PTSD after trauma: symptoms, risk factors, care and recovery explained

It is normal to feel afraid during and after a frightening event. For most people these reactions fade with time. For some, symptoms continue and begin to disrupt life, and this may be post-traumatic stress disorder, or PTSD. This article uses information from the NHS, the US National Institute of Mental Health and the World Health Organization (WHO).

1. Introduction

The NHS describes PTSD as a mental health condition that develops after very stressful, frightening or distressing events ^[1]. The National Institute of Mental Health says anyone can develop it at any age, and notes that most people recover from trauma-related reactions over time ^[2]. WHO estimates that about 70% of people worldwide will experience a potentially traumatic event, but only about 5.6% go on to develop PTSD ^[3].

2. Causes and risk factors

The NHS lists events such as serious accidents, physical or sexual assault, childhood or domestic abuse, war, serious illness (for example, intensive care admission) and difficult births. Some jobs, including police, paramedics and healthcare work, carry extra exposure. The trauma may be lived through, witnessed or learned about when it happens to someone close ^[1].

The National Institute of Mental Health describes these risk factors ^[2]:

• earlier trauma, especially in childhood
• being injured or seeing others hurt
• intense fear, helplessness or horror during the event
• little social support afterwards
• ongoing stress such as bereavement or loss of a job or home
• a personal or family history of mental illness or substance use

It also lists protective factors: seeking and accepting support, having a coping strategy and feeling reasonably settled about one's actions during the event ^[2]. WHO adds that social support after a trauma can lower the risk ^[3].

3. Signs and symptoms

Symptoms can begin soon after the event or months or years later ^[1]. They fall into groups ^{[1, 2, 3]}:

• Re-experiencing: flashbacks, upsetting memories and nightmares, sometimes triggered by sounds or smells.
• Avoidance: staying away from people, places or talk linked to the event. WHO notes that avoidance can make re-experiencing worse over time ^[3].
• Feeling on edge: being easily startled, constant alertness, irritability and poor sleep.
• Mood and thinking changes: negative beliefs about oneself, self-blame, loss of interest, feeling detached or emotionally numb.
• Body symptoms: the NHS mentions unexplained headaches, stomach problems or pain ^[1].

Children may show different signs, such as re-enacting the event in play, nightmares, bedwetting or clinging to caregivers ^{[1, 2]}.

The NHS also describes complex PTSD, which has similar symptoms but usually follows repeated or prolonged trauma such as childhood abuse or ongoing domestic abuse ^[1].

4. Diagnosis

A mental health professional decides whether symptoms meet the criteria for PTSD. The National Institute of Mental Health says symptoms usually last more than a month and are severe enough to interfere with work or relationships, and that they cannot be explained by medicine, substance use or another illness ^[2]. WHO stresses that distress alone does not mean PTSD ^[3]. The NHS says a GP asks about symptoms and refers you to a specialist, such as a talking therapies service or a psychiatrist ^[1].

PTSD often occurs alongside depression, anxiety or substance use problems, so these are assessed too ^{[2, 3]}.

5. Treatment and management

A plan is made by your doctor and specialist to suit you ^[1]. The main options are:

• Trauma-focused talking therapy. WHO says the best-supported approaches are trauma-focused cognitive behavioural therapy and eye movement desensitisation and reprocessing (EMDR), a therapy that uses guided eye movements while recalling the memory. Many use exposure, where the person recalls or faces reminders in a safe setting. Some are available online or as self-help guides ^[3]. The National Institute of Mental Health says therapy often lasts 6 to 12 weeks, sometimes longer ^[2].
• Medicines. The NHS says antidepressants are usually used, may cause side effects and should not be stopped without medical advice. Some are unsafe in pregnancy, so tell your doctor if you are pregnant or planning to be ^[1]. The National Institute of Mental Health notes that other medicines may be used for sleep problems and nightmares ^[2].
• Treating danger and other conditions. If a person is still in a harmful situation, such as an abusive relationship, treatment works best when safety is addressed too ^[2].

The NHS says PTSD improves for most people, although some have more severe or longer-lasting symptoms ^[1]. WHO says that up to 40% of people with PTSD recover within a year ^[3].

6. Self-care and support

The sources suggest ^{[1, 2, 3]}:

• keep normal routines for meals, sleep and exercise
• talk to trusted people when you feel ready
• take regular exercise and try breathing or relaxation exercises
• keep a diary to spot triggers, such as certain smells or sounds
• avoid recreational drugs, smoking and too much alcohol

If you are helping a loved one, the National Institute of Mental Health suggests being patient, listening, learning about PTSD and encouraging them to seek treatment ^[2].

7. Access to care

WHO notes that only about 1 in 4 people with PTSD in low- and middle-income countries seek any treatment, because of limited services, stigma and low awareness that PTSD can be treated ^[3]. If you are unsure where to begin, a family doctor can refer you to a specialist.

8. When to see a doctor

See a doctor if you think you may have PTSD, if symptoms last more than a month or disrupt daily life, or if treatment is not helping ^{[1, 2]}. The NHS says that if there is a risk of self-harm, suicide or harm to others, hospital admission or crisis team support may be needed ^[1]. If you are in distress or having thoughts of suicide or self-harm, reach out for help right now. In India, call Tele-MANAS on 14416. In the United States, call or text 988. You do not have to cope alone.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

PTSD can follow many kinds of trauma, and anyone can be affected. Effective talking therapies exist, with medicines used for some people, and support from family and friends helps recovery. If symptoms persist, reach out to a doctor early.