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?
PTSD can affect people after severe trauma, including assault, serious accidents, difficult births or war. Not everyone exposed to trauma develops it; symptoms and their timing vary.
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 trauma-related symptoms are distressing or interfere with daily life; do not wait four weeks if symptoms are severe. Get urgent mental health assessment for suicidal thoughts. If you cannot keep yourself safe, seek emergency care now.
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)
Trauma-focused CBT is a recommended treatment. A trained therapist helps process traumatic memories and associated beliefs, often over 8 to 12 sessions, with more sessions when needed.
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
An SSRI such as sertraline, or venlafaxine, may be considered if an adult prefers medicine, with regular review. Psychological therapy remains an important option; the choice should reflect benefits, risks and preferences.
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
Routine psychologically focused debriefing after trauma is not recommended. Practical support, safety and social connection can help. Early assessment and appropriate trauma-focused therapy may reduce persistent symptoms, but cannot guarantee prevention.
Sources for targeted updates
Updated: 24 October 2026. Targeted corrections to urgent-care guidance, treatment, prevention, frequency. This update covers the named sections; a full review of the remaining guide is pending.