Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening.
Anyone who has gone through a life-threatening event can develop PTSD. These events can include: combat or military exposure, child sexual or physical abuse, terrorist attacks, sexual or physical assault, serious accidents such as a car wreck, and natural disasters such as a fire, tornado, hurricane, flood, or earthquake.
After the event, you may feel scared, confused, or angry. If these feelings don’t go away or they get worse, you may have PTSD. These symptoms may disrupt your life, making it hard to continue with your daily activities.
How Does PTSD Develop?
All people with PTSD have lived through a traumatic event that caused them to fear for their lives, see horrible things, and feel helpless. Strong emotions caused by the event create changes in the brain that may result in PTSD.
Most people who go through a traumatic event have some symptoms at the beginning. Yet only some will develop PTSD. It isn’t clear why some people develop PTSD and others don’t. How likely you are to get PTSD depends on many things. These include: how intense the trauma was or how long it lasted; if you lost someone you were close to or were hurt; how close you were to the event; how strong your reaction was; how much you felt in control of events; and how much help and support you got after the event.
Many people who develop PTSD get better at some time. But about 1 out of 3 people with PTSD may continue to have some symptoms. Even if you continue to have symptoms, treatment can help you cope. Your symptoms don’t have to interfere with your everyday activities, work, and relationships.
What Are the Symptoms of PTSD?
Symptoms of posttraumatic stress disorder (PTSD) can be terrifying. They may disrupt your life and make it hard to continue with your daily activities. It may be hard just to get through the day.
PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years later. They also may come and go over many years. If the symptoms last longer than 4 weeks, cause you great distress, or interfere with your work or home life, you probably have PTSD. There are four types of symptoms: reliving the event, avoidance, numbing, and feeling keyed up.
Reliving the Event
Bad memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. You may have nightmares. You even may feel like you’re going through the event again. This is called a flashback. Sometimes there is a trigger: a sound or sight that causes you to relive the event. Triggers might include: hearing a car backfire, which can bring back memories of gunfire and war for a combat veteran; seeing a car accident, which can remind a crash survivor of his or her own accident; seeing a news report of a sexual assault, which may bring back memories of assault for a woman who was raped.
Avoiding Situations That Remind You of the Event
You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event. A person who was in an earthquake may avoid watching television shows or movies in which there are earthquakes. A person who was robbed at gunpoint while ordering at a hamburger drive-in may avoid fast-food restaurants. Some people may keep very busy or avoid seeking help. This keeps them from having to think or talk about the event.
Feeling numb – You may find it hard to express your feelings. This is another way to avoid memories. You may not have positive or loving feelings toward other people and may stay away from relationships. You may not be interested in activities you used to enjoy. You may forget about parts of the traumatic event or not be able to talk about them.
Feeling keyed up (also called hyper arousal) – You may be jittery, or always alert and on the lookout for danger. This is known as hyper arousal. It can cause you to: suddenly become angry or irritable, have a hard time sleeping, have trouble concentrating, fear for your safety and always feel on guard, or be very startled when someone surprises you.
What Are Other Common Problems?
People with PTSD may also have other problems. These include: drinking or drug problems, feelings of hopelessness, shame, or despair, employment problems, relationship problems including divorce and violence, and physical symptoms.
Can Children Have PTSD?
Children can have PTSD too. They may have the symptoms described above or other symptoms depending on how old they are. As children get older their symptoms are more like those of adults. Young children may become upset if their parents are not close by, have trouble sleeping, or suddenly have trouble with toilet training or going to the bathroom. Children who are in the first few years of elementary school (ages 6 to 9) may act out the trauma through play, drawings, or stories. They may complain of physical problems or become more irritable or aggressive. They also may develop fears and anxiety that don’t seem to be caused by the traumatic event.
Treatment of PTSD
When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But treatment can help you get better.
There are good treatments available for PTSD. Cognitive-behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. A similar kind of therapy called EMDR, or eye movement desensitization and reprocessing, is also used for PTSD. Medications can be effective too. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.
Today, there are good treatments available for PTSD. When you have PTSD dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can help you get better.
Cognitive-behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used for PTSD. Medications have also been shown to be effective. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.
