Shawn Faust, DNP, PMHNP-BC
Published on 6/22/2026
What Is Post-Traumatic Stress Disorder?
Post-Traumatic Stress Disorder (PTSD) is a type of trauma– and stressor-related disorder that can develop after exposure to a traumatic event — such as combat, sexual assault, a serious accident, natural disaster, childhood abuse, or any situation involving actual or threatened death, serious injury, or violence. While it is normal to feel distressed after a traumatic experience, PTSD occurs when the mind and body remain stuck in a state of danger long after the event has ended.¹
PTSD affects approximately 6–8% of people at some point in their lives, with rates significantly higher among certain groups — including military veterans, first responders, and survivors of sexual violence.¹˒² Women are approximately twice as likely as men to develop PTSD.¹ The condition can begin at any age, including childhood.¹ PTSD is not a sign of weakness — it is a medical condition that reflects how the brain processes overwhelming experiences. Effective, evidence-based treatments are available.³˒⁴
What PTSD Feels Like
Living with PTSD often feels like being trapped in a moment that has already passed. The traumatic event may replay in the mind without warning — as vivid flashbacks, intrusive images, or nightmares that feel as real as the original experience. A sound, a smell, a phrase, or a location can trigger an overwhelming flood of fear, as though the danger is happening right now.
Between these intrusions, there is often a pervasive sense of being on guard. The nervous system stays locked in a state of high alert — scanning for threats, startling easily, and struggling to relax even in safe environments. Sleep becomes a battleground: falling asleep is difficult because the mind will not quiet down, and nightmares may make sleep feel unsafe.
Many people with PTSD describe a painful emotional numbness — a disconnection from feelings, from loved ones, and from activities that once brought joy. There may be a sense of being fundamentally changed, of no longer fitting into the life that existed before the trauma. Guilt and shame are common — replaying what could have been done differently, or feeling responsible for what happened.
Avoidance becomes a survival strategy. People, places, conversations, and even thoughts associated with the trauma are carefully avoided. But avoidance, while providing temporary relief, keeps the trauma locked in place and prevents healing.
Signs and Symptoms of PTSD
PTSD involves four clusters of symptoms that develop after exposure to a traumatic event.
DSM-5 Diagnostic Criteria
To be diagnosed with PTSD, a person must have been exposed to actual or threatened death, serious injury, or sexual violence — either directly, by witnessing it, by learning it happened to a close family member or friend, or through repeated professional exposure to traumatic details. Symptoms from all four of the following clusters must be present for at least one month:¹
Intrusion symptoms (at least one required):
- Recurrent, involuntary, and distressing memories of the event
- Distressing dreams or nightmares related to the trauma
- Flashbacks — feeling or acting as if the event is happening again
- Intense psychological distress when exposed to reminders of the trauma
- Physical reactions (racing heart, sweating, nausea) to trauma reminders
Avoidance symptoms (at least one required):
- Avoiding thoughts, feelings, or memories associated with the trauma
- Avoiding people, places, activities, or situations that trigger reminders
Negative changes in thoughts and mood (at least two required):
- Inability to remember important aspects of the trauma
- Persistent negative beliefs about oneself, others, or the world (“I am broken,” “No one can be trusted,” “The world is completely dangerous”)
- Distorted blame of self or others for the trauma
- Persistent negative emotions — fear, horror, anger, guilt, or shame
- Markedly diminished interest in activities
- Feeling detached or estranged from others
- Inability to experience positive emotions (emotional numbness)
Changes in arousal and reactivity (at least two required):
- Irritability or angry outbursts
- Reckless or self-destructive behavior
- Hypervigilance (being constantly on guard)
- Exaggerated startle response
- Difficulty concentrating
- Sleep disturbance
Additional & Associated Features
Beyond the formal diagnostic criteria, many people with PTSD also experience:¹
- Dissociative symptoms — feeling detached from one’s own body or surroundings (depersonalization/derealization)
- Somatic complaints such as headaches, gastrointestinal distress, or chronic pain
- Intense shame or self-blame that goes beyond what the situation warrants
- Difficulty trusting others or maintaining close relationships
Care Built Around Understanding.
How PTSD Affects Daily Life
PTSD can profoundly disrupt every area of life. Work performance may suffer due to concentration difficulties, irritability, sleep deprivation, and the emotional toll of managing symptoms throughout the day. Some people are unable to work at all during severe episodes.
Relationships are often deeply affected. The emotional numbness, irritability, and withdrawal that characterize PTSD can create distance from partners, children, and friends. Loved ones may feel shut out or may not understand why certain situations trigger intense reactions. Intimacy — both emotional and physical — can become difficult, particularly for survivors of interpersonal trauma.
