What Is PTSD? Symptoms, Causes, Diagnosis, and Treatment

Post-traumatic stress disorder (PTSD) happens when some individuals have a certain reaction to witnessing or experiencing a shocking or traumatic event. Examples include, but are not limited to, sustaining a life-threatening injury or witnessing death on the battlefield, an instance of sexual assault, a school shooting, a natural disaster, or a car accident, according to the National Institute of Mental Health (NIMH). (1)

The event does not need to be directly experienced. PTSD may develop after witnessing another person experience a traumatic event or after learning that a relative or close friend was exposed to a trauma — for example, witnessing death by a first responder or watching a family member go through a traumatic event. (1)

Symptoms of PTSD can be triggered by anything that leads the person to feel threatened, whether it’s real or perceived danger. Triggers may include a noise, a smell, or a song. “Typically it tends to be emotionally related to a past issue,” says Lori Russell-Chapin, PhD, professor and co-director for the Center for Collaborative Brain Research (CCBR) at Bradley University in Peoria, Illinois.

Both the NIMH and the American Psychiatric Association (APA) outline four symptom clusters of PTSD from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), outlined below. (2,3)

Reexperiencing the Event

Intrusive memories, which are memories about the trauma that happen after a triggering stimulus (like a taste or a smell), can come back at any time, and an individual may feel as though they are reexperiencing the trauma again.

Or one may reexperience the event by having flashbacks, which are less common, but can be extremely disturbing. “The one that we think about and hear about most often are flashbacks, when in fact, flashbacks are fairly rare,” says Michele Pole, PhD, clinic director at West Chester University’s department of Community Mental Health Services in West Chester, Pennsylvania.

People with PTSD can also experience dreams and nightmares about the trauma. “These cause a lot of distress for people, and they often try to find ways to manage their emotions when this happens,” Dr. Pole says.

Avoidance

People with PTSD will actively try to avoid thoughts, feelings, people, places, or situations that remind them of the trauma. They may also avoid talking about their trauma with others.

For example, if the person was in a serious car accident, he or she may drive several miles out of the way to avoid the intersection where that traumatic event occurred.

Avoidance can lead to unhealthy behaviors. People may start to drink or use drugs or use them more frequently. “It’s a way to self-medicate [and] avoid feeling the [typical] feelings that come up after somebody experiences trauma,” Pole says.

Arousal and Reactivity

Feelings of hypervigilance or arousal occur when people with PTSD become stuck in fight-or-flight mode and their nervous system is on high alert at all times. “An individual scans the environment for danger because there’s this fear that danger is around any corner,” Pole says.

People with PTSD who experience the symptom of hypervigilance also may have an increased startle response, may have trouble with concentration, and may experience sleep problems. They may also engage in destructive behaviors and have aggressive outbursts.

Mood and Cognitive Changes

People with PTSD may have a shift in the way they view the world, themselves, and others. They may feel more negative thoughts and feelings, and they may feel they can’t trust other people or themselves. “They may decide the world is not a safe place,” Pole says.

It’s also common for people with PTSD to feel shame. In an effort to make sense of the event, they blame themselves. They may falsely believe that it’s their fault, or that they can make sure it doesn’t happen again, which may be particularly true for women who are victims of sexual assault.

People may feel shame because they believe they weren’t strong enough to stop the trauma. “It’s a way to feel that they have some control over what happened to them. But what that shame does is keep them stuck,” Pole says.

Other mood and cognition symptoms of PTSD include difficulty remembering certain parts of the trauma, feelings of isolation and detachment, decreased interest in activities you once enjoyed, and difficulties experiencing positive emotions. These symptoms can be especially challenging to cope with because they are not easy to diagnose.

Learn More About Signs and Symptoms of PTSD

The most significant risk factor for PTSD is previous trauma. The more trauma a person experiences, the higher his or her predisposition is to developing PTSD, says Dr. Russell-Chapin.

This is thought to be because trauma leads to physical changes in the brain. It increases activity in the amygdala, which is the part of the brain where the fight-or-flight response is initiated, and it may decrease connectivity in the prefrontal cortex, which is the area of the brain that’s responsible for decision making and planning processes, like reasoning. (4)

“People struggle to think through this and respond logically to a situation,” Russell-Chapin says. “What happens to people with repeated trauma is they quit responding to life, and they continue to just react to life.”

Other risk factors include being injured in the traumatic event, individuals who experience physical or sexual assault, or who are involved in combat are at higher risk for PTSD. (5)

Gender and genetics are other possible risk factors. When traumatic events and revictimizations are controlled for, women are diagnosed with PTSD more often than men, which suggests there may be a genetic factor at play, says Obianuju Berry, MD, a psychiatrist at NYU Langone Health in New York City. In fact, women are estimated to be twice as likely to develop PTSD as men. (3)

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Intergenerational transmission of trauma is an idea that the effects of trauma can be passed down to offspring of the survivors’ through in-utero exposure to trauma. Whether the intergenerational trauma transmission is a consequence of in-utero neurodevelopmental disruptions — which may cause fetal DNA damage versus the damage to the early-life caregiver-infant interaction — is complicated. (6, 7)

But the risk for intergenerational transmission of trauma is also greater on an individual’s maternal side. “If the mother has PTSD, upon exposure to a traumatic event, the likelihood that the child would develop PTSD is greater when compared with the general population,” says Arielle Schwartz, PhD, a clinical psychologist in Boulder, Colorado, and author of The Complex PTSD Workbook.

