Post-traumatic stress disorder (PTSD)
- Dr Liz Russell, Consultant Psychiatrist
Post-traumatic stress disorder (PTSD) is a mental health condition that’s caused by experiencing or witnessing a traumatic event. You may develop it immediately after the event or some time later. Symptoms of PTSD can include flashbacks to the event and nightmares about it.
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About post-traumatic stress
It’s not unusual to feel negative emotions or to have negative thoughts and memories after going through a traumatic event. It’s completely normal to feel in a daze, irritable or agitated, and unable to cope or plan ahead for a few days after the trauma. You may feel hopeless and avoid seeing people too. But many people recover after a week or so. If you continue to worry and be anxious and these reactions interfere with your daily life, you may have post-traumatic stress disorder (PTSD).
Causes of post-traumatic stress disorder
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 post-traumatic stress disorder (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, it’s important to seek help and support.
Symptoms of post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) symptoms can be delayed and you may get PTSD symptoms months or even years afterwards.
Symptoms of PTSD can vary between individuals, but they usually fall into the following types.
Re-living the trauma
These symptoms may include:
- flashbacks or vivid memories of what happened
- recurring nightmares
- thoughts and images that intrude into your mind
- being distressed when something reminds you of the trauma
- reliving the emotional and physical reactions of the incident – for example, being shaky, sweaty, trembling, feeling sick
These are the most characteristic symptoms of PTSD.
Avoidance
These symptoms may include:
- feeling disconnected from yourself and/or the world around you
- avoiding people or situations that remind you of the trauma
- 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 you from gradually being able to live with what happened and cause you to feel low.
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
You can have PTSD and also symptoms of depression and anxiety at the same time.
Feeling ‘on edge’ all the time
These symptoms may include:
- being extremely alert to 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 have PTSD symptoms, 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 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 ask you to complete a short questionnaire.
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. For some people, PTSD is a life-long condition. You may have times when you feel OK and times when you feel worse. Treatment can help you with this.
PTSD treatment may involve:
- watchful waiting
- psychological therapies
- medicines
Your doctor will listen to your own preferences to find the best treatment for you.
Watchful waiting
If the traumatic event happened recently and your symptoms aren’t too severe, your GP or specialist may recommend watchful waiting or active monitoring. This means you wait to see if your response to the stress of the trauma gets better. Your symptoms may go away and you may not get PTSD. Your GP or specialist may ask to see you again to assess how you are.
Psychological therapies
Psychological therapies for PTSD will primarily help you to manage any anxiety and agitation that you’re feeling. There’s evidence that mindfulness, meditation and relaxation, and breathing techniques can help PTSD. Find an activity you enjoy to help you overcome feelings of numbness.
When you’re ready to think about your trauma, PTSD therapy may help; this 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 (TFCBT)
- a therapy called eye movement desensitisation and reprocessing (EMDR)
You will normally be offered up to 12 sessions of therapy. But your doctor may offer you more sessions 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.
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. EMDR therapy examines, challenges, and reprocesses the trauma. It can help to replace stressful thoughts with less stressful ones and change the way you feel about the memories of the trauma.
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 TFCBT. For more information about the different types of TFCBT, speak to a suitably qualified health professional.
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:
- fluoxetine or venlafaxine
- a type of medicine called a selective serotonin re-uptake inhibitor (SSRI) – for example, sertraline
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 that 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 look after your physical health. Try to exercise regularly if you can and eat 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, symptoms may include:
- feeling ‘on-edge’, irritable and being easily startled – you may have problems sleeping too
- avoiding situations or things that remind you of the traumatic event
- re-living the experience over again in flashbacks or nightmares
- feelings of anger, guilt and shame
- physical symptoms like headaches, stomach problems, and skin problems
In PTSD, these symptoms last for more than a month after a traumatic event and interfere with your daily activities.
For more information, see our section on the symptoms of post-traumatic stress disorder.
PTSD may go away. Your symptoms may stop without needing any treatment. PTSD will only be diagnosed if your symptoms carry on for more than a month. Many people need treatment for PTSD, which can ease their symptoms significantly. While it can a few years for symptoms to improve, it will be much quicker than without treatment. Even with treatment, PTSD is a life-long condition for some people.
For more information, see our section on the treatment of post-traumatic stress disorder.
How PTSD affects your life is unique to you. You may experience the same type of trauma as someone else, yet be affected in different ways. The symptoms of PTSD can cause a lot of distress and can affect all aspects of your life. For example, your symptoms may affect your relationships with friends and family or how you perform at work.
For more information, see our section on the symptoms of post-traumatic stress disorder.
The symptoms of PTSD van vary between people but a PTSD episode may look like a flashback to the event. You may feel or act as if the traumatic event is happening again. This reaction may be brief, but you could feel very distressed afterwards.
For more information, see our section on the symptoms of post-traumatic stress disorder.
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
Read our guide for information about the symptoms, treatment and causes of 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.
Other helpful websites
- UK Psychological Trauma Society
- MIND
- Rethink Mental Illness
- Mental Health Foundation
- Young Minds
- Combat Stress
Discover other helpful health information websites
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- Rachael Mayfield-Blake, Freelance Health Editor
