Posttraumatic Stress Disorder (PTSD)

Medically Reviewed by Zilpah Sheikh, MD on July 14, 2024
Written by WebMD Editorial Contributors
12 min read

Posttraumatic stress disorder (PTSD) is a serious condition that can develop after someone experiences or witnesses a traumatic or terrifying event involving serious physical harm or the threat of it. Examples of things that can bring on PTSD include sexual or physical assault, the unexpected death of a loved one, an accident, a war, or a natural disaster. Families of victims can develop PTSD, as can emergency personnel and rescue workers.

Most people who have a traumatic event may have reactions such as shock, anger, nervousness, fear, and even guilt. These reactions are common, and for most people, they go away over time. For someone with PTSD, however, these feelings continue and even increase. That can make it hard to hold a job, have a relationship, and even take care of yourself.

PTSD history

Descriptions of trauma-related symptoms can be found in writings going back thousands of years. In the mid-19th century, doctors started trying to explain and address physical and mental symptoms experienced by military service members. People called it things such as "war neurosis," "shell shock," and "battle fatigue."

When the American Psychiatric Association published its first Diagnostic and Statistical Manual of Mental Disorders in 1952, it included what was called "gross stress reaction." As a result of research involving veterans of the Vietnam War, Holocaust survivors, sexual assault victims, and others, PTSD became a formal diagnosis in 1980. At that time, it was classified as a type of anxiety disorder.

Understanding of the disorder has evolved over time, and the definition and specific symptoms have changed somewhat. It's now in a separate category under the umbrella of trauma and stressor-related disorders.

There are certain criteria for a PTSD diagnosis. You have to have been impacted by a stressful event beyond what most people are able to deal with. 

Your symptoms need to have gone on for at least a month. These often begin within 3 months of the event, but it may take years for them to appear.

While one person's symptoms may be more intense than another's, they must cause significant problems in your personal or work life. You also have to have symptoms from each of these four categories:

Unwanted memories. People with PTSD relive the ordeal again and again through thoughts and memories. These may take the form of:

These are very upsetting. You may also feel dread or terror any time something reminds you of the trauma, such as the anniversary date.

Avoiding. You go out of your way to keep from being reminded of the event. You may:

  • Stay away from certain places
  • Stop doing activities you used to enjoy
  • Refuse to talk about the trauma or get help
  • Become detached and isolated from family and friends
  • Stay constantly busy or distracted

Changes in physical and emotional reactions. These include:

  • Problems relating to others, including feeling or showing affection
  • Trouble falling or staying asleep
  • Irritability
  • Outbursts of anger
  • Acting aggressively or taking risks
  • Trouble concentrating
  • Being "jumpy" or easily startled
  • Increased blood pressure and heart rate
  • Fast breathing
  • Muscle tension
  • Nausea and diarrhea

Changes in thinking and mood. The way you see yourself and the world often turns negative after the traumatic event. For example, you may:

  • Blame yourself for the event
  • Think of yourself as weak or worthless
  • Feel hopeless about the future
  • Be suspicious of others
  • Have a hard time feeling happiness or enjoyment

PTSD symptoms may increase or become more intense when you feel stress overall, or when you encounter a specific reminder about what happened.

PTSD flashbacks

Flashbacks are a common symptom of PTSD. More realistic than a memory, it can seem like the trauma is happening again. You may see the event play out in front of you like a movie, or experience smells or sounds related to it.

Certain things may trigger a flashback for you, or one could seem to come out of the blue. You may feel very intense emotions during a flashback and have trouble telling what's real.

Experts say this happens because your brain doesn't process and store traumatic memories the way it does other ones. When something causes them to be called up again, you experience them differently from other memories.

Talk to your doctor about how to manage them. These strategies may help:

  • Learn what triggers flashbacks for you.
  • Move to a calm, quiet environment when you feel one starting.
  • Tell yourself that you're safe and that the event isn't actually happening.
  • Use techniques to focus on what's real, such as listing or describing things you can see or hear around you.
  • Learn deep breathing and other relaxation methods.

Signs of PTSD in kids and teens

Children and teenagers may have different symptoms than adults and may have a hard time expressing what they're feeling. 

Very young children may become clingy and have trouble separating from their parents or caregivers. They may throw tantrums and have physical symptoms such as stomach aches. It may seem like they're going backward in development areas such as toilet training, motor skills, and language.

School-aged children may act out the traumatic event when they play, draw pictures, or write stories about it.

Teenagers are more likely to show aggressive or risky behavior, such as getting in fights or abusing alcohol or drugs. 

When to get emergency help for PTSD symptoms

It's not uncommon for someone with PTSD to think about suicide or attempt it. You can call or text 988 to get help from the 988 Suicide and Crisis Lifeline around the clock. If you think someone is in immediate danger, call 911 or take them to the emergency room.

