Post Traumatic Stress Disorder (PTSD)
Understanding PTSD
What is post-traumatic stress disorder, or PTSD?
It is natural to feel afraid during and after a traumatic situation. Fear is a part of the body’s “fight-or-flight” response, which helps us avoid or respond to potential danger. People may experience a range of reactions after trauma, and most will recover from their symptoms over time. Those who continue to experience symptoms may be diagnosed with post-traumatic stress disorder (PTSD).
Who develops PTSD?
Anyone can develop PTSD at any age. This includes combat veterans and people who have experienced or witnessed a physical or sexual assault, abuse, an accident, a disaster, a terror attack, or other serious events. People who have PTSD may feel stressed or frightened, even when they are no longer in danger.
Not everyone with PTSD has been through a dangerous event. Sometimes, learning that a relative or close friend experienced trauma can cause PTSD.
About 6 of every 100 people will experience PTSD at some point in their lifetime, according to the National Center for PTSD, a U.S. Department of Veterans Affairs program. Women are more likely than men to develop PTSD. Certain aspects of the traumatic event and biological factors (such as genes) may make some people more likely to develop PTSD.
What are the symptoms of PTSD?
Symptoms of PTSD usually begin within 3 months of the traumatic event, but they sometimes emerge later. To meet the criteria for PTSD, 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 medication, substance use, or other illness.
The course of the disorder varies. Although some people recover within 6 months, others have symptoms that last for 1 year or longer. People with PTSD often have co-occurring conditions, such as depression, substance use, or one or more anxiety disorders.
After a dangerous event, it is natural to have some symptoms. For example, some people may feel detached from the experience, as though they are observing things as an outsider rather than experiencing them. A mental health professional—such as a psychiatrist, psychologist, or clinical social worker—can determine whether symptoms meet the criteria for PTSD.
To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:
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
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
Thoughts and feelings can trigger these symptoms, as can words, objects, or situations
that are reminders of the event.
Avoidance symptoms
Staying away from places, events, or objects that are reminders 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
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. They can lead to feelings of stress and anger and may interfere with parts of daily life, such as sleeping, eating, or concentrating.
Cognition and mood symptoms
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
Cognition and mood symptoms can begin or worsen after the traumatic event. They can lead people to feel detached from friends or family members.
How do children and teens react to trauma?
Children and teens can have extreme reactions to traumatic events, but their symptoms may not be the same as those seen in 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.
Find more information on helping children and adolescents cope with traumatic events.
Why do some people develop PTSD and other people do not?
Not everyone who lives through a dangerous event develops PTSD—many factors play a part. Some of these factors are present before the trauma; 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
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 a coping strategy for getting through and learning from a traumatic event
Being prepared and able to respond to upsetting events as they occur, despite feeling fear
Your PTSD Care, Step by Step
1. Before Your First Visit: Forms & Records
You’ll complete questionnaires about mood, anxiety, sleep, and trauma-related symptoms (like nightmares or flashbacks). Please bring a list of current medications/supplements, any past evaluations, and your insurance card.
2. Initial Evaluation: Sharing Your Story at Your Pace
We’ll discuss your symptoms and how they affect your life, such as nightmares, flashbacks, avoidance, feeling on edge, or emotional numbing. You do not have to go into every detail of the trauma at the first visit. We also review your overall health, stressors, and past treatments.
3. Clarifying the Diagnosis
PTSD can overlap with depression, anxiety, or substance use. We use your history, symptom checklists, and sometimes input from family or therapists (with your permission) to confirm PTSD and identify related conditions.
4. Collaborative Treatment Plan (Multimodal)
Your plan may include:
Trauma-focused therapy (first-line): evidence-based approaches such as EMDR (Eye Movement Desensitization and Reprocessing), prolonged exposure therapy, or trauma-focused CBT.
Medication (if helpful): SSRIs or SNRIs are often used to reduce anxiety, depression, and sleep problems. Prazosin may help with trauma-related nightmares. Medication is tailored to your symptoms and history.
Coping skills & tools: grounding exercises, breathing techniques, mindfulness, journaling, and relaxation strategies to manage triggers and flashbacks.
Lifestyle supports: sleep hygiene, exercise, balanced nutrition, reducing alcohol/substance use, and building structure into your day.
Support systems: involving trusted family or friends, support groups, or peer support, if you choose.
5. If Trying Medication: Safety and Clarity
We’ll explain what to expect, possible side effects, and how long it may take to notice improvement (usually a few weeks). Medications are often combined with therapy rather than used alone.
6. Short-Term Follow-Ups: Steady Check-Ins
We’ll meet more often at the beginning to monitor your progress. We’ll ask about sleep, nightmares, flashbacks, anxiety, and daily functioning. Adjustments to therapy focus, medications, or coping strategies are made as needed.
7. Building Skills That Last
Therapy and coping strategies are central in PTSD care. You’ll learn grounding tools for when you’re triggered, ways to manage intrusive thoughts, and strategies to reduce avoidance so you can regain control of your life.
8. Ongoing Care
Once symptoms begin improving, visits are usually every 1–3 months. We’ll continue to use rating scales and check in on your goals. Long-term support is often needed for PTSD, but intensity of visits may decrease as stability improves.
9. Care Coordination (With Your Permission)
We can collaborate with your therapist, primary care provider, or other specialists to make sure your care is consistent and supportive in every setting.
10. Annual Review & Long-Term Planning
Each year we step back to review progress, adjust medications or therapy focus, and discuss future goals. Some people remain in therapy long-term, while others transition to maintenance visits and coping tools.
11. If Your Needs Change
PTSD symptoms can resurface with stress, anniversaries, or new trauma. If that happens, we’ll adapt quickly—adjusting therapy focus, medication, or supports to help you regain stability.
What You Can Do to Get the Most From Care
Practice grounding and coping skills between visits
Be open about triggers and challenges
Track progress, even small steps forward
Reach out if symptoms worsen or safety concerns arise
Bring your goals and questions to each appointment