Post-traumatic stress disorder (PTSD)

PTSD used to be called ‘shell shock’ when it was seen in veterans, but we now know it doesn’t just affect soldiers. Anyone who experiences or witnesses an extremely stressful event can develop PTSD.

PTSD isn’t a sign of weakness or a choice. It can be very distressing but there is treatment available, no matter how long ago you experienced trauma.

What are the symptoms of PTSD?

It’s normal to feel shocked and distressed after a traumatic event, but most people feel better after a few weeks. However, sometimes trauma can cause difficulties with your daily life, including looking after yourself, trusting people and holding down a job. It can make you more vulnerable to developing mental and physical health problems. And for some people, experiencing trauma can lead to PTSD.

PTSD causes three main groups of symptoms.

  • Reliving the event. This can include flashbacks, nightmares, intrusive thoughts and physical symptoms such as pain or nausea.
  • Avoiding people or places that remind you of the traumatic event. You might distract yourself with work or hobbies, and try not to talk about what happened. You may try to deal with the pain by becoming emotionally numb.
  • Feeling on edge. You might be easily startled and feel you’re constantly on alert for danger. This is called hypervigilance. You may feel anxious, irritable or angry and have difficulty concentrating or sleeping.

You might also have difficulties with daily life such as looking after yourself, maintaining friendships or holding down a job.

Different types of PTSD

When you’re diagnosed with PTSD, you might be told it is mild, moderate or severe. This describes how your symptoms are affecting you.

You might also be told you have a specific type of PTSD.

  • Complex PTSD can be caused by repeated trauma such as violence, neglect or abuse. As well as the symptoms of PTSD, you may also experience shame or guilt, have difficulty controlling your emotions, feel numb or spaced out (dissociation) or try to cope through self-harm or alcohol or drug misuse
  • Birth trauma can develop after a traumatic childbirth experience
  • Delayed-onset PTSD is where your symptoms began more than six months after experiencing trauma

What causes PTSD?

Being involved in any traumatic event – something that causes fear, helplessness or horror – can lead to PTSD. Some examples include:

  • being involved in a serious accident such as a car crash
  • getting diagnosed with a life-threatening illness
  • being physically or sexually assaulted, abused or bullied
  • having a job where you see or hear distressing things, such as a paramedic or soldier
  • being caught up in a terrorist incident
  • losing someone close to you in upsetting circumstances
  • surviving a natural disaster such as an earthquake or flood
  • being kidnapped or held hostage
  • being admitted to an intensive care unit
  • being sectioned

Who is at risk of developing PTSD?

Some factors make it more likely you will develop PTSD or experience more severe symptoms, including:

  • experiencing depression or anxiety in the past
  • having no support from friends or family
  • being physically hurt
  • experiencing trauma for a long time

Why does PTSD develop?

While it isn’t clear why PTSD develops, there are a number of possible reasons.

  • It could be an automatic survival mechanism intended to help you survive further trauma. Flashbacks force you to relive the event in detail so you’re prepared if it happens again; being on guard means you can react quickly if another crisis happens. While in theory this is intended to help you survive, in reality it stops you from processing your trauma and moving forward with your life
  • When you’re in danger, your body produces stress hormones to trigger a ‘fight or flight’ reaction to help you survive. People with PTSD can have unusually high levels of stress hormones even when they’re out of danger. This could be why you feel on edge or numb
  • Scans have shown changes to the part of the brain responsible for emotions and memory in people with PTSD. This can stop you processing flashbacks and nightmares properly, meaning you feel anxious

The NHS website has further explanations of why PTSD can develop.

Getting support

PTSD can be treated years after the traumatic event occurred, so it’s never too late to get help. Speak to your GP if you’re experiencing symptoms of PTSD. They may suggest the following treatments.

Active monitoring

If you’ve had symptoms for less than four weeks or they’re relatively mild, your GP may recommend carefully monitoring them to see if they get better or worse. This is because two out of three people who develop problems after a traumatic experience get better by themselves within a few weeks. You should be offered a follow-up appointment within a month.

Talking therapies

NICE – the organisation that produces guidelines for healthcare professionals – recommends two kinds of talking therapy for PTSD.

  • Trauma-focused cognitive behavioural therapy (TF-CBT). This is a type of CBT specifically designed for PTSD. It uses a range of techniques to help you process the traumatic event, including carefully talking through what happened and learning ways to ground yourself and manage any overwhelming feelings.
  • Eye movement desensitisation and reprocessing (EMDR). It involves recalling a traumatic memory while doing specific eye movements, guided by your therapist. It aims to help your brain process the memory properly so it’s no longer so intense. The eye movements mimic the way your eyes move rapidly during sleep as your brain processes the events of the day. You can read more about it on the EMDR Association website.

You may be offered these therapies for complex PTSD too, but with additional support to help you get the most out of your treatment. You may be offered more or longer sessions than usual to allow you to build trust with your therapist. You should be offered treatment for any other problems you have too, such as dissociation or drug or alcohol misuse. 

You can self-refer for talking therapy on the NHS if you live in England.

Medication

Antidepressants are sometimes used to treat PTSD. However, they will only be offered if you’re unable or unwilling to try talking therapy, or if you’re tried it and it hasn’t been helpful. You may also be offered medication if you also experience depression, anxiety or sleep problems.

The NHS website has more information about medication for PTSD.

Ways you can look after yourself

The symptoms of PTSD can feel overwhelming. While it’s important to get professional help, there are things you can try for yourself too.

  • Flashbacks can be very distressing. Grounding techniques can help bring you back to the present and feel more aware of your own body. For example, focus on breathing slowly and deeply, carry a small object to touch to comfort you, or describe what you’re doing right now in great detail (out loud if you can). Tell yourself you’re having a flashback and that you’re safe now. Get Self Help has more ways to cope with flashbacks.
  • Learn ways to relax such as meditating or listening to music.
  • Talk to someone you trust. You don’t have to talk about the trauma if you don’t want to, but you could share how you’re feeling right now. PTSD can make it hard to trust and open up to people, so take your time.
  • Understand what triggers your flashbacks or other symptoms. This could be places, people, sounds, phrases or smells, for example. Being prepared can help you use self-care tips to look after yourself.
  • Look after your physical health. For example, try to eat well, keep physically active and get help with any sleep problems. PTSD can be exhausting so it can be hard to take care of yourself, but feeling better physically will help you feel better emotionally.

PTSD UK has more tips on coping with hypervigilance (feeling like you’re always on alert).

Further resources and information

The Birth Trauma Association helps people who have been traumatised by childbirth.

Cruse Bereavement Care provides information and support to anyone who has been bereaved. They have information about traumatic bereavement.

Disaster Action supports people affected by major disasters.

PTSD Resolution provides counselling to veterans, reservists and their families.

PTSD UK provides support and information to anyone experiencing PTSD.

Rape Crisis supports women and girls who have been sexually abused or raped. They also signpost to help for men and boys.

Victim Support helps people affected by crime. They offer emotional and practical support, no matter how long ago the crime happened.

* Last updated: 15 February 2022