Post-traumatic stress disorder (PTSD)

Overview

Post-traumatic stress disorder (PTSD) is a mental health condition that's caused by an extremely stressful or terrifying event — either being part of it or witnessing it. Symptoms may include flashbacks, nightmares, severe anxiety and uncontrollable thoughts about the event.

Most people who go through traumatic events may have a hard time adjusting and coping for a short time. But with time and by taking good care of themselves, they usually get better. If the symptoms get worse, last for months or years, and affect their ability to function daily, they may have PTSD.

Getting treatment after PTSD symptoms arise can be very important to ease symptoms and help people function better.

Symptoms

Post-traumatic stress disorder symptoms may start within the first three months after a traumatic event. But sometimes symptoms may not appear until years after the event. These symptoms last more than one month and cause major problems in social or work situations and how well you get along with others. They also can affect your ability to do your usual daily tasks.

Generally, PTSD symptoms are 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:

• Unwanted, distressing memories of a traumatic event that come back over and over again.
• Reliving a traumatic event as if it were happening again, also known as flashbacks.
• Upsetting dreams or nightmares about a traumatic event.
• Severe emotional distress or physical reactions to something that reminds you of a traumatic event.

Avoidance

Symptoms of avoidance may include:

• Trying not to think or talk about a traumatic event.
• Staying away from places, activities or people that remind you of a 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.
• Ongoing negative emotions of fear, blame, guilt, anger or shame.
• Memory problems, including not remembering important aspects of a traumatic event.
• Feeling detached from family and friends.
• Not being interested in activities you once enjoyed.
• Having a hard time feeling 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.
• Physical reactions, such as sweating, rapid breathing, fast heartbeat or shaking.

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

• Reenacting a traumatic event or aspects of a traumatic event through play.
• Frightening dreams that may or may not include aspects of a traumatic event.

Intensity of symptoms

Over time, PTSD symptoms can vary in how severe they are. You may have more PTSD symptoms when you're generally stressed or when you come across reminders of what you went through, including the same time of year when a past traumatic event happened. 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 assault.

When to see a doctor

Talk to your healthcare professional or a mental health professional if you have disturbing thoughts and feelings about a traumatic event for more than a month, especially if they're severe. Also, see a health professional if you're having trouble getting your life back under control. 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:

• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone in your faith community.
• Contact a suicide hotline.
  • In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.
  • U.S. veterans or service members who are in crisis can call 988 and then press "1" for the Veterans Crisis Line. Or text 838255. Or chat online.
  • The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
• Make an appointment with your healthcare professional or 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 right away.

If you know someone who's in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person for safety. Call 911 or your local emergency number right away. Or, if you can do so safely, take the person to the nearest hospital emergency department.

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 assault.

Healthcare professionals aren't sure why some people get PTSD. As with most mental health problems, a mix of factors probably causes it, including:

• Extremely stressful experiences, as well as 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. But you may be more likely to develop PTSD after a traumatic event if you:

• Have severe or long-lasting traumatic experiences.
• Were physically injured during the traumatic event.
• Have been exposed to other trauma earlier in life, such as childhood abuse.
• Have a job that exposes you to traumatic events, such as being in the military or being a first responder.
• Have other mental health problems, such as anxiety or depression.
• Drink too much or misuse drugs.
• Do not have a good support system of family and friends.
• Have blood relatives with mental health problems, including PTSD or depression.

Traumatic events that raise risk

The most common events that can lead to 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, a life-threatening medical diagnosis, a terrorist attack, and other extreme or life-threatening events.

Complications

Post-traumatic stress disorder can disrupt your whole life — your education, job, how well you get along with others, physical health and enjoyment of everyday activities. Having PTSD also may raise your risk of other mental health problems, such as:

• Depression and anxiety disorders.
• Issues with drugs or alcohol use.
• Thinking about and attempting suicide.

Prevention

After surviving a traumatic event, many people have PTSD-like symptoms at first, such as not being able to stop thinking about what's happened. Fear, anxiety, anger, depression and guilt are all common reactions to trauma. But most people exposed to trauma don't go on to develop PTSD.

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

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

Diagnosis

To diagnose post-traumatic stress disorder, your healthcare professional likely will do a:

• Physical exam to check for medical problems that may be causing your symptoms.
• Mental health evaluation that includes talking about your symptoms and the trauma that led up to them. You also may fill out questionnaires asking about your experiences and symptoms.

A diagnosis of PTSD means a person has gone through an event that involved an actual or possible threat of death, violence or serious injury. That can happen in one or more of these ways:

• You directly experienced a traumatic event.
• You witnessed, in person, a traumatic event happening to others.
• You learned that someone close to you had a traumatic event.
• You're exposed to graphic details of traumatic events over and over again, as is the case for first responders.

You may have PTSD if the problems you have after this exposure last for more than a month and greatly affect your ability to function in social and work settings and how you get along with others.

Don't try to handle the burden of PTSD on your own. Get help from an expert who's experienced in treating PTSD.

Treatment

Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The main treatment is talk therapy, also known as psychotherapy. But treatment also can include medicine.

Combining these treatments can make your symptoms better by:

• Teaching you skills to manage 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.

Psychotherapy

Several types of talk therapy, also called psychotherapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:

• Exposure therapy. This behavioral therapy helps you safely face situations and memories that you find frightening so that you can learn to cope with them. This is done in a gradual, predictable and controllable manner. Exposure therapy can be particularly helpful for flashbacks and nightmares. One approach uses virtual reality programs that allow you to reenter the setting in which you experienced trauma.
• Cognitive therapy. This type of talk therapy helps you see the ways of thinking, also known as cognitive patterns, that are keeping you stuck. Examples include negative beliefs about yourself and the risk of traumatic things happening again. For PTSD, cognitive therapy often is used along with exposure therapy.

