What Is PTSD? Symptoms, Causes, Diagnosis, and Treatment

Post-traumatic stress disorder (PTSD) happens when some individuals have a certain reaction to witnessing or experiencing a shocking or upsetting event, including an injury or death on the battlefield, an instance of sexual assault, a school shooting, a natural disaster, or a car accident, according to the U.S. Department of Veterans Affairs (VA). (1)

That experience doesn’t necessarily have to be direct — first responders and medics, for example, may develop PTSD after witnessing another person face a traumatic event, as noted in previous research. (2)

To be diagnosed with PTSD, the event that triggered the trauma has to have felt threatening to your life or well-being, says Michele Pole, PhD, clinic director at West Chester University’s department of Community Mental Health Services in West Chester, Pennsylvania.

Symptoms of PTSD can be triggered by anything that leads the person to feel threatened, whether it’s real or subjective danger. Triggers may include a noise, an aroma, or a song. “Typically it tends to be emotionally related to a past issue,” Russell-Chapin says.

Both the National Institute of Mental Health (NIMH) and the American Psychiatric Association (APA) outline four symptom clusters of PTSD from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), outlined below. (3,4)

Reexperiencing and Intrusive Thoughts

“The one that we think about and hear about most often are flashbacks when, in fact, flashbacks are fairly rare,” Pole says. When people with PTSD have flashbacks, they feel as though they’re experiencing the trauma again. Flashbacks therefore differ from intrusive memories, which are memories about the trauma that happen after a triggering stimulus, like a taste or a smell, and are the more common symptom of the two.

People with PTSD can also experience dreams about the trauma. “These cause a lot of distress for people, and they often try to find ways to manage their emotions when this happens,” she says.

Avoidance

People with PTSD will actively try to avoid thoughts, feelings, people, places, or situations that remind them of the trauma. They may also avoid talking about their trauma with others.

For example, if the person was in a serious car accident, he or she may drive several miles out of the way to avoid the intersection where that traumatic event occurred.

Avoidance can lead to unhealthy behaviors. People may start to drink or use drugs or use them more frequently. “It’s a way to self-medicate [and] avoid feeling the natural feelings that come up after somebody experiences trauma,” Pole says.

Arousal and Reactivity

Feelings of hypervigilance or arousal occur when people with PTSD become stuck in fight-or-flight mode and their nervous system is on high alert at all times. “An individual scans the environment for danger because there’s this fear that danger is around any corner,” Pole says.

People with PTSD who experience this symptom also may have an increased startle response, may have trouble with concentration, and may experience sleep problems. They may also engage in destructive behaviors and have aggressive outbursts.

Mood and Cognitive Changes

People with PTSD may have a shift in the way they view the world, others, and themselves. They often feel they can’t trust other people or themselves. “They may decide the world is not a safe place,” Pole says.

It’s also common for people with PTSD to feel shameful. In an effort to make sense of the event, they blame themselves. They falsely believe that if it’s their fault, they can make sure it doesn’t happen again, which is particularly true for women who experience sexual assault.

Men, on the other hand, often feel shame because they believe they weren’t strong enough to stop the trauma. “It’s a way to feel that they have some control over what happened to them. But what that shame does is keep them stuck,” Pole says.

Other mood and cognition symptoms of PTSD include difficulty remembering certain parts of the trauma, feelings of isolation and detachment, decreased interest in activities you once enjoyed, and difficulties experiencing positive emotions. These symptoms can be especially challenging for patients to cope with because they’re not easily diagnosable.

Learn More About Signs and Symptoms of PTSD

When traumatic events and revictimizations are controlled for, women are still diagnosed with PTSD more often than men, which suggests there may be a genetic factor at play, says Obianuju Berry, MD, a psychiatry instructor at Columbia University Medical Center in New York City. In fact, women are estimated to be twice as likely to develop PTSD as men. (4)

Intergenerational transmission of trauma is an idea that the effects of trauma can be passed down to survivors’ children and grandchildren through their DNA or when fetal DNA is affected with exposure to risk factors, such as altered maternal care in utero, Dr. Pole says.

In fact, according to a study published in July 2017 in the journal Psychiatry Research, Jewish Israelis who were in Israel during the wave of terrorist attacks between 2015 and 2016, experienced trauma, and had all four grandparents who survived the Holocaust, saw a higher level of anxiety about ISIS anxiety than other groups. (5)

The risk for intergenerational transmission of trauma is also greater on a person’s maternal side. “If the mother has PTSD, upon exposure to a traumatic event, the likelihood that the child would develop PTSD is greater when compared with the general population,” says Arielle Schwartz, PhD, a clinical psychologist in Boulder, Colorado, and author of The Complex PTSD Workbook.

