Posttraumatic Stress Disorder (PTSD)

The traumatic event may repeatedly reappear in the form of involuntary, unwanted memories or recurrent nightmares. Some people have flashbacks, in which they relive events as if they were actually happening rather than simply being remembered.

People may also experience intense reactions to reminders of the event. A combat veteran's symptoms might be triggered by fireworks, for example, whereas those of a robbery victim may be triggered by seeing a gun in a movie.

People persistently avoid things—activities, situations, or people—that are reminders of the trauma. For example, they may avoid entering a park or an office building where they were assaulted or avoid speaking to people of the same race as their assailant. They may even attempt to avoid thoughts, feelings, or conversations about the traumatic event.

People may be unable to remember significant parts of the traumatic event (called dissociative amnesia Dissociative Amnesia Dissociative amnesia is amnesia (memory loss) caused by trauma or stress, resulting in an inability to recall important personal information. People have gaps in their memory, which may span... read more ).

People may feel emotionally numb or disconnected from other people. Depression Depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to... read more is common, and people show less interest in previously enjoyed activities.

How people think about the event may become distorted, leading them to blame themselves or others for what happened. Feelings of guilt are also common. For example, they may feel guilty that they survived when other people did not. They may feel only negative emotions, such as fear, horror, anger, or shame, and may be unable to feel happy or satisfied or to love.

People may have difficulty falling asleep or concentrating.

They may become excessively vigilant for warning signs of risk. They may be easily startled.

People may become less able to control their reactions, resulting in reckless behavior or angry outbursts.

Some people develop ritual activities to help reduce their anxiety. For example, people who were sexually assaulted may bathe repeatedly to try to remove the sense of being unclean.

Many people with PTSD try to relieve their symptoms with alcohol or recreational drugs and develop a substance use disorder Substance Use Disorders Substance use disorders generally involve behavior patterns in which people continue to use a substance (for example, a recreational drug) despite having problems caused by its use. The substances... read more .

Psychotherapy is central to the treatment of posttraumatic stress disorder (PTSD).

Education about PTSD can be an important early step in therapy. The symptoms of PTSD can feel overwhelmingly confusing, and it is often very useful for people and loved ones to understand how PTSD can include seemingly unrelated symptoms.

Stress management techniques, such as breathing and relaxation, are important. Exercises that reduce and control anxiety (for example, yoga, meditation) can relieve symptoms and also prepare people for treatment that involves stress-inducing exposure to memories of the trauma.

The strongest current evidence favors structured, focused psychotherapy Psychotherapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment... read more , usually a type of cognitive-behavioral therapy (CBT) Behavioral therapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment... read more called exposure therapy that helps to extinguish the fear left over from the traumatic event.

In exposure therapy, the therapist has people imagine being in situations associated with prior trauma. For example, they may be asked to imagine visiting a park where they were assaulted. The therapist may help people reimagine the traumatic event itself. Because of the often intense anxiety associated with traumatic memories, it is important for the people to feel supported and for the exposure to proceed at the right pace. People who have been traumatized may be especially sensitive to being traumatized again, so treatment can get stalled if it goes too quickly. Often, treatment may shift from exposure to a more supportive, open-ended treatment, to help people be more comfortable with exposure therapy.

Broader and more exploratory psychotherapy may also ease return to a happier life, such as by focusing on relationships that may have been fractured by PTSD. Other types of supportive and psychodynamic psychotherapy can also be useful as long as they do not shift the focus of treatment away from exposure therapy.

Eye movement desensitization and reprocessing (EMDR) is treatment in which people are asked to follow the therapist's moving finger while they imagine being exposed to the trauma. Some experts think that the eye movements themselves help with desensitization, but EMDR probably works mainly because of the exposure, not the eye movements.

Antidepressants are considered first-line treatment for PTSD, even in people who do not also have major depression Depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to... read more . Selective serotonin reuptake inhibitors and other antidepressants such as mirtazapine and venlafaxine are most often recommended.

To treat insomnia and nightmares, doctors sometimes give drugs such as olanzapine and quetiapine (also used as antipsychotic drugs Antipsychotic drugs Schizophrenia is a mental disorder characterized by loss of contact with reality (psychosis), hallucinations (usually, hearing voices), firmly held false beliefs (delusions), abnormal thinking... read more ) or prazosin (also used to treat high blood pressure). However, these drugs do not treat PTSD itself.