Post-Traumatic Stress Disorder (PTSD)
PTSD can leave you feeling stuck with a constant sense of danger and painful memories. But with new coping skills, you can feel safe again and move on from the trauma.
What is PTSD?
After a traumatic experience, it’s normal to feel frightened, sad, anxious, and disconnected. But if the upset doesn’t fade, you may be suffering from post-traumatic stress disorder (PTSD). PTSD can develop following any event that makes you fear for your safety. 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.
What causes PTSD?
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.
- Re-experiencing the traumatic event through intrusive memories, flashbacks, nightmares, or intense mental or physical reactions when reminded of the trauma.
- Avoidance and numbing, such as avoiding anything that reminds you of the trauma, being unable to remember aspects of the ordeal, a loss of interest in activities and life in general, feeling emotionally numb and detached from others and a sense of a limited future.
- Hyperarousal, including sleep problems, irritability, hypervigilance (on constant “red alert”), feeling jumpy or easily startled, angry outbursts, and aggressive, self-destructive, or reckless behavior.
- Negative thought and mood changes like feeling alienated and alone, difficulty concentrating or remembering, depression and hopelessness, feeling mistrust and betrayal, and feeling guilt, shame, or self-blame.
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PTSD symptoms in children
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.
Do you have PTSD?
If you answer yes to three or more of the questions below, you may have PTSD and it’s worthwhile to visit a qualified mental health professional.
- Have you witnessed or experienced a traumatic, life- threatening event?
- Did this experience make you feel intensely afraid, horrified, or helpless?
- Do you have trouble getting the event out of your mind?
- Do you startle more easily and feel more irritable or angry than you did before the event?
- Do you go out of your way to avoid activities, people, or thoughts that remind you of the event?
- Do you have more trouble falling asleep or concentrating than you did before the event?
- Have your symptoms lasted for more than a month?
- Is your distress making it hard for you to work or function normally?
PTSD 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.
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.
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.
What is complex PTSD (CPTSD)?
Complex post-traumatic stress disorder (CPTSD or C-PTSD) is often considered more severe than PTSD. It’s caused by chronic exposure to traumatic events. If you grew up in an abusive household, for example, years of sustained domestic violence could result in CPTSD. People who experience the prolonged trauma of conditions like slavery or torture might also suffer from this disorder.
If you have CPTSD, you may experience many of the same symptoms of PTSD, such as hypervigilance, flashbacks, and emotional numbness, as well as:
Negative thoughts about yourself. You struggle with consistent thoughts of worthlessness and intense shame.
Difficulty controlling emotions. You have intense reactions, feeling overly sensitive, and struggle with anger. You might experience dissociation, a feeling of disconnection with the world around you.
Difficulty with relationships. You have a hard time establishing or maintaining friendships and romantic relationships. Feelings of isolation are common.
Complex PTSD also has some overlapping symptoms with borderline personality disorder (BPD). For many people, trauma may play a role in the development of BPD.
Whatever your personal experiences or symptoms of PTSD, the following tips can offer effective ways to help you heal and move on:
PTSD self-help tip 1: Challenge your sense of helplessness
Recovery from PTSD is a gradual, ongoing process. Healing doesn't happen overnight, nor do the memories of the trauma ever disappear completely. This can make life seem difficult at times. But there are many steps you can take to cope with the residual symptoms and reduce your anxiety and fear.
Overcoming your sense of helplessness is key to overcoming PTSD. Trauma leaves you feeling powerless and vulnerable. It's important to remind yourself that you have strengths and coping skills that can get you through tough times.
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. Instead of focusing on your thoughts, 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. Anyone with PTSD can benefit from the relaxation, seclusion, and peace that come with being out in nature. 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 who care about you. 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. Or you could 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.
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: Support PTSD treatment with 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, interferes with treatment, and can 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, watch a funny show, or read something light) and make your bedroom as quiet, dark, and soothing as possible.
Getting professional help for PTSD
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.
Why you should seek help for PTSD
Early treatment is better. Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes.
PTSD symptoms can change family life. PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life.
PTSD can be related to other health problems. PTSD symptoms can make physical health problems worse. For example, studies have shown a relationship between PTSD and heart trouble. Getting help for your PTSD could also improve your physical health.
Source: National Center for PTSD
Breaking the Cycle of Trauma
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PTSD treatment and therapy
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 for PTSD
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.
Authors: Melinda Smith, M.A., Lawrence Robinson, Robert Segal, M.A., and Jeanne Segal, Ph.D.
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Helplines and support
Find treatment and support for PTSD
UK: PTSD UK offers treatment and support options.
Australia: Phoenix Australia offers PTSD helplines and resources.
Canada: Find Your Local CMHA division for support and treatment options.
If you’re a veteran with PTSD:
In the U.S.: Call the Veterans Crisis Line at 1-800-273-8255 (Press 1); call the Veteran Center Call Center hotline to talk with another combat veteran at 1-877-927-8387; or use the PTSD Program Locator to find specialized VA PTSD treatment.
UK: Visit Combat Stress or call the 24-hour helpline 0800 138 1619.
Canada: Visit Operational Stress Injury Social Support (OSISS) for a local number to talk to a peer who has been through similar experiences.
Australia: Visit Veterans and Veterans Families Counselling Service (VVCS) or call 1800 011 046.
Last updated: November 22, 2022