Post-traumatic stress disorder (PTSD)

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.

Most people who go through traumatic events may have temporary difficulty adjusting and coping, but with time and good self-care, they usually get better. If the symptoms get worse, last for months or even years, and interfere with your day-to-day functioning, you may have PTSD.

Getting effective treatment after PTSD symptoms develop can be critical to reduce symptoms and improve function.

Symptoms

Post-traumatic stress disorder symptoms may start within one month 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. They can also interfere with your ability to go about your normal daily tasks.

PTSD symptoms are generally 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.

Intrusive memories

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 or nightmares about the traumatic event
• Severe emotional distress or physical reactions to something that reminds you of the traumatic event

Avoidance

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 thoughts about yourself, other people or the world
• Hopelessness about the future
• Memory problems, including not remembering important aspects of the traumatic event
• Difficulty maintaining close relationships
• Feeling detached from family and friends
• Lack of interest in activities you once enjoyed
• Difficulty experiencing positive emotions
• Feeling emotionally numb

Changes in physical and emotional reactions

Symptoms of changes in physical and emotional reactions (also called arousal symptoms) may include:

• Being easily startled or frightened
• Always being on guard for danger
• Self-destructive behavior, such as drinking too much or driving too fast
• Trouble sleeping
• Trouble concentrating
• Irritability, angry outbursts or aggressive behavior
• Overwhelming guilt or shame

For children 6 years old and younger, signs and symptoms may also include:

• Re-enacting the traumatic event or aspects of the traumatic event through play
• Frightening dreams that may or may not include aspects of the traumatic event

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 come across 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 doctor or a mental health professional. Getting treatment as soon as possible can help prevent PTSD symptoms from getting worse.

If you have suicidal thoughts

If you or someone you know has 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 1-800-273-TALK (1-800-273-8255) to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.
• Make an appointment with your doctor or a mental health 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 attempting suicide or has made a suicide attempt, make sure someone stays with that person to keep him or her safe. Call 911 or your local emergency number immediately. Or, if you can do so safely, take the person to the nearest hospital emergency room.

Causes

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:

• Stressful experiences, including the amount and severity of trauma you've gone through in your life
• Inherited mental health risks, such as a family history of anxiety and depression
• Inherited features of your personality — often called your temperament
• The way your brain regulates the chemicals and hormones your body releases in response to stress

Risk factors

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, such as childhood abuse
• 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
• Having problems with substance misuse, such as excess drinking or drug use
• Lacking a good support system of family and friends
• Having blood relatives with mental health problems, including anxiety or depression

Kinds of traumatic events

The most common events leading to the development of PTSD include:

• Combat exposure
• Childhood physical abuse
• Sexual violence
• Physical assault
• Being threatened with a weapon
• An accident

Many other traumatic events also can lead to PTSD, such as fire, natural disaster, mugging, robbery, plane crash, torture, kidnapping, life-threatening medical diagnosis, terrorist attack, and other extreme or life-threatening events.

Complications

Post-traumatic stress disorder can disrupt your whole life ― your job, your relationships, your health and your enjoyment of everyday activities.

Having PTSD may also 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

Prevention

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 timely help and support may prevent normal stress reactions from getting worse and developing into PTSD. This may mean turning to family and friends who will listen and offer comfort. It may mean seeking out a mental health professional for a brief course of therapy. Some people may also find it helpful to turn to their faith community.

Support from others also may help prevent you from turning to unhealthy coping methods, such as misuse of alcohol or drugs.

Diagnosis

To diagnose post-traumatic stress disorder, your doctor will likely:

• Perform a physical exam to check for medical problems that may be causing your symptoms
• Do a psychological evaluation that includes a discussion of your signs and symptoms and the event or events that led up to them
• Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Diagnosis of PTSD requires exposure to an event that involved the actual or possible threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:

• You directly experienced the traumatic event
• You witnessed, in person, the traumatic event occurring to others
• 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 may have PTSD if the problems you experience after this exposure continue for more than a month and cause significant problems in your ability to function in social and work settings and negatively impact relationships.

Treatment

Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but can also include medication. Combining these treatments can help improve your symptoms by:

• Teaching you skills to address your symptoms
• Helping you think better about yourself, others and the world
• Learning ways to cope if any symptoms arise again
• Treating other problems often related to traumatic experiences, 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.

Psychotherapy

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 beliefs about yourself and the risk of traumatic things happening again. For PTSD, cognitive therapy often is used along with exposure therapy.
• Exposure therapy. This behavioral therapy helps you safely face both situations and memories that you find frightening so that you can learn to cope with them effectively. Exposure therapy can be particularly helpful for flashbacks and nightmares. One approach 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 them.

Your therapist can help you develop stress management skills to help you better handle stressful situations and cope with stress in your life.

All these approaches can help you gain control of lasting fear after a traumatic event. You and your mental health 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.

Medications

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 can relieve severe anxiety and related problems. Some anti-anxiety medications have the potential for abuse, so they are generally used only for a short time.
• Prazosin. While several studies indicated that prazosin (Minipress) may reduce or suppress nightmares in some people with PTSD, a more recent study showed no benefit over placebo. But participants in the recent study differed from others in ways that potentially could impact the results. Individuals who are considering prazosin should speak with a doctor to determine whether or not their particular situation might merit a trial of this drug.

You and your doctor can work together to figure out the best medication, 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 doctor 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.

Coping and support

If stress and other problems caused by a traumatic event affect your life, see your doctor or mental health professional. You can also 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 and routinely communicating with your mental health professional 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. Try to reduce or 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, interfere with effective treatments and prevent real healing.
• Break the cycle. When you feel anxious, take a brisk walk or jump into a hobby to re-focus.
• Stay connected. Spend time 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 mental 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.

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 avoidance and withdrawal are 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. Try not to force your loved one to talk about the trauma until he or she is ready.
• 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 stress.
• Stay safe. Plan a safe place for yourself and your children if your loved one becomes violent or abusive.

Preparing for an appointment

If you think you may have post-traumatic stress disorder, make an appointment with your doctor or a mental health professional. Here's some information to help you prepare for your appointment, and what to expect.

Take a trusted family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you.

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.
• Things you have stopped doing or are avoiding because of your stress.
• 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.
• Questions to ask so that you can make the most of your appointment.

Some basic questions to ask your doctor or mental health professional may 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 co-workers about my diagnosis?
• Are there any printed materials on PTSD that I can have? What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

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 symptoms are concerning to you or your loved ones?
• When did you or your loved ones first notice your symptoms?
• Have you ever experienced or witnessed a traumatic event?
• Do you have disturbing thoughts, memories or nightmares of the trauma you experienced?
• Do you avoid certain people, places or situations that remind you of the traumatic experience?
• 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 recreational 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?

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