Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after a stressful, frightening or distressing event. The memory does not settle into the past, returning as images or nightmares that feel as though the event is happening now.
Key points
- PTSD can follow a frightening or distressing event, though most people who experience trauma do not develop it. NICE puts the figure at 25% to 30% of those exposed.
- The four symptom clusters are re-experiencing, avoidance, hyperarousal, and negative changes in mood and thinking, often with dissociation.
- ICD-11, the system the NHS uses, lists complex PTSD separately, and DSM-5 does not.
- NICE recommends trauma-focused CBT and EMDR, and advises against debriefing after a traumatic event.
Symptoms
- Re-experiencing: flashbacks where part of the event feels as though it is happening now, and nightmares.
- Avoidance: staying away from people, places or conversations linked to what happened.
- Hyperarousal: feeling constantly alert for danger, irritability, anger, startling easily, poor sleep.
- Negative changes in mood and thinking: feeling diminished or worthless, guilt out of proportion to events, low mood, dissociation.
Causes and risk factors
- Exposure to a traumatic event, though exposure alone does not explain who develops PTSD.
- Serious accidents, assault, abuse, violence, war, disasters, serious illness or a difficult birth.
- Trauma that was prolonged or repeated, injury during the event, little support afterwards, an existing mental health condition.
Treatment
- Within the first month: active monitoring for milder symptoms, and NICE advises against psychologically focused debriefing.
- More than a month after: individual trauma-focused CBT, typically 8 to 12 sessions.
- EMDR (eye movement desensitisation and reprocessing) is recommended more than three months after a non-combat trauma.
- Venlafaxine or an SSRI can be considered where someone prefers medication.
When to speak to a professional
- Symptoms have lasted more than about a month, or are getting in the way of work, study, sleep or relationships.
- You are using alcohol or drugs to cope, or flashbacks and dissociation are frequent enough to be unsafe.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.