Learn More About the Causes of PTSD: Rick Factors, Genetics, and More

Some individuals who experience a traumatic event may have initial distressing symptoms but may not go on to develop PTSD. They might have acute stress reactions that are transitory but resolve spontaneously, or, with time, limited mental health treatment, Pole says.

Individuals who have these distressing symptoms that persist beyond one month should be referred directly to a mental health professional. Individuals may also self-refer themselves after taking a PTSD self-screen. (8) The mental health professional will typically administer a clinical interview and use the DSM-5, the standard classification of mental disorders used to diagnose mental disorders. The DSM-5 cites several required criteria to diagnose PTSD.

The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) was developed by the U.S. Department of Veterans Affairs National Center for PTSD, and is considered a more accurate way to make a diagnosis, evaluate the PTSD symptoms someone may have experienced within the last week, and understand the lifetime diagnosis. (9)

Diagnosing PTSD isn’t always straightforward, Pole says. The best way to ensure an accurate diagnosis is to see a mental health professional who has experience with PTSD and understands what it can look like without relying too heavily on the diagnostic tools. “Just because someone doesn’t meet full criteria for PTSD, that doesn’t mean that they’re not suffering,” Pole says, or that they shouldn’t seek help or wouldn’t benefit from treatment.

After a traumatic event, distressing symptoms may be present almost immediately, or it may take up to three months for symptoms to appear.

As noted above, for PTSD to be diagnosed, symptoms must last longer than one month and the symptoms must cause significant distress or interfere with your life.

The duration of PTSD varies from individual to individual; for some it may take weeks, months, or years to see an improvement in symptoms, but treatment can help increase the chances that you will recover sooner. Sometimes, however, PTSD symptoms may persist if the traumatic event is ongoing, such as with domestic abuse. (1,2,3)

Medical professionals say self-education is the first step toward identifying a proper treatment plan. There’s an emotional benefit to reading up on PTSD as well: “When they understand what they’re experiencing is normal within the circumstances they have been through, there’s a real relief in that,” Pole says.

Counseling Options

There are several effective treatments available for PTSD, according to the U.S. Department of Veterans Affairs (VA). They include trauma-focused psychotherapies, such as exposure therapy, cognitive processing therapy (CPT), and eye-movement desensitization and reprocessing (EMDR). (10)

Group therapy may be another option for people with PTSD. This may be done in a group with other individuals who have experienced similar traumas — for example veterans or perhaps with family members. (3)

Medication Options

Although there are no oral medication treatments specifically indicated for PTSD, some medications may be helpful in dealing with specific symptoms. For example, antidepressants, such as selective serotonin reuptake inhibitors (SSRs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are sometimes useful to help with mood disturbances of anxiety associated with PTSD. (11)

Alternative and Complementary Therapies

Complementary therapies for PTSD include acupuncture, yoga, and meditation, though the VA says scientists are still exploring how big of a role these modes can play in relieving PTSD symptoms. (12)

Learn More About Treatment for PTSD: Counseling, Medication, Alternative and Complementary Therapies, and More

Prognosis of PTSD

Recovering from PTSD is dependent on several factors, including whether or not an individual is in treatment with therapy or medication. Having this condition doesn’t mean that a person is automatically bound to experience symptoms for the rest of their lives.

The exact outlook depends on how soon a person with PTSD is able to access treatment. According to the NIMH, recovery is possible for some people within six months, while others may have symptoms that last for more than a year. (2)

PTSD may lead to the following complications: (13,5)

• Depression and anxiety
• Substance misuse (specifically alcohol and drugs)
• Sleep disorders
• Eating disorders
• Suicidal thoughts or attempts

PTSD Stigma

Stigma is defined by the Carter Center as “a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses.” (14 PDF)

People with PTSD are often depicted as dangerous, unpredictable, incompetent, or to blame for their illness. People with PTSD can feel stigma from others and experience self-stigma.

Military service personnel may fear that talking about their illness will hurt their careers, or they will be viewed by others in their unit as weak or unable to protect them, for example. (15)

According to research, combat veterans of Operation Enduring Freedom and Operation Iraqi Freedom who sought treatment for PTSD reported faced common perceived stereotypes of veterans seeking treatment, including labels such as “crazy,” and “dangerous or violent,” and were made to believe they were responsible for their diagnoses. Most of the study participants also reported that they initially avoided seeking treatment to avoid the “mental illness” label. (16)

“It reinforces to the individual with PTSD that they’re weak or that there’s something wrong with them and that really feeds that shame,” according to Pole. “In fact, people who have been through trauma are some of the strongest individuals I’ve ever worked with.”

