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Post-Traumatic Stress Disorder (PTSD)

Key takeaways Post-traumatic stress disorder (PTSD) is a mental health disorder that can arise after experiencing or witnessing a traumatic event, leading to a heightened sense of danger and altered fight-or-flight responses. PTSD reflects changes in brain chemistry and neuronal function. Symptoms of PTSD vary but commonly include intrusion, avoidance, arousal, reactivity, and changes in cognition and mood. Women and members of the LGBTQI community may experience PTSD differently due to factors like delayed treatment and identity-based trauma. Treatment options include therapy, medication, or a combination of both, with cognitive behavioral therapy (CBT) and exposure therapy being common approaches. Support groups and lifestyle adjustments, such as a balanced diet and regular exercise, can also help manage symptoms and promote recovery. Post-traumatic stress disorder (PTSD) is a mental health disorder that begins after a traumatic event. That event may involve a real or perceived threat of injury or death. This can include: a natural disaster like an earthquake or tornado military combat physical or sexual violence physical or sexual abuse an accident People with PTSD often feel a heightened sense of danger. Their natural fight-or-flight response is altered, causing them to feel stressed or fearful, even when they're in a safe situation. PTSD used to be called 'shell shock' or 'battle fatigue' because it often affects war veterans. According to the National Center for PTSD, it's estimated that about 15 percent of Vietnam War veterans and 12 percent of Gulf War veterans have PTSD. But PTSD can happen to anyone at any age. It occurs as a response to chemical and neuronal changes in the brain after exposure to threatening events. Having PTSD does not mean you're flawed or weak. PTSD symptoms PTSD can disrupt your normal activities and your ability to function. Words, sounds, or situations that remind you of trauma can trigger your symptoms. Symptoms of PTSD fall into four groups: Intrusion flashbacks where you feel like you relive the event over and over vivid, unpleasant memories of the event infiltrating seemingly unrelated thoughts or memories frequent nightmares about the event intense mental or physical distress when you think about the event Avoidance Avoidance, as the name implies, means avoiding people, places, or situations that remind you of the traumatic event. Arousal and reactivity trouble concentrating startling easily and having an exaggerated response when you're startled a constant feeling of being on edge irritability bouts of anger Cognition and mood negative thoughts about yourself distorted feelings of guilt, worry, or blame trouble remembering important parts of the event reduced interest in activities you once loved In addition, people with PTSD may experience depression and panic attacks. Panic attacks can cause symptoms like: agitation dizziness lightheadedness fainting a racing or pounding heart headaches PTSD symptoms in women According to the American Psychiatric Association (APA), women are twice as likely as men to get PTSD, and the symptoms manifest slightly differently. Women may feel more: anxious and depressed numb, with no emotions easily startled sensitive to reminders of the trauma Women's symptoms may last longer than men's. This is because, on average, women wait 4 years to see a doctor, while men usually ask for help within 1 year after their symptoms start, according to the U.S. Department of Health and Human Services, Office of Women's Health. PTSD symptoms in men Men usually have the more talked about PTSD symptoms of re-experiencing, avoidance, cognitive and mood issues, and arousal concerns. These symptoms often start within the first month after the traumatic event, but it can take months or years for signs to appear. Even knowing the above description of symptoms, everyone with PTSD has a different experience. Their specific symptoms may be unique based on their biology and the trauma they have experienced. PTSD in the LGBTQI community According to the National Alliance on Mental Health, individuals in the LGBTQI community are at a significantly higher risk for PTSD than individuals who identify as heterosexual and cisgender due to the possible trauma associated with homophobia, biphobia, transphobia, bullying and feeling identity-based shame. PTSD treatment If you're diagnosed with PTSD, your healthcare professional will likely prescribe therapy, medication, or a combination of the two treatments. Cognitive behavioral therapy (CBT) or 'talk therapy' encourages you to process the traumatic event and change the negative thinking patterns linked to it. In exposure therapy, you re-experience elements of the trauma in a safe environment. This can help desensitize you to the event and reduce your symptoms. Antidepressants, anti-anxiety drugs, and sleep aids may help relieve symptoms of depression and anxiety. Two antidepressants are FDA-approved to treat PTSD: sertraline (Zoloft) and paroxetine (Paxil). Looking for ways to support your mental health and well-being? Try Healthline's FindCare tool to connect with mental health professionals nearby or virtually so you can get the care you need. PTSD causes PTSD can develop in people who've been through or witnessed a traumatic event like a natural disaster, military combat, or assault. While not everyone who experiences one of these events will develop PTSD, research is revealing that trauma may cause actual changes to the brain. For example, a 2018 study suggests people with PTSD have a smaller hippocampus — an area of the brain involved in memory and emotion. However, it's unknown whether they had a smaller hippocampal volume before the trauma or if the trauma caused a decrease in hippocampal volume. More research is needed in this area. People diagnosed with PTSD may also have abnormal levels of stress hormones, which