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What is PTSD?
Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.
It is natural to feel afraid during and after a traumatic situation. Fear is a part of the body’s “fight-or-flight” response, which helps us avoid or respond to potential danger. People may experience a range of reactions after trauma, and most people recover from initial symptoms over time. Those who continue to experience problems may be diagnosed with PTSD.
What are the signs and symptoms of PTSD?
Symptoms of PTSD usually begin within 3 months of the traumatic event, but they sometimes emerge later. To meet the criteria for PTSD, a person must have symptoms for longer than 1 month, and the symptoms must be severe enough to interfere with aspects of daily life, such as relationships or work. The symptoms also must be unrelated to medication, substance use, or other illness.
The course of the disorder varies. Some people recover within 6 months, while others have symptoms that last for 1 year or longer. People with PTSD often have co-occurring conditions, such as depression, substance use, or one or more anxiety disorders.
After a dangerous event, it is natural to have some symptoms. For example, some people may feel detached from the experience, as though they are observing things rather than experiencing them. A mental health professional who has experience helping people with PTSD, such as a psychiatrist, psychologist, or clinical social worker, can determine whether symptoms meet the criteria for PTSD.
To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:
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At least one re-experiencing symptom
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At least one avoidance symptom
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At least two arousal and reactivity symptoms
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At least two cognition and mood symptoms
Re-experiencing symptoms include:
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Experiencing flashbacks—reliving the traumatic event, including physical symptoms such as a racing heart or sweating
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Having recurring memories or dreams related to the event
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Having distressing thoughts
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Experiencing physical signs of stress
Thoughts and feelings can trigger these symptoms, as can words, objects, or situations that are reminders of the event.
Avoidance symptoms include:
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Staying away from places, events, or objects that are reminders of the traumatic experience
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Avoiding thoughts or feelings related to the traumatic event
Avoidance symptoms may cause people to change their routines. For example, some people may avoid driving or riding in a car after a serious car accident.
Arousal and reactivity symptoms include:
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Being easily startled
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Feeling tense, on guard, or on edge
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Having difficulty concentrating
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Having difficulty falling asleep or staying asleep
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Feeling irritable and having angry or aggressive outbursts
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Engaging in risky, reckless, or destructive behavior
Arousal symptoms are often constant. They can lead to feelings of stress and anger and may interfere with parts of daily life, such as sleeping, eating, or concentrating.
Cognition and mood symptoms include:
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Having trouble remembering key features of the traumatic event
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Having negative thoughts about oneself or the world
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Having exaggerated feelings of blame directed toward oneself or others
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Having ongoing negative emotions, such as fear, anger, guilt, or shame
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Losing interest in enjoyable activities
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Having feelings of social isolation
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Having difficulty feeling positive emotions, such as happiness or satisfaction
Cognition and mood symptoms can begin or worsen after the traumatic event. They can lead a person to feel detached from friends or family members.
How is PTSD treated?
It is important for anyone with PTSD symptoms to work with a mental health professional who has experience treating PTSD. The main treatments are psychotherapy, medications, or a combination of psychotherapy and medications. A mental health professional can help people find the best treatment plan for their symptoms and needs.
Some people with PTSD, such as those in abusive relationships, may be living through ongoing trauma. In these cases, treatment is usually most effective when it addresses both the traumatic situation and the symptoms of PTSD. People who experience traumatic events or who have PTSD also may experience panic disorder, depression, substance use, or suicidal thoughts. Treatment for these conditions can help with recovery after trauma. Research shows that support from family and friends also can be an important part of recovery.
Psychotherapy
Psychotherapy (sometimes called talk therapy) includes a variety of treatment techniques that mental health professionals use to help people identify and change troubling emotions, thoughts, and behaviors. Psychotherapy can provide support, education, and guidance to people with PTSD and their families. Treatment can take place one on one or in a group and usually lasts 6 to 12 weeks but can last longer.
Some types of psychotherapy target PTSD symptoms, while others focus on social, family, or job-related problems. Effective psychotherapies often emphasize a few key components, including learning skills to help identify triggers and manage symptoms.
One common type of psychotherapy, called cognitive behavioral therapy, can include exposure therapy and cognitive restructuring:
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Exposure therapy helps people learn to manage their fear by gradually exposing them, in a safe way, to the trauma they experienced. As part of exposure therapy, people may think or write about the trauma or visit the place where it happened. This therapy can help people with PTSD reduce symptoms that cause them distress.
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Cognitive restructuring helps people make sense of the traumatic event. Sometimes people remember the event differently from how it happened. They may feel guilt or shame about something that is not their fault. Cognitive restructuring can help people with PTSD think about what happened in a realistic way.
Medications
The U.S. Food and Drug Administration (FDA) has approved two selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication, for the treatment of PTSD. SSRIs may help manage PTSD symptoms such as sadness, worry, anger, and feeling emotionally numb. Health care providers may prescribe SSRIs and other medications along with psychotherapy. Some medications may help treat specific PTSD symptoms, such as sleep problems and nightmares.