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Post-traumatic stress disorder (PTSD)


Expert reviewer Dr Liz Russell, Consultant Psychiatrist
Next review due August 2022

Post-traumatic stress disorder (PTSD) is a mental health condition that affects people who have experienced or witnessed a highly-traumatic or catastrophic event. People with PTSD may have flashback to the event, or nightmares about it.

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Causes of post-traumatic stress

PTSD is caused by extremely stressful and threatening situations. You may experience or witness the event, hear about it, or be exposed to uncomfortable or alarming details. Events that may cause PTSD include:

  • being diagnosed with a life-threatening illness
  • someone close to you dying suddenly or becoming injured
  • being involved in, or witnessing a serious accident
  • being assaulted (such as being sexually assaulted or abused, or physically attacked)
  • experiencing military combat (war veterans, having lived in a war zone)
  • experiencing some form of torture
  • seeing or being involved in a terrorist attack
  • natural disasters, such as experiencing an earthquake
  • trouble during or after childbirth

Other stressful experiences such as divorce, losing your job or failing an exam don’t usually lead to PTSD. The type of events that can cause PTSD are usually where you feel life is in danger, or there’s a risk of serious injury or harm.

Symptoms of post-traumatic stress disorder

There are three ‘clusters’ of symptoms associated with PTSD.

1. Continuously re-experiencing the trauma

After a traumatic event, it’s common to ‘re-live’ it over and over. You may have flashbacks – seeing the event happening in your mind – or nightmares. You may feel certain emotions, such as fear and physical sensations like sweating or a particular smell that happened, or was present, at the time.

Flashbacks can be triggered by seemingly normal events. For example, a certain place or smell might cause a flashback.

2. Avoidance and numbing

Re-living an experience again and again can be distressing, so you may try to distract yourself. You may try to keep your mind busy – for instance, by working hard, or being absorbed in a hobby. Steering clear of places or people that remind you of the trauma is also a common sign of post-traumatic stress disorder. Or you may try to overcome the trauma by numbing any pain or feelings you have towards the event completely. You may begin to feel detached from people and give up the things you once enjoyed. It’s also possible to forget, or be unable to recall, key parts of a traumatic event.

Some people with PTSD think deeply about, or ruminate over, the event. This can stop them from moving forward and feeling better about, or at ease with, what they’ve experienced.

3. Feeling ‘on-guard’ all the time

You might find that you’re constantly on edge or alert a lot of the time. After such a traumatic experience, many people constantly look out for danger and can’t relax. This is known as hypervigilance, and you’ll probably feel anxious, or find it hard to sleep or concentrate on tasks. You may be easily startled or have angry outbursts for no real reason.

Most people will have symptoms of PTSD after a traumatic event – it’s completely understandable. But for some, these symptoms persist and they’re unable to come to terms with what has happened. These long-term and severe symptoms are what doctors call PTSD. For more information, see our FAQ: Do I have PTSD or is this just a normal reaction to stress?

Symptoms of PTSD usually start shortly after the trauma, but in some people they can be delayed for months or even years. This is especially true for those who’ve experienced abuse as a child.

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Diagnosis of PTSD

If you are, or think you may be, experiencing symptoms of PTSD, you can speak to your GP. They can refer you to your local psychological therapy service where an appropriate specialist will assess you and help you to get the right treatment and support, if needed. You may also be able to refer yourself directly to these services. Find psychological services near you.

Your GP, or specialist at your local psychological therapy service will ask you about your symptoms and how you’re feeling. They’ll ask about your day-to-day life, including your work, relationships and social life and about any traumatic experiences you’ve had – either recently or in your past. They may also ask you to complete a short questionnaire to measure and assess your symptoms.

PTSD is diagnosed on your symptoms and how long you’ve had them for.

Treatment for post-traumatic stress disorder

At first your GP or specialist may suggest regular catch-ups to see how you are – this is known as active monitoring or watchful waiting.

Some people with symptoms of PTSD get better without any treatment, but others may need specific treatments to help them feel better again. Whether you need treatment of not, it’s important to seek professional help to discuss how you’re feeling. If you need treatment, there are options available to you.

Treatment for PTSD includes a range of different types of psychological therapy, which you may be able to access directly through local psychological therapy services. There are some medicines that can help with PTSD too, but your specialist and/or GP will only recommend these in certain situations.

Speak to those in charge of your care about how you’re feeling and discuss your options – together you can find a treatment that works best for you. You can also find out more about looking after yourself with our FAQ: How can I help myself? below.