may set off an overreactive fight or flight response. Additionally, some people may be more adept at managing stress than others. While certain factors seem to protect against the development of PTSD, there is nothing 'wrong' or 'broken' in people who develop it. Medical PTSD A life threatening medical emergency can be just as traumatic as a natural disaster or violence. A study from 2018 found that about 1 in 8 people who have a heart attack develop PTSD afterward. The study also found that people who develop PTSD after a medical event are less likely to stay on the treatment regimen that they need to get better. You don't need to have a serious condition to develop PTSD. Even a minor illness or surgery can be traumatic if it really upsets you. It's possible to develop PTSD if you keep thinking about and reliving a medical event and if you feel like you're still in danger after the problem has passed. If you find yourself worried and anxious weeks after a medical event has subsided, you may want to talk with a healthcare professional about being screened for PTSD. Postpartum PTSD Childbirth is normally a happy time, but for some new moms, it can be a challenging experience. According to a 2018 study, up to 4 percent of women experience PTSD after the birth of their child. Women who have pregnancy complications or who give birth too early are more likely to get PTSD. You're at higher risk for postpartum PTSD if you: have depression are afraid of childbirth had a bad experience with a past pregnancy don't have a support network Having PTSD can make it harder for you to care for your new baby. If you have symptoms of PTSD after the birth of your child, it's a good idea to see a healthcare professional for an evaluation. PTSD diagnosis There's no specific test to diagnose PTSD. It can be difficult to diagnose because people with the disorder may be hesitant to recall or discuss the trauma, or their symptoms. The symptoms of PTSD may also mirror those of other mental health conditions, such as panic disorder. A mental health professional, such as a psychiatrist, psychologist, or psychiatric nurse practitioner, is best qualified to diagnose PTSD. To be diagnosed with PTSD, you must experience all of the following symptoms for 1 month or longer: at least one re-experience symptom at least one avoidance symptom at least two arousal and reactivity symptoms at least two cognition and mood symptoms Symptoms must be serious enough to interfere with your daily activities, which can include going to work or school, or being around friends and family members. Types of PTSD PTSD is one condition, but some experts break it down into subtypes depending on a person's symptoms, also known as condition 'specifiers,' to make it easier to diagnose and treat. Acute stress disorder (ASD) is not PTSD. It's a cluster of symptoms like anxiety and avoidance that develop within a month after a traumatic event. Many people with ASD go on to develop PTSD. Dissociative PTSD is when you detach yourself from the trauma. You feel separated from the event or like you're outside of your own body. Uncomplicated PTSD is when you have PTSD symptoms like re-experiencing the traumatic event and avoiding people and places related to the trauma, but you don't have any other mental health issues such as depression. People with the uncomplicated subtype often respond well to treatment. Comorbid PTSD involves symptoms of PTSD, along with another mental health disorder like depression, panic disorder, or a substance abuse problem. People with this type get the best results from treating both PTSD and the other mental health issue. Other specifiers include: ' With derealization ' means a person feels emotionally and physically detached from people and other experiences. They have trouble understanding the realities of their immediate surroundings. 'With delayed expression' means a person doesn't meet full PTSD criteria until at least 6 months after the event. Some symptoms may occur immediately but not enough for a full PTSD diagnosis to be made. Complex PTSD Many of the events that trigger PTSD — like a violent attack or car accident — happen once and are over. Others, like sexual or physical abuse at home, human trafficking, or neglect can continue for many months or years. Complex PTSD is a separate but related term used to describe the emotional repercussions of continued and long-term trauma, or multiple traumas. Chronic trauma can cause psychological damage even more severe than that of a single event. It should be noted that considerable debate exists among professionals as to the diagnostic criteria for complex PTSD. People with the complex type may have other symptoms in addition to the typical PTSD symptoms, such as uncontrollable feelings or negative self-perception. PTSD risk factors Certain traumatic events are more likely to trigger PTSD, including: military combat childhood abuse sexual violence assault accident disasters Not everyone who lives through a traumatic experience gets PTSD. Other factors that may also increase your risk for PTSD include: depression and other mental health issues substance misuse a lack of support a job that increases your exposure to traumatic events, such as police officer, military member, or first responder being assigned female at birth family members with PTSD PTSD complications PTSD can interfere with every part of your life, including your work and relationships. It can increase the risk of: depression anxiety suicidal thoughts or actions Some people with PTSD turn to drugs and alcohol to cope with their symptoms. While these methods may temporarily relieve negative feelings, they don't treat the underlying cause. They can even worsen some symptoms. If you've been using substances to cope, your therapist may recommend a program to help reduce your dependence on drugs or alcohol. Suicide prevention If you think someone is at immediate risk of self-harm or hurting another person: Call 911 or