Post Traumatic Stress Disorder (PTSD) is a mental health condition that develops in some people who have experienced terrifying events, experiencing it, and/or witnessing it. Even in the unexpected or sudden death of a loved one, symptoms of PTSD can emerge.
It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened even when they are not in danger.
Post-traumatic stress disorder symptoms may start within one month of a traumatic event, but sometimes symptoms may not appear until 3 months to years later, after the event. Some individuals may have symptoms for long periods of time (chronic) where others may have symptoms of PTSD for shorter amounts of time (acute). These signs and symptoms tend to cause significant problems in social or work situations and in relationships. They can also interfere with your ability to go about normal daily tasks.
SIGNS AND SYMPTOMS
Intrusive and Reliving the memories
- Recurrent, unwanted distressing memories of the traumatic event
- Reliving the traumatic event as if it were happening again (flashbacks)
- Upsetting dreams or nightmares about the traumatic event
- Severe emotional distress or physical reactions to something that reminds you of the traumatic event
Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.
- Trying to avoid thinking or talking about the traumatic event
- Avoiding places, activities or people that remind you of the traumatic event
Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car, and/or refuse to drive long distances to avoid another car accident.
Negative changes in thinking and mood
- Negative thoughts about yourself, other people or the world
- Hopelessness about the future
- Memory problems, including not remembering important aspects of the traumatic event
- Difficulty maintaining close relationships
- Feeling detached from family and friends
- Lack of interest in activities you once enjoyed
- Difficulty experiencing positive emotions
- Feeling emotionally numb
- Distorted feelings like guilt or blame
Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members.
Physical and emotional (arousal) reactions
- Being easily startled or frightened
- Always being on guard for danger
- Self-destructive behavior, such as drinking too much or driving too fast
- Trouble sleeping
- Trouble concentrating
- Irritability, angry outbursts or aggressive behavior
- Overwhelming guilt or shame
Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.
Intensity of symptoms
PTSD symptoms can vary in intensity over time. You may have more PTSD symptoms when you’re stressed in general, or when you come across reminders of what you went through. For example, you may hear a car backfire and relive combat experiences. Or you may see a report on the news about a sexual assault and feel overcome by memories of your own assault.
It is natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.
Not everyone with PTSD has been through a dangerous event. Some people develop PTSD after a friend or family member experiences danger or harm. The sudden, unexpected death of a loved one can also lead to PTSD.
Why do some people develop PTSD and other people do not?
It is important to remember that not everyone who lives through a dangerous event develops PTSD. In fact, most people will not develop the disorder.
Many factors play a part in whether a person will develop PTSD. Some examples are listed below. Risk factors make a person more likely to develop PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder.
Risk Factors and Resilience Factors for PTSD
Some factors that increase risk for PTSD include:
- Living through dangerous events and traumas
- Getting hurt
- Seeing another person hurt, or seeing a dead body
- Childhood trauma
- Feeling horror, helplessness, or extreme fear
- Having little or no social support after the event
- Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
- Having a history of mental illness or substance abuse
Some resilience factors that may reduce the risk of PTSD include:
- Seeking out support from other people, such as friends and family
- Finding a support group after a traumatic event
- Learning to feel good about one’s own actions in the face of danger
- Having a positive coping strategy, or a way of getting through the bad event and learning from it
- Being able to act and respond effectively despite feeling fear
Researchers are studying the importance of these and other risk and resilience factors, including genetics and neurobiology. With more research, someday it may be possible to predict who is likely to develop PTSD and to prevent it.
Those individuals dealing with PTSD face horrific side effects from nightmares, to hearing voices, recycling the trauma and memories, feeling paralyzed by unconscious fears of the attacks, bombs, and triggers that bring on heightened anxiety, stress, and deep underlying anger. As noted above, those who do find any type of escape is usually through self diagnosis by replenishing their body with substance abuse, narcotics, cutting themselves, physical, emotional, sexual, and/or psychological abuse, assault, and extreme depression. Recovery does not come easy with PTSD. The brain is still a mystery to mankind, and therefore, we are still finding ways to relinquish the deadly hold that addiction carries with it.
