Post-Traumatic Stress Disorder (PTSD)

Overview

People may have a range of reactions after experiencing or witnessing a traumatic event, such as an act of violence, natural disaster, or serious accident. Common reactions include feeling anxious, sad, angry and afraid. Most people will recover from their symptoms, and their reactions will lessen over time.

Those who continue to experience symptoms for an extended period after the trauma, and whose symptoms begin to interfere with their daily lives, may be diagnosed with PTSD. People with this condition feel stressed or frightened even when they are not in danger.

Anyone can develop PTSD at any age. This includes veterans and people exposed to war as well as those who have experienced or witnessed an assault, abuse, accident, natural disaster, terror attack, or other violent or intensely frightening events. People who experience serious medical conditions also may experience PTSD. Cancer patients, for example, may develop PTSD. Sometimes witnessing or learning that a relative or close friend experienced trauma can also cause PTSD.

Signs and Symptoms

Symptoms of PTSD usually begin within three months of the traumatic event, but they sometimes emerge later. The course of the disorder varies. Most people will experience some symptoms immediately after being exposed to trauma but will naturally recover in the initial weeks. However, some people will continue to experience symptoms for months or years, especially if treatment is not received.

Adults

To be diagnosed with PTSD, an adult must have been exposed to a traumatic event and develop or have existing symptoms significantly exacerbated for at least one month, including:

• At least one re-experiencing symptom
• At least one avoidance symptom
• At least two arousal and reactivity symptoms
• At least two cognition and mood symptoms

Re-experiencing symptoms include:

• Flashbacks: reliving the traumatic event, including physical symptoms such as a racing heart or sweating
• Recurring memories or dreams related to the event
• Distressing thoughts
• Physical signs of stress from reminders of the event

Thoughts and feelings can trigger these symptoms, as can words, objects, or situations that are reminders of the event.

Avoidance symptoms include:

• Staying away from places, events, or objects that remind the person of the experience
• 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:

• Being easily startled
• Feeling tense, on guard, or on edge
• Having difficulty concentrating
• Having difficulty falling asleep or staying asleep
• Feeling irritable and having angry or aggressive outbursts
• Engaging in risky, reckless, or destructive behavior

Arousal symptoms are often constant and can lead to feelings of stress and anger. They may interfere with parts of daily life, such as sleeping, eating, or concentrating.

Cognition and mood symptoms include:

• Trouble remembering key features of the traumatic event
• Negative thoughts about oneself or the world
• Exaggerated feelings of blame directed toward oneself or others
• Ongoing negative emotions, such as fear, anger, guilt, or shame
• Loss of interest in previous activities
• Feelings of social isolation
• Difficulty feeling positive emotions, such as happiness or satisfaction

These symptoms can lead people to feel detached from friends or family.

Children and Teens

Children and teens can have extreme reactions to traumatic events, but their symptoms may not be the same as those experienced by adults. In children younger than age 6, symptoms can include:

• Wetting the bed after having learned to use the toilet
• Forgetting how to talk or being unable to talk
• Acting out the scary event during playtime
• Being unusually clingy with a parent or other adult

Older children and teens usually show symptoms more like those seen in adults. They also may develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilt over not preventing injury or death or have thoughts of revenge.

Many of these reactions are normal and will lessen with time. If these symptoms last for more than a month, the family should reach out to a healthcare provider.

Related Health Effects

People with PTSD often have co-occurring conditions such as depression, substance use, or one or more anxiety disorders. People who experience traumatic events or who have PTSD may also experience panic disorder or suicidal thoughts. In severe forms, PTSD can significantly impair a person’s ability to function at work, at home, and socially.

Co-Occurring Substance Use Disorders

Many people with PTSD also have co-occurring substance use disorders. People with both disorders may have more chronic physical health problems, more social problems, and an increased risk of violence or suicide. When someone has a substance use disorder and another mental disorder, it is usually better to treat both disorders at the same time rather than separately.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. In life-threatening situations, call 911.

Pregnancy Complications

During pregnancy, PTSD increases the risk of preterm birth and low birth weight. PTSD also increases the risk for behaviors such as smoking and drinking, which can contribute to other problems impacting the health of the mother and baby.

Causes and Risk Factors

Most people who live through a dangerous event do not develop PTSD; many factors play a part. Some of these factors are present before the trauma, whereas others play a role during and after a traumatic event.

Risk factors that may increase the likelihood of developing PTSD include:

• Exposure to previous traumatic experiences, particularly during childhood
• Getting hurt or seeing people hurt or killed
• Feeling horror, helplessness, or extreme fear
• Having little or no social support after the event
• Dealing with stressors after the event, such as the loss of a loved one, pain and injury, or loss of a job or home
• Having a personal history or family history of mental illness or substance use

Studies show traumatic, extremely stressful experiences like abuse, violence, neglect, or the death of a loved one make a person more vulnerable to developing a substance use disorder.

The use of substances like drugs and alcohol to cope is risky and can lead to additional problems.

Prevention Guidance

Protective factors such as optimism and environmental influences like healthy family and peer relationships, as well as targeted prevention interventions, can reduce the risk of developing both PTSD and a substance use disorder after trauma.

