What Should You Do If You Think You Have PTSD?
If you are experiencing intrusive memories, nightmares, hypervigilance, or emotional numbing after a traumatic event, reach out to a mental health professional trained in trauma treatment. PTSD is a treatable condition, and recovery is possible. The NIMH reports that evidence-based therapies help the majority of people with PTSD achieve significant improvement.
Post-traumatic stress disorder affects approximately 6% of the U.S. population at some point in their lives, with women twice as likely as men to develop the condition according to the National Institute of Mental Health. Despite its prevalence, many people with PTSD delay seeking treatment for years due to avoidance symptoms, stigma, or not recognizing their experiences as PTSD. Trauma responses including nightmares, hypervigilance, emotional numbness, and avoidance of reminders are your brain's attempt to protect you from perceived danger, but these responses can become self-reinforcing and worsen without treatment. Seeking help is not a sign of weakness but a proactive step toward reclaiming your life from the impact of trauma.
Your first step should be finding a therapist specifically trained in trauma-focused treatments such as Cognitive Processing Therapy, Prolonged Exposure, or EMDR. The APA, VA/DoD clinical practice guidelines, and NICE all recommend these trauma-focused therapies as first-line treatments over general supportive counseling, which has shown limited effectiveness for PTSD. SAMHSA's National Helpline at 1-800-662-4357 can provide free referrals to trauma-trained therapists in your area. The PTSD Foundation, NAMI, and the International Society for Traumatic Stress Studies also maintain provider directories. Many trauma therapists now offer telehealth sessions, which can be particularly helpful for people whose PTSD symptoms make leaving home difficult.
While connecting with professional help, establishing basic safety and stability is essential. This means ensuring your physical safety, maintaining basic self-care routines including regular meals and sleep, and connecting with supportive people in your life. Avoid using alcohol or drugs to manage symptoms, as substance use worsens PTSD outcomes and is associated with higher rates of re-traumatization. If you are experiencing suicidal thoughts, call 988 or go to your nearest emergency department immediately. Veterans can also contact the Veterans Crisis Line by pressing 1 after dialing 988. Recovery from PTSD is not linear, and setbacks are a normal part of the healing process, but the evidence clearly shows that most people who engage in trauma-focused treatment experience meaningful improvement.
PTSD affects approximately 6% of the U.S. population according to NIMH
What Are the Symptoms of PTSD?
The DSM-5-TR groups PTSD symptoms into four clusters: intrusive re-experiencing such as flashbacks and nightmares, avoidance of trauma-related stimuli, negative changes in thoughts and mood including guilt and emotional numbing, and hyperarousal symptoms such as hypervigilance and exaggerated startle response. Symptoms must persist for at least one month.
Intrusive re-experiencing is the hallmark of PTSD and includes unwanted, distressing memories of the traumatic event that feel as if the trauma is happening again in the present moment. Flashbacks involve vivid sensory re-experiencing, including images, sounds, smells, and physical sensations associated with the original trauma. Nightmares related to the trauma may occur several times per week, severely disrupting sleep quality. These intrusive symptoms are driven by the amygdala's failure to properly process the traumatic memory, leaving it stored in a fragmented, emotionally charged state that can be triggered by sensory reminders. The American Psychiatric Association emphasizes that these are neurological symptoms, not character flaws or imagination.
Avoidance is both an emotional and behavioral symptom cluster in which the person deliberately or automatically avoids thoughts, feelings, people, places, or situations that are reminders of the trauma. A combat veteran might avoid fireworks or crowded spaces. A sexual assault survivor might avoid certain locations, clothing styles, or intimate relationships. This avoidance provides temporary relief from distress but prevents the brain from processing and integrating the traumatic memory, thereby maintaining PTSD. Negative changes in cognition and mood include persistent and distorted blame of self or others, diminished interest in activities, feeling detached from others, and inability to experience positive emotions, a symptom called emotional anhedonia.
Hyperarousal symptoms reflect a nervous system that remains on high alert long after the danger has passed. Hypervigilance involves constantly scanning the environment for threats, leading to exhaustion and difficulty concentrating. Exaggerated startle response causes intense reactions to unexpected sounds or movements. Sleep disturbance, irritability, and difficulty concentrating are common. Reckless or self-destructive behavior, including substance use and dangerous driving, may also be present, particularly in men. The NIMH notes that PTSD symptoms can fluctuate in intensity, with periods of relative stability interrupted by symptom flares triggered by anniversaries, media coverage of similar events, or new life stressors. Symptoms lasting longer than one month that cause significant distress or functional impairment warrant professional evaluation.
The DSM-5-TR defines four symptom clusters for PTSD diagnosis
How Do Trauma-Focused Therapies Treat PTSD?
Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and EMDR are the three evidence-based trauma-focused therapies recommended as first-line treatments by the APA and VA/DoD. These therapies achieve PTSD remission in 53-70% of patients by helping the brain reprocess traumatic memories and change maladaptive beliefs.
Cognitive Processing Therapy is a 12-session structured therapy developed by Patricia Resick that addresses the distorted beliefs that develop after trauma, called stuck points. Common stuck points include self-blame, beliefs that the world is completely dangerous, and feelings of permanent damage. CPT teaches you to identify these stuck points, examine the evidence for and against them, and develop more balanced beliefs. For example, a survivor who believes the assault was their fault works with the therapist to examine this belief using Socratic questioning and written exercises. Research published in JAMA Psychiatry found that CPT produced clinically meaningful symptom reduction in 53% of veteran participants and in over 60% of civilian sexual assault survivors across multiple randomized controlled trials.
Prolonged Exposure therapy, developed by Edna Foa at the University of Pennsylvania, involves 8-15 sessions of gradually confronting trauma-related memories and situations in a safe, therapeutic context. The two main components are imaginal exposure, in which you repeatedly recount the traumatic memory in detail, and in-vivo exposure, in which you gradually approach real-world situations you have been avoiding. Through repeated exposure, the fear response associated with the traumatic memory decreases through a process called extinction learning. The VA/DoD clinical practice guidelines cite PE as having the strongest overall evidence base for PTSD treatment, with response rates of 60-70% in randomized controlled trials. Prolonged Exposure is available at most VA medical centers and many civilian trauma treatment programs.
EMDR uses bilateral stimulation, most commonly guided lateral eye movements, while the patient holds the traumatic memory in mind. The Adaptive Information Processing model proposes that bilateral stimulation facilitates the brain's natural memory reconsolidation process, allowing the traumatic memory to be integrated with adaptive information and lose its emotional charge. EMDR typically requires 8-12 sessions for a single-trauma PTSD. The World Health Organization, APA, and International Society for Traumatic Stress Studies all recommend EMDR as a first-line PTSD treatment. A network meta-analysis published in Psychological Medicine comparing all PTSD treatments found EMDR and trauma-focused CBT (which includes PE and CPT) were equally effective and both superior to pharmacotherapy alone. EMDR may be particularly appealing for individuals who find the detailed verbal recounting required in PE too distressing.
CPT produced clinically meaningful symptom reduction in over 60% of participants in JAMA Psychiatry trials
A network meta-analysis in Psychological Medicine found EMDR and trauma-focused CBT equally effective
What Medications Are Used for PTSD?
Sertraline (Zoloft) and paroxetine (Paxil) are the only two FDA-approved medications for PTSD and are recommended as first-line pharmacotherapy by the APA when medication is indicated. The VA/DoD guidelines also include venlafaxine as an option. Medications are most effective when combined with trauma-focused psychotherapy.
SSRIs are the preferred medication class for PTSD because they address the serotonin dysregulation implicated in hyperarousal, intrusive symptoms, and mood disturbance associated with the disorder. Sertraline and paroxetine have both demonstrated efficacy in large-scale randomized controlled trials leading to their FDA approval. Sertraline is typically started at 25 mg daily and titrated up to 50-200 mg based on response and tolerability. Paroxetine is started at 20 mg daily with a target dose of 20-60 mg. A meta-analysis published in Psychological Medicine found that SSRIs produced statistically significant improvement compared to placebo across all four PTSD symptom clusters, with moderate effect sizes.
Venlafaxine (Effexor XR), an SNRI, is recommended by the VA/DoD guidelines as an alternative to SSRIs for PTSD treatment. Its dual action on serotonin and norepinephrine may be particularly beneficial for PTSD patients with comorbid depression or chronic pain. The VA/DoD guidelines specifically recommend against using benzodiazepines for PTSD, as evidence shows they do not improve PTSD outcomes and may interfere with extinction learning, the therapeutic mechanism underlying trauma-focused therapy. Prazosin, an alpha-1 adrenergic blocker, is sometimes prescribed for trauma-related nightmares, though the large RASKIND VA trial published in the New England Journal of Medicine showed mixed results regarding its efficacy.
The APA and VA/DoD guidelines emphasize that trauma-focused psychotherapy should be the primary treatment for PTSD, with medication serving as an adjunct or alternative when therapy is unavailable, declined, or insufficient alone. Combined treatment with therapy and medication is reasonable for moderate-to-severe PTSD. Medication typically takes 4-8 weeks to show full effect and should be continued for at least 12 months after symptom improvement to prevent relapse. Research published in the American Journal of Psychiatry indicates that patients who respond to medication and then discontinue it have relapse rates of approximately 50% within six months, underscoring the importance of adequate treatment duration and the advantages of combining medication with skills-based therapy.
