PTSD symptoms and treatment

PTSD (post-traumatic stress disorder) is a condition that can develop after you go through or witness something frightening, such as an assault, an accident, combat, a disaster or the sudden loss of someone close. It's normal to feel shaken after trauma. PTSD is when the reactions don't fade: for more than a month, you keep reliving the event, avoiding reminders, and feeling on guard. Effective treatments exist, and most people improve with them.

What are the symptoms of PTSD?

PTSD symptoms fall into four groups:

• Reliving the event: unwanted memories, nightmares, or flashbacks that feel like it's happening again. Reminders can trigger strong distress or physical reactions like a racing heart.
• Avoidance: staying away from people, places, conversations or thoughts that bring the event back.
• Changes in thoughts and mood: blaming yourself, feeling detached from others, losing interest in things, finding it hard to feel positive emotions, or believing the world is completely dangerous.
• Feeling on edge: being easily startled, always on guard, irritable, having trouble sleeping or concentrating, or acting in risky ways.

Symptoms usually start within three months of the trauma, but sometimes they appear years later.

Is it PTSD or a normal reaction to trauma?

Most people have some of these reactions in the days and weeks after something traumatic, and for many they ease with time and support. Clinicians consider PTSD when the symptoms last more than a month, cause real distress, and get in the way of work, relationships or daily life.

If you're not sure, the free PTSD self-check uses the PC-PTSD-5, a five-question screener from the US Department of Veterans Affairs. It never asks what happened to you.

How common is PTSD?

About 6 in every 100 people in the US will have PTSD at some point in their lives, and about 5 in 100 adults have it in a given year, according to the VA's National Center for PTSD. Women are more likely to develop it than men, partly because of the types of trauma they're more likely to experience, such as sexual assault.

Who gets PTSD?

Anyone can develop PTSD, at any age. It's not a sign of weakness. The chances are higher when the trauma was severe or lasted a long time, when it involved being hurt or seeing others hurt, when there's little support afterward, or when other stress piles on. Having had anxiety or depression before also raises the risk.

PTSD often comes with other problems, like depression, anxiety, and drinking or drug use to cope. See the alcohol use self-check if that's something you've noticed.

How is PTSD diagnosed?

A mental health clinician diagnoses PTSD through a conversation about what you're experiencing, how long it's lasted and how it affects you. You may be asked about the traumatic event in general terms, but you don't have to share details before you're ready. Questionnaires like the PC-PTSD-5 and PCL-5 help measure symptoms.

How is PTSD treated?

The treatments with the strongest evidence are trauma-focused therapies. Most last about 8 to 16 sessions.

Cognitive processing therapy (CPT), a form of cognitive behavioral therapy, helps you look at and change painful beliefs about the trauma, such as that it was your fault.

Prolonged exposure (PE) helps you gradually and safely approach memories and situations you've been avoiding, so they lose their power.

EMDR (eye movement desensitization and reprocessing) has you recall the trauma while paying attention to a back-and-forth movement or sound, which helps the memory become less distressing.

Medication. Some antidepressants, especially sertraline, paroxetine, fluoxetine and venlafaxine, can reduce PTSD symptoms. Medication can be used alone or alongside therapy. Prazosin is sometimes used for trauma-related nightmares.

Therapy can feel hard at first, because it involves facing what you've been avoiding. A good therapist goes at a pace you can handle.

Who should I see for PTSD?

Look for a therapist or psychologist trained in a trauma-focused therapy such as CPT, PE or EMDR, and ask about it when you call. If you'd like to try medication, or have other conditions like severe depression, a psychiatrist or psychiatric nurse practitioner can help. Veterans can get PTSD care through the VA.

Our guide on how to find a therapist who fits covers what to ask before you book.

Does insurance cover PTSD treatment?

Most health plans cover therapy and medication visits for PTSD, and federal parity rules mean most plans can't make mental health care harder to use than comparable medical care. Check whether the therapist is in-network and what your copay will be. See how much does therapy cost for typical prices.