your local emergency number. Stay with the person until help arrives. Remove any guns, knives, medications, or other things that may cause harm. Listen but don't judge, argue, threaten, or yell. If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255. PTSD dreams When you have PTSD, sleep may no longer be a restful time. Most people who've lived through an intense trauma have trouble falling asleep or sleeping through the night. Even when you do fall asleep, you may have nightmares about the traumatic event. In fact, one study from 2018 explains that nightmares are 'the hallmark' of PTSD. This means they are one of the most defining symptoms. PTSD-related bad dreams are sometimes called replicative nightmares. They can happen a few times a week, and they may be even more vivid and upsetting than typical bad dreams. PTSD and depression These two conditions often go hand in hand. Having depression increases your risk for PTSD and vice versa. Many of the symptoms overlap, which can make it hard to figure out which one you have. Symptoms common to both PTSD and depression include: emotional outbursts loss of interest in activities trouble sleeping Some of the same treatments can help with both PTSD and depression. If you think you might have one or both of these conditions, learn where to find help. PTSD in children In many instances, kids may have a stronger ability to recover from traumatic events compared with adults. But there are still times when they may continue to relive the event or have other PTSD symptoms a month or more afterward the event. Common PTSD symptoms in children include: nightmares trouble sleeping continued fear and sadness irritability and trouble controlling their anger avoiding people or places linked to the event regularly expressing negative emotions CBT and medication are helpful for children with PTSD, just as they are for adults. Kids may also need extra care and support from their care network, which may include parents, teachers, and friends, to help them feel safe again. PTSD in teens The teenage years can be an emotionally challenging time. Processing trauma can be difficult for someone who's no longer a child but isn't quite an adult. PTSD in teens often manifests as aggressive or irritable behavior. Teens may engage in activities with a higher potential for negatively affecting their lives like drug or alcohol use to cope. They may also be reluctant to talk about their feelings. Just as in children and adults, CBT is a helpful treatment for teens with PTSD. Along with therapy, teenagers may benefit from being prescribed antidepressants or other medications. Coping with PTSD Psychotherapy is an important tool to help you cope with PTSD symptoms. It can help you identify symptom triggers, manage your symptoms, and face your fears. Having your support network to lean on is extremely helpful, too. Learning about PTSD will help you understand your feelings and how to effectively deal with them. Prioritizing health-promoting activities and your well-being can also help with the symptoms of PTSD. This includes: eating a nutrient-rich, balanced diet getting enough quality rest and sleep getting regular exercise limiting exposure to situations or people that increase stress or anxiety, as often as possible Support groups Support groups can provide a safe space where you can discuss your feelings with other people who have PTSD. This can help you understand that your symptoms are not unusual and that you're not alone. To find an online or community PTSD support group, you can start with the following resources: Community Page on PTSD PTSD Meetup Groups Non-Military PTSD Community Page U.S. Department of Veteran Affairs National Alliance on Mental Illness (NAMI) Gift From Within PTSD Anonymous Living with someone who has been diagnosed with PTSD PTSD does not only affect the person who has it. It can also affect those around them. The emotions, such as anger and fear, that people with PTSD are often challenged with can strain even the strongest relationships. Learning all you can about PTSD can help you be a better advocate and supporter for your loved one. Joining a support group for family members or caretakers of people living with PTSD can give you access to helpful tips from people who've been or are currently in your shoes. Try to make sure that your loved one is getting proper treatment which can include therapy, medication, or a combination of the two. Also, try to recognize and accept that living with someone who has PTSD can present challenges. Reach out for caregiver support if you feel the need to do so. Therapy is available to help you work through your personal challenges that may include frustration and worry. PTSD prevention Unfortunately, there's no way to foretell and prevent the traumatic events that can lead to PTSD. But if you've survived one of these events, there are a few things you can do to help protect yourself from flashbacks and other symptoms. Having a strong support system may help prevent PTSD. Lean on the people you trust most, which may be your partner, friends, siblings, or a trained therapist. When your experience weighs heavily on your mind, talk about it with those in your support network. Try to reframe the way you think about a difficult situation. For example, think about and see yourself as a survivor not a victim. Helping other people heal from a traumatic life event may help you bring meaning to the trauma you experienced, which can also help you heal. When to get help for PTSD If you're experiencing symptoms of PTSD, know that you're not alone. According to the National Center for PTSD, about 15 million U.S. adults have PTSD in any given year. If you have frequent upsetting thoughts, are unable to manage your actions, or fear that you might hurt yourself or others, seek help right away. See your healthcare professional or a mental health professional immediately or call the National Suicide Prevention Lifeline at 800-273-8255.