What Is PTSD, And Who Can Be Affected By It?

Post-traumatic stress disorder (PTSD) is a complex psychological condition that can develop after an individual experiences a traumatic event or series of events. While psychological trauma impacts many parts of the brain, PTSD can also impact a person’s immune system, nervous system, and endocrine system, causing a variety of physical symptoms. 

Treatment for PTSD, therefore, usually involves addressing the mental, emotional, and physical manifestations of a person’s psychological trauma. Here, we’ll provide a general overview of PTSD, discuss who is more likely to develop PTSD, and discuss how the condition is diagnosed and treated.

Defining PTSD

Before being studied and classified as a stress disorder, post-traumatic stress disorder was known as "shell shock" or "combat fatigue" and was thought to only affect war veterans. Over time, researchers and mental health practitioners have come to understand that children and adults of all genders and situations can develop PTSD following a range of traumatic experiences. 

The American Psychological Association defines PTSD as “a disorder that may result when an individual lives through or witnesses an event in which they believe that there is a threat to life or physical integrity and safety and experiences fear, terror, or helplessness.” Surviving sexual assault, war, domestic violence, or police brutality, or being a witness to or the victim of a serious accident or violent crime are just a few situations that can lead to developing post-traumatic stress disorder. 

It's important to note that not everyone who experiences a traumatic or life-threatening event will develop post-traumatic stress disorder (PTSD). After going through a traumatic experience, it's normal to have trouble sleeping, experience intrusive thoughts or flashbacks, and feel anxious, sad, or scared. In most cases, these feelings fade away with time. When these symptoms last no more than four weeks, they are classified as “acute stress disorder.” 

For people who develop post-traumatic stress disorder (PTSD), however, these and other symptoms can develop months to years after the traumatic event(s) ended and can linger for years, sometimes getting worse over time. In some cases, PTSD may be a lifelong condition, though symptoms are considered treatable or manageable in many cases. 

Understanding PTSD

PTSD begins in the brain. When you feel threatened or go through a scary experience, your brain’s amygdala and hypothalamus respond by cueing the sympathetic nervous system to release the stress hormones adrenaline and cortisol, which prepare you to either fight or flee the threat. In response, your heart rate quickens, your pupils dilate, your sense of hearing sharpens, and your digestive functions pause—all to better prepare you to escape or defend yourself. 

Less well-known are the brain’s other two responses to threat: freeze or fawn. Depending on the situation and the individual, the person may react by freezing in the face of danger or, if the threat is human, trying to appease them into changing their threatening behavior. It is important to note that not all threatening situations that lead to PTSD involve physical violence. Psychological abuse, which is often present in situations of intimate partner or domestic violence, can also lead to PTSD.

If the person was able to deflect or defuse the threat in some way and then re-establish their sense of safety (physical and/or psychological, such as receiving emotional comfort from someone who calms their distress), their brain will likely send signals to the rest of the body that it can return to its normal functions. 

However, many traumatic situations prevent a person from fighting, fleeing, or re-establishing a sense of safety. Sometimes a threat is continuous, such as in cases of domestic violence or war. In other situations, a person may not have the option to call for help or fight to defend themselves. A survivor may also lack a supportive family or community to seek comfort and safety from afterwards, leading them to remain silent about the trauma they experienced. 

PTSD symptoms

Symptoms of PTSD can develop within a few months of a traumatic event or can take as long as several years to manifest. While these can vary somewhat from person to person, there are some physical and mental health symptoms that commonly appear among many of those diagnosed, including:

• Intense memories that feel as though the event is recurring in real time (often called “flashbacks”)

• Nightmares and dreams related to the trauma

• Incessant rumination about the traumatic event

• Insomnia

• Hypervigilance; feeling constantly on guard

• Being easily startled 

• Chronic fatigue

• Difficulty remembering events that occurred during the trauma; fragmented memories 

• Feeling numb or distant; having dissociative experiences 

• Difficulty concentrating

• Avoiding places, situations, or topics that remind you of the trauma

• Distress when reminded of the trauma (such as when hearing a story related to the trauma) 

• Fear

• Feelings of hopelessness or helplessness 

• Addressing emotional symptoms with self-destructive behaviors (such as drinking excessively)

• Irritability and anger

• Experiencing feelings of guilt, shame, and/or self-blame

The symptoms of PTSD in children can be similar to the symptoms described above. In addition, children may feel cranky and have difficulty staying focused in school. They may lose interest in the games and activities that previously brought them joy. It is also normal for children to act out what happened to them or create drawings depicting the trauma they experienced.

Complex PTSD

When post-traumatic stress disorder is the result of systematic or chronic exposure to traumatic events and experiences over a long period of time as opposed to a single event, it may be referred to as complex post-traumatic stress disorder (C-PTSD). Some examples of people who might develop complex PTSD include: 

• Child, adolescent, and adult survivors of domestic abuse

• Survivors of human trafficking

• Prisoners of war

• Refugees 

• People who have lived in a place where war is occuring

People with complex PTSD may experience general PTSD symptoms as well as other clusters of symptoms related to:

• Emotional control: having a hard time communicating wishes or expressing emotions, experiencing depression, thoughts of self-harm and suicide

• Disassociation: amnesia, feeling a sense of detachment from the experience, as though it happened to someone else

• Self-concept: feeling shame, guilt, or self-hatred

• Behavioral control: explosive anger, aggression

• Insecure attachment: lack of trust in others, social withdrawal

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7.

Who can develop PTSD?