Psychological therapies

These include:


To have these therapies, you need to be able to think about and recall your trauma. If you aren’t ready, or able, to revisit your trauma, your specialist may suggest certain types of CBT, which focus on improving symptoms like feeling angry or not being able to sleep instead.

Trauma-focused cognitive behavioural therapy (TFCBT)

There are different types of TFCBT including:

  • cognitive processing therapy
  • cognitive therapy for PTSD
  • narrative exposure therapy
  • prolonged exposure therapy

These therapies can help you to approach and change negative patterns in how you think, feel and behave. Sessions may be done in person, or you may be supported with computerised trauma-focused CBT. For more information about the different types of TFCBT, speak to a suitably qualified health professional.

Eye movement desensitisation and reprocessing (EMDR)

EMDR helps people process flashbacks and make sense of what they have witnessed or experienced. It involves shifting your focus repeatedly from right to left (usually with eye movements), while your therapist helps you to recall the traumatic event. Thinking about and imagining the event while doing this helps you to process what you’ve seen or experienced into a memory. This memory can then be filed away so that it becomes a past event rather than something that you continue to fear.

Medicines

Some antidepressant medicines such as venlafaxine or sertraline – a type of medicine known as a selective serotonin re-uptake inhibitor – can help to treat PTSD.

Depending on your symptoms and situation, a specialist doctor may suggest an anti-psychotic medicine like Risperidone.

These medicines may cause side-effects. So, your doctor will review your medication regularly to see how you are getting on.

Getting support

You may find it helpful to contact a support group if you or someone close to you has post-traumatic stress disorder. There are many organisations which provide help and support. See our ‘other helpful websites’ section below for more details.

Frequently asked questions

  • It’s completely normal to experience symptoms of PTSD after a stressful or traumatic event.

    When something stressful or traumatic happens, you may initially feel panicky and anxious – your heart thumps quickly in your chest and you start to sweat. You may feel confused and disorientated.

    You may also go on to experience typical PTSD symptoms like:

    • feeling ‘on-guard’
    • avoid situations or things that remind you of the event
    • re-living the experience over again in flashbacks or nightmares

    These symptoms usually get better within a few days and last no longer than a month. If they do persist for longer than a month, you may have PTSD.

  • If you haven’t done so already, make sure you seek help from a qualified healthcare professional. They are best placed to assess your symptoms and help you to get better.

    It may also help to talk to someone whom you trust about how you’re feeling. This could be friends or family, or you might like to talk to people who understand what it’s like to experience PTSD by attending a support group.

    If you’re having difficulty with specific symptoms like flashbacks, the following may help.

    • Take a moment to breathe – focus on your breath as you inhale and exhale.
    • Ground yourself in the present moment. You might like to look at or hold something that reminds you of the present moment or look at your surroundings and really focus on them. Describe them out loud to yourself or set yourself a task like identifying all the blue objects in your surroundings.

    It’s also important to make sure that you look after your physical health. Try to exercise regularly and have a healthy, balanced diet. Keep meal times regular and don’t use alcohol or other substances to help you cope or mask how you’re feeling – it will only make things worse.


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Related information

    • Post-traumatic stress disorder. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised January 2019
    • Post-traumatic stress disorder. PatientPlus. patient.info/doctor, January 2016
    • Post traumatic stress disorder. www.rcpsych.ac.uk, accessed May 2019
    • Post-traumatic stress disorder. BMJ Best Practice. bestpractice.bmj.com, last updated April 2019
    • Post-traumatic stress disorder. National Institute for Health and Care Excellence. www.nice.org.uk, published December 2018
    • Post-traumatic stress disorder. MIND. www.mind.org.uk, published May 2017
    • Cognitive processing therapy (CPT). American Psychological Association. www.apa.org, updated July 2017
    • Cognitive therapy (CT). American Psychological Association. www.apa.org, updated July 2017
    • Narrative exposure therapy (NET). American Psychological Association. www.apa.org, updated July 2017
    • Prolonged exposure (PE). American Psychological Association. www.apa.org, updated July 2017
    • Eye movement desensitisation and reprocessing (EMDR). American Psychological Association. www.apa.org, updated July 2017

  • Reviewed by Laura Blanks, Specialist Health Editor, Bupa Health Content Team, July 2019
    Expert reviewer Dr Liz Russell, Consultant Psychiatrist
    Next review due August 2022



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