A traumatic event is a shocking, scary, or dangerous experience that can affect someone emotionally and physically. Experiences like natural disasters (such as hurricanes, earthquakes, and floods), acts of violence (such as assault, abuse, terrorist attacks, and mass shootings), as well as car crashes and other accidents can all be traumatic. Researchers are investigating the factors that help people cope or that increase their risk for other physical or mental health problems following a traumatic event.
Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened, even when they are not in danger.
Responses to trauma can be immediate or delayed, brief or prolonged. Most people have intense responses immediately following, and often for several weeks or months after a traumatic event. These responses can include:
- Feeling anxious, sad, or angry
- Trouble concentrating and sleeping
- Continually thinking about what happened
- For most people, these are normal and expected responses and generally lessen with time.
In some cases, these responses continue for a longer period of time and interfere with everyday life. If they are interfering with daily life or are not getting better over time, it is important to seek professional help. Some signs that an individual may need help include:
- Worrying a lot or feeling very anxious, sad, or fearful
- Crying often
- Having trouble thinking clearly
- Having frightening thoughts or flashbacks, reliving the experience
- Feeling angry, resentful, or irritable
- Having nightmares or difficulty sleeping
- Avoiding places or people that bring back disturbing memories and responses.
- Becoming isolated from family and friends
Children and teens can have different reactions to trauma than those of adults. Symptoms sometimes seen in very young children (less than six years old) can include:
- Wetting the bed after having learned to use the toilet
- Forgetting how to or being unable to talk
- Acting out the scary event during playtime
- Being unusually clingy with a parent or other adults
Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.
Physical responses to trauma may also mean that an individual needs help. Physical symptoms may include:
- Stomach pain and digestive issues
- Feeling tired
- Racing heart and sweating
- Being very jumpy and easily startled
Individuals who have a mental health condition or who have had traumatic experiences in the past, who face ongoing stress, or who lack support from friends and family may be more likely to develop more severe symptoms and need additional help. Some people turn to alcohol or other drugs to cope with their symptoms. Although substance use may seem to relieve symptoms temporarily, it can also lead to new problems and get in the way of recovery.
While most but not all traumatized people experience short term symptoms, the majority do not develop ongoing (chronic) PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.
A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD.
To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:
- At least one re-experiencing symptom
- At least one avoidance symptom
- At least two arousal and reactivity symptoms
- At least two cognition and mood symptoms
Re-experiencing symptoms include:
- Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
- Bad dreams
- Frightening thoughts
Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.
Avoidance symptoms include:
- Staying away from places, events, or objects that are reminders of the traumatic experience
- Avoiding thoughts or feelings related to the traumatic event
Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.
Arousal and reactivity symptoms include:
- Being easily startled
- Feeling tense or “on edge”
- Having difficulty sleeping
- Having angry outbursts
Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.
Cognition and mood symptoms include:
- Trouble remembering key features of the traumatic event
- Negative thoughts about oneself or the world
- Distorted feelings like guilt or blame
- Loss of interest in enjoyable activities
Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members.
It is natural to have some of these symptoms for a few weeks after a dangerous event. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.