PTSD: Signs and Symptoms

Medically Reviewed by Jabeen Begum, MD on April 18, 2024
Written by Kathryn Whitbourne
7 min read

When time passes after a traumatic event, it's natural to think your mind and body have healed and moved on. But symptoms of posttraumatic stress disorder (PTSD) can pop up months or even years later.

Unlike a rash or broken arm, PTSD can be tough to identify, especially when it's happening in your own mind. Though it can look and feel like depression or rage, PTSD is different. And it can affect everything from the way you sleep to your relationships at home and work.

PTSD symptoms are grouped in four main clusters:

Memories

Whether you're thinking about it or not, memories of the traumatic event can come back to bother you. You may experience them in your sleep as nightmares or during the day as flashbacks. That means you relive the event as if it's happening for the first time.

Both can cause you to feel anxious, afraid, guilty, or suspicious. These emotions may play out physically in the form of chills, shaking, headaches, heart palpitations, and panic attacks.

Avoidance

You don't want to think about it. You don't want to talk about it. You steer clear of everyone and everything that reminds you of the event, including places and activities.

Avoidance can also mean staying away from people in general -- not just the ones connected with the event. This can cause you to feel detached and alone.

Behavior changes

Your emotions are more intense or you react differently than normal. For example, if you're a careful driver, you might start driving too fast or be super-aggressive on the road. Irrational, angry outbursts are very common.

You may find it hard to focus. Feelings of danger and being under attack can ruin concentration and keep you from finishing tasks you do every day. This can also lead to trouble sleeping, whether you're having nightmares or not.

Mood swings

PTSD doesn't always come with clues like nightmares and flashbacks. Sometimes it seems like a mood change unrelated to the traumatic event.

You'll know it by its negativity. You may feel hopeless, numb, or bad about yourself or others. Thoughts of suicide can come and go. Deep feelings of guilt and shame are common, as well.

Activities you normally enjoy may not interest you anymore. Your motivation to maintain relationships with close friends and family could be low.

If your symptoms persist for one month after the traumatic event, you may have PTSD. About 6% of Americans have PTSD at some point in their lives. But most people who go though a traumatic event do not get PTSD.

Events that may lead to PTSD include:

  • Surviving a serious car accident
  • Sexual assault or rape
  • War or combat 
  • Childhood abuse 
  • Domestic violence
  • Being tortured
  • Experiencing natural disasters, like a fire, hurricane, or earthquake
  • Witnessing traumatic events, like seeing a loved one die
  • Hearing about loved ones in danger or experiencing trauma

In 1988, Judith Herman, MD, an American psychiatrist, suggested that a new diagnosis was needed to describe the symptoms experienced by people with long-term trauma from ongoing situations--for instance, repeated domestic violence or living in a prisoner of war camp. In these situations, you're under the control of someone else for an extended period of time. Herman called this diagnosis complex PTSD.

Symptoms of complex PTSD include:

  • Being aggressive
  • Misusing drugs and alcohol
  • Experiencing rage, depression, or panic
  • Finding it hard to connect with people or make friends
  • Feeling worthless or filled with guilt

Most of these symptoms can also be present in people with PTSD, so some experts think that complex PTSD (CPTSD) shouldn't be a separate diagnosis. It's not listed in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the official U.S. guide for diagnosing mental disorders. 

For those who think it should be a separate diagnosis, one distinction is that people with CPTSD are triggered by relationships, while people with PTSD are usually triggered by sights, sounds, or smells. The troubling relationships usually involve people who are normally thought to be safe, like a parent, so people with CPTSD find it hard to trust others. Also, PTSD can happen based on a single incident (for example, being held up at gunpoint), while CPTSD is an ongoing pattern of trauma that embeds itself in your nervous system.

 

If you have this type of PTSD, you may experience the following symptoms, in addition to other signs of PTSD:

Depersonalization. You feel detached from your body, as if you're an outside observer of your own experiences (disconnection from self).