Cognitive Behavioral Therapy – In cognitive therapy, your therapist helps you understand and change how you think about your trauma and its aftermath. Your goal is to understand how certain thoughts about your trauma cause you stress and make your symptoms worse. You will learn to identify thoughts about the world and yourself that are making you feel afraid or upset. With the help of your therapist, you will learn to replace these thoughts with more accurate and less distressing thoughts. You also learn ways to cope with feelings such as anger, guilt, and fear.
After a traumatic event, you might blame yourself for things you couldn’t have changed. For example, a soldier may feel guilty about decisions he or she had to make during war. Cognitive therapy, a type of CBT, helps you understand that the traumatic event you lived through was not your fault.
Exposure Therapy – In exposure therapy your goal is to have less fear about your memories. It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event.
By talking about your trauma repeatedly with a therapist, you’ll learn to get control of your thoughts and feelings about the trauma. You’ll learn that you do not have to be afraid of your memories. This may be hard at first. It might seem strange to think about stressful things on purpose. But you’ll feel less overwhelmed over time. With the help of your therapist, you can change how you react to the stressful memories. Talking in a place where you feel secure makes this easier.
You may focus on memories that are less upsetting before talking about worse ones. This is called “desensitization,” and it allows you to deal with bad memories a little bit at a time. Your therapist also may ask you to remember a lot of bad memories at once. This is called “flooding,” and it helps you learn not to feel overwhelmed. You also may practice different ways to relax when you’re having a stressful memory. Breathing exercises are sometimes used for this.
EMDR – Eye movement desensitization and reprocessing (EMDR) is a fairly new therapy for PTSD. Like other kinds of counseling, it can help change how you react to memories of your trauma. While talking about your memories, you’ll focus on distractions like eye movements, hand taps, and sounds. For example, your therapist will move his or her hand near your face, and you’ll follow this movement with your eyes. Experts are still learning how EMDR works. Studies have shown that it may help you have fewer PTSD symptoms. But research also suggests that the eye movements are not a necessary part of the treatment.
Medication – Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medicine. These can help you feel less sad and worried. They appear to be helpful, and for some people they are very effective. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft). Chemicals in your brain affect the way you feel. When you have or depression you may not have enough of a chemical called serotonin. SSRIs raise the level of serotonin in your brain. There are other medications that have been used with some success. Talk to your doctor about which medications are right for you.
Group Therapy – Many people want to talk about their trauma with others who have had similar experiences. In group therapy, you talk with a group of people who also have been through a trauma and who have PTSD. Sharing your story with others may help you feel more comfortable talking about your trauma. This can help you cope with your symptoms, memories, and other parts of your life.
Group therapy helps you build relationships with others who understand what you’ve been through. You learn to deal with emotions such as shame, guilt, anger, rage, and fear. Sharing with the group also can help you build self-confidence and trust. You’ll learn to focus on your present life, rather than feeling overwhelmed by the past.
Brief Psychodynamic Psychotherapy – In this type of therapy, you learn ways of dealing with emotional conflicts caused by your trauma. This therapy helps you understand how your past affects the way you feel now.
Your therapist can help you: identify what triggers your stressful memories and other symptoms, find ways to cope with intense feelings about the past, become more aware of your thoughts and feelings so you can change your reactions to them, and raise your self-esteem.
Family Therapy – PTSD can impact your whole family. Your kids or your partner may not understand why you get angry sometimes, or why you’re under so much stress. They may feel scared, guilty, or even angry about your condition. Family therapy is a type of counseling that involves your whole family. A therapist helps you and your family communicate, maintain good relationships, and cope with tough emotions. Your family can learn more about PTSD and how it is treated.
In family therapy, each person can express his or her fears and concerns. It’s important to be honest about your feelings and to listen to others. You can talk about your PTSD symptoms and what triggers them. You also can discuss the important parts of your treatment and recovery. By doing this, your family will be better prepared to help you. You may consider having individual therapy for your PTSD symptoms and family therapy to help you with your relationships.
How Long Does Treatment Last?
For some people, treatment for PTSD can last 3 to 6 months. If you have other mental health problems as well as PTSD, treatment for PTSD may last for 1 to 2 years or longer.
What if Someone Has PTSD and Another Disorder? Is the Treatment Different?