Your therapist can help you build stress management skills to help you better handle stressful situations and cope with stress in your life. Skills such as relaxation, sleep and exercise can be helpful.

All these approaches can help you gain control of lasting fear after a traumatic event. You and your mental health professional can talk about 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 medicines can help make symptoms of PTSD better:

• Antidepressants. These medicines can ease symptoms of depression and anxiety. They also can help make sleep problems and concentration better. The selective serotonin reuptake inhibitor (SSRI) medicines sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) to treat PTSD. Venlafaxine (Effexor XR) also may be prescribed. Talk with your healthcare team about possible side effects.
• Anti-anxiety medicines. These medicines can ease severe anxiety and related problems. Some anti-anxiety medicines could be misused. Generally, they are used only for a short time.

Research studies on medicines for PTSD include:

• Stellate ganglion block. This procedure involves injecting medicine into a collection of nerves on the side of the neck. While the FDA has not approved this procedure to treat PTSD, studies have shown promising results.
• Prazosin. Prazosin (Minipress) is usually used to manage high blood pressure. Several studies indicate that it may reduce or suppress nightmares in some people with PTSD. But other studies show no benefit. Ask a healthcare professional for more information.

You and your healthcare professional can work together to figure out the best medicine, with the fewest side effects, for you. Your mood and other symptoms may get better within a few weeks.

Tell your healthcare professional about any side effects or problems with medicines. You may need to try more than one medicine, or your healthcare professional may need to adjust your dose or medicine schedule, before finding the right fit for you.

Coping and support

If a traumatic event causes stress and other problems that affect your life, see your healthcare professional or mental health professional. You also can take these actions as you continue with treatment for PTSD:

• Follow your treatment plan. Although it may take a while to feel the benefits of therapy or medicines, treatment can be effective. Most people recover. Remind yourself that it takes time. Following your treatment plan and routinely reaching out to 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 build coping strategies to respond effectively.
• Take care of yourself. Get enough rest, eat a healthy diet, exercise and take time to relax. Try to reduce or not use 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, hinder effective treatments and prevent real healing.
• Break the cycle. When you feel anxious, take a brisk walk or work on a hobby to refocus.
• Stay connected. Spend time with supportive and caring people — family, friends, faith leaders or others. You don't have to talk about what happened. 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 or withdrawn and depressed, for example. PTSD can greatly strain the emotional and mental health of loved ones and friends.

Hearing about a trauma that led to your loved one's PTSD may be painful for you and even cause you to relive hard events. You may find yourself avoiding your loved one's 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 speed up the healing process.

Remember that you can't change someone. But you can:

• Learn about PTSD. This can help you know what your loved one is going through.
• Be aware that PTSD includes avoiding and withdrawing from others. If your loved one doesn't want your help, allow space and let your loved one know that you're available when the time is right.
• Offer to go to healthcare appointments. If your loved one is willing, going to appointments can help you learn more about and help with treatment.
• Be willing to listen. Let your loved one know you're willing to listen, but you understand if this isn't the right time to talk. Try not to force your loved one to talk about a trauma until your loved one is ready.
• Urge get-togethers. Plan opportunities for activities with family and friends, but respect the person's decision if the time isn't right to participate. Celebrate events.
• Make your health a priority. Take care of yourself by eating healthy, being physically active and getting enough rest and sleep. Take time alone or with friends. And take part in activities that help you recharge.
• Seek help if you need it. If you have a hard time coping, talk with your healthcare professional. You may need to see 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 healthcare professional or mental health professional. Here's some information to help you prepare for your appointment and know what to expect.

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

What you can do

Before your appointment, make a list of:

• Any symptoms you've been having, 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 healthcare professional 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 staying away from because of your stress.
• Your medical information, including other physical or mental health conditions that you've been diagnosed with. Also, include any medicines or supplements you're taking, and the doses.
• Questions to ask so that you can make the most of your appointment.

Basic questions to ask your healthcare professional or mental health professional include:

• What is causing my symptoms?
• Are there any other possible causes?
• How will you diagnose my condition?
• Is my condition likely short term or long term?
• What treatments do you recommend for this condition?
• How best can I manage my other health problems with PTSD?
• How soon do you expect my symptoms to get better?
• Does PTSD raise my risk of other mental health problems?
• Do you recommend any changes at home, work or school to support 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 healthcare professional likely will ask you several questions, such as:

• What symptoms are concerning to you or your loved ones?
• When did you or your loved ones first notice your symptoms?
• Have you ever been a part of or witnessed a traumatic event?
• Do you have disturbing thoughts, memories or nightmares of a trauma you had?
• Do you stay away from certain people, places or situations that remind you of a traumatic experience?
• Have you been having any problems at school, work or in how you get along with others?
• Have you ever thought about harming yourself or others?
• How often do you drink alcohol or use recreational drugs?
• Have you been treated for other mental health symptoms or a mental health condition in the past? If yes, what type of therapy was most helpful?

Your healthcare professional or mental health professional will ask more questions based on your responses, symptoms and needs. You may be given questionnaires to fill out that will ask you about events you have had and your symptoms. Preparing and anticipating questions will help you make the most of your time with the healthcare professional.