Derealization. You've often experienced your surroundings as if they're unreal or from a dream (disconnection from environment).

About 15% of people with PTSD experience depersonalization and derealization. Usually they've had traumatic childhoods, where they were abused or neglected. They may have amnesia, flashbacks, suicidal thoughts, or make suicidal attempts.

 

 

 

 

 

 

Children who've experienced severe trauma (like being abused or witnessing the death of a parent) may develop PTSD.  Childhood PTSD symptoms include:

  • Reliving the traumatic event over and over in thoughts or at play 
  • Experiencing nightmares or problems going to sleep
  • Feeling intense fear or sadness
  • Having angry outbursts
  • Denying the event took place or avoiding people and places associated with the event.
  • Having trouble at school
  • Reverting to toddler behavior, like thumb-sucking and bed-wetting
  • Losing interest in things they used to enjoy

 

Combat veterans are at a much higher risk of experiencing PTSD than other people. One study of Iraq and Afghanistan veterans showed that 15.7% of deployed veterans had experienced PTSD. Other studies put the rate even higher, at 20-30%. Some symptoms include:

  • Reliving the event (having nightmares about it or flashbacks where you feel you're going through the event again). You might see, smell, or hear something that triggers the event.
  • Avoiding things that remind you of the event. For instance, you stay away from crowds because they feel dangerous or avoid driving if your military convoy was bombed.
  • Having more negative thoughts and feelings than you did before the event. You distance yourself from loved ones and feel no one can be trusted.
  • Feeling on edge all the time. You have to be hypervigilant because the world seems dangerous. You may start drinking or doing drugs to cope.

Many veterans experience PTSD a few months after coming home from war. But others don't experience PTSD until years later, maybe after they retire and have less to distract their thoughts. A third group might have PTSD right after their war experience, go through a long period without post traumatic stress disorder symptoms, and then relive it later in life.

Women are twice as likely as men to develop PTSD. Researchers are trying to find out exactly why, but one theory is that women are much more like to be sexually attacked or raped than men, traumas that carry a very high risk of PTSD. Half of the women who've been raped develop PTSD. Women with PTSD are more likely than men to have the following signs:

  • Be easily startled
  • Feel numb or have trouble feeling emotions
  • Avoid things that might remind them of the traumatic incident
  • Feel depressed and anxious

Traumatic childbirth experiences, like losing a baby, can also bring on PTSD. So can childhood sexual abuse, something girls are much more likely to experience than boys. 

Woman usually have PTSD symptoms longer before diagnosis and treatment than men. One study showed it took 4 years for women to get diagnosis and treatment versus 1 year for men.

Although women are more likely to experience PTSD than men, men are actually exposed to more traumatic situations. Six of every 10 men (60%) and 5 of every 10 women (50%) experience at least one traumatic event in their lives. The higher rates for men are because they're more likely than women to:

  • Be in an accident
  • Be physically assaulted
  • Experience combat 
  • Witness death or injury

Signs and symptoms of PTSD are similar to those of women, but men are more likely to:

  • Have problems with drugs or alcohol
  • Have trouble controlling anger
  • Be hypervigilant
  • Have nightmares

 

It's normal to feel on edge or have trouble sleeping after a traumatic event. But if your thoughts and feelings still bother you more than month past the event (and are interfering with your daily life), you could have posttraumatic stress disorder (PTSD). Trauma-focused talk therapy and medication are both helpful in treating PTSD. 

What happens when PTSD is triggered?

When your PTSD is triggered by a sight, sound, or smell, you may feel distress, start to sleep badly, drink or use drugs, or become angrier. You might also try to stay away from people who remind you of the event, or from social media and TV. Research shows that veterans' PTSD may be triggered by news reports of war or veteran gatherings.

Does PTSD ever go away?

Many people get better on their own. Others need treatment. With treatment, about 30% of patients recover from PTSD. Another 40% may still have symptoms, but they're much milder.