Someone with PTSD may also lash out with violent or abusive behavior. If you're the target, get to a safe place and call for help.

They aren't separate diagnoses, but several terms are used to describe PTSD based on a specific cause or the way the symptoms appear.

Complex PTSD

This term has been proposed for the experience of people who've had ongoing trauma, rather than one traumatic event. This may cause a personality change that goes beyond other PTSD symptoms, with trouble managing your emotions and relating to other people. People at risk include prisoners of war, refugees, and victims of sex trafficking, domestic violence, and childhood abuse.

Delayed-onset PTSD 

Also called PTSD with delayed expression, this means symptoms started at least 6 months after the traumatic event. Sometimes, PTSD doesn't develop until years later.

Birth trauma

Childbirth can be a source of trauma. Maybe you had a particularly difficult or painful delivery, you needed an emergency C-section, or you or your baby had to have other emergency treatment. It can also affect you if you're the partner of someone who went through a traumatic childbirth.

Racial trauma

PTSD symptoms can come from experiencing hate, discrimination, and other forms of racism.

Military PTSD

Military veterans are more likely to have PTSD than civilians, particularly those who were involved in combat.

Secondary trauma

If the traumatic event happened to someone else, but you're having PTSD, that may be referred to as secondary trauma. It can happen to people such as first responders, journalists, witnesses to a crime or accident, or a caregiver for someone with PTSD.

Everyone reacts to traumatic events differently. Each person is unique in their ability to manage fear, stress, and the threat posed by a traumatic event or situation. For that reason, not everyone who has a trauma will develop PTSD. Also, the type of help and support you get from friends, family members, and professionals following the trauma may influence whether you get PTSD and how serious the symptoms are.

Some events likely to cause PTSD are:

  • Military combat
  • Sexual assault or threatening sexual harassment
  • Other physical violence or the threat of it, such as being beaten, kidnapped, or robbed
  • Abuse during childhood
  • Terrorist acts
  • An accident, such as a car crash, house fire, or plane crash
  • A tornado, flood, wildfire, or any other natural disaster

Researchers have found brain changes in people who have PTSD that may explain why it causes memory problems, puts you on edge, and makes you less able to handle stress.

Anyone who has had a traumatic event can develop PTSD. But some things may make it more likely, for example:

  • You've experienced other traumatic events.
  • Your job exposes you to life-threatening situations often, such as first responders and military service members.
  • You were injured during the event.
  • The event went on for a long time or was especially intense.
  • You have a history of other mental health problems.
  • You have blood relatives with mental health problems.
  • You have a history of alcohol or drug abuse.
  • You don't have family or close friends to support you.

How common is PTSD?

It's hard to pinpoint exactly how many people have PTSD. The U.S. Department of Veterans Affairs estimates 5% of U.S. adults have it in any given year, and 6% will have it in their lifetimes. In 2020, the estimate was 13 million people.

PTSD can develop at any age, including childhood. Women are more likely to have it than men -- about 8% vs. 4%. This may be due to the fact that people assigned female at birth are more likely to be victims of domestic violence, abuse, and rape.

Rates are also higher among certain minority groups. One study found a higher percentage of Black people experience PTSD than whites, Hispanics, or Asians. And researchers estimate that more than 40% of people in the LGBTQ community have PTSD symptoms.

One possible reason: if you're Black, or identify as LGBTQ, you're more likely to experience violent assaults than others. Also, being on the receiving end of hate and discrimination — whether based on your gender, race, or other part of your identity — causes stress and can change the way you see yourself.

PTSD isn’t diagnosed until at least 1 month has passed since the traumatic event happened. If you have symptoms, the doctor will begin an evaluation with a complete medical history and physical exam. Although there are no lab tests to specifically diagnose PTSD, you may get tests to rule out physical illness as the cause of the symptoms.

If no physical illness is found, you may be referred to a psychiatrist, psychologist, or other mental health professional who is specially trained to diagnose and treat mental illnesses.

PTSD test

You won't be given a test, but you may be asked to fill out a questionnaire or have an interview so the doctor can learn more about your thoughts, feelings, and behaviors. There are several different assessment tools used to evaluate someone for PTSD or other psychiatric conditions. The questions involve things such as what kind of symptoms you have, how often you have them, and how they affect your day-to-day life. 

An assessment could take up to a couple of hours depending on your situation. You don't have to share more information about your traumatic experience than you're comfortable with.

The goal of PTSD treatment is to reduce the emotional and physical symptoms and improve how you manage your daily life. Treatment may involve psychotherapy (a type of counseling), medication, or both.

PTSD medications

Doctors use certain antidepressant medications to treat PTSD -- and to control the feelings of anxiety and its associated symptoms -- including:

Certain blood pressure medicines are also sometimes used to control particular symptoms:

Experts discourage the use of tranquilizers such as lorazepam (Ativan) or clonazepam (Klonopin) for PTSD because studies have not shown them to be helpful, plus you can become physically dependent on them. 