It is very common to have PTSD at that same time as another mental health problem. Depression, alcohol or substance abuse problems, panic disorder, and other anxiety disorders often occur along with PTSD. In many cases, the PTSD treatments described above will also help with the other disorders. The best treatment results occur when both PTSD and the other problems are treated together rather than one after the other.
What Will We Work on in Therapy?
When you begin therapy, you and your therapist should decide together what goals you hope to reach in therapy. Not every person with PTSD will have the same treatment goals. For instance, not all people with PTSD are focused on reducing their symptoms.
Some people want to learn the best way to live with their symptoms and how to cope with other problems associated with PTSD. Perhaps you want to feel less guilt and sadness? Perhaps you would like to work on improving your relationships at work, or communication issues with your friends and family. Your therapist should help you decide which of these goals seems most important to you, and he or she should discuss with you which goals might take a long time to achieve.
What Can I Expect from My Therapist?
Your therapist should give you a good explanation for the therapy. You should understand why your therapist is choosing a specific treatment for you, how long they expect the therapy to last, and how they see if it is working. The two of you should agree at the beginning that this plan makes sense for you and what you will do if it does not seem to be working. If you have any questions about the treatment your therapist should be able to answer them.
You should feel comfortable with your therapist and feel you are working as a team to tackle your problems. It can be difficult to talk about painful situations in your life, or about traumatic experiences that you have had. Feelings that emerge during therapy can be scary and challenging. Talking with your therapist about the process of therapy, and about your hopes and fears in regards to therapy, will help make therapy successful. If you do not like your therapist or feel that the therapist is not helping you, it might be helpful to talk with another professional. In most cases, you should tell your therapist that you are seeking a second opinion.
How Common is PTSD?
Posttraumatic stress disorder (PTSD) can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger. You may feel afraid or that you have no control over what is happening.
Experiencing a traumatic event is not rare. About 60% of men and 50% of women experience this type of event in their lives. Women are more likely to experience sexual assault and child sexual abuse. Men are more likely to experience accidents, physical assault, combat, disaster or to witness death or injury.
But going through a traumatic event doesn’t mean you’ll get PTSD. About 8% of men and 20% of women develop PTSD after a traumatic event.
Here are some facts:
- In the United States, about 8% of the population will have PTSD symptoms at some point in their lives.
- About 5.2 million adults have PTSD during a given year. This is only a small portion of those who have experienced a traumatic event.
- Women are more likely than men to develop PTSD. About 10% of women develop PTSD compared with 5% of men.
- Women are more likely than men to develop PTSD for all types of traumatic events, except sexual assault or abuse. When these traumas occur, men are just as likely as women to get PTSD.
Who is Most Likely to Develop PTSD?
Most people who experience a traumatic event will not develop PTSD. However, you are more likely to develop PTSD if you: were directly exposed to the traumatic event as a victim or a witness, were seriously injured during the event, went through a trauma that was long lasting or very severe, believed that you were in danger, believed that a family member was in danger, had a severe reaction during the event, such as crying, shaking, vomiting, or feeling apart from your surroundings, or have felt helpless during the trauma and were not able to help yourself or a loved one.
You are also more likely to develop PTSD if you: had an earlier life-threatening event or trauma, such as being abused as a child, have another mental health problem, have family members who have had mental health problems, have little support from family and friends, have recently lost a loved one, especially if it was unexpected, have had recent, stressful life changes, drink a lot of alcohol, are a woman, are poorly educated, or are younger.
Some groups of people, including blacks and Hispanics, may be more likely than whites to develop PTSD. This may be because these groups are more likely to experience a traumatic event. For example, in veterans who survived Vietnam, a larger percent of blacks, Hispanics, and Native Americans were in combat than whites. Your culture or ethnic group also may affect how you react to PTSD. For example, people from groups that are open and willing to talk about problems may be more willing to seek help.
PTSD and the Military
If you are in the military, you may have seen combat. You may have been on missions that exposed you to horrible and life-threatening experiences. You may have been shot at, seen a buddy shot, or seen death. These are types of events that can lead to PTSD.