Learn More About the Causes and Effects of PTSD Stigma

Suicide Linked to PTSD

A report by the VA found the risk for suicide was 41 percent higher among deployed veterans than civilians in the United States, but that risk was actually higher — 61 percent — for nondeployed vets. Regardless of deployment status, the report noted that the suicide risk was higher among younger, male, white service members, whether active or veterans. (17)

According to the Centers for Disease Control and Prevention (CDC), while women attempt suicide more frequently, men are 4 times more likely to die by suicide than women. (18)

Fortunately, with treatment, research shows that suicidal thoughts among people with PTSD decreases. (19)

If you or a loved one is having suicidal thoughts stemming from PTSD, seek help immediately.

You can call the National Suicide Prevention Lifeline to do so — dial 988.

Learn More About the Link Between Suicide and PTSD

Research suggests nearly 90 percent of people in the United States are exposed to a traumatic event in their lifetime, but only 5 to 10 percent develop PTSD. About 7 to 8 percent of the population will have PTSD at some point in their lives. (20) Women are more than twice as likely as men to develop PTSD. An estimated 10 percent of women will develop PTSD in their lives, compared with 4 percent of men. (1)

The reason women may be more statistically affected by PTSD compared with men may have less to do with concrete prevalence and more to do with the diagnosis rates, because women are more likely to seek mental health treatment. (21)

PTSD in the Military

Military service members and veterans can develop PTSD as a result of the events they experienced or witnessed.

The estimated percentage of veterans affected by PTSD varies by war, as outlined by the VA: (15)

• Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF): between 11 and 20 percent
• Gulf War: 12 percent
• Vietnam War: between 15 and 30 percent

According to a 2017 study, the PTSD symptoms and experiences followed similar trajectories for both veterans and active service members. But the researchers noted that veterans were more likely to “have a higher burden of PTSD than current military personnel, given a higher proportion in sub-optimal PTSD [symptoms].” (22)

Types of trauma include trauma that occurred during combat or military sexual trauma (MST), which includes sexual harassment and sexual assault that occurs during training, combat, or peacetime. (15)

The Department of Defense (DOD) and the VA have invested time and money on research and providing programs to help prevent military personnel from developing PTSD. These efforts include training civilians and veterans to tolerate stress more effectively, instituting treatment protocols after a diagnosis, and treating chronic PTSD, Dr. Berry says.

Learn More About PTSD in the Military and Whether It Can Be Prevented

While PTSD can affect anyone who experiences trauma, research has found that this condition disproportionately affects minority groups. According to the APA, Hispanic Americans, Black Americans, and Native Americans all have higher rates of PTSD compared with Non-Hispanic white Americans. (3)

The highest lifetime prevalence is in Black Americans, at 8.7 percent, while both Hispanic Americans and white Americans experienced PTSD at a rate of 7.4 percent, according to research. Comparatively, an estimated 7 percent of white Americans experience PTSD. The same study found the lowest rates in the Asian American population, at about 4 percent.

All non-white groups were also found to be less likely to seek treatment for PTSD compared with white Americans. (23,24 PDF)

Black Americans and Hispanic Americans and PTSD

Compared with white Americans, Black and Hispanic Americans were more likely to witness domestic violence. (23)

Indigenous Communities and PTSD

While more research is needed on PTSD and Indigenous Americans, a 2015 review noted that trauma from violence and combat affects Indigenous populations, causing more symptoms compared with white Americans. (25)

People with PTSD, especially those who have experienced repeated trauma, can develop other mental illnesses, such as anxiety, depression, and even other physical ailments, such as chronic pain, according to previously published research. (26,27) “If someone already had a vulnerability to develop a mood disorder, experiencing trauma could really trigger a full-blown major depressive episode,” Pole says.

Substance use disorders, traumatic brain injuries (TBIs), and neurocognitive disorders (NCDs) are also common comorbidities of PTSD.

Previous research also indicates a strong connection between PTSD and a higher risk of cardiovascular disease, high blood pressure (hypertension), high cholesterol, and obesity. PTSD could also increase the risk for stroke. (28) Chronic stress may increase your heart rate and place added stress on your vascular system, which could in turn explain such links.

There are also possible links between PTSD and cancer. While research from 2015 found no significant risk for cancer in general, a study from 2019 found an increased risk of ovarian cancer in premenopausal women. (29,30)

Other related conditions to PTSD include: (3)

• Anxiety disorders
• Adjustment disorder
• Acute stress disorder
• Reactive attachment disorder
• Disinhibited social engagement disorder
• And two conditions specific to children: reactive attachment disorder and disinhibited social engagement disorder

Learn More About Related Conditions of PTSD

PTSD Myths

Although there’s a greater awareness of PTSD today, misconceptions around the disorder still exist. For one, some people still associate the mental illness only with military veterans, when in fact other individuals — like those who’ve experienced an assault or a natural disaster, for example — are also diagnosed with PTSD.

Then there’s the idea that PTSD can’t be treated, which is a common misconception. If you or a loved one is suffering from PTSD, know that you have many options at your disposal, from psychotherapy to oral medication to alternative therapies, as noted above.

Unfortunately, many of the myths about PTSD can be harmful. But by knowing how to recognize them, you can overcome this potential barrier to care and regain your health.

Learn More About Some Common PTSD Myths and Why They’re Not True