Medically Reviewed

Post-Traumatic Stress Disorder (PTSD): Everything You Need to Know

Get the doctor-approved details on causes, symptoms, treatments, and other facts and tips that can make life with PTSD easier.

Updated Sep 28, 2022

By

Matt McMillen

Medical ReviewerDenise Miles, PsyD

Our Experts: Debra Lee Kaysen, Ph.D.; Catherin Mogil, Psy.D.; Ken Yeager, Ph.D.

Debra Lee Kaysen, Ph.D.Clinical Psychologist and Professor of Psychiatry and Behavorial Sciences Standford University, Palo Alto, CA

Catherin Mogil, Psy.D.Associate Clinical Professor and Clinical Director UCLA Family Stress, Trauma and Resilience (STAR) Clinic, Los Angeles, CA

Ken Yeager, Ph.D.Associate Clinical Professor and Clinical Director Ohio State Wexner Medical Center Family Stress, Trauma and Resilience (STAR) Clinic, Columbus, OH

You’ve survived a tremendous trauma—sexual violence, a terrorist attack, a car accident, or maybe life in a warzone—and though it’s now in the past, you keep returning to it in nightmares and flashbacks. But such hallmark symptoms of post-traumatic stress disorder (PTSD) are not the only way this at-times debilitating disorder may manifest. If you are battling crippling anxiety about a past trauma that is holding you back (physically or emotionally) from living a full and free life, it’s important to know that there is hope—and help. Effective treatments exist to end the disorder’s hold on you. Our experts walk you through what you need to know about PTSD and how it can be successfully overcome.

When you experience trauma while in combat, during a violent assault, or in a horrific accident, to name just a few potentially traumatic situations, it’s normal to be psychologically affected. Your emotions can run the gamut—fear, sadness, confusion, anger, shock, numbness—as you process what has happened to you, or what you’ve witnessed. Your behavior may change. You may become more vigilant about your safety, for example, or avoid people, places, or situations that take your mind back to all you have endured. You might blame yourself for what happened, become easily angered or irritated with others, or prefer to withdraw from the world. You may even relive the event, time and again, in your thoughts and dreams.

These reactions and more make up a common and complex response to trauma. Most of the time people who experience these reactions to trauma will recover and feel better on their own, within a few weeks or months. But for some their response can become chronic, a new and unfortunate normal that rarely improves without therapy or medication, or both. This may lead to a diagnosis of what’s known as post-traumatic stress disorder, or PTSD.

So what, exactly, is going on in the brain when you have PTSD? First, it's important to know that we all have what is often referred to as a fight-or-flight response to danger. When human beings feel threatened, a part of the brain called the amygdala sends out distress signals that prep our body to act. Our heart rates rise, we start to sweat, and our muscles tense. After the danger passes, we calm down again.

In PTSD, the fight-or-flight response has stopped working properly. It triggers much more easily than it should. An example: Your PTSD developed in combat. Now, every time a car engine backfires, your brain instead hears a gunshot and you go into danger mode. At the same time, a part of your brain—called the prefrontal cortex, which helps manage your emotional responses—shuts down. You become less able to rationalize what’s happening or recognize that you’re not truly in danger.

The part of your brain that processes memories—the hippocampus—can also get out whack. This can lead to flashbacks of the trauma and other painful memories, as well as false or fragmented memories. You may fixate on the trauma because your hippocampus can’t make proper sense of the memories of what happened.

PTSD affects about 12 million U.S. adults, and an estimated 6% of the U.S. population will develop PTSD at some point in their lives, according to the U.S. Department of Veterans Affairs (VA). Women are two-to-three times more likely than men to develop PTSD for reasons we’ll detail in short order.

PTSD can occur in young children and teens, too. The VA estimates that 3% to 15% of girls and 1% to 6% of boys will develop PTSD.

Some research suggests that Black Americans have a greater risk of developing PTSD at some point in their lives than their white counterparts. For example, a 2018 study reported that the U.S. Black population’s risk of PTSD was 25% higher.

What Is Trauma?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which psychiatrists and psychologists use to diagnose mental illnesses, defines trauma as exposure to death, serious injury, sexual violence, or to the threat of any of those things. A soldier in combat, for example, would be exposed to both actual and threatened death, as well as serious injury. A victim of rape or even attempted rape would be traumatized by sexual violence.

