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Post-Traumatic Stress Disorder (PTSD)

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Post-Traumatic Stress Disorder (PTSD) is a disorder that develops in some people who have experienced or been a survivor of a shocking, scary, or dangerous event or witnessed a traumatic or terrifying event in which serious physical harm occurred or was threatened.

  • It was once called shell shock or battle fatigue syndrome.
  • 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.
  • Not every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD.
  • Not everyone with PTSD has been through a dangerous event.
    • Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD.

Signs & Symptoms:

  • Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward.
  • Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD.
  • The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.
  • A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD.
  • To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:
    • 1) At least one re-experiencing symptom:
      • This 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.
      • Symptoms include:
        • Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
        • Nightmares
        • Frightening thoughts
    • 2) At least one avoidance symptom
      • 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.
      • Symptoms include:
        • Staying away from places, events, or objects that are reminders of the traumatic experience
        • Avoiding thoughts or feelings related to the traumatic event
    • 3) At least two arousal and reactivity symptoms
      • 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.
      • Symptoms include:
        • Being easily startled
        • Feeling tense or “on edge”
        • Having difficulty sleeping
        • Having angry outbursts
    • 4) At least two cognition and mood symptoms
      • 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. 
      • Symptoms include:
        • Trouble remembering key features of the traumatic event
        • Negative thoughts about oneself or the world
        • Distorted feelings like guilt or blame
        • Loss of interest in enjoyable activities
  • 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.

Do children react differently than adults?

  • Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults.
    • In very young children (less than 6 years of age), these symptoms can include:
      • Wetting the bed after having learned to use the toilet
      • Forgetting how to 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 are more likely to show symptoms similar to those seen in adults.
      • They may also develop disruptive, disrespectful, or destructive behaviors.
      • Older children and teens may feel guilty for not preventing injury or deaths.
      • They may also have thoughts of revenge.
  • For additional information, visit the "Learn More" section below. The National Institute of Mental Health (NIMH) offers free print materials in English and Spanish. These can be read online, downloaded, or delivered to you in the mail.

Risk Factors:

  • Anyone can develop PTSD at any age. This includes war veterans, children, and people who have been through a physical or sexual assault, abuse, accident, disaster, or many other serious events.
  • Genes may make some people more likely to develop PTSD than others.
  • 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.
  • Anyone who has been victimized or has witnessed a violent act, or who has been repeatedly exposed to life-threatening situations. This includes survivors of:
    • Domestic or intimate partner violence
    • Rape or sexual assault or abuse
    • Physical assault such as mugging or carjacking
    • Other random acts of violence such as those that take place in public, in schools, or in the workplace
    • Children who are neglected or sexually, physically, or verbally abused, or adults who were abused as children
    • Survivors of unexpected events in everyday life such as:
      • Car accidents or fires
      • Natural disasters, such as tornadoes or earthquakes
      • Major catastrophic events such as a plane crash or terrorist act
      • Disasters caused by human error, such as industrial accidents
  • Combat veterans or civilian victims of war
  • Professionals who respond to victims in trauma situations, such as, emergency medical service workers, police, firefighters, military, and search and rescue workers
  • Those diagnosed with a life-threatening illness or who have undergone invasive medical procedures
  • People who learn of the sudden unexpected death of a close friend or relative
  • 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.
    • Some factors that increase risk for PTSD include:
      • Living through dangerous events and traumas
      • Extended or repeated events for prolonged time- help captive/hostage, military deployment, being a serial victim
      • 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

Treatments & Therapies:

  • The main treatments for people with PTSD are medications, psychotherapy (“talk” therapy), or both.
  • Everyone is different, and PTSD affects people differently so a treatment that works for one person may not work for another.
  • It is important for anyone with PTSD to be treated by a mental health provider who is experienced with PTSD.
  • Some people with PTSD need to try different treatments to find what works for their symptoms.
  • If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be addressed.
  • Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal.
  • Medications:
    • 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.
  • Psychotherapy:
    • 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.
    • Effective psychotherapies tend to emphasize a few key components, including education about symptoms, teaching skills to help identify the triggers of symptoms, and skills to manage the symptoms.

Getting Immediate Help

  • If you are in crisis, and need immediate support or intervention, call, or go the website of the National Suicide Prevention Lifeline (1-800-273-8255).
    • Trained crisis workers are available to talk 24 hours a day, 7 days a week.
    • Your confidential and toll-free call goes to the nearest crisis center in the Lifeline national network. These centers provide crisis counseling and mental health referrals.
  • If the situation is potentially life-threatening, call 911 or go to a hospital emergency room.
  • In other countries, call your country’s emergency services number or visit IASP (https://www.iasp.info/resources/Crisis_Centres/) to find a suicide prevention helpline.
    • Click on the continents, in the map shown, to find crisis centers in Africa, Asia, Europe, North America, Oceania and South America.
    • Other services & numbers are also listed.