Environment also plays a role in the risk for PTSD, especially for people who have a temperament that leads them to have less resilience to stress and distress. “People who tend to react to stress more negatively and don’t bounce back, they’re not going to go through that natural recovery processes as readily, and they’re more likely to go down the pathway to PTSD,” Pole says.

But the most significant risk factor for PTSD is additional traumas. The more trauma a person experiences, the higher his or her predisposition is to develop PTSD, says Lori Russell-Chapin, PhD, professor and codirector for the Center for Collaborative Brain Research (CCBR) at Bradley University in Peoria, Illinois.

Trauma leads to brain changes that appear physically. Namely, trauma increases activity in the amygdala, which is the part of the brain where the fight-or-flight response is initiated, and it may decrease connectivity in the prefrontal cortex, which is the area of the brain that’s responsible for decision making and planning processes, like reasoning. “People struggle to think through this and respond logically to a situation,” Dr. Russell-Chapin says. “What happens to people with repeated trauma is they quit responding to life and they continue to just react to life.”

Learn More About the Causes of PTSD: Rick Factors, Genetics, and More

After a traumatic event, it can take about three months for symptoms to appear. (4) For PTSD to be diagnosed, they must last longer than one month. (1)

It may take weeks, months, or years to see an improvement in symptoms, but treatment can help increase the chances that you will recover sooner. (4)

Sometimes, however, PTSD symptoms may endure if the traumatic event is recurring, such as with domestic abuse. (3)

Prevention of PTSD in the Military

Military servicemen and -women and veterans can develop PTSD as a result of the events they experienced or witnessed. These can include trauma that occurred during combat or military sexual trauma (MST), which includes sexual harassment and sexual assault that occurs during training, combat, or peacetime.

The estimated percentage of veterans affected by PTSD varies by war, as outlined by the VA: (8)

• Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF): between 11 and 20 percent
• Gulf War: 12 percent
• Vietnam War: between 15 and 30 percent

Nevertheless, a study published in June 2017 in the Journal of Psychiatric Research found that PTSD affects veterans and active-duty military service members in similar ways. (9)

The Department of Defense (DOD) and the Department of Veterans Affairs (VA) have invested time and money on research and providing programs to help prevent military personnel from developing PTSD. These efforts include training civilians and veterans to tolerate stress more effectively, instituting treatment protocols after a diagnosis, and treating chronic PTSD, Dr. Berry says.

Learn More About PTSD in the Military and Whether It Can Be Prevented

According to the Mayo Clinic, PTSD may lead to the following complications: (10)

• Depression
• Additional anxiety disorders (such as social phobia)
• Alcohol or drug abuse
• Eating disorders
• Suicidal thoughts or actions

PTSD Stigma

Stigma is defined by the Carter Centers as “a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses.” (11)

People with PTSD are often depicted as dangerous, unpredictable, incompetent, or to blame for their illness. People with PTSD can feel stigma from others and experience self-stigma.

Military service personnel may fear that talking about their illness will hurt their careers, or they will be viewed by others in their unit as weak or unable to protect them, for example. (8)

According to previous research, combat veterans of Operation Enduring Freedom and Operation Iraqi Freedom who sought treatment for PTSD reported faced common perceived stereotypes of veterans seeking treatment, including labels such as “crazy,” and “dangerous or violent,” and were made to believe they were responsible for their diagnoses. Most of the study participants also reported that they initially avoided seeking treatment to avoid the “mental illness” label. (12)

“It reinforces to the individual with PTSD that they’re weak or that there’s something wrong with them and that really feeds that shame,” according to Pole. “In fact, people who have been through trauma are some of the strongest individuals I’ve ever worked with.”

Learn More About the Causes and Effects of PTSD Stigma

Suicide Linked to PTSD

A report by the VA found the risk for suicide was 22 percent higher among veterans than civilians in the United States. (13) And a February 2015 study in the Annals of Epidemiology found veterans who were on active duty during the Iraq and Afghanistan wars had a 41 to 61 percent higher risk of suicide than the general population. Another interesting takeaway from the study: Deployment wasn’t associated with an increased risk of suicide. In fact, deployed vets had a lower risk of suicide than nondeployed vets. (14)

According to the Centers for Disease Control and Prevention (CDC), while women attempt suicide more frequently, men are 4 times more likely to die by suicide than women. (15)

Fortunately, with treatment, research shows that suicidal thoughts among people with PTSD decreases. (16)

If you or a loved one is having suicidal thoughts stemming from PTSD, seek help immediately.

