After a dangerous or scary event, it is normal to feel upset, afraid, and anxious. For most people, these feelings fade within a few weeks. But some people continue to have these feelings for months or years afterward. They may keep reliving the event and avoid items and places that might remind them of what happened. This is called post-traumatic stress disorder (PTSD). Women are about twice as likely as men to develop PTSD in their lifetimes.

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.

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

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. 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.

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.

Women are about twice as likely as men to develop PTSD. 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.

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.
• 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

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.

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

PTSD causes the following symptoms:

• 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:

• 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. 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.

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.

When you experience a traumatic event, it's common to have an emotional reaction. Such stress reactions are normal and not weakness. Most people recover in time. Learn about stress reactions and problems that occur after trauma.

What Are Common Reactions to Trauma?

All kinds of trauma create stress reactions. People often say that their first feeling is relief to be alive after a traumatic event. This may be followed by stress, fear and anger. Trauma may also lead people to find they are unable to stop thinking about what happened. Traumatic events can create a high level of arousal—or feeling alert or "on guard"—as well, which causes people to react strongly to sounds and sights around them.

If you understand what is happening when you or someone you know reacts to a traumatic event, you may be less fearful and better able to cope. Reactions are common for anyone, even Service members and Veterans, or disaster rescue and relief workers, who have been trained to respond to crises.

Here are some common reactions to trauma:

• Losing hope for the future
• Feeling distant (detached) or losing a sense of concern about others
• Being unable to concentrate or make decisions
• Feeling jumpy and getting startled easily at sudden noises
• Feeling on guard and alert all the time
• Having dreams and memories that upset you
• Having problems at work or school
• Avoiding people, places and things related to the event

You may also experience more physical reactions such as:

• Stomach upset and trouble eating
• Trouble sleeping and feeling very tired
• Pounding heart, rapid breathing, feeling shaky
• Sweating
• Severe headache if thinking of the event
• Not keeping up with exercise, diet, safe sex or—regular health care
• Smoking more, using alcohol or drugs more, or eating too much
• Having your ongoing medical problems get worse

You may have more emotional troubles such as:

• Feeling nervous, helpless, fearful, sad
• Feeling shocked, numb, or not able to feel love or joy
• Being irritable or having angry outbursts
• Getting easily upset or agitated
• Blaming yourself or having negative views of oneself or the world
• Being unable to trust others, getting into fights, or being trying to control everything
• Being withdrawn, feeling rejected, or abandoned
• Feeling detached, not wanting intimacy

Recovery From Stress Reactions

Turn to your family and friends when you are ready to talk. They are your personal support system. Recovery is an ongoing gradual process. Don't look to be "cured" all of a sudden or assume that you will forget what happened. Most people will recover from trauma naturally. If your stress reactions are getting in the way of your relationships, work or other important activities, you may want to talk to a counselor or your doctor. Good treatments are available.

Common Problems That Can Occur After a Trauma

Posttraumatic Stress Disorder (PTSD). PTSD is a condition that can develop after you have gone through a life-threatening event. If you have PTSD, you may have trouble keeping yourself from thinking over and over about what happened to you. You may try to avoid people and places that remind you of the trauma. You may feel numb. Lastly, if you have PTSD, you might find that you have trouble relaxing. You may startle easily, and you may feel on guard most of the time.

Depression. Depression involves feeling down or sad more days than not. If you are depressed, you may lose interest in activities that you used to enjoy or find fun. You may feel low in energy and be overly tired. You may feel hopeless or in despair, and you may think that things will never get better. Depression is more likely when you have had losses such as the death of close friends. If you are depressed, at times you might think about hurting yourself. For this reason, getting help for depression is very important.

Self-blame, guilt and shame. Sometimes in trying to make sense of a traumatic event, you may blame yourself. You may think you are to blame for bad things that happened, or for surviving when others didn't. You may feel guilty for what you did or did not do. Remember, we all tend to be our own worst critics.

Suicidal thoughts. Trauma and loss can lead someone who is depressed to think about self-harm. If you have thoughts of suicide, talk to someone. If you think someone you know may be thinking about suicide, ask them. You will NOT put the idea in their head. If you or someone you care about is thinking about suicide:

• Call the Suicide and Crisis Lifeline at 988 or visit 988lifeline.org.
• If you are a Veteran, or you are concerned about one, call 988 and press 1 to speak with a responder trained to help Veterans. Visit the Veterans Crisis Line.
• You can also call a counselor or doctor; or dial 911 for emergency response services (like police or an ambulance).