Trauma does not have to be direct. A witness to a terrible car accident, for example, could develop PTSD as a result of what they saw. Learning that a relative or close friend experienced trauma—such as a violent death—can be enough to trigger PTSD, experts say. Finally, people who are indirectly exposed to trauma, such as police, paramedics, and other first responders, can also develop PTSD (though it’s important to note that these groups can also be exposed to direct trauma, too).

Everyone with PTSD must meet certain criteria, as defined by the DSM-5. Criteria include one or more of the symptoms below that last at least one month and cause significant distress in your daily life, such that you experience problems in your social life, at work, school, or in other every day activities. The DSM-5 identifies the following as symptoms of PTSD:

Reliving the Trauma

People with PTSD often have highly vivid and graphic nightmares that take them back to the trauma. Involuntary and intrusive memories or flashbacks of the trauma also may occur. Such reminders can cause emotional stress and physical reactions, such as breaking out in a cold sweat or shaking. These flashbacks are not simply memories of what happened. According to a 2015 review of these types of experiences, flashbacks bring with them a sense of “nowness,” meaning, those who have them feel like the event is occurring in the present moment. Your list of symptoms must include some type of flashback in order for you to be diagnosed with PTSD.

Avoidance of Reminders of the Trauma

People with PTSD actively try to avoid thoughts, feelings, people, and places that might bring back memories of the trauma. If you’ve been in a bad car accident on the highway, for example, you may avoid highways or even getting into cars altogether. You might avoid talking about it, or about your feelings, even with your loved ones. You must have at least one type of avoidance behavior to be diagnosed with PTSD.

Changes in the Way You Think and Feel

If you have PTSD, you’re likely to have negative thoughts or feelings because of the trauma, which can be expressed in many ways. In order to be diagnosed with PTSD, you must have at least two types of emotional changes. Examples: You may struggle to recall details of the event or place unrealistic, exaggerated blame for the event on yourself or others. You may no longer care about some of the activities that you once enjoyed. Loss of trust and no longer feeling safe in the world are typical, as are ongoing feelings of fear, shame, anger, and guilt also are common, per the DSM-5. In fact, recent research suggests that feelings of guilt and shame following a traumatic event may help drive the disorder. In one review, researchers point out that shame may exacerbate common PTSD symptoms such as avoidance and withdrawal. Feelings of guilt, meanwhile, may not only contribute to worse PTSD symptoms; they also may help trigger the development of the disorder in the first place, according to one study. In addition, you may no longer feel positive emotions, such as happiness.

Changes in How You React the World Around You

The traumatic event may have put you in a constant state of alert and on edge, suspicious of your surroundings, because the world feels like a less safe place now. You may find that you startle much more easily than you used to, such as when a car backfires or fireworks go off. This state of being, called hyperarousal, is common in PTSD. And, according to a 2021 study , increases the risk of suicide. You also may have trouble sleeping and concentrating. You may be more irritable than before and less able to control your temper. You may engage in reckless, risky, and destructive behavior. One study showed that trauma upped the risk for 38 self-destructive behaviors.

As we mentioned above, most people who experience a traumatic event do not develop PTSD. Those who do go on to develop the disorder typically have some things in common. Here are a few examples.

• Exposure to previous trauma. This can include combat, child abuse, and other threatening situations.

• Getting injured seeing someone else injured. This can include seeing a dead body during a traumatic event.

• Lack of social support. After a traumatic experience if adequate support is not in place, the risk for PTSD increases.

• Mental illness. This can include depression, anxiety, or substance use disorder. If someone is already suffering and then you add this type of psychological injury, it is much harder to be resilient.

• Stress. Loss of a job, financial struggles, problems in your intimate relationships, or other stressors may make you less able to cope with the feelings you experience following the traumatic event.

PTSD may be more likely if there was some degree of real or perceived intention behind the traumatic event. For example, if someone attacks you personally versus experiencing an act of nature, such as a tornado or hurricane.

Genetics also appears to play a role, as it does with other mental disorders. According to a 2018 review of past studies of PTSD, about 5% to 20% of cases of PTSD are linked with genes that may increase the risk of PTSD following exposure to trauma.

Why Are Women at Higher Risk for PTSD?

