Post-traumatic stress disorder

PTSD happens when people who have experienced or witnessed a traumatic event continue to experience symptoms for more than a month that make it difficult to live their lives normally. Traumatic events can include physical or sexual assault, war, natural disasters, car accidents, or any event experienced as deeply scary and upsetting. Although PTSD is often associated with military service members, PTSD may develop after any type of traumatic event.

People with PTSD may continue to experience the traumatic event through flashbacks, nightmares, or memories they cannot control. These thoughts can create serious emotional pain for the person and problems at home, work, or school or with relationships. Most often, the traumatic event happened to the person with PTSD, but sometimes PTSD can happen to a person who witnesses someone else experiencing a trauma. People who develop PTSD usually experience symptoms soon after the traumatic event, but sometimes symptoms don’t appear for months or years afterward.²

PTSD causes the following symptoms:^2,3

• You relive the event, sometimes through nightmares or flashbacks. You may feel physical effects, such as a racing heart or sweating.
• You avoid situations that remind you of the event. For example, if you were in a car crash, you might avoid being in a car or at the location of the crash.
• You have negative thoughts and feelings that make it hard to live your life. You may have trouble remembering; feel anger, guilt, or shame; or have more negative thoughts about yourself. You might feel empty or numb. It might be hard to show interest or happiness in activities you used to enjoy.
• You feel jittery, nervous, or tense. This may make it hard to sleep or concentrate on everyday activities like work, school, or reading.

If you’ve experienced some or all of these symptoms for at least 1 month and they are making it hard to live your life normally, talk to a doctor, nurse, or mental health professional.

Women may experience PTSD differently from men. Women with PTSD may be more likely than men with PTSD to:⁴

• Be easily startled
• Have more trouble feeling emotions or feel numb
• Avoid things that remind them of the trauma
• Feel depressed and anxious

Women usually have PTSD symptoms longer than men (on average, 4 years versus 1 year) before diagnosis and treatment.⁵ Women with PTSD are less likely than men to have problems with alcohol or drugs after the trauma. Both women and men who have PTSD may also develop physical health problems.⁴

Any dangerous or life-threatening event, trauma, or intensely scary situation can increase the risk of PTSD. These situations include:

• Violent crimes: being a victim of or seeing violent crimes, such as a mugging, shooting, physical abuse, or rape
• Loved ones in danger: hearing of someone you are very close to, such as a child or spouse, experiencing a trauma
• Sudden death or illness: the accidental or violent death or serious illness of a loved one
• War: being exposed to war or combat, either through military service or as a civilian
• Accidents: car accidents, plane or train crashes, or other types of serious accidents
• Natural disasters: hurricanes, tornadoes, earthquakes, floods, or fires

Many other types of trauma can increase the risk for PTSD, but being in an accident or being physically or sexually assaulted are the most common events that lead to PTSD. Women with PTSD are more likely than men with PTSD to have been physically or sexually attacked.⁶

Not everyone who lives through a dangerous event develops PTSD. But anyone can develop PTSD at any age.

PTSD starts at different times for different people. Symptoms of PTSD may start immediately after a traumatic event and then continue. But people may develop new or more severe PTSD symptoms months or even years later.

Anyone who has been through an experience that was intensely scary, dangerous, or life threatening is at risk of PTSD. Experiencing this type of trauma is common: At least 4 in 5 people experience some type of trauma in their lifetimes.¹ The majority of people who experience a trauma do not develop PTSD. The more serious the trauma was or the more directly it affected you, the higher your risk of developing PTSD afterward.⁷

Military veterans as a group are at very high risk of PTSD. About 14% of veterans of the more recent conflicts in Iraq and Afghanistan developed PTSD after returning home.⁸

Women are about twice as likely as men to develop PTSD.⁹ Women who have gone through trauma, including women in the military, are more likely than men who’ve experienced trauma to develop PTSD. Among women who are raped, about half develop PTSD.⁶

Learn more about how trauma affects women.

Yes, although most women who go through trauma won’t get PTSD. But you may be more likely to develop PTSD if you:

• Were directly exposed to the trauma as a victim or a witness. As many as half of women who are raped develop PTSD.¹⁰
• Were seriously hurt during the traumatic event
• Went through a trauma that lasted a long time or was very severe
• Have another mental health condition like depression or anxiety
• Drink a lot of alcohol
• Don’t have a good support network
• Experienced trauma during childhood

About 1 woman in 10 will develop PTSD at some point in her lifetime.¹¹ Women are about twice as likely as men to develop PTSD.¹²

A mental health professional can diagnose PTSD. To be diagnosed with PTSD, an adult must have symptoms for at least 1 month, and the symptoms must be severe enough to affect that person’s ability to function at work and at home.^2,3

Having some symptoms of PTSD does not always mean you have PTSD. You could have another mental health condition, or you could be having a natural response in the weeks following the traumatic event. If you think you might have PTSD, the following questions can help you find out whether you should see a mental health professional for PTSD. If you answer “yes” to any three of these questions, talk to your doctor or nurse.¹³

In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you:

• Have had nightmares about it or couldn’t stop yourself from thinking about it, even when you did not want to?
• Went out of your way to avoid situations or people that reminded you of it?
• Were constantly on guard, anxious, or easily startled?
• Felt numb or detached from others, activities, or your surroundings?