Anyone can experience trauma and anyone can develop post-traumatic stress disorder. The National Center for PTSD estimates that 6% of Americans will have PTSD at some point in their lives. Certain factors can put people at a higher risk for developing this condition, such as: 

• The length and type of trauma experienced by the person

• A previous history of traumatic events and experiences

• A lack of support during and after the traumatic experience

• Choice of career, as police, military, first responders, firefighters, and other people who face high-risk environments at work have a higher risk of developing post-traumatic stress disorder (PTSD). According to the National Center for PTSD, veterans who experienced combat or were deployed to war zones are also more likely to develop PTSD. 

• Individual personality and manner of handling the traumatic experience

• Growing up in hostile or dangerous circumstances as a child

• Gender, as those who identify as women are estimated to be twice as likely to develop PTSD as men per the National Center for PTSD—which may be because women are more likely to experience sexual assault, rape, and gender-based violence 

• Identifying as LGBTQ+, as queer people are potentially ten times more likely to experience PTSD than heterosexual, cisgender people, according to the National Center for PTSD, due to the prevalence of violent harassment and discrimination against them 

The process of receiving a PTSD diagnosis

If you believe you may be experiencing PTSD symptoms, it’s usually recommended that you bring it up with your doctor. They may do a physical evaluation to rule out other causes or medical conditions. Next, they may conduct a psychological evaluation, and a diagnosis can be made based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), if applicable. 

It is also possible to do a self-test by filling out a self-reported questionnaire like the PTSD Symptom Scale if you’re trying to decide whether it may be time to seek professional support. The questionnaire contains 17 items, and a score of 13 or higher means PTSD is likely. While a self-test on social media or online isn’t a substitute for a professional diagnosis or treatment, it may help you understand when it may be time to see a doctor or therapist for evaluation, health information, and treatment advice.

PTSD treatment

People with PTSD live with a potentially debilitating condition that can affect many aspects of life. There is no single cure for PTSD, but it can typically be managed and treated successfully through a variety of options. Psychotherapy is usually the first-line treatment, sometimes in combination with medication and complementary therapeutic practices. With treatment, symptoms may go away completely or diminish considerably.

Because PTSD affects both mental and physical health, many people seek holistic treatment for their PTSD symptoms. The following are common treatments for PTSD. 

Psychotherapy with a licensed professional 

• Cognitive behavioral therapy (CBT): Through talk therapy, a CBT provider will help their client recognize, understand, and change the patterns of thoughts and feelings—particularly negative thoughts and feelings like guilt or shame—that they have adopted as a result of their trauma. CBT may also include some form of exposure therapy in which the therapist will gradually help their client expose themselves in a safe way to their traumatic memories. 

• Narrative exposure therapy: In this type of therapy, a provider will help their client craft a chronological narrative of their life to help them place their trauma in context and understand traumatic memories. 

• Eye movement desensitization and reprocessing (EMDR): With this type of treatment, a therapist will guide their client through thinking or speaking of a traumatic memory while the client simultaneously focuses on an external stimulus, such as hand-tapping, a sound, or a moving visual cue. EMDR can help reduce physical arousal and emotional distress triggered by traumatic memories. 

Medication as prescribed by a health professional like a psychiatrist or doctor 

• Selective serotonin reuptake inhibitors (SSRIs): Sertraline and paroxetine are the only two SSRIs currently approved by the FDA for posttraumatic stress disorder. 

• Selective serotonin-norepinephrine reuptake inhibitor (SNRI): Venlafaxine is conditionally approved for PTSD. 

Be sure to consult with your doctor before starting, stopping, or changing any medication.

Complementary therapeutic practices

• Yoga and meditation: According to the National Institute of Health’s National Library of Medicine, both practices may help reduce stress and muscle tension, improve one’s connection with their body (which can help address symptoms of dissociation), and increase the ability to self-control emotions through conscious breathing. 

• Dance: In combination with psychotherapy, dance may help clients reduce their symptoms, in part due to strengthening the connection between their mind and body as well as allowing them to physically and artistically express their emotions. 

Finding meaning and community 

Health care in the form of group therapy and support groups can be beneficial, especially for young people or teens who are trying to make sense of what's happening to them. Support groups can help people of all ages realize they're not alone in dealing with PTSD.

Traumatic events often feel tragic, bewildering, and random and can change the course of a person’s life. Survivors of trauma may find a greater sense of agency or closure from finding ways to make meaning out of what they experienced. They may do this through creating artistic works, supporting fellow survivors, or becoming activists and advocates. 

Getting help for PTSD

If you experienced a traumatic event(s) and have been experiencing some of the symptoms mentioned above, you might take a look through the PTSD Checklist and then make an appointment with your doctor or mental health care professional as soon as you can.

One option for getting psychotherapy treatment for symptoms of a mental illness is online therapy, which research suggests can be effective in addressing a range of mental health conditions—including PTSD. For example, clinical trials from 2023 suggest that online cognitive behavioral therapy (CBT) can be as effective as in-person CBT for treating PTSD in many cases. 

PTSD symptoms can be distressing in and of themselves, and they can also hold people back from getting the help they need. Fear of having a flashback in public, for instance, can prevent some individuals with PTSD from leaving their homes. In these cases, online therapy can be a viable option because it is available from home or anywhere you have an internet connection. 

Online therapy may also have shorter wait times for starting therapy. BetterHelp can match you to a therapist who specializes in PTSD in as little as 48 hours of you completing a simple online therapy intake questionnaire.