Experts think PTSD occurs: in about 30% of Vietnam veterans, or about 30 out of 100 Vietnam veterans, in as many as 10% of Gulf War (Desert Storm) veterans, or in 10 veterans out of 100.9, in about 6% to 11% of veterans of the Afghanistan war (Enduring Freedom), or in 6 to 11 veterans out of 100, and in about 12% to 20% of veterans of the Iraq war (Iraqi Freedom), or in 12 to 20 veterans out of 100.
Other factors in a combat situation can add more stress to an already stressful situation and may contribute to PTSD and other mental health problems. These factors include what you do in the war, the politics around the war, where it’s fought, and the type of enemy you face.
Another cause of PTSD in the military can be military sexual trauma (MST). This is any sexual harassment or sexual assault that occurs while you are in the military. MST can happen to men and women and can occur during peacetime, training, or war.
Among veterans using VA health care, about 23 out of 100 women (23%) reported sexual assault when in the military and 55 out of 100 women (55%) and 38 out of 100 men (38%) have experienced sexual harassment when in the military. Even though military sexual trauma is far more common in women, over half of all veterans with military sexual trauma are men.
Helping a Family Member Who Has PTSD
When someone has PTSD, it can change family life. The person with PTSD may act differently and get angry easily. He or she may not want to do things you used to enjoy together. You may feel scared and frustrated about the changes you see in your loved one. You also may feel angry about what’s happening to your family or wonder if things will ever go back to the way they were. These feelings and worries are common in people who have a family member with PTSD.
It is important to learn about PTSD so you can understand why it happened, how it is treated, and what you can do to help. But you also need to take care of yourself. Changes in family life are stressful and taking care of yourself will make it easier to cope.
How Can I Help?
You may feel helpless, but there are many things you can do. Nobody expects you to have all the answers. Learn as much as you can about PTSD. Knowing how PTSD affects people may help you understand what your family member is going through. The more you know, the better you and your family can handle PTSD. Offer to go to doctor visits with your family member. You can help keep track of medicine and therapy, and you can be there for support. Tell your loved one you want to listen and that you also understand if he or she doesn’t feel like talking. Plan family activities together, like having dinner or going to a movie. Take a walk, go for a bike ride, or do some other physical activity together. Exercise is important for health and helps clear your mind. Encourage contact with family and close friends. A support system will help your family member get through difficult changes and stressful times.
Your family member may not want your help. If this happens, keep in mind that withdrawal can be a symptom of PTSD. A person who withdraws may not feel like talking, taking part in group activities, or being around other people. Give your loved one space but tell him or her that you will always be ready to help.
How Can I Deal with Anger or Violent Behavior?
Your family member may feel angry about many things. Anger is a normal reaction to trauma, but it can hurt relationships and make it hard to think clearly. Anger also can be frightening. If anger leads to violent behavior or abuse, it’s dangerous. Go to a safe place and call for help right away. Make sure children are in a safe place as well.
It’s hard to talk to someone who is angry. One thing you can do is set up a time-out system. This helps you find a way to talk even while angry. Agree that either of you can call a time-out at any time. Agree that when someone calls a time-out, the discussion must stop right then. Decide on a signal you will use to call a time-out. The signal can be a word that you say or a hand signal. Agree to tell each other where you will be and what you will be doing during the time-out. Tell each other what time you will come back.
While you are taking a time-out, don’t focus on how angry you feel. Instead, think calmly about how you will talk things over and solve the problem. After you come back, take turns talking about solutions to the problem. Listen without interrupting. Use statements starting with “I,” such as “I think” or “I feel.” Using “you” statements can sound accusing. Be open to each other’s ideas and don’t criticize each other. Focus on things you both think will work. It’s likely you will both have good ideas. Together, agree which solutions you will use.
How Can I Communicate Better?
You and your family may have trouble talking about feelings, worries, and everyday problems. To communicate better, be clear and to the point and be positive. Blame and negative talk won’t help the situation. Be a good listener. Don’t argue or interrupt. Repeat what you hear to make sure you understand and ask questions if you need to know more. Put your feelings into words. Your loved one may not know you are sad or frustrated unless you are clear about your feelings. Help your family member put feelings into words. Ask, “Are you feeling angry? Sad? Worried?” Ask how you can help. Don’t give advice unless you are asked.
