Posttraumatic stress disorder (PTSD) is a psychiatric condition that may occur in people who have experienced or witnessed a traumatic event or series of traumatic events. The individual often experience the event or events as emotionally or physically harmful or life-threatening. Examples include, but are not limited to, abuse (physical, sexual, emotional), natural disasters, serious accidents, terrorist acts, war/combat exposure, intimate partner violence, and medical illness. However, most individuals who experience traumas do not go on to develop PTSD.

Many people who are exposed to a traumatic event experience symptoms similar to PTSD in the days following the event. However, for a person to be diagnosed with PTSD, symptoms must last for more than a month and must cause significant distress or problems in the individual’s daily functioning. Many individuals develop symptoms within three months of the trauma, but symptoms may appear later and often persist for months and sometimes years. PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems.

PTSD can occur in anyone of any ethnicity, nationality or culture, and at any age. The prevalence of PTSD in the U.S. is estimated to be approximately 4% of U.S. adults and 8% of U.S. adolescents aged 13-18. The lifetime prevalence in the U.S. is estimated to be 6%. PTSD risk factors include:

• Prior history of trauma (and the severity and frequency of events; perceived lack of support following event(s))
• Childhood adversity/trauma
• Female gender
• Member of a marginalized group (such as non-white, LGBTQ+, living with a disability)
• Immigrant status

Symptoms of PTSD fall into four categories. Specific symptoms can vary in severity.

1. Intrusion: Intrusive (unwanted and involuntary) thoughts such as repeated memories, distressing dreams, or flashbacks of traumatic events. Flashbacks may be so vivid that people feel they are reliving the traumatic experience or seeing it before their eyes and may cause significant fear and panic. These memories and/or nightmares may be triggered by something that reminds the individual of the traumatic event or may be spontaneous.
2. Avoidance: Avoiding reminders of the traumatic event(s) may include avoiding people, places, activities, objects, and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. Additionally, they may resist talking about what happened or how they feel about it. Oftentimes, these behaviors lead to dysfunction in everyday life.
3. Changes in cognition and mood: Individuals with PTSD may initially present with depressive symptoms. These include low mood (feeling sad), inability to feel happiness, and a lack of interest in activity and/or people that they used to enjoy. Additionally, individuals with PTSD may have trouble with memory; maybe be unable to remember important aspects of the traumatic event have negative thoughts and feelings leading to ongoing and distorted beliefs about themself or others (e.g., “I am bad,” “No one can be trusted”); have distorted thoughts about the cause or consequences of the event leading to wrongly blaming self or other; have ongoing fear, horror, anger, guilt or shame; have much less interest in activities previously enjoyed; feel detached or estranged from others; or be unable to experience positive emotions (a void of happiness or satisfaction).
4. Changes in arousal and reactivity: People with PTSD may describe being irritable and having angry outbursts, behaving recklessly or in a self-destructive way, being overly watchful of their surroundings in a suspecting way, being easily startled, or having problems concentrating or sleeping.

Dissociation

Some individuals with PTSD will have the dissociative symptoms:

• Derealization – The feeling that life is not real. Individual may describe feeling like they are in a movie or in a dream.
• Depersonalization – The feeling that one is outside of their body.

These symptoms are not required for a PTSD diagnosis and can vary in intensity across the PTSD illness.

The four tabs below provide brief descriptions of four conditions related to PTSD:  acute stress disorder, adjustment disorder, disinhibited social engagement disorder, and reactive attachment disorder.

 Acute Stress

 Adjustment Disorder

 Disinhibited social engagement disorder

 Reactive attachment disorder

It is important to note that not everyone who experiences trauma develops PTSD, and not everyone who develops PTSD requires psychiatric treatment. For some people, symptoms of PTSD subside or disappear over time. Others get better with the help of their support system (family, friends or clergy). But many people with PTSD need professional treatment to recover from psychological distress that can be intense and disabling. It is important to remember that trauma may lead to severe distress. That distress is not the individual’s fault, and PTSD is treatable. The earlier a person gets treatment, the better chance of recovery.

