Learn about the signs, risk factors, treatments, and social support services for post-traumatic stress disorder (PTSD).
Learn more about PTSD:
- Signs and Symptoms
- Risk Factors
- Evidence-based Treatments
- Complementary Therapies and Activities
- Recovery and Support Services and Activities
- Future Directions in Research and Treatment
- Finding Treatment
Post-traumatic stress disorder (PTSD) is a mental disorder that can occur when a person has seen or lived through trauma. Most people have a natural response to trauma, called the fight-or-flight response. The response can protect a person from harm by causing changes in the body to help defend against danger (fight) or avoid it (flight). In some cases, a person has a third type of response (freeze) and cannot do anything.
In PTSD, exposure to a traumatic event or situation usually includes:
- Directly experiencing the event
- Witnessing the event in person
- Learning that a close family member or close friend faced a violent or accidental event that caused or threatened death
- Having first-hand repeated or extreme exposure to graphic details of the event—but not just through pictures, television, movies, or other media
Not everyone exposed to trauma develops PTSD. Some events that a person would call “traumatic” or stressful are unlikely to lead to PTSD, such as divorce, losing a job, or being severely ill. PTSD symptoms usually begin soon after the event, most often within three months. Sometimes the symptoms start years later. It is natural to have some PTSD symptoms after a dangerous event. In acute stress disorder, serious symptoms go away after a few weeks. Acute stress disorder sometimes leads to PTSD.
PTSD symptoms that last more than one month and disrupt a person’s daily routine and life may benefit from treatment. Often, a person with PTSD also has depression, substance use disorders, or an anxiety disorder.
The four main types of PTSD symptoms are intrusive symptoms, avoidance symptoms, thought and mood symptoms, and arousal and reactivity symptoms. Learn more about each:
Examples of intrusive symptoms include:
- Frightening and distressing thoughts linked to memories of trauma
- Disturbing dreams or nightmares about trauma
- Flashbacks—or reliving trauma over and over—including a racing heart, sweating, or other physical symptoms
Words, objects, or situations that are reminders of trauma can trigger these symptoms.
Avoidance symptoms include:
- Avoiding distressing memories, thoughts, or feelings that are reminders of trauma
- Avoiding places, events, or objects that are reminders of trauma
- Having trouble remembering trauma
Things that remind a person of trauma can trigger these symptoms. The symptoms may lead to changes in a person’s daily routine.
Thought and Mood Symptoms
Examples of thought and mood symptoms include:
- Viewing oneself and the world in negative ways
- Having lasting and distorted feelings such as anger, guilt, shame, and fear
- Having lasting feelings of blame toward oneself and others
- Losing interest in enjoyable activities, and not having positive or happy feelings
- Feeling isolated from others
- Feeling emotionally numb and unable to feel any emotion
These symptoms can start or worsen after trauma, and can make the person feel alone or separated from friends or family.
Arousal and Reactivity Symptoms
Examples of arousal and reactivity symptoms include:
- Feeling angry and having frequent angry outbursts
- Being reckless or self-destructive
- Being overly cautious or focused on what is going on around you
- Being easily startled or feeling tense or “on edge”
- Having trouble concentrating
- Having trouble sleeping
These symptoms are usually constant and not triggered by reminders of trauma. The symptoms can make the person feel stressed and angry. They may make it hard to sleep, eat, concentrate, or do daily tasks.
Anyone can develop PTSD. This includes war veterans, children, and people who have faced physical or sexual assault, abuse, accidents, disasters, or other serious events.
PTSD occurs in about 8% of people. Women are more likely than men to have PTSD.
A person with PTSD is at greater risk for suicidal ideas and attempts. Trauma, including childhood abuse, increases the risk of suicide. Suicide is a major health concern and is preventable. People of all genders, ages, and ethnicities can be at risk for suicide. If you are having suicidal thoughts or are worried that someone you know might be suicidal, contact the Suicide Prevention Lifeline, 1-800-273-TALK (8255).
For statistics on PTSD by age group and other demographics, visit Any Anxiety Disorder Among Adults from the National Institute of Mental Health (NIMH) and Any Anxiety Disorder Among Children from NIMH. For statistics on PTSD among veterans, members of the military, and the general population, visit How Common is PTSD? from the National Center for PTSD at the Department of Veterans Affairs (VA).
Factors Before, During, and After Trauma
There is no way to predict who will develop PTSD. Some factors may increase the risk of PTSD, while protective factors may reduce the risk. Risk and protective factors are often divided into those before, during, or after trauma:
- Difficult or negative events in childhood
- Previous trauma in childhood and/or adulthood
- Having a mental disorder
- Family member(s) with PTSD or other mental disorders
Protective Factors include having a supportive and nurturing family, friendship, and a strong support system of friends and family.
- Trauma that is more severe
- Feeling that trauma is life threatening or likely to cause personal injury
- Trauma that includes violence from a parent or caregiver
- Seeing violence to a parent, caregiver, or sibling
- Seeing oneself negatively
- Not having skills to cope with one's feelings
- Having acute stress disorder
- Facing situations or reminders that are upsetting
- Other difficult life events such as financial or trauma-related losses
Protective Factors include having involved and supportive family and friends.
Military and Veteran Populations
People in the military often face trauma and life-threatening events. They are at risk for PTSD. Their risk for PTSD is linked to their role in military service, previous exposure to trauma, where the war was fought, and the type of enemy. For more information on PTSD and veterans, access the National Center for PTSD at the VA.
Effective treatments for PTSD include psychotherapy, medication, and combinations of both. Many people with PTSD have other mental and/or substance use disorders that need treatment.
The treatment plan should consider each person’s needs and choices. A person should consult a healthcare professional when choosing the right treatment and consider his or her own gender, race, ethnicity, language, and culture.