If your family is having a lot of trouble talking things over, consider trying family therapy. Family therapy is a type of counseling that involves your whole family. A therapist helps you and your family communicate, maintain good relationships, and cope with tough emotions. During therapy, each person can talk about how a problem is affecting the family. Family therapy can help family members understand and cope with PTSD. Your health professional or a religious or social services organization can help you find a family therapist who specializes in PTSD.
How Can I Take Care of Myself?
Helping a person with PTSD can be hard on you. You may have your own feelings of fear and anger about the trauma. You may feel guilty because you wish your family member would just forget his or her problems and get on with life. You may feel confused or frustrated because your loved one has changed, and you may worry that your family life will never get back to normal.
All of this can drain you. It can affect your health and make it hard for you to help your loved one. If you’re not careful, you may get sick yourself, become depressed, or burn out and stop helping your loved one. To help yourself, you need to take care of yourself and have other people help you.
Don’t feel guilty or feel that you have to know it all. Remind yourself that nobody has all the answers. It’s normal to feel helpless at times. Don’t feel bad if things change slowly. You cannot change anyone. People have to change themselves. Take care of your physical and mental health. If you feel yourself getting sick or often feel sad and hopeless, see your doctor. Don’t give up your outside life. Make time for activities and hobbies you enjoy. Continue to see your friends. Take time to be by yourself. Find a quiet place to gather your thoughts and “recharge.” Get regular exercise, even just a few minutes a day. Exercise is a healthy way to deal with stress. Eat healthy foods. When you are busy, it may seem easier to eat fast food than to prepare healthy meals. But healthy foods will give you more energy to carry you through the day. Remember the good things. It’s easy to get weighed down by worry and stress. But don’t forget to see and celebrate the good things that happen to you and your family.
During difficult times, it is important to have people in your life that you can depend on. These people are your support network. They can help you with everyday jobs, like taking a child to school, or by giving you love and understanding. You may get support from: family members, friends, coworkers, neighbors, members of your religious or spiritual group, support groups, and doctors and other health professionals
What Can I Do if I Think I Have PTSD?
If you think you have PTSD, it’s important to get treatment. Treatment can work, and early treatment may help reduce long-term symptoms. If you think you have PTSD, talk to your family doctor. Talk to a mental health professional, such as a therapist. If you’re a veteran, contact your local VA hospital or Vet Center. Talk to a close friend or family member. He or she may be able to support you and find you help. Talk to a religious leader. Fill out a PTSD screen (www.ncptsd.va.gov/ncmain/ncdocs/assmnts/the_primary_care_ptsd_screen_pcptsd.html) and take it with you to the doctor. An online PTSD screen is available for PTSD related to stressful military experiences, but you can also answer the questions as they would apply to any other traumatic event.
Many people who might need assistance with something like the symptoms of PTSD are afraid to go for help. 1 out of 5 people say they might not get help because of what other people might think. 1 out of 3 people say they would not want anyone else to know they were in therapy.
A study that’s been done of soldiers coming home from Iraq found that only 4 in 10 service members with mental health problems said they would get help. Some of the most common reasons they gave were: worried about what others would think, thought it might hurt their military career, might be seen as weak.
Why Seek Help?
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 worsen physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD you could also improve your physical health.
It may not be PTSD. Having symptoms of PTSD does not always mean you have PTSD. Some of the symptoms of PTSD are also symptoms for other mental health problems. For example, trouble concentrating or feeling less interested in things you used to enjoy can be symptoms of both depression and PTSD. And, different problems have different treatments.
While it may be tempting to identify PTSD for yourself or someone you know, the diagnosis generally is made by a mental-health professional. This will usually involve a formal evaluation by a psychiatrist, psychologist, or clinical social worker specifically trained to assess psychological problems.
If you do not want to be evaluated but feel you have symptoms of PTSD you may choose “watchful waiting.” Watchful waiting means taking a wait-and-see approach. If you get better on your own, you won’t need treatment. If your symptoms do not get better after 3 months and they are either causing you distress or are getting in the way of your work or home life, talk with a health professional.
In a few cases, your symptoms may be so severe that you need immediate help. Call 911 or other emergency services immediately if you think that you cannot keep from hurting yourself or someone else.
