Overview
Post-traumatic stress disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a terrifying event. It involves persistent re-experiencing of the trauma, avoidance of reminders, negative changes in thoughts and feelings, and heightened arousal. PTSD can develop after any traumatic experience and is highly treatable with specific psychological therapies.
How common is it?
About 4% of adults in the UK have PTSD at any given time. It is twice as common in women as in men. About 20% of those exposed to severe trauma develop PTSD. It is particularly common in combat veterans, survivors of sexual assault, and emergency service workers.
Causes and risk factors
PTSD occurs when the normal fear response to trauma becomes dysregulated, producing persistent memory consolidation abnormalities and amygdala hyperactivity.
Common risk factors
- Any event perceived as threatening life or physical integrity
- Combat, war, and military trauma
- Sexual or physical assault
- Road traffic accidents or natural disasters
- Childhood abuse or neglect
- Witnessing traumatic events (including healthcare workers in emergency settings)
- Prior trauma history
- Lack of social support after trauma
- Biological vulnerability (hippocampal volume, HPA axis reactivity)
Symptoms
- Re-experiencing: intrusive memories, flashbacks, nightmares — feel as vivid and distressing as the original event
- Avoidance of thoughts, feelings, people, or places associated with the trauma
- Negative alterations in cognition and mood: guilt, shame, persistent negative emotions, feeling detached, inability to experience positive emotions
- Hyperarousal: sleep disturbance, hypervigilance, exaggerated startle response, angry outbursts, concentration difficulties
- Symptoms lasting more than 1 month and causing significant impairment
When to see a doctor
Seek help if symptoms have lasted more than 4 weeks and are interfering with daily life. Seek urgent help for active suicidal thoughts or plans. PTSD is often missed — if a healthcare professional does not ask, bring it up yourself.
Diagnosis
Clinical assessment using PCL-5 (PTSD Checklist) or IES-R as screening tools. DSM-5 or ICD-11 criteria for diagnosis. Distinguish from adjustment disorder, acute stress reaction, depression, and complex PTSD.
Treatments
Trauma-focused CBT (TF-CBT)
The evidence-based first-line treatment. Involves structured exploration of the traumatic memory combined with cognitive restructuring. Typically 8 to 12 sessions. Produces remission in 50 to 75% of patients.
EMDR (Eye Movement Desensitisation and Reprocessing)
Equally effective to TF-CBT. Uses bilateral eye movements or tapping while the patient processes traumatic memories. Mechanism is debated but robust evidence for efficacy.
SSRIs and SNRIs
Sertraline, paroxetine (licensed for PTSD), venlafaxine reduce hyperarousal, depression, and nightmares. Used when psychological therapy is not available or not tolerated, or as adjuncts.
Prazosin for nightmares
An alpha-1 blocker that reduces noradrenergic arousal during sleep, specifically reducing PTSD nightmares. Evidence is mixed but used in treatment-resistant nightmare disorder.
Self-care and lifestyle
- Maintain social connections and avoid prolonged isolation
- Limit alcohol (commonly used to numb symptoms but worsens PTSD long-term)
- Regular exercise reduces hyperarousal and depression
- Sleep hygiene is important but address underlying hyperarousal rather than just sleep habits
Prevention
Psychological debriefing immediately after trauma has not been shown to prevent PTSD and may be harmful. Psychological first aid (practical support, social connection, avoiding re-traumatisation) is the recommended early response. Early access to TF-CBT or EMDR prevents chronicity.