the traumatic event, through flashbacks or hallucinations?
- Do you avoid certain people, places or situations that remind you of the traumatic experience?
- Have you lost interest in things or felt numb?
- Do you feel jumpy, on guard or easily startled?
- Do you frequently feel irritable or angry?
- Are you having trouble sleeping?
- Is anything happening in your life right now that's making you feel unsafe?
- Have you been having any problems at school, work or in your personal relationships?
- Have you ever thought about harming yourself or others?
- Do you drink alcohol or use illegal drugs? How often?
- Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most helpful?
Post-traumatic stress disorder is diagnosed based on signs and symptoms and a thorough psychological evaluation. Your health care provider will likely ask you to describe your signs and symptoms and the event that led up to them. You may also have a physical exam to check for medical problems.
To be diagnosed with PTSD, you must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
DSM criteria for PTSD
Diagnosis of PTSD requires exposure to an event that involved or held the threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:
- You experienced the traumatic event
- You witnessed, in person, the traumatic event
- You learned someone close to you experienced or was threatened by the traumatic event
- You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)
You experience one or more of the following signs or symptoms after the traumatic event:
- You relive experiences of the traumatic event, such as having distressing images and memories.
- You have upsetting dreams about the traumatic event.
- You experience flashbacks as if you were experiencing the traumatic event again.
- You experience ongoing or severe emotional distress or physical symptoms if something reminds you of the traumatic event.
In addition, for more than one month after the traumatic event you may:
- Try to avoid situations or things that remind you of the traumatic event
- Not remember important parts of the traumatic event
- View yourself, others and the world in a negative way
- Lose interest in activities you used to enjoy and feel detached from family and friends
- Feel a sense of emotional numbness, feel irritable or have angry or violent outbursts
- Engage in dangerous or self-destructive behavior
- Feel as if you're constantly on guard or alert for signs of danger and startle easily
- Have trouble sleeping or concentrating
Your symptoms cause significant distress in your life or interfere with your ability to go about your normal daily tasks.
For children younger than 6 years old, signs and symptoms may include:
- Reenacting the traumatic event or aspects of the traumatic event through play
- Frightening dreams that may or may not include aspects of the traumatic event
Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but often includes medication. Combining these treatments can help improve your symptoms, teach you skills to address your symptoms, help you feel better about yourself and learn ways to cope if any symptoms arise again.
Psychotherapy and medications can also help you if you've developed other problems related to your traumatic experience, such as depression, anxiety, or misuse of alcohol or drugs. You don't have to try to handle the burden of PTSD on your own.
Several types of psychotherapy, also called talk therapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:
- Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative or inaccurate ways of perceiving normal situations. For PTSD, cognitive therapy often is used along with exposure therapy.
- Exposure therapy. This behavioral therapy helps you safely face what you find frightening so that you can learn to cope with it effectively. One approach to exposure therapy uses "virtual reality" programs that allow you to re-enter the setting in which you experienced trauma.
- Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to traumatic memories.
All these approaches can help you gain control of lasting fear after a traumatic event. You and your health care professional can discuss what type of therapy or combination of therapies may best meet your needs.
You may try individual therapy, group therapy or both. Group therapy can offer a way to connect with others going through similar experiences.
Several types of medications can help improve symptoms of PTSD:
- Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
- Anti-anxiety medications. These drugs also can improve feelings of anxiety and stress for a short time to relieve severe anxiety and related problems. Because these medications have the potential for abuse, they are not usually taken long term.
- Prazosin. If symptoms include insomnia or recurrent nightmares, a drug called prazosin (Minipress) may help. Although not specifically FDA-approved for PTSD treatment, prazosin may reduce or suppress nightmares in many people with PTSD.
You and your doctor can work together to figure out the best treatment, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks.
Tell your health care professional about any side effects or problems with medications. You may need to try more than one or a combination of medications, or your doctor may need to adjust your dosage or medication schedule before finding the right fit for you.
If stress and other problems caused by a traumatic event affect your life, see your health care professional. You also can take these actions as you continue with treatment for post-traumatic stress disorder:
- Follow your treatment plan. Although it may take a while to feel benefits from therapy or medications, treatment can be effective, and most people do recover. Remind yourself that it takes time. Following your treatment plan will help move you forward.
- Learn about PTSD. This knowledge can help you understand what you're feeling, and then you can develop coping strategies to help you respond effectively.
- Take care of yourself. Get enough rest, eat a healthy diet, exercise and take time to relax. Avoid caffeine and nicotine, which can worsen anxiety.