Daily routines may be organized around avoidance. Certain routes, stores, social gatherings, or even times of day may be avoided because they trigger distressing memories. Sleep disruption leads to chronic fatigue, which compounds every other symptom. Many people with PTSD turn to alcohol or other substances to manage their symptoms, which can create additional problems. PTSD carries a significant risk of suicide — initial and ongoing suicide risk assessment is an important part of care.³˒⁵
Common Causes and Risk Factors for PTSD
PTSD develops after exposure to a traumatic event, but not everyone who experiences trauma develops PTSD. The majority of trauma-exposed individuals do not develop the condition.⁵˒⁶ Several factors influence vulnerability.
Types of trauma: Interpersonal trauma — particularly sexual assault, childhood abuse, and combat — carries the highest risk of PTSD. Events that are prolonged, repeated, or involve betrayal by a trusted person are especially likely to lead to PTSD.¹˒⁵
Genetics: The risk of developing PTSD following trauma has been shown to be moderately heritable, with twin studies estimating heritability at approximately 30–40%.¹˒⁷ Genome-wide association studies have identified specific genetic loci associated with PTSD risk, with some variation by sex and ancestry.⁷
Brain biology: PTSD involves changes in brain regions responsible for fear processing (amygdala), memory (hippocampus), and emotional regulation (prefrontal cortex). The stress hormone system (HPA axis) also functions differently in people with PTSD.⁵
Temperament: Childhood emotional problems, prior mental health conditions (particularly depression and anxiety), high neuroticism, and trait impulsivity increase vulnerability.¹
Life experiences: Prior trauma exposure (especially during childhood), childhood adversity, lower socioeconomic status, lower education, and fewer social supports all increase risk. Conversely, strong social support is one of the most protective factors.¹˒⁵˒⁶
Peri-traumatic factors: The severity of the trauma, perceived life threat, physical injury, and dissociation during the event (feeling detached or unreal) are associated with higher PTSD risk.⁵˒⁶
Other factors: Female sex, military service, first-responder occupations, and lack of social support after the trauma increase the likelihood of developing PTSD.¹˒²
How PTSD Is Diagnosed
PTSD is diagnosed through a clinical interview with a mental health professional — not through lab work or imaging. Validated screening tools such as the PCL-5 (PTSD Checklist for DSM-5) are commonly used to identify symptoms and track progress over time.³
To meet diagnostic criteria, symptoms from all four clusters (intrusion, avoidance, negative cognitions/mood, and arousal/reactivity) must be present for at least one month and must cause significant distress or impairment.¹
The clinician will also assess for conditions that frequently co-occur with PTSD, including depression, substance use disorders, and anxiety disorders. Acute Stress Disorder involves similar symptoms but occurs within the first month after trauma — if symptoms persist beyond one month, the diagnosis may change to PTSD.¹
It is important to note that many people do not seek help for years after the trauma. There is no time limit on when PTSD can be diagnosed — symptoms that began months or even years after the event still warrant evaluation and treatment.
The evaluation is straightforward and conversational — the goal is to understand your experience so the right treatment can begin.
Treatment for PTSD
PTSD responds well to treatment, even in severe cases. The two main evidence-based approaches are psychotherapy and medication, and they can be used alone or in combination. Most people improve significantly with evidence-based treatment.³˒⁴
Lifestyle strategies: Regular exercise, maintaining consistent sleep routines, limiting alcohol and substance use, and building social support all complement formal treatment.
Psychotherapy: Trauma-focused psychotherapy is the first-line treatment for PTSD.³˒⁴˒⁸ Recommended approaches include:
- EMDR (Eye Movement Desensitization and Reprocessing) — processing traumatic memories while maintaining dual focus on an external stimulus
- Prolonged Exposure (PE) — systematically confronting trauma memories and avoided situations to reduce their power
- Cognitive Processing Therapy (CPT) — identifying and changing maladaptive beliefs related to the trauma
These therapies help the brain process traumatic memories so they no longer trigger the same intense emotional and physical reactions. Trauma-focused therapies have larger effect sizes than medication and more sustained long-term benefits.³˒⁴ A typical course is 8–16 sessions.⁴˒⁹
Medication: SSRIs and SNRIs are first-line medications for PTSD. Commonly used medications include:
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluoxetine (Prozac)
- Venlafaxine (Effexor)
Sertraline and paroxetine are the only FDA-approved medications for PTSD, though this reflects which agents underwent FDA trials rather than superiority over other SSRIs/SNRIs.⁴˒⁸ Medication is recommended when trauma-focused psychotherapy is unavailable, when patients prefer medication, or for residual symptoms after psychotherapy — up to half of patients have residual symptoms after therapy alone.³˒⁴ Medications typically take several weeks to reach full effect.
