Post-Traumatic Stress Disorder (PTSD)

Reviewed by Andrea Tarantella, Licensed Professional Counselor, NCC at ADHD Advisor, a Certified Clinical Trauma Professional (CCTP) with specialized training in trauma treatment

What is post-traumatic stress disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is a condition that can follow experiencing or witnessing any disturbing event that makes you fear for your safety. While it’s normal to feel frightened, sad, anxious, and disconnected after a traumatic experience, if the upset doesn’t fade, you may be suffering from PTSD.

Most people associate PTSD with rape or battle-scarred soldiers—and military combat is the most common cause in men. But any event, or series of events, that overwhelms you with feelings of hopelessness and helplessness and leaves you emotionally shattered, can trigger PTSD—especially if the event feels unpredictable and uncontrollable.

PTSD can affect people who personally experience the traumatic event, those who witness the event, or those who pick up the pieces afterwards, such as emergency workers and law enforcement officers. It can even occur in the friends or family members of those who went through the actual trauma. Whatever the cause for your PTSD, by seeking treatment, reaching out for support, and developing new coping skills, you can learn to manage your symptoms, reduce painful memories, and move on with your life.

Traumatic events that can lead to PTSD include:

• War
• Natural disasters
• Car or plane crashes
• Terrorist attacks
• Sudden death of a loved one
• Rape
• Kidnapping
• Assault
• Sexual or physical abuse
• Childhood neglect

Or any shattering event that leaves you stuck and feeling helpless and hopeless.

Causes

When you experience a stressful event, your nervous system reacts with the fight-or-flight response. Your heart pounds faster, your blood pressure rises, and your muscles tighten, increasing your strength and reaction speed. Once the danger has passed, your nervous system calms your body, lowers your heart rate and blood pressure, and winds back down to its normal state.

PTSD occurs when you experience too much stress in a situation. Even though the danger has passed, your nervous system is “stuck,” unable to return to its normal state of balance and you’re unable to move on from the event. Recovering from PTSD involves helping your nervous system become “unstuck” so you can heal and move on from the trauma.

PTSD vs. a normal response to traumatic events

Following a traumatic event such as a natural disaster, traffic accident, terrorist attack, or assault, almost everyone experiences at least some of the symptoms of PTSD. When your sense of safety and trust are shattered, it’s normal to feel unbalanced, disconnected, or numb. It’s very common to have bad dreams, feel fearful, and find it difficult to stop thinking about what happened. These are normal reactions to abnormal events.

For most people, however, these symptoms are short-lived. They may last for several days or even weeks, but they gradually lift. But if you have post-traumatic stress disorder, the symptoms don’t decrease and you don’t feel a little better each day. In fact, you may start to feel worse.

Signs and symptoms of PTSD

PTSD develops differently from person to person because everyone's nervous system and tolerance for stress is a little different. While you're most likely to develop symptoms of PTSD in the hours or days following a traumatic event, it can sometimes take weeks, months, or even years before they appear. Sometimes symptoms appear seemingly out of the blue. At other times, they are triggered by something that reminds you of the original traumatic event, such as a noise, an image, certain words, or a smell.

While everyone experiences PTSD differently, there are four main types of symptoms:

1. Re-experiencing the traumatic event

This can involve:

• Intrusive, upsetting memories of the event.
• Flashbacks (acting or feeling like the event is happening again).
• Nightmares (either of the event or other frightening things).
• Feelings of intense distress when reminded of the trauma.
• Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating).

2. Avoidance and numbing

Such as:

• Avoiding activities, places, thoughts, or feelings that remind you of the trauma.
• Inability to remember important aspects of the event.
• Loss of interest in activities and life in general.
• Feeling detached from others and emotionally numb.
• Sense of a limited future (you don’t expect to live a normal life span, get married, have a career).