In general, women are at higher risk of PTSD, and they tend to develop PTSD when exposed to stressors at a much higher rate than men. The reasons are complex. Women and men are exposed to different types of traumatic events. Women are more likely to be exposed to interpersonal violence, such as sexual assault, intimate partner violence, and child sexual abuse. And those types of events have a high rate of leading to PTSD. In fact, three out of four victims of sexual assault meet the criteria for PTSD a month after their assault. Within a year, more than 40% still meet PTSD criteria. More than nine out of 10 victims of rape and sexual assault are women, according to the National Sexual Violence Resource Center.

Within a military setting, women are more likely to be exposed to sexual trauma, which is associated with very high rates of PTSD. Almost one in four women in the military report sexual assault, according to one report . Men, on the other hand, are more likely to be exposed to traumas like combat trauma or physical assault.

Another factor: Women are more likely to be exposed to be traumatized by someone that they know and potentially trust—think sexual assault—which contributes to the traumatic experience, while men are more likely to be trauma exposed by someone unknown.

Finally, women may seek help more than men do, which could affect the numbers of those identified as having PTSD.

Right now, it remains unclear how much of the difference between women’s and men’s risk of PTSD is due to actual biological differences, as opposed to the types of trauma to which women are more frequently exposed.

First, it’s important to know that PTSD is underdiagnosed. Some research suggests that as many as half of adults who suffer from PTSD don’t seek help for the disorder. Avoidance symptoms, for example, make it very difficult to discuss the trauma and confront the emotions that would come with such a discussion. Such symptoms increase the likelihood that someone with PTSD won’t want to talk about it, even with a professional therapist.

The result: Many people live with the disorder for years before it is recognized and treated, if it ever is. That’s unfortunate, because the earlier the disorder is diagnosed and treated, the less it progresses and impacts your life.

But before you can get treated, you need an official diagnosis of PTSD. To get one, you’ll need a psychological evaluation. The Veterans Administration’s website provides many resources for finding a therapist for both soldiers and civilians. Check out this page.

Psychological Evaluation With Health History

Your therapist will ask you many questions about your life, including:

• Do you have any co-existing psychological disorders? This includes those that you have previously been diagnosed with, as well as those you may battle without an official diagnosis—especially common mental health conditions that commonly accompany PTSD, such as depression, anxiety, and substance use disorder.

• What PTSD symptoms are you experiencing? Your therapist will review what you’re going through, such as flashbacks, social isolation, avoidance of things that remind you of your traumatic experience, and more.

• What did you go through, and what was your reaction to a traumatic event, or events? These details will likely be discussed gradually as you’re ready to confront them with professional guidance.

Your therapist may approach these questions in a couple of different ways. Some prefer an unstructured, conversational approach to draw out the details of your experience. Others may use a standardized assessment tool that covers your experience in a very focused way. Several such tools exist, but the gold standard is the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), a 30-item questionnaire that covers PTSD symptoms, how long you’ve been experiencing them, how often they occur, their severity, and more.

As mentioned above, the symptoms that you report to your therapist must have been troubling you for at least a month in order to meet the criteria for a PTSD diagnosis. They also must in some way cause distress or affect your ability to maintain your normal social life or to function in your job. Additionally, your therapist must rule out other possible causes of your symptoms, such as substance use, medication, or another illness, such as depression.

If you meet the criteria and receive a diagnosis, you will start treatment for PTSD.

Experts agree that talk therapy, a.k.a. psychotherapy, is the most effective form of treatment for PTSD, with trauma-focused psychotherapies having the highest success rate, according to research. Such talk therapies help you process your trauma. We’ll get into the various specific approaches in a moment, but first, let’s talk about what they have in common.

Therapy will start with helping you understand just what PTSD is and why you have it. It can be helpful to understand that PTSD is your brain’s response to trauma.

Your therapist will help you learn calming and coping skills that you can use when you are troubled by symptoms. These skills also can help you sleep better at night. This is important because many people with PTSD can’t sleep because their bodies remain on high alert.

Once you have developed some coping skills, you will address the trauma itself. Successful therapies share these elements.

• Exposure. You and your therapist will explore the memories, the emotions, and the sensory experience that you associate with the trauma.

• Cognitive restructuring. Therapy will teach you how to evaluate and change your thinking about why the trauma happened and what it means to you.