Resilience factors that may reduce the likelihood of developing PTSD include:

• Seeking out and receiving support from friends, family, or support groups
• Learning to feel okay with one’s actions in response to a traumatic event
• Having healthy coping strategies to adjust or learn from a traumatic event
• Being prepared and able to respond to upsetting events as they occur, despite feeling fear

Diagnosis

A mental health professional such as a psychiatrist, psychologist, or clinical social worker can determine whether a person’s symptoms meet the criteria for PTSD. To meet these criteria, 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 medicine, substance use, or other illnesses.

Treatment and Management

It is important for people with PTSD symptoms to work with a mental health professional who has experience treating PTSD. The main treatments are psychotherapy, medicines, or a combination of both. An experienced mental health professional can help people find the best treatment plan for their symptoms and needs. Research shows that support from family and friends also can be an essential 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. Treatment can take place one-on-one or in a group setting and usually lasts 6 to 12 weeks but can last longer or be compressed to be delivered over a shorter duration.

A common type of psychotherapy called cognitive behavioral therapy (CBT) can include:

Exposure therapy helps people learn to manage their fear by gradually exposing them, in a safe way, to the trauma they experienced. People may think or write about the trauma or visit the place where it happened. This therapy can help reduce symptoms that cause distress.

Cognitive restructuring helps people make sense of the traumatic event. Sometimes people remember the event differently from how it happened, or they feel guilt or shame about something that is not their fault. Cognitive restructuring can help people change their negative thinking patterns.

Medicines

The U.S. Food and Drug Administration (FDA) has approved two selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medicine, for the treatment of PTSD. SSRIs may help people manage PTSD symptoms, such as sadness, worry, anger, and feeling emotionally numb. Healthcare providers may prescribe SSRIs and other medicines along with psychotherapy. Some medicines may help treat specific PTSD symptoms, such as sleep problems and nightmares.

People should work with their healthcare providers to find the best medicine or combination of medicines and the right dose. Read the latest medicine warnings, patient medicine guides, and information on newly approved medicines on the FDA website.

Living With PTSD

People with PTSD can get better with treatment. Here are some coping strategies:

• Talk with a healthcare provider about treatment options and follow the treatment plan.
• Avoid the use of alcohol or drugs.
• Engage in exercise, mindfulness, or other activities that help reduce stress.
• Try to maintain routines for meals, exercise, and sleep.
• Set realistic goals.
• Spend time with trusted friends or relatives and tell them about things that may trigger symptoms.
• Expect symptoms to improve gradually, not immediately.

How to Help a Loved One

If you know someone who may be experiencing PTSD, help that person get the right diagnosis and treatment. Some people need help making an appointment with their healthcare provider; others may benefit from having someone accompany them to their healthcare visits.

If a close friend or relative is diagnosed with PTSD, encourage them to follow their treatment plan. If their symptoms do not improve after 6 to 8 weeks, encourage them to discuss options with their healthcare provider. You also can:

• Offer emotional support, understanding, patience, and encouragement.
• Learn about PTSD to understand what your loved one is experiencing.
• Listen carefully. Pay attention to the person’s feelings and the situations that may trigger PTSD symptoms.
• Share positive distractions, such as walks, outings, and other activities.

How to Help a Child or Teen

Caregivers and family members can help children cope with trauma by creating a safe and supportive environment, remaining calm, and reducing stressors. Children and adolescents need to know their family members love them and will do their best to take care of them.

Helpful actions include:

• Ensuring children and adolescents are safe and that their basic needs are addressed
• Allowing them to be sad or cry
• Letting them talk, write, or draw pictures about the event and their feelings
• Limiting their exposure to repetitive news reports about traumatic events
• Trying to stick to routines, such as reading bedtime stories, eating dinner together, and playing games

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on PTSD.

Find Treatment

If you have concerns about your or your loved one’s mental health, talk to a healthcare provider. They can refer you to a qualified mental health professional, such as a psychologist, psychiatrist, or clinical social worker, who can help figure out the next steps. Find tips for talking with a healthcare provider about your or your loved one’s mental health.

You can also learn about finding support and locating mental health services in your area on the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

For cancer-related PTSD, call the Cancer Information Service, NCI’s contact center, at 1-800-4-CANCER (1-800-422-6237).

Community Support

The following organizations provide information and support for people with PTSD and their families:

• National Alliance on Mental Illness (NAMI) offers support groups and family education programs for people with schizophrenia and their loved ones. 
• The NAMI HelpLine can connect you with the NAMI office in your state and help you find programs close to home.   
• National Center for PTSD (U.S. Department of Veterans Affairs) provides information and resources for anyone interested in PTSD, including veterans and their family and friends, researchers, and health care providers. The site offers videos, apps, online programs, and other tools to help people with PTSD and their loved ones. 
• National Child Traumatic Stress Network provides resources for children and families affected by traumatic stress.

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, and treat PTSD. Researchers are working to understand what causes specific PTSD symptoms and why symptoms differ in type and severity from person to person. This includes research on biological, cognitive, behavioral, and developmental factors.

NIH is supporting research on ways to identify which trauma survivors are likely to recover naturally and which survivors may benefit from treatment. Research is also focused on developing and improving mental health treatments, including more effective medicines, psychotherapies, and device-based treatments.

NIH supports research to better understand the impact of trauma and chronic stress on the risk of developing a substance use disorder, and on how to prevent that outcome.

NIH supports research to understand how traumatic experiences across the lifespan including in childhood, adolescence, during pregnancy, and in the postpartum period are associated with developmental, physical, and mental health outcomes.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.