Anger or aggressive behavior. Trauma is related to anger in many ways. After a trauma, you might think that what happened to you was unfair or unjust. You might not understand why the event happened and why it happened to you. These thoughts can result in intense anger. Anger is a natural and healthy emotion, but strong feelings of anger and aggressive behavior can cause problems with family, friends or co-workers. If you become violent when angry, it makes the situation worse. Violence can lead to injury, and there may be legal outcomes.

Alcohol or drug abuse. Drinking or "self-medicating" with drugs is a common, and unhealthy, way of coping with upsetting events. You may drink too much or use drugs to numb yourself and to try to deal with difficult thoughts, feelings and memories related to the trauma. While using alcohol or drugs may offer a quick solution, it can lead to more problems. If someone close to you begins to lose control of drinking or drug use, try to get them to see a health care provider about managing their drinking or drug use.

Summing It All Up

Right after a trauma, almost every survivor will find it hard to stop thinking about what happened. Stress reactions—such as fear, anxiety, jumpiness, upsetting memories, and efforts to avoid reminders—will gradually decrease over time for most people.

Use your personal support systems, family and friends, when you are ready to talk. Or, be a support for someone you care about who has been through a trauma. Recovery is an ongoing gradual process that takes time. Don't look for a quick "cure" or assume that you will forget what happened. Most people will recover from trauma on their own. If your emotional reactions are getting in the way of your relationships, work or other important activities, you may want to talk to a counselor or your doctor. Good treatments are available.

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.

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.

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?

The only way to know for sure if you have PTSD is to talk with a mental health care provider. The provider will ask you about your trauma, your symptoms and any other problems you have.

Talk With Someone You Trust

After a traumatic event, it's normal to think, act, and feel differently than usual. Most people will start to feel better after a few weeks. If your symptoms last longer than a few months, are very upsetting, and disrupt your daily life, you should get help. Whether or not you have PTSD, treatment can help if thoughts and feelings from the trauma are bothering you. Take a first step by talking with:

• Your family doctor.
• A mental health professional, such as a therapist or counselor.
• Someone who works at your local VA facility or Vet Center, if you are a Veteran
• A close friend or family member who can support you while finding help
• A clergy member

Another option is for you to fill out a PTSD questionnaire or screen (see below). You can use this to help you talk about what you are feeling with someone you trust.

Take a Self-Screen for PTSD

A screen is a brief (short) set of questions to help you know if it is likely you might have PTSD. Below is the Primary Care PTSD Checklist for DSM-5, or the PC-PTSD-5 screen.

Primary Care PTSD Checklist for DSM-5

Sometimes things happen to people that are unusually or especially frightening, horrible, or traumatic. For example:

• a serious accident or fire
• a physical or sexual assault or abuse
• an earthquake or flood
• a war
• seeing someone be killed or seriously injured
• having a loved one die through homicide or suicide

Have you ever experienced this kind of event? YES / NO
If no, screen total = 0. Please stop here.

If yes, please answer the questions below:
In the past month, have you ...

• Had nightmares about the event(s) or thought about the event(s) when you did not want to? YES / NO
• Tried hard not to think about the event(s) or went out of your way to avoid situations that reminded you of the event(s)? YES / NO
• Been constantly on guard, watchful, or easily startled? YES / NO
• Felt numb or detached from people, activities, or your surroundings? YES / NO
• Felt guilty or unable to stop blaming yourself or others for the event(s) or any problems the event(s) may have caused? YES / NO

If you answer "yes" to any 3 items (items 1 to 5 above), you should talk to a mental health care provider to learn more about PTSD and PTSD treatment.

Answering "yes" to 3 or more questions on the PC-PTSD-5 does not mean you have PTSD. Only a mental health care provider can tell you for sure. And, if you do not answer "yes" to 3 or more questions, you may still want to talk to a mental health care provider. If you have symptoms that last following a trauma, treatment can help—whether or not you have PTSD.

Get Help

It's common to think that your PTSD symptoms will just go away over time. But this is unlikely, especially if you've had symptoms for longer than a year. Here are some of the reasons why getting help is important.

Early treatment is better

Symptoms of PTSD may get worse. Dealing with them now might help stop symptoms from getting worse in the future and lead to a better quality of life for you.

It's never too late to get PTSD treatment

Treatment can help even if your trauma happened years ago. And treatment for PTSD has gotten much better over the years. If you tried treatment before and you're still having symptoms, it's a good idea to try again or try a different treatment.

PTSD symptoms can affect those you love

PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your relationships.

PTSD can be related to other health problems

PTSD symptoms can affect physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD, you could also improve your physical health.

It may not be PTSD

Having some symptoms of PTSD does not always mean you have PTSD. Some of the symptoms of PTSD are also symptoms of other mental health problems. For example, trouble concentrating or feeling less interested in things you used to enjoy can be symptoms of both depression and PTSD. And, different problems have different treatments.

