Post-Traumatic Stress Disorder (PTSD) is a mental health condition that develops after witnessing or directly experiencing a traumatic event.
Traumatic events that lead to PTSD can be life-threatening or generally pose a danger to a person’s physical or mental well-being. Events such as natural disasters, serious accidents, witnessing violence, being assaulted, and the sudden death of a loved one are among the common causes of PTSD.
Although going through these types of events can lead to difficulties adjusting and having a hard time coping, not everybody who witnesses something traumatic develops PTSD.
Individuals who suffer from PTSD struggle with significant psychological, cognitive, and behavioral symptoms long after the traumatic event, lasting months or years, and affecting their ability to lead a functional life. However, PTSD is treatable, and recognizing it as such is crucial to recovery.
DSM-5 diagnostic criteria and symptoms
According to the DSM-5, PTSD symptoms need to be present following the exposure to actual or threatened death, serious injury, or sexual violence. This exposure can happen by experiencing the event directly, learning it happened to a loved one, witnessing it in person, or by repeated exposure to the details of trauma (ex. first responders).
In order to be diagnosed with PTSD, symptoms must last longer than a month and cause significant impairment in social, occupational, or cognitive functioning. Symptoms are categorized into four clusters:
Intrusion symptoms
These symptoms occur involuntarily and can present themselves in the form of unwanted intrusive thoughts or memories about the event, nightmares about the event, or flashbacks, which can feel very real to the individual experiencing them.
Avoidance
People who suffer from PTSD tend to put a lot of effort into avoiding reminders of the experienced trauma. Avoidance can manifest externally through behavior such as avoiding places, people and activities associated with the trauma, or internally, by avoiding thinking about or remembering the event. Some also avoid talking about their thoughts or feelings surrounding the event.
Negative changes in cognition and mood
This cluster of symptoms includes a broad spectrum of emotional and cognitive difficulties. These symptoms include persistent negative beliefs about oneself or the world, decreased interest in activities, distorted blame of oneself or others, and an inability to experience positive emotions. Memory problems related to the trauma (forgetting important details) are also typical.
Changes in arousal and reactivity
Symptoms in this cluster present themselves in the form of irritability, aggressiveness, reckless behavior, hypervigilance (where the body is in a constant state of fight or flight), problems with concentration, sleep disturbances, and an exaggerated startle response.
It is important to note that in order to be diagnosed, an individual needs to experience at least one intrusion symptom, one avoidance symptom, two symptoms of negative changes in cognition and mood, and two symptoms of changes in arousal and reactivity. In addition, these disturbances can’t be attributed to another medical condition or the use of substances.
Symptom intensity
The intensity of PTSD symptoms is not static—it can change over time. Periods of increased general stress, major life changes, or exposure to reminders of the trauma can trigger an escalation in symptoms. These reminders, known as trauma cues, can be external (for example, a loud bang resembling gunfire, or visiting a location linked to the event) or internal (for example, certain bodily sensations or emotions).
Some individuals notice seasonal patterns, with symptoms intensifying around the anniversary of the traumatic event. For example, a veteran might hear a car backfire and feel like they are back in the combat zone, or a sexual assault survivor might experience intrusive memories after hearing a news story similar to theirs. This variability in intensity is common and doesn’t indicate a relapse, but it does show the brain’s ongoing sensitivity to triggers, which can be addressed in therapy.
PTSD test for DSM-5 (PCL-5)
You can use the checklist below to evaluate your PTSD symptoms. Note that the test cannot diagnose PTSD—this must be done by a licensed psychologist or psychiatrist.
Instructions: below is a list of problems that people sometimes experience in response to a very stressful experience. Please read each one carefully and then indicate how much you have been bothered by that problem in the past month.
