Posttraumatic stress disorder (PTSD) is a mental disorder that can develop after a person is exposed to a traumatic event, such as sexual assault, warfare, traffic collisions, or other threats on a person’s life. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in how a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress but instead may express their memories through play. A person with PTSD is at a higher risk for suicide and intentional self-harm.
Most people who have experienced a traumatic event will not develop PTSD. People who suffer interpersonal trauma (for example rape or child abuse) are more likely to develop PTSD, as compared to people who experience non-assault based trauma, such as accidents and natural disasters. About half of people develop PTSD following rape. Children are less likely than adults to develop PTSD after trauma, especially if they are under ten years of age. Diagnosis is based on the presence of specific symptoms following a traumatic event.
Prevention may be possible when therapy is targeted at those with early symptoms but is not effective when provided to all individuals whether or not symptoms are present. The main treatments for people with PTSD are counseling and medication. Some different types of therapy may be useful. This may occur one-on-one or in a group. Antidepressants of the selective serotonin reuptake inhibitor type are the first-line medications for PTSD and result in benefit in about half of people. These benefits are less than those seen with therapy. It is unclear if using medications and therapy together has more significant benefit. Other medications do not have enough evidence to support their use, and in the case of benzodiazepines, may worsen outcomes.
In the United States, about 3.5% of adults have PTSD in a given year, and 9% of people develop it at some point in their life. In much of the rest of the world, rates during a given year are between 0.5% and 1%. Higher rates may occur in regions of armed conflict. It is more common in women than in men. Symptoms of trauma-related mental disorders have been documented since at least the time of the ancient Greeks. During the World Wars, the condition was known under various terms including “shell shock” and “combat neurosis”. The term “posttraumatic stress disorder” came into use in the 1970s in large part due to the diagnoses of U.S. military veterans of the Vietnam War. It was officially recognized by the American Psychiatric Association in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders
Signs and symptoms
Service members use art to relieve PTSD symptoms.
Symptoms of PTSD generally begin within the first three months after the inciting traumatic event, but may not begin until years later. In the typical case, the individual with PTSD persistently avoids trauma-related thoughts and emotions, and discussion of the traumatic event, and may even have amnesia of the event. However, the event is commonly relived by the individual through intrusive, recurrent recollections, dissociative episodes of reliving the trauma (“flashbacks”), and nightmares. While it is common to have symptoms after any traumatic event, these must persist to a sufficient degree (i.e., causing dysfunction in life or clinical levels of distress) for longer than one month after the trauma to be classified as PTSD (clinically significant dysfunction or distress for less than one month after the trauma may be acute stress disorder).
Associated medical conditions
Drug abuse and alcohol abuse commonly co-occur with PTSD. Recovery from posttraumatic stress disorder or other anxiety disorders may be hindered, or the condition worsened when substance use disorders are comorbid with PTSD. Resolving these problems can bring about improvement in an individual’s mental health status and anxiety levels.
No quieren (They do not want to) by Francisco Goya (1746–1828) depicts an elderly woman wielding a knife in defense of a girl being assaulted by a soldier.
Persons considered at risk include combat military personnel, victims of natural disasters, concentration camp survivors, and victims of violent crime. Persons employed in occupations that expose them to violence (such as soldiers) or disasters (such as emergency service workers) are also at risk. Other occupations that are at higher risk include police officers, firefighters, ambulance personnel, health care professionals, train drivers, divers, journalists, and sailors, in addition to people who work at banks, post offices or in stores. The size of the hippocampus is inversely related to post-traumatic stress disorder and treatment success; the smaller the hippocampus, the higher risk of PTSD.
PTSD has been associated with a wide range of traumatic events. The risk of developing PTSD after a traumatic event varies by trauma type and is highest following exposure to sexual violence (11.4%), particularly rape (19.0%). Men are more likely to experience a traumatic event, but women are more likely to experience the kind of high-impact traumatic event that can lead to PTSD, such as interpersonal violence and sexual assault.
Posttraumatic stress reactions have not been studied as well in children and adolescents as adults. The rate of PTSD may be lower in children than adults, but in the absence of therapy, symptoms may continue for decades. One estimate suggests that the proportion of children and adolescents having PTSD in a non-wartorn population in a developed country may be 1% compared to 1.5% to 3% of adults, and much lower below the age of 10 years. On average, 16% of children exposed to a traumatic event develop PTSD, varying according to type of exposure and gender.
Predictor models have consistently found that childhood trauma, chronic adversity, and familial stressors increase the risk for PTSD as well as risk for biological markers of risk for PTSD after a traumatic event in adulthood. Experiencing bullying as a child or an adult has been correlated with the development of PTSD. Peritraumatic dissociation in children is a predictive indicator of the development of PTSD later in life. This effect of childhood trauma, which is not well understood, may be a marker for both traumatic experiences and attachment problems. Proximity to, duration of, and severity of the trauma make an impact, and interpersonal traumas cause more problems than impersonal ones.
The risk of developing PTSD is increased in individuals who are exposed to physical abuse, physical assault, or kidnapping. Women who experience physical violence are more likely to develop PTSD than men.
To diagnose post-traumatic stress disorder, your doctor will likely:
Perform a physical exam to check for medical problems that may be causing your symptoms
Do a psychological evaluation that includes a discussion of your signs and symptoms and the event or events that led up to them
Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
Diagnosis of PTSD requires exposure to an event that involved the actual or possible threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:
You directly experienced the traumatic event
You witnessed, in person, the traumatic event occurring to others
You learned someone close to you experienced or was threatened by the traumatic event
You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)
You may have PTSD if the problems you experience after this exposure continue for more than a month and cause significant problems in your ability to function in social and work settings and negatively impact relationships.
Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but can also include medication. Combining these treatments can help improve your symptoms by:
Teaching you skills to address your symptoms
Helping you think better about yourself, others and the world
Learning ways to cope if any symptoms arise again
Treating other problems often related to traumatic experiences, such as depression, anxiety, or misuse of alcohol or drugs
You don’t have to try to handle the burden of PTSD on your own.
Several types of psychotherapy, also called talk therapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:
Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative beliefs about yourself and the risk of traumatic things happening again. For PTSD, cognitive therapy often is used along with exposure therapy.
Exposure therapy. This behavioral therapy helps you safely face both situations and memories that you find frightening so that you can learn to cope with them effectively. Exposure therapy can be particularly helpful for flashbacks and nightmares. One approach uses virtual reality programs that allow you to re-enter the setting in which you experienced trauma.
Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to them.
Your therapist can help you develop stress management skills to help you better handle stressful situations and cope with stress in your life.
All these approaches can help you gain control of lasting fear after a traumatic event. You and your mental health professional can discuss what type of therapy or combination of therapies may best meet your needs.
You may try individual therapy, group therapy or both. Group therapy can offer a way to connect with others going through similar experiences.
Several types of medications can help improve symptoms of PTSD:
Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
Anti-anxiety medications. These drugs can relieve severe anxiety and related problems. Some anti-anxiety medications have the potential for abuse, so they are generally used only for a short time.
Prazosin. If symptoms include insomnia with recurrent nightmares, a drug called prazosin (Minipress) might help. Although not specifically FDA approved for PTSD treatment, prazosin may reduce or suppress nightmares in many people with PTSD.
You and your doctor can work together to figure out the best medication, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks.
Tell your doctor about any side effects or problems with medications. You may need to try more than one or a combination of medications, or your doctor may need to adjust your dosage or medication schedule before finding the right fit for you.