Combination treatment: Combining psychotherapy and medication may be appropriate when symptoms are severe or when either approach alone has been insufficient.
Treatment duration: Medication is generally continued for at least 6–12 months after symptom improvement, with gradual tapering to reduce relapse risk.⁵ For individuals with chronic or recurrent symptoms, longer-term maintenance treatment may be necessary. Psychotherapy benefits tend to be more durable than medication alone, with lower relapse rates after treatment ends.³˒⁴
When to Seek Professional Help for PTSD
Consider reaching out to a mental health professional if:
- Distressing memories, nightmares, or flashbacks of a traumatic event persist for more than a month
- Avoidance of trauma reminders is increasing and limiting daily life
- Relationships, work, or daily functioning are being significantly affected
- Sleep is being regularly disrupted by nightmares or hyperarousal
- There is reliance on alcohol or other substances to cope with trauma-related symptoms
- Emotional numbness or detachment from loved ones is worsening
Seek immediate help if experiencing thoughts of self-harm or suicide. Contact the 988 Suicide and Crisis Lifeline by calling or texting 988, available 24/7. Veterans can press 1 for the Veterans Crisis Line.
Conditions That Can Look Similar to PTSD
Acute Stress Disorder: Acute Stress Disorder involves similar symptoms to PTSD but occurs within the first month after trauma. If symptoms persist beyond one month, the diagnosis may change to PTSD.¹
Adjustment Disorder: Adjustment Disorder involves emotional or behavioral symptoms in response to a stressor, but the symptoms are less severe and do not meet the full criteria for PTSD. Symptoms typically resolve within six months of the stressor ending.¹
Major Depressive Disorder (MDD): MDD shares features with PTSD such as loss of interest, sleep disturbance, and difficulty concentrating. The distinguishing features of PTSD are the intrusion symptoms (flashbacks, nightmares) and avoidance of trauma reminders.¹
Frequently Asked Questions About PTSD
Does everyone who experiences trauma develop PTSD?
No. Most people who experience a traumatic event do not develop PTSD. The U.S. lifetime prevalence is approximately 6–8%, though rates are significantly higher among those exposed to certain types of trauma, such as sexual assault or combat.¹˒²
Can PTSD develop years after the trauma?
Yes. While PTSD symptoms often begin within three months of the trauma, delayed-onset PTSD — where full diagnostic criteria are not met until six months or more after the event — does occur. There is no time limit on seeking evaluation and treatment.¹
Is PTSD only a military condition?
No. While PTSD is common among veterans, it can affect anyone who has experienced or witnessed a traumatic event, including survivors of assault, accidents, natural disasters, childhood abuse, or medical trauma.¹˒²
Can children develop PTSD?
Yes. Children can develop PTSD, though their symptoms may look different from adults. Young children may express trauma through play, have frightening dreams without clear content, or regress in developmental milestones (e.g., bedwetting after being toilet trained).¹
Do I need to talk about the trauma in therapy?
Not necessarily. While the most effective therapies (PE, CPT, EMDR) involve engaging with the traumatic memory in a structured way, non-trauma-focused therapies such as present-centered therapy are also available and can be effective, particularly for those who are not ready for direct trauma processing.⁴
References
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Publishing; 2022.
- Flesaker M, Slimovitch R, Shiner B, Sumner JA, Gradus JL. State of the Science: The Epidemiology of Posttraumatic Stress Disorder. J Trauma Stress. 2026;39(3).
- Sartor Z, Kelley L, Laschober R. Posttraumatic Stress Disorder: Evaluation and Treatment. Am Fam Physician. 2023;107(3):273-281.
- Schnurr PP, Hamblen JL, Wolf J, et al. The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med. 2024;176(3):340-351.
- Shalev A, Liberzon I, Marmar C. Post-Traumatic Stress Disorder. N Engl J Med. 2017;376(25):2459-2469.
- Tortella-Feliu M, Fullana MA, Pérez-Vigil A, et al. Risk Factors for Posttraumatic Stress Disorder: An Umbrella Review of Systematic Reviews and Meta-Analyses. Neurosci Biobehav Rev. 2019;107:154-165.
- Nievergelt CM, Maihofer AX, Klengel T, et al. International Meta-Analysis of PTSD Genome-Wide Association Studies Identifies Sex- and Ancestry-Specific Genetic Risk Loci. Nat Commun. 2019;10(1):4558.
- Zoellner LA, Schulz PM, Campbell-Law L, et al. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults (2025). American Psychological Association. 2025.
- Steenkamp MM, Litz BT, Hoge CW, Marmar CR. Psychotherapy for Military-Related PTSD: A Review of Randomized Clinical Trials. JAMA. 2015;314(5):489-500.
6/22/2026