The VA/DoD Clinical Practice Guideline recommends trauma-focused therapy as primary PTSD treatment
How Does PTSD Affect Relationships and Daily Life?
PTSD significantly impacts relationships, work performance, and daily functioning. Research in JAMA Psychiatry shows that people with PTSD have higher rates of relationship difficulties, unemployment, and physical health problems. Emotional numbing, hypervigilance, anger outbursts, and avoidance behaviors create barriers to intimacy and social connection that often cause secondary distress for partners and family members.
The avoidance and emotional numbing symptoms of PTSD create significant barriers to intimate relationships. Partners often report feeling shut out, rejected, or confused by the emotional withdrawal that characterizes PTSD. A person with PTSD may avoid physical intimacy, struggle to express affection, or become emotionally detached as a protective mechanism. Research published in the Journal of Traumatic Stress found that relationship satisfaction was significantly lower in couples where one partner had PTSD compared to those without. The hyperarousal symptoms, particularly irritability and anger outbursts, can create an atmosphere of tension and unpredictability in the home that affects all family members including children.
Work and daily functioning are also profoundly affected. Concentration difficulties, sleep deprivation from nightmares, and hypervigilance create cognitive impairments that interfere with job performance. Avoidance symptoms may make commuting, attending meetings, or interacting with coworkers distressing. The World Health Organization estimates that PTSD accounts for significant global disability burden, and research in the American Journal of Industrial Medicine found that PTSD is associated with higher rates of unemployment, reduced work productivity, and increased healthcare utilization. Physical health comorbidities are common, with studies in JAMA Internal Medicine linking PTSD to increased rates of cardiovascular disease, autoimmune disorders, chronic pain, and metabolic syndrome.
Despite these challenges, treatment can restore quality of life across all these domains. As PTSD symptoms improve with evidence-based therapy, relationship satisfaction, work performance, and physical health outcomes typically improve as well. Couples therapy specifically designed for PTSD, such as Cognitive-Behavioral Conjoint Therapy for PTSD, can address relationship impacts directly. NAMI offers family support groups that help loved ones understand PTSD and develop effective communication strategies. Vocational rehabilitation programs through the VA and state agencies can support workforce re-entry. Recovery from PTSD extends far beyond symptom reduction, encompassing meaningful reengagement with the relationships, activities, and goals that give life purpose.
NIMH reports on the widespread functional impact of PTSD across life domains
What Is Complex PTSD and How Is It Different?
Complex PTSD (C-PTSD) develops from prolonged, repeated trauma such as childhood abuse, domestic violence, or captivity, and includes all standard PTSD symptoms plus difficulties with emotional regulation, self-identity, and interpersonal relationships. The WHO's ICD-11 officially recognized C-PTSD as a distinct diagnosis in 2018, while the DSM-5-TR addresses these features through the dissociative subtype of PTSD.
Complex PTSD was first conceptualized by psychiatrist Judith Herman of Harvard Medical School to describe the unique symptom profile that develops from chronic, inescapable traumatic experiences, as distinct from the single-incident traumas that typically cause standard PTSD. The ICD-11, published by the World Health Organization, formally recognizes C-PTSD as requiring all standard PTSD criteria plus three additional symptom domains: difficulties in affect regulation including emotional reactivity and dissociation, negative self-concept including persistent shame and feelings of worthlessness, and disturbances in relationships including difficulty trusting others and patterns of revictimization. These additional symptoms reflect the developmental impact of prolonged trauma, particularly when it occurs during childhood.
Treatment for complex PTSD typically requires a phase-based approach that begins with stabilization before progressing to trauma processing. The International Society for Traumatic Stress Studies recommends starting with skills training in emotional regulation, distress tolerance, and interpersonal effectiveness before introducing exposure-based trauma work. Dialectical Behavior Therapy (DBT), originally developed for borderline personality disorder which shares many features with C-PTSD, provides effective skills-building for emotional dysregulation. The STAIR/NST protocol, developed at the National Center for PTSD, combines skills training in affective and interpersonal regulation with narrative storytelling therapy and has shown efficacy in randomized controlled trials published in the American Journal of Psychiatry.
Recovery from complex PTSD is possible but typically takes longer than recovery from single-incident PTSD. Treatment may span one to several years, reflecting the depth of the developmental impact. Building a therapeutic relationship based on safety and trust is itself a healing process for people whose trauma occurred within relationships. Support groups through organizations like NAMI and the National Child Traumatic Stress Network can provide peer connection and validation. Understanding that the difficulties you experience with emotions, self-image, and relationships are predictable consequences of what happened to you, not inherent flaws, is often a pivotal moment in the recovery process.
The ICD-11 published by the WHO formally recognized Complex PTSD as a distinct diagnosis