Talk therapy typically lasts for six to 15 weekly sessions. However, recent research suggests that daily therapy, which can be finished in as little as a week, may be just as effective or even more effective than weekly sessions.

The three types of talk therapy that have the most evidence behind them are:

Prolonged Exposure

During this therapy, you will gradually confront memories, feelings, and situations related to your trauma. You will be recorded as you speak, and you will listen to these recordings between sessions to help you become more comfortable with dealing with them. You also will slowly re-introduce yourself to things that you have been avoiding. For example, if your trauma has led you to avoid driving a car, you may watch videos of cars driving safely, followed by sitting in a car, to eventually driving. You do this at your own pace, accompanied by your therapist at first, and then on your own as you become able to tolerate it. According to a review of studies on psychotherapy for PTSD, 41% to 95% of people who underwent prolonged exposure no longer had PTSD at the end of treatment.

Cognitive Processing Therapy (CPT)

Like prolonged exposure therapy, this is a type of cognitive behavioral therapy (CBT) that specifically addresses trauma. You and your therapist will gradually discuss your trauma and how it has affected you. You will talk about how you think and feel about what happened, reviewing negative thoughts, such as blaming yourself for the trauma or feelings of worthlessness, fear, anger, and lack of trust. Then you and your therapist will consider different ways of thinking about what happened and why. The goal of this approach is that these new ways of looking at the trauma eventually will replace your negative thoughts.

Eye Movement Desensitization and Reprocessing (EMDR)

During this type of therapy, you will consider the memory of the trauma you experienced as well as the negative thoughts and feelings that its memory evokes. While you focus on the memory, you will pay attention to a back and forth movement, such as a finger moving right to left, left to right in front of your face, or to a sound, like a beep that repeats in one ear at a time. While it is not clear how this works, it is one of the most effective treatments for PTSD, according to the Veterans Administration.

A PTSD Plan for What Comes Next

The last part of treatment is planning for the future. You likely will occasionally re-experience some of your symptoms during your everyday life, so part of your therapy will be developing the skills to manage those symptoms when they occur. It’s common, for example, to have some symptoms around the anniversary of your trauma. So, don’t worry or put too much weight on it if this happens to you: That’s normal.

Four medications have been shown effective at reducing the symptoms of PTSD. All but one of them are part of a class of antidepressant drugs called selective serotonin uptake inhibitors. They are:

• Paxil (Paroxetine)

• Prozac (Fluoxetine)

• Zoloft (Sertraline)

The fourth drug, Effexor (Venlafaxine), is a type of antidepressant called a selective norepinephrine reuptake inhibitor.

While these drugs are considered effective, they don’t work for everyone. According to a review of studies about medications for PTSD, less than 60% of those who take the drugs listed above see meaningful improvements in symptoms, and only 20% to 30% become PTSD-free.

Which PTSD Treatment Approach Is Better?

So, which is better: talk therapy or medication? According to a review of scientific studies, talk therapy was the clear winner. It showed effectiveness long after treatment ends, compared to medications, which need to be taken on an ongoing basis. The reason may be that the medications simply blunt the symptoms of PTSD, while talk therapy targets the thought processes that create the symptoms in the first place. According to a review of treatments for PTSD, talk therapy leads to stable symptoms or continued improvement after treatment ends. Stopping medications, on the other hand, is likely to result in a relapse.

According to the Veterans Administration, the three most effective forms of talk therapy (those mentioned above) have a 53% success rate; medications have 42% success rate. Medication, however, is much more easily available than talk therapy for many people.

Antidepressants can play an important role, however, and not only because they can help ease symptoms. About half of those with PTSD also develop depression, and these drugs can be very effective for that disorder.

Right now, it’s still unclear whether both medication and talk therapy are more effective when taken together than either is on its own. What is clear: Both are better than nothing. Fewer than 10% of people with PTSD get better without treatment.

Life does get better with PTSD treatment, and it does so quickly. Talk therapy for the disorder lasts no more than 12 weeks or so, even for people who have suffered with the disorder for years or decades. After that, your likelihood of a relapse is very low. However, as mentioned above, it’s important to keep in mind that you may experience symptoms on occasion. The goal of treatment is to help you manage them so that you can get back to living a normal life, and it’s very good at doing just that. For added support, reach out to the National Center for PTSD and speak to others who understand all you’ve been through.