A doctor, nurse, or mental health professional who has experience in treating people with PTSD can help you. Treatment may include therapy or counseling, medicine, or both.

• Cognitive processing therapy (CPT) is a type of talk therapy that was developed specifically to treat PTSD. CPT helps you pay attention to and change your upsetting thoughts.
• Prolonged exposure therapy is another type of talk therapy. A therapist will help you talk about and slowly remember the traumatic event repeatedly over time. Over time, the therapist will guide you through the difficult feelings and memories. By confronting the trauma, you may become less sensitive to the memories and related situations.¹⁴
• Eye movement desensitization and reprocessing (EMDR) therapy is another type of therapy used to treat PTSD. During EMDR, you will be asked to remember and talk about the trauma while also focusing on a specific visual item, like the therapist’s hand, or listening to a specific sound, like beeps.
• Medicines to treat PTSD symptoms may include antidepressants and anti-anxiety medicine.

Treatments can last weeks, months, or longer. Treatment is not the same for everyone. What works for you might not work for someone else with PTSD. Drinking alcohol or using other drugs will not help PTSD go away and may even make it worse.

Many people with PTSD have other mental health conditions, such as depression, anxiety, or even suicidal thoughts or behaviors. Getting treatment for PTSD and any other mental health conditions will help you get better. Treatment for PTSD works best when you and your doctor know about the effects of other mental health conditions and take steps to treat them at the same time.

For more information about PTSD, call the OWH Helpline at 1-800-994-9662 or check out the following resources from these organizations:

• Accommodation and Compliance Series: Employees with Post Traumatic Stress Disorder — Publication from the Job Accommodation Network.
• Anxiety Disorders — Publication from the National Institute of Mental Health.
• PTSD: National Center for PTSD — Information for the general public from the Department of Veterans Affairs (VA).
• Post-Traumatic Stress Disorder — Information from the National Institute of Mental Health.
• Post-Traumatic Stress Disorder — Fact sheet from Mental Health America.
• Posttraumatic Stress Disorder (PTSD)  — Information from the Anxiety and Depression Association of America.
• PTSD in Children and Teens — Information from the VA.

1. Kilpatrick, D.G., Resnick, H.S., Milanak, M.E., Miller, M.W., Keyes, K.M., Friedman, M.J. (2013). National Estimates of Exposure to Traumatic Events and PTSD Prevalence Using DSM-IV and DSM-5 Criteria. Journal of Traumatic Stress; 26(5): 537–547.
2. National Institute of Mental Health. (2016). Post-Traumatic Stress Disorder.
3. U.S. Department of Veterans Affairs. (2017). PTSD and DSM-5.
4. Hourani, L., Williams, J., Bray, R., Kandel, D. (2015). Gender differences in the expression of PTSD symptoms among active duty military personnel. Journal of Anxiety Disorders; 29: 101–108.
5. Breslau, N.N. (2001). Outcomes of posttraumatic stress disorder. Journal of Clinical Psychiatry; 62(17): 55–59.
6. Brown, K. (n.d.). Halting the Legacy of PTSD. Harvard Public Health.
7. Breslau, N.N., Peterson, E.L., Poisson, L.M., Schultz, L.R., Lucia, V.C. (2004). Estimating post-traumatic stress disorder in the community: lifetime perspective and the impact of typical traumatic events. Psychological Medicine; 34(5): 889–898.
8. RAND Corporation. (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery.
9. Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M., Nelson, C.B. (1995). Posttraumatic Stress Disorder in the National Comorbidity Survey. Archives of General Psychiatry; 52(12): 1048–1060.
10. Paul, L.A., Walsh, K., McCauley, J.L., Ruggiero, K.J., Resnick, H.S., Kilpatrick, D.G. (2013). College Women’s Experiences With Rape Disclosure: A National Study. Violence Against Women; 19(4): 486–502.
11. National Comorbidity Survey. (2005). NCS and NCSR Data.
12. McLean, C.P., Asnaani, A., Litz, B.T., Hofmann, S.G. (2011). Gender Differences in Anxiety Disorders: Prevalence, Course of Illness, Comorbidity and Burden of Illness. Journal of Psychiatric Research; 45(8): 1027–1035.
13. U.S. Department of Veterans Affairs. (2017). What Can I Do If I Think I Have PTSD?
14. U.S. Department of Veterans Affairs. (2017). Treatment of PTSD.