PTSD — when trauma stays in the body and mind

Post-traumatic stress disorder (PTSD) develops in some people after exposure to actual or threatened death, serious injury, or sexual violence — directly, witnessing, or learning it happened to close other.

Not weakness — normal fear circuitry fails to file memory as past event — triggers reactivate full fight-flight response.

Prevalence: ~50% experience trauma lifetime — ~20% of those develop PTSD — underdiagnosed.

Trauma examples

  • road traffic collision
  • assault, rape, domestic violence
  • childhood abuse
  • military combat
  • ** childbirth trauma**
  • natural disasters
  • ICU/near-death
  • sudden bereavement (contested in DSM — prolonged grief disorder separate)

Core symptom clusters

Re-experiencing

  • flashbacks — feels happening now
  • nightmares
  • intrusive thoughts/images
  • distress at reminders

Avoidance

  • people, places, conversations
  • emotional numbing

Cognition/mood

  • guilt, shame, blame
  • detachment, loss of interest
  • inability to remember parts of trauma
  • negative world view

Hyperarousal

  • sleep disturbance
  • irritable, angry outbursts
  • hypervigilance
  • exaggerated startle
  • concentration problems

Duration: >1 month for PTSD — <1 month — acute stress disorder.

Complex PTSD (cPTSD)

Repeated early interpersonal trauma:

  • affect dysregulation
  • negative self-concept
  • relationship difficulties
  • ICD-11 diagnosis — ** longer therapy**

Diagnosis

Clinical interview — PCL-5 questionnaire aids

Distinguish:

  • depression
  • GAD
  • substance misuse
  • TBI — overlap in veterans

Treatment — NICE recommended

Trauma-focused CBT

8–12 sessions typically:

  • psychoeducation
  • imaginal exposure — revisit memory safely
  • in vivo exposure — avoided situations
  • cognitive restructuring — guilt/distorted beliefs

EMDR

Structured protocol — bilateral eye movements/taps while processing trauma memory — equivalent efficacy to TF-CBT for many

Medication

SSRI — sertraline, paroxetine, fluoxetine — if therapy unavailable or comorbidity

Not benzodiazepines long term — impede processing, dependency

Prazosin — nightmares — off-label — mixed evidence

What does not help alone

  • generic counselling without trauma focus
  • ** alcohol** — worsens
  • avoidance forever — maintains

Single-session debriefing immediately after trauma — not recommended — may harm

Special groups

Military/veterans — Combat Stress, Op COURAGE

Emergency workers — Blue Light Together

Birth trauma — make birth better charities

Refugees/asylum — interpreter, culturally adapted therapy

Recovery

Many fully recover — therapy works

Stigma — “just get over it” — invalidating — professional help legitimate

Flashback now — grounding (5-4-3-2-1 senses) — therapy teaches skills

Common questions about post-traumatic stress disorder

What are the symptoms of PTSD?
Re-experiencing — flashbacks, nightmares, intrusive memories, physical reactions to reminders. Avoidance — places, people, thoughts related to trauma. Negative alterations — guilt, numbness, detachment, inability to feel positive. Hyperarousal — sleep problems, irritability, hypervigilance, exaggerated startle. Must last over 1 month for PTSD diagnosis.
How long after trauma can PTSD start?
Symptoms often begin within 3 months but can appear months or years later — delayed onset. Acute stress disorder — similar symptoms first month — may resolve or progress to PTSD. Early support after trauma does not always prevent PTSD but helps coping.
What is the best treatment for PTSD?
Trauma-focused cognitive behavioural therapy (TF-CBT) — gradually processing memory without retraumatisation. EMDR (eye movement desensitisation and reprocessing) — bilateral stimulation while recalling trauma — NICE approved. SSRIs (sertraline, paroxetine) if therapy waiting or comorbid depression — not first-line alone for most.
Is PTSD the same as anxiety?
PTSD is anxiety-related but specific — tied to traumatic memory re-experiencing and avoidance. Generalised anxiety lacks flashbacks to defined trauma. PTSD can coexist with depression, alcohol misuse — treat holistically.
Can PTSD be cured?
Many people recover fully with evidence-based therapy — memories remain but no longer dominate life. Some have residual symptoms manageable with skills learned in therapy. Complex PTSD from repeated trauma may need longer treatment — improvement still achievable.
How do I find a trauma or EMDR therapist?
For free help in England, refer yourself to NHS Talking Therapies and ask for a therapist trained in trauma-focused CBT or EMDR. For private therapy, use the directories of recognised bodies such as the BACP, UKCP or HCPC and search for trauma or EMDR specialists by postcode, checking they are registered. Veterans can contact Op COURAGE and Combat Stress for specialist support.

Sources

How we reviewed this page

Medically reviewed by Dr Neil Singh, MBChB, nMRCGP

General Practitioner · GMC 7039648

Dr Neil Singh is a General Practitioner based in Yorkshire with over a decade of experience working in UK primary care.

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