Post-traumatic stress disorder (PTSD)
Your health expert: Dr Naomi Humber, Clinical Psychologist
Content editor review by Dr Kristina Routh, March 2022
Next review due March 2025
Post-traumatic stress disorder (PTSD) is a mental health condition caused by experiencing or witnessing a traumatic event. Symptoms of PTSD can include flashbacks to the event and nightmares about it.
It’s not unusual to feel negative emotions or have negative thoughts and memories after going through a traumatic event. But if you don’t feel better over time and these reactions interfere with your daily life, you may have PTSD.
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- Samaritans. 116 123 (UK and ROI) - This helpline is free for you to call and talk to someone.
- NHS Services has a list of where to get urgent help for mental health.
- Mind website. Click the ‘Get help now’ button on the page. This is a tool that is designed to help you understand what’s happening to you and how you can help yourself.
If you think you might harm yourself or are worried someone else might come to immediate harm, call the emergency services on 999 or go to your local accident and emergency department.
Causes of post-traumatic stress
Post-traumatic stress disorder (PTSD) is caused by being exposed to extremely stressful and threatening situations. You may experience or witness the event, or you may learn about something happening to someone close to you. Or you may often be exposed to details of distressing events, perhaps due to your job.
Events that may cause PTSD include:
- being involved in or witnessing a serious accident
- being sexually or physically assaulted or abused
- being diagnosed with a life-threatening illness
- having serious health problems – for example, being in intensive care
- having problems during childbirth
- someone close to you dying suddenly or being injured
- experiencing war
- experiencing torture
- seeing or being involved in a terrorist attack
- natural disasters – for example, experiencing an earthquake
Some people are exposed to repeated traumatic events over many years or from a young age – for example, neglect or abuse. This may cause a type of PTSD called ‘complex PTSD’.
There are many other events that could cause PTSD – this list doesn’t cover everything. If your experience isn’t covered here but you think you may have PTSD, you should seek help and support.
Symptoms of post-traumatic stress disorder
Symptoms of post-traumatic stress disorder (PTSD) usually start shortly after the trauma. But in a few people, they can be delayed for months or even years.
Symptoms of PTSD can vary between individuals, but they usually fall into the following types.
Re-living the trauma
These symptoms may include:
- vivid flashbacks to what happened
- thoughts and images that intrude into your mind
- recurring dreams and nightmares
- being distressed when something reminds you of the trauma
- having physical reactions like sweating, sickness or trembling when remembering the event
These are the most characteristic symptoms of PTSD.
Avoidance
These symptoms may include:
- avoiding people or situations that remind you of the trauma – including TV programmes, news articles and films
- trying not to think about the event
- avoiding talking about the event
Rather than avoiding it, some people with PTSD keep going over the event in their mind.
This can stop them from gradually being able to live with what happened.
Mood and beliefs
These symptoms may include:
- being unable to remember all or parts of what happened
- blaming yourself for what happened
- feeling negatively about yourself or the world
- feelings of fear, horror, anger, guilt or shame
- not being able to have positive feelings or enjoy activities you enjoyed before
- feeling cut off from other people
Feeling ‘on edge’ all the time
These symptoms may include:
- having extreme alertness for threats – this is known as hypervigilance
- being easily startled
- being irritable and angry
- acting in a self-destructive or reckless way
- finding it difficult to concentrate and having problems sleeping
Symptoms of complex PTSD
Complex PTSD can be caused by repeated or long-term exposure to traumatic events. If you have this condition, you may have other symptoms such as:
- difficulty controlling your emotions and behaviour
- feeling worthless, hopeless or permanently damaged
- long-term difficulty in making friends or staying in relationships
Diagnosis of PTSD
If you think you may have post-traumatic stress disorder (PTSD), it can be very hard to ask for help. But it’s important that you do – PTSD can be treated. And it’s never too late to start treatment.
If you think you are experiencing symptoms of PTSD, you can speak to your GP. They can refer you to your local psychological therapy service. There, an appropriate specialist will assess you and help you to get any treatment and support you need. 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. They’ll also ask 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. If you’ve had your symptoms for over a month and they’re affecting your daily life, you may have PTSD.
Treatment for post-traumatic stress disorder
Many people with post-traumatic stress disorder (PTSD) recover with treatment. But be aware that this can be a long process, and for some people PTSD is a life-long condition. You may have times when you feel OK, and times when you feel worse. Having treatment can help you with this.
Treatment for PTSD may involve:
- watchful waiting
- psychological therapies
- medicines
Your own preferences will be considered.
Watchful waiting
If the traumatic event happened recently and your symptoms aren’t too severe, your GP or specialist may recommend waiting for a few weeks to see if your response to the stress of the trauma improves. Your symptoms may go away, and you may not get PTSD. This is called watchful waiting or active monitoring. Your GP or specialist will see you again, usually within one month, to assess how you are.