There are many forms of psychotherapy, sometimes called “talk therapy,” that are effective for PTSD. Psychotherapy involves working with a therapist one-to-one or in a group. Some therapies target PTSD symptoms directly. Other therapies focus on social, family, or job-related problems. Trauma-informed therapies can help create a safe and engaging environment to address PTSD symptoms.
Visit Psychotherapies from NIMH to learn about psychotherapies.
Cognitive behavioral threrapy uses a structured approach to identify events, situations, or objects that trigger symptoms, and to teach how to address the triggers. This is generally a short-term therapy, lasting a few months. Cognitive behavioral therapy typically covers one of more of the following:
- Education about trauma and its effects
- Relaxation and anger-control skills
- Education for better sleep, diet, and exercise habits
- Addressing feelings about the event such as guilt, shame, and blame
- Changing reactions to PTSD symptoms
Cognitive behavioral methods for treating PTSD include the following:
Exposure Therapy and Prolonged Exposure Therapy
The therapist helps the person face fears and learn to control symptoms caused by the fears. The person learns coping skills through education, mental imagery, writing, or revisiting places where trauma happened. Exposure therapy helps a person deal with feelings of shame, guilt, and anger. The person learns how to overcome or tolerate distressing emotions caused by reminders of trauma.
The person learns to recognize negative thinking and make sense of troubling memories. A person may remember an event differently than how it happened. They may feel guilt or shame about something that is not their fault. This approach helps a person view what happened in a realistic way.
Cognitive Processing Therapy
The person learns new ways to handle disturbing thoughts and understand trauma. The person learns how trauma changed the way they see themselves and the world, and how this affects their feelings and actions.
Eye Movement Desensitization and Reprocessing Therapy (EMDR)
This approach can reduce emotional distress caused by traumatic memories. It uses rapid and rhythmic eye movements to stimulate the brain, combined with guided recollection of trauma. This is thought to unlock negative emotions caused by a stressful event. The person can then better cope with memories of trauma.
Antidepressants can help control and manage PTSD symptoms, such as worry, anger, sadness, and feelings of being numb or out of control. Other medications can also be used to address additional symptoms. Professionals experienced in treating PTSD can develop a care plan that addresses a person’s needs.
For basic information about medications, visit the National Institute of Mental Health Mental Health Medications webpage. For up-to-date information on medications, side effects, and warnings, visit the Food and Drug Administration.
Other Treatment Options
Treatment of PTSD usually involves regular visits with professionals experienced in therapy and/or medication management in an office setting. Some people with PTSD who have severe symptoms may need more intensive treatment.
Complementary therapies and activities can help people improve their well-being, and are meant to be used along with evidence-based treatments. For more information on natural products or mind-body practices, access the National Center for Complementary and Integrative Health.
Acupuncture may help some people manage PTSD symptoms.
Family therapy may help families when stress and tension are likely to make a person’s PTSD symptoms worse. Also, it may help families cope with the symptoms. Family therapy can include couples counseling and cognitive behavioral conjoint therapy.
Mindfulness training and meditation may help manage triggers and symptoms of PTSD.
Yoga, recreational therapy, and aerobic exercise can help people with PTSD reduce stress and anxiety.
Psychoeducation includes resources and education to help people understand their condition, including treatments that can help. Psychoeducation helps empower a person to make treatment decisions. Also, staying connected with family and friends, getting enough sleep, and using relaxation techniques can help a person engage in treatment and manage PTSD symptoms.
Apps for health improvement and personal support are available for smartphones and tablets. The SAMHSA App Store and the federal National Center for Telehealth & Technology have free apps for download. For an up-to-date list of federal apps, visit the Federal Government Mobile App Directory.
Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. This includes:
- Overcoming or managing one’s condition(s) or symptoms
- Having a stable and safe place to live
- Conducting meaningful daily activities, such as a job, school, volunteerism, and family caretaking
- Having relationships and social networks that provide support, friendship, love, and hope
Recovery helps a person develop resilience, increasing the ability to cope with adversity and adapt to challenges or change. To learn more, visit the SAMHSA Recovery and Recovery Support topic.
Self-help and support groups can provide people with the knowledge and support to make treatment decisions that work for them. Organizations and websites provide self-help information and help people find local support groups. Peer and family support services can help foster hope and promote outreach and engagement for those with behavioral health conditions. This includes both peer-to-peer and family-to-family supports provided by a certified peer or family support specialist who can promote hope, foster recovery, and build resiliency skills.
Resources for people with PTSD and their families include:
- International Society for Traumatic Stress Studies
- Managing Stress information from Military OneSource
- Mental Health America
- National Alliance on Mental Illness (NAMI)
- National Center for PTSD at the VA
- National Center for Trauma-informed Care
- National Child Traumatic Stress Initiative and National Child Traumatic Stress Network
NIMH and the VA fund research on new treatments for people with PTSD. Scientists want to learn when and where PTSD symptoms start. They are exploring protective factors and ways to help prevent PTSD. Researchers also are exploring why some people recover from PTSD while others still struggle with symptoms. Researchers are studying risk and resilience factors, including genetics and brain function.
Studies are exploring how traumatic memories may affect learning, sleep, and other behavior. More personalized and efficient treatments are emerging, based on which people respond to different treatments and what predicts successful treatment.
Consult a healthcare professional who has training and experience working with PTSD. For general information on mental disorders and to locate treatment services in your area, contact SAMHSA’s National Helpline, 1-800-662-HELP (4357). SAMHSA’s Behavioral Health Treatment Locator and the NIMH Help for Mental Illnesses webpage have more information and resources.
If you are having suicidal thoughts or are worried that someone you know might be suicidal, contact the Suicide Prevention Lifeline, 1-800-273-TALK (8255).