Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events.
Symptoms of post-traumatic stress disorder (PTSD)
Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt.
They may also have problems sleeping, such as insomnia, and find concentrating difficult.
These symptoms are often severe and persistent enough to have a significant impact on the person's day-to-day life.
Causes of post-traumatic stress disorder (PTSD)
Any situation that a person finds traumatic can cause PTSD.
These can include:
PTSD can develop immediately after someone experiences a disturbing event, or it can occur weeks, months or even years later.
PTSD is estimated to affect about 1 in every 3 people who have a traumatic experience, but it's not clear exactly why some people develop the condition and others do not.
Complex post-traumatic stress disorder (PTSD)
People who repeatedly experience traumatic situations, such as severe neglect, abuse or violence, may be diagnosed with complex PTSD.
Complex PTSD can cause similar symptoms to PTSD and may not develop until years after the event.
It's often more severe if the trauma was experienced early in life, as this can affect a child's development.
When to seek medical advice
It's normal to experience upsetting and confusing thoughts after a traumatic event, but most people improve naturally over a few weeks.
You should see a GP if you or your child are still having problems about 4 weeks after the traumatic experience, or if the symptoms are particularly troublesome.
If necessary, your GP can refer you to mental health specialists for further assessment and treatment.
How post-traumatic stress disorder (PTSD) is treated
PTSD can be successfully treated, even when it develops many years after a traumatic event.
Any treatment depends on the severity of symptoms and how soon they occur after the traumatic event.
Any of the following treatment options may be recommended:
Each person's experience of PTSD is unique to them. You might have experienced a similar type of trauma to someone else, yet be affected in different ways.
These are some common signs and symptoms that you might recognise.
This can include:
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This can include:
The situations we find traumatic can vary from person to person. There are many different harmful or life-threatening events that might cause someone to develop PTSD. For example:
If you experience symptoms of PTSD while supporting someone close to you who has experienced trauma, this is sometimes known as ‘secondary trauma’ or ‘secondary traumatic stress’.
‘Secondary’ means that although the original (primary) trauma happened to someone else, the impact it’s having in your life is traumatic for you. It doesn’t mean it’s any less significant than any other kind of PTSD, or any easier to deal with.
Repeatedly witnessing or hearing about traumatic events in the course of your job is also sometimes called 'secondary trauma', although this experience is increasingly thought of by professionals as an original (primary) trauma.
Some factors may make you more vulnerable to developing PTSD, or may make the problems you experience more severe, including:
If you experienced trauma at an early age or you have experienced long-lasting or multiple traumas, you might be given a diagnosis of complex PTSD.
Anyone can experience traumatic events, but you may be particularly likely to have experienced trauma if you:
Complex post-traumatic stress disorder (complex PTSD, sometimes abbreviated to c-PTSD or CPTSD) is a condition where you experience some symptoms of PTSD along with some additional symptoms, such as:
Complex PTSD is a fairly new term. Professionals have recognised for a while that some types of trauma can have additional effects to PTSD, but have disagreed about whether this is a form of PTSD or an entirely separate condition, and what it should be called.
For example, you may find some doctors or therapists use one of the following terms:
Flashbacks can be very distressing, but there are things you can do that might help. You could:
Coping with PTSD can be exhausting. You might feel like you can't find the energy to take care of yourself, but looking after your physical health can make a difference to how you feel emotionally. For example, it can help to:
Lots of people who experience PTSD have problems sleeping. You might find it hard to fall or stay asleep, feel unsafe during the night, or feel anxious or afraid of having nightmares
Peer support brings together people who have had similar experiences, which some people find very helpful.
Everyone has their own unique response to trauma and it's important to take things at your own pace. For example, it may not be helpful to talk about your experiences before you feel ready. Try to be patient with yourself and don't judge yourself harshly for needing time and support to recover from PTSD.
Lots of people who experience PTSD find it hard to open up to others. This may be because you feel unable to talk about what has happened to you. However, you don't need to be able to describe the trauma to tell someone how you are currently feeling.
It could help to talk to a friend or family member, or a professional such as a GP or a trained listener at a helpline.
You might find that certain experiences, situations or people seem to trigger flashbacks or other symptoms. These might include specific reminders of past trauma, such as smells, sounds, words, places or particular types of books or films. Some people find things especially difficult on significant dates, such as the anniversary of a traumatic experience.
The main treatments for post-traumatic stress disorder (PTSD) are psychological therapies and medication.