3. Increased anxiety and emotional arousal (hyperarousal)

These symptoms include:

• Difficulty falling or staying asleep.
• Irritability or outbursts of anger.
• Difficulty concentrating.
• Hypervigilance (on constant “red alert”).
• Feeling jumpy or easily startled.
• Self-destructive or reckless behavior.

4. Negative thought and mood changes 

Such as:

• Feeling alienated and alone.
• Depression and hopelessness.
• Feelings of mistrust and betrayal.
• Guilt, shame, or self-blame.
• Substance abuse.
• Physical aches and pains.
• Suicidal thoughts.

PTSD symptoms in children and adolescents

In children—especially very young children—the symptoms of PTSD can differ from those of adults and may include:

• Fear of being separated from their parent.
• Losing previously-acquired skills (such as toilet training).
• Sleep problems and nightmares.
• Somber, compulsive play in which themes or aspects of the trauma are repeated.
• New phobias and anxieties that seem unrelated to the trauma (such as fear of monsters).
• Acting out the trauma through play, stories, or drawings.
• Aches and pains with no apparent cause.
• Irritability and aggression.

[Read: Helping Children Cope with Traumatic Events]

Do I have PTSD?

If you answer yes to three or more of the questions below, you may have PTSD:

1. Have you witnessed or experienced a traumatic, life-threatening event?
2. Did this experience make you feel intensely afraid, horrified, or helpless?
3. Do you have trouble getting the event out of your mind?
4. Do you startle more easily and feel more irritable or angry than you did before the event?
5. Do you go out of your way to avoid activities, people, or thoughts that remind you of the event?
6. Do you have more trouble falling asleep or concentrating than you did before the event?
7. Have your symptoms lasted for more than a month?
8. Is your distress making it hard for you to work or function normally?

Please note: this questionnaire is not intended to replace professional diagnosis. For an accurate diagnosis of PTSD, you’ll need to visit a qualified mental health professional.

Risk factors

While it's impossible to predict who will develop PTSD in response to trauma, there are certain risk factors that increase your vulnerability. Many risk factors revolve around the nature of the traumatic event itself. Traumatic events are more likely to cause PTSD when they involve a severe threat to your life or personal safety: the more extreme and prolonged the threat, the greater the risk of developing PTSD in response. Intentional, human-inflicted harm—such as rape, assault, and torture— also tends to be more traumatic than “acts of God,” or more impersonal accidents and disasters. The extent to which the traumatic event was unexpected, uncontrollable, and inescapable also plays a role.

Other risk factors for PTSD include:

• Previous traumatic experiences, especially in early life.
• Family history of PTSD or depression.
• History of physical or sexual abuse.
• History of substance abuse.
• History of depression, anxiety, or another mental illness.
• High level of stress in everyday life.
• Lack of support after the trauma.

Types of PTSD and trauma

Trauma or PTSD symptoms can result from many different types of distressing experiences, including military combat, childhood neglect or abuse, racism, an accident, natural disaster, personal tragedy, or violence. 

PTSD in military veterans

For all too many veterans, returning from military service means coping with symptoms of PTSD. You may have a hard time readjusting to life out of the military. Or you may constantly feel on edge, emotionally numb and disconnected, or close to panicking or exploding. But it's important to know that you're not alone and there are plenty of ways you can deal with nightmares and flashbacks, cope with feelings of depression, anxiety or guilt, and regain your sense of control.

Emotional and psychological trauma

If you've experienced an extremely stressful event—or series of events—that's left you feeling helpless and emotionally out of control, you may have been traumatized. Psychological trauma often has its roots in childhood, but any event that shatters your sense of safety can leave you feeling traumatized, whether it's an accident, injury, the sudden death of a loved one, bullying, domestic abuse, or a deeply humiliating experience. Whether the trauma happened years ago or yesterday, you can get over the pain, feel safe again, and move on with your life.

Rape or sexual trauma

The trauma of being raped or sexually assaulted can be shattering, leaving you feeling scared, ashamed, and alone, or plagued by nightmares, flashbacks, and other unpleasant memories. But no matter how bad you feel right now, it's important to remember that you weren't to blame for what happened, and you can regain your sense of safety, trust, and self-worth.