Psychotherapy

Psychotherapy for PTSD involves helping you learn skills to manage symptoms and develop ways of coping. Therapy also aims to teach you and your family about the disorder, and help you work through the fears associated with the traumatic event. Approaches include:

Cognitive processing therapy involves analyzing upsetting thoughts and feelings you have about the trauma and learning to change the ones that are incorrect or unhelpful.

Prolonged exposure therapy is a type of behavioral therapy that involves having you relive the traumatic event, or exposing you to objects or situations that cause anxiety. This is done in a well-controlled and safe environment. Prolonged exposure therapy helps you confront the fear and gradually become more comfortable with situations that are frightening and cause anxiety.

Psychodynamic therapy focuses on helping you examine personal values and the emotional conflicts caused by the traumatic event.

Family therapy may be useful because the behavior of the person with PTSD can have an affect on other family members.

Group therapy may be helpful by allowing you to share thoughts, fears, and feelings with other people who have experienced traumatic events.

Eye Desensitization and Reprocessing (EMDR) is a complex form of psychotherapy that was initially designed to relieve distress associated with traumatic memories and is now also used to treat phobias.

Trauma-focused cognitive-behavioral therapy

A special kind of therapy is sometimes used with children who have PTSD. Trauma-focused cognitive-behavioral therapy can help children feel safe and in control of their emotions. They're encouraged to talk about what they went through and how they feel about it. The therapist helps them change the way they react to memories of the event, and also change incorrect ideas they may have, like thinking they're to blame. Parents and other caregivers are also part of the therapy process.

MDMA for PTSD

Some research has been done into using the drug 3,4-methylenedioxymethamphetamine (MDMA), also known as ecstasy or Molly, along with psychotherapy for people who haven't gotten results from other treatments. The drug increases levels of so-called "feel-good" hormones in your brain, including serotonin and dopamine. That can make it easier to talk about and process your traumatic experience with a therapist.

PTSD can cause problems in every aspect of your life, including your job, relationships, health, and everyday activities. It may also make you more likely to develop other mental health problems, such as:

  • Depression and anxiety
  • Drug or alcohol abuse
  • Eating disorders
  • Suicidal thoughts and actions

Recovery from PTSD is a gradual and ongoing process. You may have periods of improvement followed by relapses. Symptoms of PTSD seldom disappear completely, but treatment can help you learn to manage it more effectively, leading to fewer and less intense symptoms. 

It's important to stick to your treatment plan. These other steps can help you feel better:

  • Educate yourself about the disorder.
  • Be patient with yourself and the pace of your recovery.
  • Take care of your physical health with exercise and a healthy diet.
  • Find sources of support, such as family, friends, or a support group.
  • Work with your therapist on a plan to handle triggers.
  • Try not to self-medicate with drugs or alcohol.

PTSD often takes a toll on relationships. It may seem like the person you care about has become someone you don't know. Their behavior may be hurtful to you and disruptive for your family.

It can be difficult to balance supporting your loved one and taking care of yourself. Here are some things you can do:

  • Educate yourself about the disorder. 
  • Encourage them to get treatment, and offer to go along on doctor or therapy visits.
  • Give them space, but let them know you're available when they want to talk.
  • Listen without judgment or trying to offer solutions.
  • Work together on ways to manage an anxiety or anger episode.
  • Participate in family or couple's therapy.
  • Encourage them to keep contact with friends and family who can be sources of support. 
  • Consider joining a support group for partners of people with PTSD.

Remember that your needs matter too, and don't feel guilty about living your life. For example, if your partner isn't comfortable in crowds or social situations, do some things by yourself.

If your child has PTSD, steps you can take to help them include:

  • Boost their sense of security with a calm environment and predictable routines.
  • Encourage them to talk about their feelings.
  • Teach them problem-solving and other life skills to increase their sense of self-sufficiency.
  • Make sure they have social activities and time with friends.
  • Ask their doctor whether therapy would be helpful.

Some studies suggest that early intervention with people who had a trauma may reduce some of the symptoms of PTSD or prevent it altogether.

Posttraumatic stress disorder can result from experiencing trauma, such as military combat or sexual assault. Talk to your doctor if you're having symptoms such as nightmares or flashbacks, or if you feel depressed or agitated more than a month after the event. Various forms of talk therapy have been shown to be helpful.

Does PTSD ever go away?

For some people, PTSD symptoms go away on their own or after treatment. For others, symptoms may continue for years or even the rest of their lives. But they may be less intense and you may have them less often if you get treatment.

Is PTSD an anxiety disorder?

No. Psychiatrists now put it in the category of trauma- and stressor-related disorders. It was classified as an anxiety disorder until 2013. The change recognizes the fact that it has a unique and complicated mix of effects on your behavior and personality.

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