Psychological therapies
Treatment for PTSD includes a range of different types of psychological therapy. You may be able to access these directly through local psychological therapy services.
Psychological therapies for PTSD include:
- a type of cognitive behavioural therapy (CBT) called trauma-focused CBT, or TFCBT for short
- a therapy called eye movement desensitisation and reprocessing (EMDR)
You would normally be offered 8 to 12 sessions of therapy. More may be offered if you need them.
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 other types of CBT. These focus on improving symptoms such as feeling angry or being unable to sleep.
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 understand and cope with your thoughts and feelings about the traumatic event. 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 traumatic memories 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 you recall the traumatic event with the help of a qualified therapist. This is thought to help you to reduce the intensity of your distress and the vividness of the memory.
Medicines
There are some medicines that can help with PTSD.
Your GP may offer medicines if you don’t wish to have psychological therapies, or if there is a delay before you can have them. They may also offer medicines if other treatment hasn’t worked or your symptoms are very severe. These medicines include:
- venlafaxine
- a type of medicine called a selective serotonin re-uptake inhibitor (SSRI) – for example, sertraline.
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’re getting on. Always read the patient information that comes with your medicine carefully.
Looking after yourself
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 you trust about how you’re feeling. This could be a friend or family member. Or you might like to talk to people who understand what it’s like to have post-traumatic stress disorder (PTSD) by joining a support group. There are many organisations which provide help and support. See our section on other helpful websites for more details.
If you’re having difficulty with specific symptoms like flashbacks, the following tips may help.
- Take a moment to breathe – focus on your breath as you inhale and exhale.
- Focus on the present moment. You might like to look at or hold something that helps you stay focused on the present. Or look at your surroundings and really focus on them.
- Write down or record some phrases to use to remind yourself that you’re safe at times like these.
- Soothe yourself – cuddle a pet, curl up in a blanket, listen to music, watch something you enjoy or take a walk in nature.
It’s also important to make sure that you look after your physical health. Try to exercise regularly if you can. and have a healthy, balanced diet.. See if you can improve how well you sleep. 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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If you have PTSD, you may experience symptoms like:
- feeling ‘on-guard’
- avoiding situations or things that remind you of the traumatic event
- re-living the experience over again in flashbacks or nightmares
- having feelings of anger, guilt and shame
- physical sensations like sweating, feeling sick or trembling
In PTSD, these symptoms last for more than a month after a traumatic event or experience and interfere with your daily activities.
If your symptoms began after a recent traumatic event, and aren’t too severe, you may be offered ‘watchful waiting’ as an initial treatment plan. This is because your symptoms may stop without needing treatment. PTSD will only be diagnosed if your symptoms carry on for more than four weeks.
For many people, treatment will be needed. With treatment, around 1 in 2 people with PTSD will see their symptoms ease significantly. Be aware that this can take several years. But it can take much longer to improve without treatment. Even with treatment, PTSD is a life-long condition for some people.
The Government’s Equality Act, 2010, makes it illegal to discriminate against people with a disability. A person has a disability if:
- they have a physical or mental impairment
- the impairment has a ‘substantial and long-term effect’ on their ability to carry out daily activities
PTSD is listed in the Act as a mental health condition that can cause such a mental impairment. You can find out more about disability discrimination and mental health from the Mind website (see our section ‘other helpful websites’ for contact details). Your GP practice may also be able to help.
Anxiety
It’s normal to feel anxious sometimes. But if your anxiety is severe, it can interfere with your everyday life.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a type of talking therapy. It helps you change how you think, feel and behave.
Depression
Talking therapies for mental health
Bupa's mental health experts have created this information to explain more about the different types of talking therapies for mental health.
Antidepressants
Antidepressants are a type of drug that can be used to treat depression and other disorders.
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- Post-traumatic stress disorder: what treatments work? Patient information from BMJ. BMJ Best practice. bestpractice.bmj.com, last published January 2021
- Post-traumatic stress disorder. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2020
- Post-traumatic stress disorder. National Institute for Health and Care Excellence (NICE), December 2018. www.nice.org.uk
- Post-traumatic stress disorder (PTSD). Royal College of Psychiatrists. rcpsych.ac.uk, accessed May 2019
- Post-traumatic stress disorder. Mind. mind.org.uk, published January 2021
- Equality Act 2010: Guidance. Office for Disability Issues, 2010. Gov.uk
- Personal communication, Dr Naomi Humber, Clinical Psychologist, March 2022
Reviewed by Dr Kristina Routh, Freelance Health Editor, March 2022
Expert reviewer, Dr Naomi Humber, Clinical Psychologist
Next review due March 2025