Here is what the Addiction Center shares on their website with regard to people who have sustained a Post Traumatic Stress Disorder…
“Most people who have suffered through traumatic events eventually overcome the anxiety, depression and agitation caused by those experiences. But when PTSD develops, these symptoms don’t just go away. They might last for months or years after the event. PTSD can emerge as a result of witnessing or experiencing:
- Military combat
- Serious accidents and injury
- Natural disasters
- Acts of terrorism
- Sexual or physical assault during childhood or as an adult
- The death of a loved one
PTSD and drug addiction often co-occur in response to serious trauma. Getting a proper dual diagnosis is crucial to treating both conditions and getting sober.
Co-occurring PTSD and Addiction
PTSD changes brain chemistry in much the same way substance abuse and addiction do. Often, these disorders form at the same time and feed off one another. The same trauma that caused PTSD can also trigger a substance use disorder.
Nearly three-quarters of those surviving violent or abusive trauma report alcohol use disorders.
Following a traumatic experience, the brain produces fewer endorphins, one of the chemicals that help us feel happy. People with PTSD may turn to alcohol and other mood-enhancing drugs, which increase endorphin levels. Over time, they may come to rely on drugs to relieve all of their feelings of depression, anxiety and irritability.
PTSD often causes people to feel disconnected from their friends and loved ones.
People with PTSD are more prone to violent outbursts and panic attacks, which can be difficult for family and friends to witness. Feelings of guilt over these outbursts can drive those with PTSD to self-medicate with drugs and alcohol. Continued use of alcohol or other drugs in this way can lead to an addiction.”
The most studied medications for treating PTSD include antidepressants, which may help control PTSD symptoms such as sadness, worry, anger, and feeling numb inside. Antidepressants and other medications may be prescribed along with psychotherapy. Other medications may be helpful for specific PTSD symptoms. For example, although it is not currently FDA approved, research has shown that Prazosin may be helpful with sleep problems, particularly nightmares, commonly experienced by people with PTSD.
Doctors and patients can work together to find the best medication or medication combination, as well as the right dose. Check the U.S. Food and Drug Administration website ( ) for the latest information on patient medication guides, warnings, or newly approved medications.
Psychotherapy (sometimes called “talk therapy”) involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but it can last longer. Research shows that support from family and friends can be an important part of recovery.
Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs.
- Exposure therapy. This helps people face and control their fear. It gradually exposes them to the trauma they experienced in a safe way. It uses imagining, writing, or visiting the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.
- Cognitive restructuring. This helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about something that is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.
There are other types of treatment that can help as well. People with PTSD should talk about all treatment options with a therapist. Treatment should equip individuals with the skills to manage their symptoms and help them participate in activities that they enjoyed before developing PTSD.
How Talk Therapies Help People Overcome PTSD
Talk therapies teach people helpful ways to react to the frightening events that trigger their PTSD symptoms. Based on this general goal, different types of therapy may:
- Teach about trauma and its effects
- Use relaxation and anger-control skills
- Provide tips for better sleep, diet, and exercise habits
- Help people identify and deal with guilt, shame, and other feelings about the event
- Focus on changing how people react to their PTSD symptoms. For example, therapy helps people face reminders of the trauma.
Beyond Treatment: How can I help myself?
It may be very hard to take that first step to help yourself. It is important to realize that although it may take some time, with treatment, you can get better. If you are unsure where to go for help, ask your family doctor. You can also check NIMH’s Help for Mental Illnesses page or search online for “mental health providers,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.
To help yourself while in treatment:
- Talk with your doctor about treatment options
- Engage in mild physical activity or exercise to help reduce stress
- Set realistic goals for yourself
- Break up large tasks into small ones, set some priorities, and do what you can as you can
- Try to spend time with other people, and confide in a trusted friend or relative. Tell others about things that may trigger symptoms.
- Expect your symptoms to improve gradually, not immediately
- Identify and seek out comforting situations, places, and people
Caring for yourself and others is especially important when large numbers of people are exposed to traumatic events (such as natural disasters, accidents, and violent acts).
When to see a doctor
If you have disturbing thoughts and feelings about a traumatic event for more than a month, if they’re severe, or if you feel you’re having trouble getting your life back under control, talk to your doctor or a mental health professional. Getting treatment as soon as possible can help prevent PTSD symptoms from getting worse.