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Post-Traumatic Stress Disorder – PTSD
The following article on Anxiety Disorders is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.
What is post-traumatic stress disorder (PTSD)?
Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.
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 people recover from initial symptoms over time. Those who continue to experience problems may be diagnosed with PTSD.
Who gets 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, or other serious events. People who have PTSD may feel stressed or frightened, even when they are not in danger.
Not everyone with PTSD has been through a dangerous event. Sometimes, learning that a friend or family member experienced trauma can cause PTSD.
According to the National Center for PTSD , a program of the U.S. Department of Veterans Affairs, about six out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men. Certain aspects of the traumatic event and some biological factors (such as genes) may make some people more likely to develop PTSD.
What are the signs and 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. Some people recover within 6 months, while 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 rather than experiencing them. A mental health professional who has experience helping people with PTSD, 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 include:
- Experiencing flashbacks—reliving the traumatic event, including physical symptoms such as a racing heart or sweating
- Having recurring memories or dreams related to the event
- Having distressing thoughts
- Experiencing 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 include:
- Staying away from places, events, or objects that are reminders of the traumatic 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 include:
- 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 include:
- Having trouble remembering key features of the traumatic event
- Having negative thoughts about oneself or the world
- Having exaggerated feelings of blame directed toward oneself or others
- Having ongoing negative emotions, such as fear, anger, guilt, or shame
- Losing interest in enjoyable activities
- Having feelings of social isolation
- Having difficulty feeling positive emotions, such as happiness or satisfaction
Cognition and mood symptoms can begin or worsen after the traumatic event. They can lead a person to feel detached from friends or family members.
How do children and teens react to trauma?
Children and teens can have extreme reactions to trauma, but some of their symptoms may not be the same as those seen in adults. In children younger than age 6, these 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 guilty for not preventing injury or deaths. They may also have thoughts of revenge.
What are the risk factors for PTSD?
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 become important during and after a traumatic event.
Risk factors that may increase the likelihood of developing PTSD include:
- Being exposed 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 extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
- Having a personal or family history of mental illness or substance use
Resilience factors that may reduce the likelihood of developing PTSD include:
- Seeking out 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 the traumatic event
- Being prepared and able to respond to upsetting events as they occur, despite feeling fear
How is PTSD treated?
It is important for anyone with PTSD symptoms to work with a mental health professional who has experience treating PTSD. The main treatments are psychotherapy, medications, or a combination of psychotherapy and medications. A mental health professional can help people find the best treatment plan for their symptoms and needs.
Some people with PTSD, such as those in abusive relationships, may be living through ongoing trauma. In these cases, treatment is usually most effective when it addresses both the traumatic situation and the symptoms of PTSD. People who experience traumatic events or who have PTSD also may experience panic disorder, depression, substance use, or suicidal thoughts. Treatment for these conditions can help with recovery after trauma. Research shows that support from family and friends also can be an important part of recovery.
Psychotherapy (sometimes called talk therapy) includes a variety of treatment techniques that mental health professionals use to help people identify and change troubling emotions, thoughts, and behaviors. Psychotherapy can provide support, education, and guidance to people with PTSD and their families. Treatment can take place one on one or in a group and usually lasts 6 to 12 weeks but can last longer.
Some types of psychotherapy target PTSD symptoms, while others focus on social, family, or job-related problems. Effective psychotherapies often emphasize a few key components, including learning skills to help identify triggers and manage symptoms.
One common type of psychotherapy, called cognitive behavioral therapy, can include exposure therapy and cognitive restructuring:
- Exposure therapy helps people learn to manage their fear by gradually exposing them, in a safe way, to the trauma they experienced. As part of exposure therapy, people may think or write about the trauma or visit the place where it happened. This therapy can help people with PTSD reduce symptoms that cause them distress.
- Cognitive restructuring helps people make sense of the traumatic event. Sometimes people remember the event differently from how it happened. They may feel guilt or shame about something that is not their fault. Cognitive restructuring can help people with PTSD think about what happened in a realistic way.
The U.S. Food and Drug Administration (FDA) has approved two selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication, for the treatment of PTSD. SSRIs may help manage PTSD symptoms such as sadness, worry, anger, and feeling emotionally numb. Health care providers may prescribe SSRIs and other medications along with psychotherapy. Some medications may help treat specific PTSD symptoms, such as sleep problems and nightmares.
People should work with their health care providers to find the best medication or combination of medications and the right dose. To find the latest information about medications, talk to a health care provider and visit the FDA website .
How can I find help for PTSD?
If you’re not sure where to get help, a health care provider can refer you to a licensed mental health professional, such as a psychiatrist or psychologist with experience treating PTSD.
The Substance Abuse and Mental Health Services Administration has an online treatment locator to help you find mental health services in your area.
Here are some things you can do to help yourself while in treatment:
- Talk with your health care provider about treatment options and follow your treatment plan.
- Engage in exercise, mindfulness, or other activities that help reduce stress.
- Try to maintain routines for meals, exercise, and sleep.
- Set realistic goals and focus on what you can manage.
- Spend time with trusted friends or relatives and tell them about things that may trigger symptoms.
- Expect your symptoms to improve gradually, not immediately.
- Avoid the use of alcohol or drugs.
How can I help a friend or relative who has PTSD?
If you know someone who may be experiencing PTSD, the most important thing you can do is to help that person get the right diagnosis and treatment. Some people may need help making an appointment with their health care provider; others may benefit from having someone accompany them to their health care visits.
If a close friend or relative is diagnosed with PTSD, you can encourage them to follow their treatment plan. If their symptoms do not get better after 6 to 8 weeks, you can encourage them to talk to their health care provider. You also can:
- Offer emotional support, understanding, patience, and encouragement.
- Learn about PTSD so you can understand what your friend is experiencing.
- Listen carefully. Pay attention to the person’s feelings and the situations that may trigger PTSD symptoms.
- Share positive distractions, such as walks, outings, and other activities.
- National Center for PTSD : Part of the U.S. Department of Veterans Affairs, this website has information and resources for anyone interested in PTSD, including veterans, family, friends, researchers, and health care providers. The site offers videos, apps, online programs, and other tools to help people with PTSD and their loved ones.
- Medications for PTSD : This webpage from the U.S. Department of Veterans Affairs describes effective medications for treating PTSD and considerations for evaluating treatment options. PTSD (MedlinePlus – also en español )
Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.
Advocacy and Policy
Mental Health Community Partners
SMHRT: Family Education
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics