Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental health problem that follows a traumatic event. It can cause symptoms such as problems sleeping, flashbacks and difficulty concentrating, and these can have a big effect on your day-to-day life.

Many different traumatic events can lead to post-traumatic stress disorder (PTSD). Some examples are:

• a serious road accident
• rape or sexual assault
• a mugging or robbery
• abuse, harassment or bullying, including racism, sexism or abuse targeting your identity
• kidnap or being held hostage
• an event where you fear for your life
• witnessing violence, including in military combat, a terrorist attack or violent assault
• seeing other people injured or killed
• natural disasters, like severe floods or earthquakes
• being diagnosed with a life-threatening condition
• an unexpected injury or death of someone you're close to
• doing a job where you see or hear traumatic things, for example in the armed forces or emergency services
• traumatic childbirth

The Royal College of Psychiatrists has advice on coping after a traumatic event.

No two people go through post-traumatic stress disorder (PTSD) in quite the same way. Symptoms can start soon after the traumatic event, or it may be some time before you notice any.

Some people with PTSD have symptoms all the time. For others, the symptoms come and go, with spells when they are worse and spells when they ease.

People with PTSD often relive the traumatic event in different ways. These can include:

• nightmares
• flashbacks (feeling like the event is happening now)
• intrusive thoughts or images
• physical sensations like pain, sweating, feeling sick or trembling

People with PTSD can feel alert or on edge, which means you may:

• panic when reminded of the trauma
• get angry or upset easily
• have sleeping problems (insomnia)
• feel jumpy or easily startled
• feel irritable
• have difficulty concentrating
• be very alert (hypervigilance)
• have symptoms of anxiety

Many people with PTSD try hard to avoid anything that reminds them of the traumatic event. If this is happening to you, you may:

• avoid people and places that remind you of the trauma
• avoid talking about your experience
• try to distract yourself with other things like work or hobbies
• be unable to remember details of what happened
• feel numb or cut off from your feelings
• feel detached from your body
• be unable to show affection
• do self-destructive or reckless things
• use alcohol or drugs

PTSD can bring difficult beliefs and feelings with it. You may feel that:

• you can't trust anyone
• nowhere is safe
• nobody understands
• you're to blame for what happened

You may also be overwhelmed by feelings of anger, sadness, guilt or shame.

PTSD (post-traumatic stress disorder) can affect children as well as adults.

Children with PTSD can have symptoms similar to those adults have. They may also:

• wet the bed
• be very anxious about being separated from a parent or another adult
• re-enact the traumatic event through play

After a traumatic event, it's normal to have upsetting and confusing thoughts. For most people, these ease within a few weeks.

Talk to your doctor if you or your child:

• are still having problems about 4 weeks after the traumatic experience, or
• have symptoms that are particularly troublesome

If necessary, your doctor can refer you to mental health specialists for further assessment and treatment.

Post-traumatic stress disorder (PTSD) can be treated, even when it starts many years after a traumatic event.

There's more than one treatment for PTSD. Which one suits you best depends on how severe your symptoms are and when they developed.

Your doctor may suggest "watchful waiting" for post-traumatic stress disorder (PTSD) if:

• you have had symptoms of PTSD for less than 4 weeks, or
• your symptoms are mild

Watchful waiting means your doctor will keep an eye on your symptoms to see whether they get better or worse. You should have a follow-up appointment within one month.

Trauma-focused CBT (cognitive behavioural therapy) uses several techniques to help you come to terms with the traumatic event. Your therapist may ask you to face your traumatic memories by thinking about them in detail, for example.

While you do this, the therapist will help you cope with any distress you feel. They'll also look for unhelpful thoughts or mistaken ideas you may have about the experience. You might feel you're to blame for what happened, or feel scared that it'll happen again.

You'll usually have 8 to 12 weekly sessions of trauma-focused CBT, although fewer may be needed. Each session usually lasts around 60 to 90 minutes, and you'll see the same therapist every week.

Eye movement desensitisation and reprocessing (EMDR) is a fairly new treatment for PTSD. While you describe the traumatic event to a therapist, you make rhythmic eye movements at the same time.

These rapid eye movements are meant to mirror the way your brain processes information when you're asleep.

Doctors don't often use medicine to treat PTSD. It may be recommended if you:

• are unable to try talking therapies like CBT, or don't want to
• also have depression
• have sleep problems caused by PTSD

If you're offered medicine for PTSD, it will usually be an antidepressant.

Many people find it helps to talk about their experience of PTSD with others who have it. Group therapy is one way to do this.

In a group, you can come to understand PTSD better. You also learn different ways to manage your symptoms.

For children and young people with post-traumatic stress disorder (PTSD), doctors usually recommend trauma-focused CBT. It's normally given over 8 to 12 sessions, and the sessions are adapted to suit the child's age, circumstances and development. If it's appropriate, the child's family will be involved in the treatment.

Medicine isn't usually recommended for children and young people with PTSD.