Traumatic events can be very difficult to come to terms with, but confronting your feelings and seeking professional help is often the only way of effectively treating PTSD.
It's possible for PTSD to be successfully treated many years after the traumatic event or events occurred, which means it's never too late to seek help.
Before having treatment for PTSD, a detailed assessment of your symptoms will be carried out to ensure treatment is tailored to your individual needs.
Your GP will often carry out an initial assessment, but you'll be referred to a mental health specialist for further assessment and treatment if you have had symptoms of PTSD for more than 4 weeks or your symptoms are severe.
There are a number of mental health specialists you may see if you have PTSD, such as a psychologist, community psychiatric nurse or psychiatrist.
If you have mild symptoms of PTSD, or you have had symptoms for less than 4 weeks, an approach called watchful waiting may be recommended.
Watchful waiting involves carefully monitoring your symptoms to see whether they improve or get worse.
It's sometimes recommended because 2 in every 3 people who develop problems after a traumatic experience get better within a few weeks without treatment.
If watchful waiting is recommended, you should have a follow-up appointment within 1 month.
If you have PTSD that requires treatment, psychological therapies are usually recommended first.
A combination of a psychological therapy and medication may be recommended if you have severe or persistent PTSD.
Your GP can refer you to a clinic that specialises in treating PTSD if there's one in your area.
Or you can refer yourself directly to a psychological therapies service.
There are 3 main types of psychological therapies used to treat people with PTSD.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act.
Trauma-focused CBT uses a range of psychological techniques to help you come to terms with the traumatic event.
For example, your therapist may ask you to confront your traumatic memories by thinking about your experience in detail.
During this process, your therapist helps you cope with any distress you feel while identifying any unhelpful thoughts or misrepresentations you have about the experience.
Your therapist can help you gain control of your fear and distress by changing the negative way you think about your experience (for example, feeling you're to blame for what happened, or fear that it may happen again).
You may also be encouraged to gradually restart any activities you have avoided since your experience, such as driving a car if you had an accident.
You'll usually have 8 to 12 weekly sessions of trauma-focused CBT, although fewer may be needed. Sessions usually last for around 60 to 90 minutes.
Eye movement desensitisation and reprocessing (EMDR)
Eye movement desensitisation and reprocessing (EMDR) is a relatively new treatment that's been found to reduce the symptoms of PTSD.
It involves making side-to-side eye movements, usually by following the movement of your therapist's finger, while recalling the traumatic incident.
Other methods may include the therapist tapping their finger or playing a tone.
It's not clear exactly how EMDR works, but it may help you change the negative way you think about a traumatic experience.
Some people find it helpful to speak about their experiences with other people who also have PTSD.
Group therapy can help you find ways to manage your symptoms and understand the condition.
There are also a number of charities that provide counselling and support groups for PTSD.
Antidepressants, such as paroxetine, sertraline, mirtazapine, amitriptyline or phenelzine, are sometimes used to treat PTSD in adults.
Of these medications, only paroxetine and sertraline are licensed specifically for the treatment of PTSD.
But mirtazapine, amitriptyline and phenelzine have also been found to be effective and may be recommended as well.
These medications will only be used if:
Amitriptyline or phenelzine will usually only be used under the supervision of a mental health specialist.
Antidepressants can also be prescribed to reduce any associated symptoms of depression and anxiety, and help with sleeping problems.
But they're not usually prescribed for people younger than 18 unless recommended by a specialist.
If medication for PTSD is effective, it'll usually be continued for a minimum of 12 months before being gradually withdrawn over the course of 4 weeks or longer.
If a medication is not effective at reducing your symptoms, your dosage may be increased.
Before prescribing a medication, your doctor should inform you about possible side effects you may have while taking it, along with any possible withdrawal symptoms when the medication is withdrawn.
For example, common side effects of paroxetine include feeling sick, blurred vision, constipation and diarrhoea.
Possible withdrawal symptoms associated with paroxetine include sleep disturbances, intense dreams, anxiety and irritability.
Withdrawal symptoms are less likely if the medication is reduced slowly.
Children and young people
Trauma-focused CBT is usually recommended for children and young people with PTSD.
This normally involves a course of 6 to 12 sessions that have been adapted to suit the child's age, circumstances and level of development.
Where appropriate, treatment includes consulting with and involving the child's family.
Children who do not respond to trauma-focused CBT may be offered EMDR.
PTSD and driving
Post-traumatic stress disorder (PTSD) may affect your ability to drive safely, so you should inform the Driver and Vehicle Licensing Agency (DVLA) about your condition.