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 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

What is the outlook for people with PTSD?

  • Recovery from PTSD is a gradual and ongoing process. Symptoms of PTSD seldom disappear completely, but treatment can help sufferers learn to cope more effectively. Treatment can lead to fewer and less intense symptoms, as well as a greater ability to cope by managing feelings related to the trauma.

How Common Is PTSD?

  • About 3.6% of adult Americans -- about 5.2 million people -- suffer from PTSD during the course of a year, and an estimated 7.8 million Americans will experience PTSD at some point in their lives.
  • PTSD can develop at any age, including childhood.
  • According to the National Center for PTSD, about 7 or 8 out of every 100 people will experience PTSD at some point in their lives.
  • Women are more likely to develop PTSD (10%) than men (4%).
    • An estimated 1 out of 10 women will get PTSD at some time in their lives.
    • This may be due to the fact that women are more likely to be victims of domestic violence, abuse, and rape.
  • An estimated 70 percent of adults in the United States have experienced a traumatic event at least once in their lives and up to 20 percent of these people go on to develop posttraumatic stress disorder, or PTSD.
  • An estimated 5 percent of Americans—more than 13 million people—have PTSD at any given time.
  • Approximately 8 percent of all adults—1 of 13 people in this country—will develop PTSD during their lifetime.
  • Estimated risk for developing PTSD for those who have experienced the following traumatic events:
    • Rape (49 percent)
    • Severe beating or physical assault (31.9 percent)
    • Other sexual assault (23.7 percent)
    • Serious accident or injury, for example, car or train accident (16.8 percent)
    • Shooting or stabbing (15.4 percent)
    • Sudden, unexpected death of family member or friend (14.3 percent)
    • Child’s life-threatening illness (10.4 percent)
    • Witness to killing or serious injury (7.3 percent)
    • Natural disaster (3.8 percent)
    • Recent wars:
      • These may be associated with surviving an IED explosion or an accident during a training exercise, or witnessing the death or injury of a buddy.
      • As of 2010, Afghanistan = 6 – 11% returning vets have PTSD
      • Operations Iraqi Freedom and Enduring Freedom: Between 11 and 20 percent of veterans.
      • Gulf War: About 12 percent of veterans
      • Vietnam War: Studies suggest about 15 percent of veterans, yet it’s estimated that about 30 percent have had PTSD in their lifetime.
      • There is historical and anecdotal evidence of PTSD affecting Veterans of wars before these as well. In the World War I era, PTSD was known more commonly as “shell shock,” and as far back as the Civil War, symptoms were referred to as “soldier’s heart” and “irritable heart.”
      • A report by Veterans Affairs suggests about 20 veterans died by suicide each day in 2014. Rates of suicide were highest among younger veterans ages 18 to 29 and lowest among older veterans older than 60.
      • As of 2010, lifetime occurrence (prevalence) in combat veterans 10 – 30%.
      • As of 2010, In the past year alone the number of diagnosed cases in the military jumped 50% – and that’s just diagnosed cases.
      • As of 2010, Studies estimate that 1 in every 5 military personnel returning from Iraq and Afghanistan has PTSD.
      • As of 2010, 20% of the soldiers who’ve been deployed in the past 6 years have PTSD. That’s over 300,000.
      • As of 2010, 17% of combat troops are women; 71% of female military personnel develop PTSD due to sexual assault within the ranks.

Learn More:

Free Booklets and Brochures

Multimedia:

  • Watch: Dr. Daniel Pine on Boosting Resilience to PTSD (NIH - Multimedia About Post-Traumatic Stress Disorder): Dr. Daniel Pine on a NIH study that tracked Israeli soldiers through deployment to ID predictors. Study found that soldiers preoccupied with threat at the time of enlistment or with avoiding it just before deployment were more likely to develop post-traumatic stress disorder (PTSD).

Federal Resources:

  • MedlinePlus offers information in English and en Español.
  • The National Center for PTSD, part of the U.S. Department of Veterans Affairs, has a website with targeted information for anyone interested in PTSD (including veterans, family, and friends) and for professional researchers and health care providers. The site also offers videos and information about an online app called PTSD Coach.
  • Clinician’s Guide to Medications for PTSD: This material was developed for researchers, providers and helpers by the U.S. Department fo Veterans Affairs.

Mass Trauma:

  • Information for health care professionals: The National Center for PTSD offers a page of general information about the effects of events such as natural disasters and terrorist acts, reviews of disaster research, and useful resources for care providers.
  • Information for the general public: The National Center for PTSD offers a page of resources for people who have experienced an act of terrorism. Materials include resources for survivors and the public, tips for veterans coping with violent events, and suggestions for helping caregivers respond to children.

How to Find Support If You’re Dealing With PTSD From Military Trauma:

PTSD Organizations: From: EveryDay Health - The Best Resources for Patients & Families Affected by PTSD

Resources for Finding Treatment:

Resources & Additional Reading
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