PTSD (post-traumatic stress disorder)

After a frightening or life-threatening experience, it's normal to feel shaken, have upsetting memories or struggle to sleep for a while. For many people, these reactions fade over the following weeks. With post-traumatic stress disorder, they persist for more than a month, or appear later, and significantly disrupt life.

PTSD can follow many kinds of trauma: combat, sexual assault, physical violence, serious accidents, natural disasters, sudden loss of a loved one, medical emergencies or witnessing harm to others. PTSD in veterans and first responders is well known, but anyone can develop it, including children.

At its core, PTSD reflects a nervous system that remains stuck in survival mode. The brain continues to treat the past event as if it were still happening, which explains why reminders can trigger such intense reactions.

Developing PTSD is not a sign of weakness. Whether someone develops it depends on the nature of the trauma, previous experiences, support afterward and many other factors. Some people experience a related condition, complex PTSD, after prolonged or repeated trauma.

PTSD symptoms are usually grouped into four clusters:

Intrusive memories
- Unwanted, distressing memories of the event
- PTSD flashbacks: feeling or acting as if the event is happening again
- Nightmares
- Strong emotional or physical reactions to reminders

Avoidance
- Avoiding thoughts, feelings or conversations about the event
- Avoiding places, people or activities that serve as reminders

Negative changes in thinking and mood
- Persistent fear, guilt, shame or anger
- Blaming yourself or others in distorted ways
- Feeling detached from people or emotionally numb
- Losing interest in activities
- Gaps in memory about the trauma

Changes in arousal and reactivity
- Being easily startled or constantly on alert
- Irritability or angry outbursts
- Trouble sleeping or concentrating
- Reckless or self-destructive behavior

Children may show PTSD differently, for example through play that repeats aspects of the trauma, clinginess or regression in development. Many people with PTSD also experience depression, anxiety or substance use problems.

PTSD triggers are reminders that bring back the trauma, often without warning. They can be obvious, such as a news story or a particular location, or subtle: a smell, a sound, a tone of voice, a time of year, a physical sensation or even an emotion. Because the brain links these cues with danger, the body may react before the mind recognizes why.

A flashback is more than a memory. During a PTSD flashback, a person may feel as though they are reliving the event, with images, sounds, emotions and physical sensations. Some people lose track of their surroundings for a moment.

Grounding techniques can help in the moment:

• Name things you can see, hear and touch around you
• Remind yourself of today's date and where you are
• Plant your feet on the floor and breathe slowly
• Hold something cold or textured

Avoiding triggers can bring short-term relief but tends to shrink life and keep PTSD going. Trauma-focused therapy helps reduce the power of triggers in a safe, gradual way.

Post-traumatic stress disorder begins with exposure to a traumatic event, either directly, by witnessing it, by learning that it happened to someone close, or through repeated exposure to distressing details as part of a job.

Not everyone exposed to trauma develops PTSD. Factors that can increase risk include:

• The severity, duration and personal nature of the trauma
• Experiencing interpersonal violence, such as assault or abuse
• Previous trauma, particularly in childhood
• Existing mental health conditions
• Lack of support after the event
• Additional stress afterward, such as job loss, injury or legal proceedings
• Intense fear, helplessness or dissociation during the event

Protective factors include strong social support, feeling able to talk about what happened, and access to care.

PTSD is related to, but different from, complex PTSD, which can follow prolonged or repeated trauma and includes difficulties with emotional regulation, self-image and relationships. It's also different from an acute stress reaction, which occurs in the first weeks after a trauma.

Effective PTSD treatment exists, and many people experience significant relief.

Trauma-focused psychotherapy is generally recommended as the first-line approach. Options with strong evidence include:

• Trauma-focused cognitive behavioral therapy (CBT), including cognitive processing therapy, which helps people understand and shift trauma-related beliefs such as self-blame
• Prolonged exposure therapy, which helps people gradually approach memories and situations they've been avoiding
• EMDR (eye movement desensitization and reprocessing), which uses bilateral stimulation while processing traumatic memories

These therapies are structured and typically last a set number of sessions. A good therapist will pace the work carefully and make sure you have coping skills first.

Medication may be recommended by a psychiatrist to help with symptoms such as anxiety, depression or sleep problems, either alone or alongside therapy.

Treatment can also address related issues, such as nightmares, substance use or relationship difficulties. Some people benefit from group programs, particularly veterans and first responders.

Look for a licensed mental health professional with specific training in trauma-focused therapy, such as a clinical psychologist or psychologist. A psychiatrist can assess whether medication would help. Veterans may have access to specialized services through veterans' health programs.

In a first appointment, you won't be expected to describe the trauma in detail. A trauma-informed clinician will ask about your symptoms, how they affect daily life, your safety and your support. You can share at your own pace and ask questions about the treatment approach.

Consider seeking help if symptoms last longer than a month, are getting worse, or are affecting work, relationships or sleep. Seek urgent help if you have thoughts of suicide or self-harm: call 911 or your local emergency number, or call or text 988 in the US (Samaritans on 116 123 in the UK and Ireland).

Meanwhile, try to keep routines, stay connected with people you trust, limit alcohol and drugs, and practice grounding when triggered.