What Are the Symptoms of PTSD?

Flashbacks, nightmares, avoidance reactions and panic attacks are all hallmarks of post-traumatic stress disorder, a mental condition some people develop after experiencing painful, shocking or terrifying events.

Post-traumatic stress disorder (PTSD) is a mental health condition that some people can develop after experiencing shocking, scary, or dangerous traumatic events. 

Fear is a natural response to a traumatic situation and most people will recover from those feelings and reactions, but people with PTSD continue to feel fearful or stressed even after the danger has passed.

Symptoms of PTSD (post-traumatic stress disorder) are categorized into four types: re-experiencing, avoidance, arousal and reactivity, and cognition and mood symptoms. 

Re-experiencing symptoms of PTSD include: 

• Flashbacks (feeling as if the trauma is happening in the present)
• Frightening thoughts or images
• Nightmares
• Intense distress at real or symbolic reminders of the trauma
• Physical sensations such as pain, sweating, nausea, or trembling

Avoidance symptoms of PTSD include:

• Avoiding places, events, or objects that are reminders of the traumatic experience
• Avoiding thoughts or feelings related to the traumatic event
• Feeling a need to keep busy
• Inability to remember details of what happened
• Feeling emotionally numb or cut off from feelings
• Feeling physically numb or detached from one’s body
• Self-destructive or reckless behaviors 
• Use of alcohol or drugs to avoid memories

Arousal and reactivity symptoms of PTSD include:

• Being easily startled
• Panicking when reminded of the trauma
• Angry outbursts
• Irritability or aggressive behavior
• Extreme alertness (hypervigilance)
• Difficulty sleeping
• Feeling tense or “on edge”
• Difficulty concentrating
• Symptoms of anxiety, such as headaches, dizziness, chest pains, and stomach aches

Cognition and mood symptoms of PTSD include:

• Difficulty remembering key features of the traumatic event
• Negative thoughts about oneself or the world
• Feeling as if no one can be trusted and no one understands
• Feeling as if no place is safe
• Distorted feelings such as guilt or self-blame
• Overwhelming feelings of anger, sadness, or shame
• Loss of interest in activities one used to enjoy

Symptoms of PTSD may also cause difficulty with some aspects of daily living, such as:

• Self-care
• Keeping a job
• Maintaining friendships or relationships
• Remembering things and making decisions
• Sex drive
• Ability to cope with change
• Enjoyment of leisure time

Other mental health problems frequent accompany PTSD, such as:

• Depression
• Anxiety disorders
• Dissociative disorders
• Self-harm
• Suicidal feelings

If you or someone you know is in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential. http://www.suicidepreventionlifeline.org 

Harmful, dangerous, stressful, or life-threatening events may cause a person to develop PTSD (post-traumatic stress disorder), such as: 

• Motor vehicle accident 
• Abuse, harassment, or bullying, including racism, sexism, homophobia, and other types of abuse that target a person’s identity
• Rape or sexual assault
• Experiencing violence, such as military combat, a terrorist attack, or a violent assault
• Witnessing others being hurt or killed
• Working in a job such as emergency services or armed forces where one repeatedly sees or hears distressing things
• Surviving a natural disaster (including the coronavirus pandemic)
• Traumatic childbirth as a mother or partner witnessing a traumatic birth
• Losing a loved one in distressing circumstances
• Being kidnapped, held hostage, or any experience in which a person fears for their life
• Receiving a diagnosis of a life-threatening medical condition
• Getting treatment in a psychiatric ward

Risk factors that may make some people more vulnerable to developing PTSD can include:

• Repeated traumatic experiences
• Childhood trauma
• Having little or no support from following the traumatic event
• Physical injury or feeling pain
• Dealing with extra stress at the same time as the traumatic event, such as bereavement, financial problems, loss of a job, racism, seeking asylum, homelessness, injury, or a prison sentence
• A history of anxiety, depression, or substance abuse
• Seeing another person hurt, or seeing a dead body

A diagnosis of PTSD (post-traumatic stress disorder) is made by a mental health professional and an adult must have all the following criteria 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

Treatment for PTSD (post-traumatic stress disorder) includes: 

• Watchful waiting
  • If PTSD symptoms have been present for less than 4 weeks or are mild, patients may be advised to wait to see if things improve
  • A follow-up appointment is recommended within one month
• Counseling/psychotherapy
  • Trauma-focused cognitive behavioral therapy (TF-CBT), a form of cognitive behavioral therapy (CBT) specifically adapted for PTSD, which may include:
    • Exposure therapy is used to help people face and control fears by gradually exposing them to the trauma they experienced in a safe way
    • Cognitive restructuring can help patients make sense of bad memories and look at what happened realistically
    • Seeking safety, in which people learn coping skills such as relaxation and mindfulness to deal with intense emotions
    • Dialectical behavior therapy (DBT), which gives patients new skills to cope with painful emotions
    • Eye movement desensitization and reprocessing (EMDR)
      • Helps to reduce PTSD symptoms such as being easily startled and involves making rhythmic eye movements while recalling the traumatic event
      • Rapid eye movements are meant to create a similar effect to the way the brain processes memories and experiences when sleeping
  • Group therapy
  • Art therapy 
• Medications 
  • Not a first-line treatment but may be used in patients who also suffer from other conditions such as depression, sleep problems, or other mental health issues
  • Antidepressants such as selective serotonin reuptake inhibitors (SSRIs)
  • Anti-anxiety medications
  • Sleep medicines
  • Antipsychotic treatments