Scoring:
0 = Not at all | 1 = A little bit | 2 = Moderately | 3 = Quite a bit | 4 = Extremely
| In the past month, how much were you bothered by… | 0 | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| 1. Repeated, disturbing, and unwanted memories of the stressful experience? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 2. Repeated, disturbing dreams of the stressful experience? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 4. Feeling very upset when something reminded you of the stressful experience? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 6. Avoiding memories, thoughts, or feelings related to the stressful experience? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 8. Trouble remembering important parts of the stressful experience? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 10. Blaming yourself or someone else for the stressful experience or what happened after it? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 11. Having strong negative feelings such as fear, horror, anger, guilt, or shame? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 12. Loss of interest in activities that you used to enjoy? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 13. Feeling distant or cut off from other people? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 15. Irritable behavior, angry outbursts, or acting aggressively? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 16. Taking too many risks or doing things that could cause you harm? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 17. Being “superalert” or watchful or on guard? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 18. Feeling jumpy or easily startled? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 19. Having difficulty concentrating? | ☐ | ☐ | ☐ | ☐ | ☐ |
| 20. Trouble falling or staying asleep? | ☐ | ☐ | ☐ | ☐ | ☐ |
How to interpret: add up the scores for all 20 items (range 0–80).
- A total score of 33 or higher is sometimes used as a cut-off for probable PTSD, but interpretation of this result should always be performed by a qualified professional.
- The checklist is not a diagnostic tool on its own; it is intended for screening and symptom monitoring.
Source: U.S. Department of Veterans Affairs – PCL-5 PDF
Treatment methods
PTSD treatment has evolved significantly over the years, with a strong emphasis on evidence-based, trauma-focused interventions. The primary goal of each treatment method is to reduce the severity of symptoms, improve daily functioning, and enhance overall quality of life.
Treatment methods include psychotherapy and medication.
Psychotherapy approaches
Trauma-focused psychotherapy approaches are considered first-line treatments. They go beyond simply talking about the traumatic event—they are often very active and collaborative. They also help the brain learn that danger is over, reduce avoidance, and rebuild a sense of safety.
Some types of trauma-focused therapies include:
- Prolonged Exposure therapy (PE) involves gradually and repeatedly confronting trauma-related memories and situations in a safe, controlled environment, reducing avoidance and fear response over time. It can also be significantly helpful with flashbacks and nightmares. There is a significant increase in the use of virtual reality programs (VRET), which allow people to reenter settings in which they experienced their trauma.
- Cognitive-Processing Therapy (CPT) focuses on identifying and modifying distorted cognitive beliefs (ex. “The world is unsafe” or “I can’t trust anyone”). Patients learn to recognize these cognitive patterns, evaluate the accuracy of their beliefs, and replace unwanted thoughts with more balanced perspectives.
- Eye-Movement Desensitization and Reprocessing (EMDR) is based on the idea that PTSD symptoms arise from incompletely processed traumatic memories. It uses bilateral stimulation such as eye movement, tapping or sounds to help the brain reprocess the memory. By focusing on the memory while engaging in bilateral stimulation, an individual can reduce the emotional intensity associated with the memory of the trauma, which is also known as desensitization.
In addition to trauma-focused therapies, other modalities such as narrative therapy can help an individual construct a coherent and empowering account of their trauma.
Group therapy provides social support along with the normalization of experiences, while cognitive behavioral therapy (CBT) helps address avoidance and dysfunctional beliefs in a similar way as CPT.
Additionally, family and couples therapy can be beneficial in addressing relationship difficulties that arise as a consequence of trauma.
Medication
Prescription medication is also used to treat PTSD in addition to psychotherapy or for temporary symptom relief. It’s not usually used as a stand-alone treatment for this condition.
Antidepressants (SSRIs and SNRIs), such as sertraline, paroxetine and venlafaxine are commonly used to treat PTSD symptoms. They can help reduce anxiety and depression by targeting neurotransmitters (serotonin and norepinephrine) in the brain.
There are other medications being tested for PTSD, however they have yet to be approved by the FDA.
Further reading and resources
- National Center for PTSD (U.S. Department of Veterans Affairs) – comprehensive educational materials, assessments, and tools https://www.ptsd.va.gov/
- National Institute of Mental Health (NIMH) – research-based information on PTSD symptoms, risk factors, and treatment options https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd
- American Psychiatric Association (APA) – clinical practice guideline for the treatment of PTSD https://www.apa.org/ptsd-guideline
- Anxiety and Depression Association of America – understanding PTSD https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd
