PTSD: understanding post-traumatic stress disorder

The world can seem like a terrifying place. Most of us have lived through life-threatening events like the COVID-19 pandemic, natural disasters, and car accidents. When any of these traumatic events happen to you or your loved one, you may develop post-traumatic stress disorder (PTSD). 

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Post-traumatic stress disorder was recognized first in soldiers and army veterans. It used to be called “battle fatigue” or “shell shock” to describe the reactions these combat veterans had to war battles and other frightening events. Today, mental health experts and clinicians recognize that PTSD is a mental health problem that can affect anyone who has experienced a traumatic event. 

What are traumatic events?

Traumatic events are life-threatening events like surviving (Mann, 2021):

• Natural disasters

• Car accidents

• Acts of terrorism

• Physical or sexual assault

• Harassment

• Abuse related to your identity

• Violence in military combat

• Work distress (people who work in emergency services)

• Pandemics like COVID-19

Some people may experience what is known as secondary trauma. Secondary trauma is when the traumatic event doesn’t happen directly to you, but instead happens to someone in your life, such as a sudden loss of a loved one or seeing other people killed or profoundly injured (Mann, 2021). 

The fight-or-flight response

The human body’s nervous and endocrine systems react immediately to a frightening event. This reaction is called “fight-or-flight,” where your body decides for you to either fight or flee. If the decision is to fight, your body gears up with cortisol, adrenaline, and other hormones. These hormones increase your heart rate and bring extra blood flow to strengthen your limbs, widen your scope of vision, and stop your need to eat, sleep, or go to the bathroom. If the decision is to flee, those hormones and neurotransmitters might give you additional strength to run, even if you’re in pain. This routine and natural reaction usually goes away after a little while (Chu, 2020). 

However, some people cannot switch off the reminders of the trauma and continue to have the physical and emotional effects of the fight-or-flight reaction. Some studies show that people diagnosed with PTSD continue to produce these hormones, even after past traumatic events and dangers have ended.  

If these intrusive memories or thoughts happen from the day after the event up to one month after the traumatic event, that is considered acute stress disorder. Most people usually recover from acute stress disorder, even without seeking treatment from a mental health professional. However, a significant number of people diagnosed with acute stress disorder progress to post-traumatic stress disorder.

Post-traumatic stress disorder is diagnosed when people continue to experience symptoms related to the traumatic event more than 30 days after the event occurred, even though they are well out of danger (Mann, 2021). 

Post-traumatic stress disorder can happen to anyone; there are no limitations around age or gender identity. Any person who witnesses or is directly affected by a traumatic event is at risk for developing PTSD. 

The National Center for PTSD says that 50% of women and 60% of men witness or experience a traumatic event at least once in their lifetime. Even with this high percentage, on average, only about 8% of people have symptoms or a diagnosis of PTSD (Hamblen, 2018). 

Certain people are more more likely to be diagnosed with PTSD than others. More women than men report symptoms of PTSD. People who have already experienced repeated traumatic events or already have a diagnosis of mental illness like anxiety or depression are at greater risk of developing PTSD. Some people who use substances or have increased stress, such as homelessness, financial difficulties, lack of support, or racism, are also at higher risk (Hamblen, 2018).

Post-traumatic stress disorder symptoms are both physical and emotional. Every person is unique, so not everyone has the same symptoms. Some people may have physical or emotional symptoms only, and others a combination of both (Mann, 2021). 

Reliving symptoms 

Most people with PTSD relive the traumatic event they went through or witnessed. Reliving includes having flashbacks (when it feels like the traumatic event is happening again), intrusive thoughts, or disturbing dreams about the trauma. Some people’s physical symptoms include feeling sweaty, trembling, nauseous, or in pain when they relive the traumatic event.

Reactivity symptoms

Reactivity symptoms include hypervigilance, which is the feeling of being on edge and super-alert. Some people are unable to sleep or have sleep problems. They may feel irritable, upset, or have angry outbursts. They may lose focus, lack concentration, or get panicked easily. They may also display symptoms of anxiety disorders, like chest pain, stomach aches, dizziness, and headaches.

Avoidance symptoms

Others may try to stop intrusive memories or thoughts. They may avoid places, people, or anything related to the traumatic event. They may feel “out-of-body” or numb and detached both in their body and mind. Some people will not be able to remember what happened. Others may try to numb their pain with substance abuse.

Mood symptoms

Some people with PTSD may have intrusive negative thoughts or feelings. These can include feeling there is no safe place and no one to trust or understand what happened. Some people blame themselves for the traumatic event and feel tremendous guilt, shame, or anger.

These troubling symptoms of PTSD may make everyday life challenging to manage. Some people with symptoms of PTSD find it hard to go to work, make decisions, look appropriately after themselves, or maintain their relationships with family members and friends. 

After a traumatic event, it is normal to feel any of these symptoms. Some people with PTSD do not show any signs right away. If you or a loved one have been suffering from any of these symptoms for at least 30 days after a traumatic event, you may need to make an appointment to see a mental health professional or clinician to pursue a diagnosis of PTSD. 

The healthcare or mental health professional will first do a thorough physical examination to determine any co-existing physical illness, mental illness such as anxiety or depression, or substance use that may show similar symptoms to PTSD.

Healthcare professionals, including specialists in psychiatry or a psychologist, diagnose PTSD when a person has the following for at least 30 days (Mann, 2021): 

• At least one symptom of avoidance

• At least one symptom of reliving  

• At least two symptoms of reactivity

• At least two mood symptoms

PTSD is divided into mild, moderate, or severe post-traumatic stress disorder. These categories focus on how the symptoms affect the person rather than how terrifying the traumatic event was. 

Another type of PTSD diagnosis includes delayed-onset or complex PTSD. This is diagnosed when a person starts showing symptoms six months or later after the traumatic event. People who experienced traumatic events in childhood or a consistent level of trauma for a while may be diagnosed with complex PTSD.

PTSD treatments are psychotherapy (talk therapy) and medication. It is essential to seek out a mental health professional with PTSD experience. Some people have underlying medical or mental health conditions or other stressful life circumstances that need treatment together with their PTSD symptoms.

Most people can get better by treating PTSD with psychotherapy. Talk therapies help people identify and deal with their emotions around the traumatic event. Some psychologists teach anger management or relaxation techniques to help manage any distressing symptoms.

Currently, there are two types of talk therapy used to successfully treat the symptoms of PTSD (Hamblen, 2018).  

Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) or trauma-focused cognitive-behavioral therapy (TF-CBT) are both used to treat PTSD. Mental health professionals in psychiatry or psychologists provide this type of therapy. 

Some CBT practitioners provide exposure therapy where people get re-exposed to the traumatic event in a safe environment and manner. Other CBT practitioners do cognitive restructuring where they reframe the traumatic event in a more grounded way. Cognitive restructuring is usually done when people have deep shame or guilt about what happened. People typically see the same therapist for at least eight weeks with 60 to 90-minute sessions (Hamblen, 2018).

Some mental health professionals and clinicians use telemedicine and online talk therapy visits. Current research shows that online talk therapy can be effective for PTSD (Lenferink, 2020). 

Eye movement desensitization and reprocessing

Eye movement desensitization and reprocessing (EMDR) is another type of therapy that helps symptoms of PTSD. The person makes rhythmic eye movements when remembering the traumatic event. These eye movements are similar to how the brain processes experiences and memories when sleeping (Lenferink, 2020).

Some people may need prescription medication to help their symptoms of PTSD resolve. Currently, the U.S. Food and Drug Administration (FDA) has only approved two medicines to treat post-traumatic stress disorder. Both are antidepressants and selective serotonin reuptake inhibitors (SSRIs): paroxetine (Paxil) and sertraline (Zoloft; see Important Safety Information). The US Department of Veterans Affairs and the American Psychiatric Association also recommend using these prescription antidepressants for PTSD treatment (Akiki, 2018).

There are other medicines that have been used to treat the symptoms of PTSD. They include drugs to treat agitation (risperidone) and seizure medications (topiramate), but these aren't considered as effective for PTSD as SSRIs are. Some healthcare professionals prescribe benzodiazepines like alprazolam (Xanax), but they are also not as effective at treating PTSD. Benzodiazepines may even increase the risk of worsening PTSD symptoms or becoming addicted to these pills (Akiki, 2018).

There is some research that (natural) cannabis and synthetic cannabinoids (CBD) may help symptoms of PTSD. Cannabis or CBD is thought to decrease high levels of anxiety and improve sleep. While this sounds promising, there isn’t enough evidence on a safe and therapeutic dose just yet (Orsolini, 2019).

There is exciting new research on MDMA, commonly known as ecstasy, for people with severe PTSD. Studies show that this treatment, done under proper medical supervision and follow-up, is safe and effective. More studies are needed to make MDMA a formal treatment for PTSD (Mitchell, 2021).

Other ways to treat PTSD

People with PTSD do get better with treatment. It may take some time, and while in treatment, you can do some other things to help the treatment be more effective (Boyd, 2018):

• Strengthen your support system by spending time with a loved one, family member, or friends. 

• Some people find going to a support group or group therapy for people with PTSD very helpful.

• Move your body to help reduce stress by walking, dancing, doing yoga, or other exercise.

• Eat nourishing food, keep yourself hydrated, and get quality sleep.

• Incorporate a mindfulness practice and a positive coping strategy.

On the horizon for PTSD relief

Many scientists and researchers are studying why and how people have such different reactions to traumatic events. They are looking at the complex relationship between biology and psychology, including how people store memories or react to inflammation, all of which may predispose some people to develop symptoms of PTSD. The hope is that with this research, we may predict and thereby prevent PTSD (Fitzgerald, 2018, Kida, 2018, Michopoulos, 2017).

Some people may think that people with PTSD symptoms are emotionally weak and should “just get over it.” They may even believe that they are stuck in the past and should be able to just move on with their lives. It is essential to realize that PTSD is a mental condition that affects a person’s body and mind.

If you have PTSD, you are not weak, and you should not expect yourself to get past your trauma quickly or that you have to do it on your own. PTSD can be cured with the help of talk therapy, medication, and time. Please remember you are not alone and that medical attention can help. 

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

June 04, 2021

Written by

Tobi Ash, MBA, RN, BSN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.