Racial trauma

Race-based traumatic stress stems from exposure to racist abuse, discrimination, or injustice. It can erode your sense of self-worth and lead to anxiety, depression, chronic stress, high blood pressure, disordered eating, substance abuse, and even symptoms of PTSD such as hypervigilance, negative thoughts, and mood changes. But there are ways to strengthen your resilience and protect your mental health.

Getting help for post-traumatic stress disorder

Recovering from PTSD involves helping your nervous system return to its pre-trauma state of balance. While this process is easier with the guidance and support of an experienced therapist or doctor, you don’t need to wait for a medical appointment to start feeling better. There are plenty of things you can do now to help yourself cope with symptoms, reduce anxiety and fear, and take back control of your life.

Healing from PTSD is a gradual, ongoing process. It doesn't happen overnight, nor do the memories of the trauma ever disappear completely. This can make life seem difficult at times. But the following tips can offer effective ways to help you start to heal and move on:

Tip 1: Challenge your sense of helplessness

Overcoming your sense of helplessness is key to overcoming PTSD. Trauma can leave you feeling powerless and vulnerable, so it's important to remind yourself that you have strengths and coping skills that can get you through these tough times.,

[Read: Surviving Tough Times by Building Resilience]

One of the best ways to reclaim your sense of power is by helping others: volunteer your time, give blood, reach out to a friend in need, or donate to your favorite charity. Taking positive action directly challenges the sense of helplessness that is a common symptom of PTSD.

Positive ways of coping with PTSD:

• Learn about trauma and PTSD.
• Join a PTSD support group.
• Practice relaxation techniques.
• Pursue outdoor activities.
• Confide in a person you trust.
• Spend time with positive people.
• Avoid alcohol and drugs.
• Enjoy the peace of nature.

Tip 2: Get moving

When you're suffering from PTSD, exercise can do more than release endorphins and improve your mood and outlook. By really focusing on your body and how it feels as you move, exercise can actually help your nervous system become “unstuck” and begin to move out of the immobilization stress response. Try:

Rhythmic exercise that engages both your arms and legs—such as walking, running, swimming, or dancing—can work well. Instead of focusing on your thoughts, though, focus on how your body feels. Notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of the wind on your skin.

Rock climbing, boxing, weight training, or martial arts. These activities can make it easier to focus on your body movements—after all, if you don't, you could get hurt.

Spending time in nature. Pursuing outdoor activities like hiking, camping, mountain biking, rock climbing, whitewater rafting, and skiing helps veterans cope with PTSD symptoms and transition back into civilian life. But it’s not just veterans who can benefit from spending time outdoors. Anyone with PTSD can benefit from the relaxation, seclusion, and peace that come with being out in nature.

Focusing on strenuous outdoor activities can also challenge your sense of helplessness and help your nervous system become “unstuck”. Seek out local organizations that offer outdoor recreation or team-building opportunities.

Tip 3: Reach out to others for support

PTSD can make you feel disconnected from others. You may be tempted to withdraw from social activities and your loved ones. But it's important to stay connected to life and the people you're close to.

Social interaction with someone who cares about you is the most effective way to calm your nervous system, so it’s important to find someone you can connect with face to face. You don't have to talk about the trauma if you don't want to, but the caring support and companionship of others is vital to your recovery.

Reach out to someone you can connect with for an uninterrupted period of time, someone who will listen when you want to talk without judging, criticizing, or continually getting distracted. That person may be your significant other, a family member, a friend, or a professional therapist.

You can also try:

Volunteering your time or reaching out to a friend in need. This is not only a great way to connect to others, but can also help you reclaim your sense of control.

[Read: Volunteering and its Surprising Benefits]

Joining a PTSD support group. This can help you feel less isolated and alone and also provide invaluable information on how to cope with symptoms and work towards recovery.

Tip 4: Adopt a healthy lifestyle

The symptoms of PTSD can be hard on your body so it's important to take care of yourself and develop some healthy lifestyle habits.

Take time to relax. Relaxation techniques such as meditation, deep breathing, massage, or yoga can activate the body's relaxation response and ease symptoms of PTSD.

Avoid alcohol and drugs. When you're struggling with difficult emotions and traumatic memories, you may be tempted to self-medicate with alcohol or drugs. But substance use worsens many symptoms of PTSD, including emotional numbing, social isolation, anger, and depression. It can also interfere with treatment, and add to problems in your relationships.

Eat a healthy diet. Start your day right with breakfast, and keep your energy up and your mind clear with balanced, nutritious meals throughout the day. Omega-3s play a vital role in emotional health so incorporate foods such as fatty fish, flaxseed, and walnuts into your diet. Limit processed food, fried food, refined starches, and sugars, which can exacerbate mood swings and cause fluctuations in your energy.

Get enough sleep. Sleep deprivation can trigger anger, irritability, and moodiness. Aim for somewhere between 7 to 9 hours of sleep each night. Develop a relaxing bedtime ritual (listen to calming music or an audiobook, or read something light) and make your bedroom as quiet, dark, and soothing as possible.

Getting professional treatment

If you suspect that you or a loved one has post-traumatic stress disorder, it's important to seek help right away. The sooner PTSD is treated, the easier it is to overcome. If you're reluctant to seek help, keep in mind that PTSD is not a sign of weakness, and the only way to overcome it is to confront what happened to you and learn to accept it as a part of your past. This process is much easier with the guidance and support of an experienced therapist or doctor.

It's only natural to want to avoid painful memories and feelings. But if you try to numb yourself and push your memories away, PTSD will only get worse. You can't escape your emotions completely—they emerge under stress or whenever you let down your guard—and trying to do so is exhausting. The avoidance will ultimately harm your relationships, your ability to function, and the quality of your life.

Types of treatment and therapies

Treatment for PTSD can relieve symptoms by helping you deal with the trauma you've experienced. A doctor or therapist will encourage you to recall and process the emotions you felt during the original event in order to reduce the powerful hold the memory has on your life.

During treatment, you'll also explore your thoughts and feelings about the trauma, work through feelings of guilt and mistrust, learn how to cope with intrusive memories, and address the problems PTSD has caused in your life and relationships.

The types of treatment available for PTSD include:

Trauma-focused cognitive-behavioral therapy involves gradually “exposing” yourself to feelings and situations that remind you of the trauma, and replacing distorted and irrational thoughts about the experience with a more balanced picture.

Family therapy can help your loved ones understand what you're going through and help you work through relationship problems together as a family.

Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety, although they do not treat the causes of PTSD.

EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. EMDR therapy techniques work by “unfreezing” the brain's information processing system, which is interrupted in times of extreme stress.

Finding a therapist

When looking for a therapist, seek out mental health professionals who specialize in the treatment of trauma and PTSD. You can ask your doctor or other trauma survivors for a referral, call a local mental health clinic, psychiatric hospital, or counseling center.

Beyond credentials and experience, it's important to find a PTSD therapist who makes you feel comfortable and safe. Trust your gut; if a therapist doesn't feel right, look for someone else. For therapy to work, you need to feel comfortable and understood.

How to help someone with PTSD

If a loved one has post-traumatic stress disorder, it can take a heavy toll on your relationship and family life. It can be hard to understand why your loved one won’t open up to you—why they are less affectionate and more volatile. The symptoms of PTSD can also result in job loss, substance abuse, and other stressful problems.

No matter how distant, irritable, or closed off your loved one seems, try not to take the symptoms of PTSD personally. Remember that this likely has nothing to do with you or your relationship. Instead, there are steps you can take to help someone with PTSD move on from the trauma, take back control of their life, and enable your relationship to return to normal.

Read: Helping Someone with PTSD.

Last updated or reviewed on December 21, 2023