Psychiatrists and other mental health professionals use various effective and research-proven methods to help people recover from PTSD. Both talk therapy (psychotherapy) and medication provide effective evidence-based treatments for PTSD.

Cognitive Behavioral Therapy

One category of psychotherapy, cognitive behavior therapies (CBT), is very effective. Cognitive processing therapy, prolonged exposure therapy and stress inoculation therapy (described below) are among the types of CBT used to treat PTSD.

• Cognitive Processing Therapy is an evidence-based, cognitive behavioral therapy designed specifically to treat PTSD and comorbid symptoms. It focuses on changing painful negative emotions (such as shame, guilt, etc.) and beliefs (such as “I have failed;” “the world is dangerous”) due to the trauma. Therapists help the person confront such distressing memories and emotions.
• Prolonged Exposure Therapy uses repeated, detailed imagining of the trauma or progressive exposures to symptom “triggers” in a safe, controlled way to help a person face and gain control of fear and distress and learn to cope. For example, virtual reality programs have been used to help war veterans with PTSD re-experience the battlefield in a controlled, therapeutic way.
• Trauma Focused Cognitive Behavioral Therapy is an evidence-based treatment model for children and adolescents that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles and techniques.
• Eye Movement Desensitization and Reprocessing for PTSD is a trauma-focused psychotherapy which is administered over approximately three months. This therapy helps a person to reprocess the memory of the trauma so that it is experienced in a different way. After a thorough history is taken and a treatment plan developed the therapist guides the patient through questions about the traumatic memory. Eye movements similar to those in REM sleep is recreated during a session by having the patient watch the therapist’s fingers go back and forth or by watching a light bar. The eye movements last for a brief time period and then stop. Experiences during a session may include changes in thoughts, images, and feelings. After repeated sessions  the memory tends to change and is experienced in a less negative manner.
• Group therapy encourages survivors of similar traumatic events to share their experiences and reactions in a comfortable and non-judgmental setting. Group members help one another realize that many people would have responded the same way and felt the same emotions. Family therapy may also help because the behavior and distress of the person with PTSD can affect the entire family.

Other psychotherapies such as interpersonal, supportive and psychodynamic therapies focus on the emotional and interpersonal aspects of PTSD. These may be helpful for people who do not want to expose themselves to reminders of their traumas.

Often individuals will explore various psychotherapy options to find the right fit for them. Additionally, individuals may transition from one therapy to another during their treatment. There is no significant evidence that one psychotherapy is more effective than another. Thus, the decision about which psychotherapy to use should be individualized to each patient.

Medication

Medication can help to control the symptoms of PTSD. In addition, the symptom relief that medication provides allows many people to participate more effectively in psychotherapy.

SSRIs and SNRIs (antidepressants) are commonly used to treat the core symptoms of PTSD and co-occurring mood symptoms. They are used either alone or in combination with psychotherapy or other treatments.

Prazosin, a blood pressure medication, is often prescribed to help with sleep issues related to nightmares in people owith PTSD.

People with PTSD may experience hallucinations that cause significant distress. They may be prescribed antipsychotic medications. These medications may also help with mood, anxiety, and sleep.

There is ongoing research examining the use of psychedelics such as psylocibin and MDMA to treat PTSD. They are typically used along with psychotherapy under the care of a trained professionals in a controlled setting. Currently, there is no FDA-approval for psychedelics to treat PTSD.

Other Treatments

Other treatments including complementary and alternative therapies are also increasingly being used to help people with PTSD. These approaches provide treatment outside the conventional mental health clinic and may require less talking and disclosure than psychotherapy. Examples include acupuncture, yoga and animal-assisted therapy.

In addition to treatment, many people with PTSD find it very helpful to share their experiences and feelings with others who have similar experiences, such as in a peer support group.

Physician Review Donald Egan, M.D. March 2025