When you get help, your mental health care provider can determine whether you need treatment for PTSD, or another type of treatment.

Find the Best Treatment for You

Today, there are several treatment options for PTSD. For some people, these treatments can get rid of symptoms altogether. Others find they have fewer symptoms or feel that their symptoms are less intense.

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.
• 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.

We hear about traumatic or life-threatening events on the news all the time. They can include large events such as natural disasters and wars, or events like accidents, sexual abuse, violence, or sudden loss.

These events affect millions of Americans, of all ages, in many different ways, both physically and emotionally. While nearly everyone will experience some symptoms after a traumatic event, fortunately most people recover from them and do not develop long-lasting disorders.

Post-traumatic stress disorder (PTSD) is one of the more common conditions that can develop for some survivors. Traumatic events that can lead to PTSD include those that are emotionally painful, shocking, stressful, and sometimes life-threatening.

This can include witnessing or being a survivor of distressing events, or friends or loved ones of survivors. People react to these events in many different ways.

After a traumatic event

Many trauma survivors, whether they are children, war veterans, or rescue workers, recover from traumatic events on their own with the help of family members, friends, and safe environments.

Others may experience psychological and physical reactions weeks, months, and even years later.

Reactions to trauma include depression, anxiety, flashbacks, disturbing and recurring dreams, irritability, anger, emotional numbing, guilt or shame about the event, and even thoughts of suicide.

Other reactions and symptoms can include headaches, stomach pain, sleeping or eating problems, drug or alcohol abuse, and being easily startled.

It's important to know that reactions and symptoms are not a matter of will or weakness. Trauma can cause changes to how our brains function. These changes can lead to problems with thinking clearly, memory, and behavior.

Seeking help after trauma

People who experience post-trauma symptoms may feel guilty for surviving a devastating event and hopeless for the future. It's normal and not uncommon to feel these reactions after a traumatic event.

But if feelings last longer than a month after the event or become life-threatening, experts recommend getting help.

Current treatment for PTSD can include talking with a health care provider, including a mental health therapist.

Treatment plans may also include medications, such as antidepressants. Antidepressants help treat depression and anxiety and are helpful to many people. Medications may also make going through talk therapy easier and more effective.

Treating the individual

Because reactions to trauma are so different from one person to another, researchers are working to find the underlying causes of these post-trauma differences to develop better and more individualized treatments for trauma survivors.

"While we have interventions, treatments, and help for people, we're not completely satisfied," says Farris Tuma, Sc.D., chief of the National Institute of Mental Health's (NIMH) Traumatic Stress Research Program.

"We are trying to understand individual needs and help each person individually instead of applying general therapies and medications to everyone who is struggling with PTSD."

Dr. Tuma says that researchers from the University of North Carolina and Harvard University are studying 5,000 emergency room trauma patients.

They are collecting many types of data, including patients' symptoms, experiences, biology, and genetic information. The study, known as the AURORA study, was funded by NIMH.

The information collected will help researchers better understand what causes post-trauma disorders. It will also help them determine who will be affected by it in the future and how to best treat those in need.

"Everyone reacts differently to trauma. There is no reliable way to predict who will recover without treatment and who will develop lasting problems after trauma," Dr. Tuma says.

Dr. Tuma wants to learn what contributes to these issues so that mental health experts can better predict outcomes for people and treat them early and effectively.

Road to recovery

If you or a loved one has experienced a traumatic event, there are steps you can take to recover. (See our sidebar on page 26 for recovery information.)

Traumatic stress not only affects the survivor, but also those around him or her. Families, co-workers, and community members who have close contact with trauma survivors can be impacted as well.

Recovery can be long or short—each person is different.

It's important for family members, friends, and colleagues to know how to support them.

With a better understanding and awareness of traumatic stress, those close to survivors can handle situations better and help them get treatment.

"This is a story of hope," Dr. Tuma says. "We have imperfect solutions today, but over time, we'll be pushing the envelope with better treatments and possibly cures for trauma-related psychiatric problems, which is arguably something we should be able to prevent or cure."

If you know someone who may be experiencing PTSD, the most important thing you can do is to help that person get the right diagnosis and treatment. Some people may need help making an appointment with their health care provider; others may benefit from having someone accompany them to their health care visits.

If a close friend or relative is diagnosed with PTSD, you can encourage them to follow their treatment plan. If their symptoms do not get better after 6 to 8 weeks, you can encourage them to talk to their health care provider. You also can:

• Offer emotional support, understanding, patience, and encouragement.
• Learn about PTSD so you can understand what your friend is experiencing.
• Listen carefully. Pay attention to the person’s feelings and the situations that may trigger PTSD symptoms.
• Share positive distractions, such as walks, outings, and other activities.