You can call the National Suicide Prevention Lifeline to do so: 800-273-8255.

Learn More About the Link Between Suicide and PTSD

While PTSD can affect anyone who experiences trauma, research has found that this condition disproportionately affects minority groups. According to the APA, Hispanic Americans, Black Americans, and Native Americans all have higher rates of PTSD compared with Non-Hispanic white Americans. (4)

The highest lifetime prevalence is in Black Americans, at 8.7 percent, while both Hispanic Americans and white Americans experienced PTSD at a rate of 7.4 percent, according to previous research. Comparatively, an estimated 7 percent of white Americans experience PTSD. The same study found the lowest rates in the Asian American population, at about 4 percent.

All non-white groups were also found to be less likely to seek treatment for PTSD compared with white Americans. (19)

Black Americans and Hispanic Americans and PTSD

Compared with white Americans, Black and Hispanic Americans were more likely to witness domestic violence. (19)

Native Americans and PTSD

While more research is needed on PTSD and Native Americans, a March 2015 review published in Social Psychiatry and Psychiatric Epidemiology noted that trauma from violence and combat affects Indigenous populations in the United States and causes more symptoms compared with white Americans. (20)

PTSD Myths

Although there’s a greater awareness of PTSD today, misconceptions around the disorder still exist. For one, some people still associate the mental illness only with military veterans, when in fact other individuals — like those who’ve experienced sexual assault or a natural disaster, for example — are also diagnosed with PTSD.

Then there’s the idea that PTSD can’t be treated, which is certifiably false. If you or a loved one is suffering from PTSD, know that you have many options at your disposal, from psychotherapy to oral medication to alternative therapies. (Read more on those approaches above.)

Unfortunately, many of the myths about PTSD can be harmful. But by knowing how to recognize them, you can overcome this other barrier to care and regain your health.

Learn More About Some Common PTSD Myths and Why They’re Not True

Favorite Orgs for Essential PTSD Info

Anxiety and Depression Association of America (ADAA)

Established in 1979 as a nonprofit dedicated to the treatment and prevention of depression and anxiety disorders, the ADAA has since evolved into a leading source of mental health information worldwide. Be sure to check out the free webinars, podcasts, blogs, and community discussions located throughout this site.

National Institute of Mental Health (NIMH)

The NIMH is a branch of the National Institutes of Health, which is a leading government organization dedicated to research and education in the realm of public health. Follow the NIMH if you want to know the latest scientific research on PTSD.

PTSD Alliance

As a professional advocacy group, the PTSD Alliance relies on partnerships with other medical and mental health organizations (such as the ADAA) to help spread awareness and information about treatment options for PTSD. Consider bookmarking this site for educational information, as well as resources for treatment, self-help, advocacy, addiction, and more.

U.S. Department of Veterans Affairs (VA)

Aside from continuing education, check out the VA’s treatment and consultation resources designed specifically for veterans and their loved ones.

Favorite Online Support Networks

ADAA Online Support Group

While still a relatively new support system, the ADAA’s online group has at least 40,000 subscribers and counting. This free peer-to-peer support groups is exclusively online, so you can still connect with others going through similar struggles with PTSD without the added stress of making a meeting at a specific time.

The Mighty

The Mighty is known for its personal stories about chronic illnesses, disabilities, and mental illnesses, but did you know you can also engage within the community? Bookmark the PTSD page for inspirational stories, and click on "Post a Thought” or “Ask a Question” for support.

Favorite Resources for Becoming an Advocate

PTSD Foundation of America

Want to get involved with PTSD advocacy for yourself or a loved one who is a veteran of the Armed Forces? We like the PTSD Foundation of America for its resources on volunteer opportunities and fundraiser ideas. While you’re at it, check out ways you can help sponsor a veteran or get involved in your local chapter.

National Alliance on Mental Illness (NAMI)

Looking to change local and federal policy to support mental health initiatives? NAMI is your best resource for how to get involved. Even if you can’t make it to Capitol Hill personally, NAMI offers ideas on how to write letters, engage in your own community, and more.

Learn More About Additional Resources and Support for PTSD