- Don't self-medicate. Turning to alcohol or drugs to numb your feelings isn't healthy, even though it may be a tempting way to cope. It can lead to more problems down the road and prevent real healing.
- Break the cycle. When you feel anxious, take a brisk walk or jump into a hobby to re-focus.
- Talk to someone. Stay connected with supportive and caring people — family, friends, faith leaders or others. You don't have to talk about what happened if you don't want to. Just sharing time with loved ones can offer healing and comfort.
- Consider a support group. Ask your health professional for help finding a support group, or contact veterans' organizations or your community's social services system. Or look for local support groups in an online directory or in your phone book.
When someone you love has PTSD
The person you love may seem like a different person than you knew before the trauma — angry and irritable, for example, or withdrawn and depressed. PTSD can significantly strain the emotional and mental health of loved ones and friends.
Hearing about the trauma that led to your loved one's PTSD may be painful for you and even cause you to relive difficult events. You may find yourself avoiding his or her attempts to talk about the trauma or feeling hopeless that your loved one will get better. At the same time, you may feel guilty that you can't fix your loved one or hurry up the process of healing.
Remember that you can't change someone. However, you can:
- Learn about PTSD. This can help you understand what your loved one is going through.
- Recognize that withdrawal is part of the disorder. If your loved one resists your help, allow space and let your loved one know that you're available when he or she is ready to accept your help.
- Offer to attend medical appointments. If your loved one is willing, attending appointments can help you understand and assist with treatment.
- Be willing to listen. Let your loved one know you're willing to listen, but you understand if he or she doesn't want to talk.
- Encourage participation. Plan opportunities for activities with family and friends. Celebrate good events.
- Make your own health a priority. Take care of yourself by eating healthy, being physically active and getting enough rest. Take time alone or with friends, doing activities that help you recharge.
- Seek help if you need it. If you have difficulty coping, talk with your doctor. He or she may refer you to a therapist who can help you work through your emotions.
- Stay safe. Plan a safe place for yourself and your children if your loved one becomes violent or abusive.
After surviving a traumatic event, many people have PTSD-like symptoms at first, such as being unable to stop thinking about what's happened. Fear, anxiety, anger, depression, guilt — all are common reactions to trauma. However, the majority of people exposed to trauma do not develop long-term post-traumatic stress disorder.
Getting support can help you recover. This may mean turning to family and friends who will listen and offer comfort. It may mean seeking out a mental health provider for a brief course of therapy. Some people may also find it helpful to turn to their faith community.
Getting timely help and support may prevent normal stress reactions from getting worse and developing into PTSD. Support from others may also help prevent you from turning to unhealthy coping methods, such as misuse of alcohol or drugs.
Apr. 15, 2014
- Posttraumatic stress disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed Nov. 5, 2013.
- Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Association. http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf. Accessed Oct. 8, 2013.
- Stress disorders. Merck Manual for Health Care Professionals. http://www.merckmanuals.com/professional/psychiatric_disorders/anxiety_disorders/stress_disorders.html?qt=PTSD&alt=sh. Accessed Nov. 5, 2013.
- What is posttraumatic stress disorder (PTSD)? National Alliance on Mental Illness. http://www.nami.org/Template.cfm?Section=posttraumatic_stress_disorder. Accessed Nov. 5, 2013.
- Post-traumatic stress disorder (PTSD). National Institute of Mental Health. http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml. Accessed Nov. 5, 2013.
- Stein MB. Pharmacotherapy for posttraumatic stress disorder. http//www.uptodate.com/home. Accessed Nov. 5, 2013.
- Rothbaum BO. Psychotherapy for posttraumatic stress disorder. http//www.uptodate.com/home. Accessed Nov. 5, 2013.
- Helping a family member who has PTSD. U.S. Department of Veterans Affairs. http://www.ptsd.va.gov/public/pages/helping-family-member.asp. Accessed Nov. 9, 2013.
- Lifestyle changes recommended for PTSD patients. U.S. Department of Veterans Affairs. http://www.ptsd.va.gov/public/pages/coping-ptsd-lifestyle-changes.asp. Accessed Nov. 9, 2013.
- PTSD overview. U.S. Department of Veterans Affairs. http://www.ptsd.va.gov/public/pages/fslist-ptsd-overview.asp. Accessed Nov. 9, 2013.
- Depression. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/depression/index.shtml. Accessed Nov. 14, 2013.
- Lineberry TW (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 30, 2013.
- Posttraumatic stress disorder. American Psychiatric Association. http://www.dsm5.org/Pages/Default.aspx. Accessed Jan. 8, 2014.