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PTSD

Overview

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.

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.

Reference

Post-traumatic stress disorder (PTSD). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967. Published December 13, 2022. Accessed January 11, 2023.

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