PTSD-Post Traumatic Stress Disorder

How common is PTSD?

PTSD affects about 7.7 million American adults, but it can occur at any age, including childhood. Women are more likely to develop the disorder than men, and there is some evidence that it may run in families. PTSD is frequently accompanied by depression, substance abuse, or anxiety disorders. When other conditions are appropriately diagnosed and treated, the likelihood of successful treatment increases.

Roughly 30 percent of Vietnam veterans developed PTSD. The disorder also has been detected in as many as 10% of Gulf War (Desert Storm) veterans, about 6% to 11% of veterans of the Afghanistan war, and about 12% to 20% of veterans of the Iraq war.

Posttraumatic stress disorder (PTSD) can occur after you have been through a trauma. A trauma is a shocking and scary event that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger. You may feel afraid or think that you have no control over what is happening.

Going through trauma is not rare. About 6 of every 10 (or 60%) of men and 5 of every 10 (or 50%) of women experience at least one trauma in their lives. Women are more likely to experience sexual assault and child sexual abuse. Men are more likely to experience accidents, physical assault, combat, disaster, or to witness death or injury.

Going through a trauma does not mean you’ll get PTSD, though. Even though over half of us go through some type of trauma, a much smaller percent develop PTSD.

Here are some facts (based on the U.S. population):

• About 7 or 8 out of every 100 people (or 7-8% of the population) will have PTSD at some point in their lives.
• About 5.2 million adults have PTSD during a given year. This is only a small portion of those who have gone through a trauma.
• About 10 of every 100 (or 10%) of women develop PTSD sometime in their lives compared with about 4 of every 100 (or 4%) of men. Learn more aboutwomen, trauma and PTSD.

Who is most likely to develop PTSD?

Although most people who go through trauma will not get PTSD, you are more likely to develop PTSD if you:

• Were directly exposed to the trauma as a victim or a witness
• Were seriously hurt during the event
• Went through a trauma that was long-lasting or very severe
• Believed that you were in danger
• Believed that a family member was in danger
• Had a severe reaction during the event, such as crying, shaking, vomiting, or feeling apart from your surroundings
• Felt helpless during the trauma and were not able to help yourself or a loved one

You are also more likely to develop PTSD if you:

• Had an earlier life-threatening event or trauma, such as being abused as a child
• Have another mental health problem
• Have family members who have had mental health problems
• Have little support from family and friends
• Have recently lost a loved one, especially if it was not expected
• Have had recent, stressful life changes
• Drink a lot of alcohol
• Are a woman
• Are poorly educated
• Are younger

Some groups of people, including African-Americans and Hispanics, may be more likely than whites to develop PTSD. This may be because these groups are more likely to go through a trauma. For example, in Veterans who survived Vietnam, a larger percent of African-Americans, Hispanics, and Native Americans were in combat than whites.

Your culture may also affect how you react to trauma. For example, people from groups that are open and willing to talk about problems may be more willing to seek help.

PTSD and the Military

When you are in the military, you may see combat. You may have been on missions that exposed you to horrible and life-threatening experiences. You may have been shot at, seen a buddy get shot, or seen death. These types of events can lead to PTSD.

The number of Veterans with PTSD varies by service era:

• Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF): About 11-20 out of every 100 Veterans (or between 11-20%) who served in OIF or OEF have PTSD in a given year.
• Gulf War (Desert Storm): About 12 out of every 100 Gulf War Veterans (or 12%) have PTSD in a given year.
• Vietnam War: About 15 out of every 100 Vietnam Veterans (or 15%) were currently diagnosed with PTSD at the time of the most recent study in the late 1980s, the National Vietnam Veterans Readjustment Study (NVVRS). It is estimated that about 30 out of every 100 (or 30%) of Vietnam Veterans have had PTSD in their lifetime.

Other factors in a combat situation can add more stress to an already stressful situation. This may contribute to PTSD and other mental health problems. These factors include what you do in the war, the politics around the war, where the war is fought, and the type of enemy you face.

Another cause of PTSD in the military can be military sexual trauma (MST). This is any sexual harassment or sexual assault that occurs while you are in the military. MST can happen to both men and women and can occur during peacetime, training, or war.

Among Veterans who use VA health care, about:

• 23 out of 100 women (or 23%) reported sexual assault when in the military.
• 55 out of 100 women (or 55%) and 38 out of 100 men (or 38%) have experienced sexual harassment when in the military.

There are many more male Veterans than there are female Veterans. So, even though military sexual trauma is more common in women Veterans, over half of all Veterans with military sexual trauma are men.

 

Frequently asked questions about PTSD

What treatments are available for PTSD?

There are many types of treatment for PTSD. You and your doctor will discuss the best treatment for you. You may have to try more than one treatment before you find the best one for you.

Two types of treatment appear to be the most effective for PTSD at this time. They are:

• A type of counseling called cognitive-behavioral therapy (CBT)
• Medicines known as SSRIs

Treatment can help you feel more in control of your emotions and result in fewer symptoms. However, even with treatment, you may still have some bad memories.

For more information, please see our fact sheet on Treatment of PTSD.

If I am in crisis what can I do to get help?

If you are in crisis:

• Call 911.
• Go to your nearest Emergency Room.
• Call the National Suicide Prevention Lifeline: 1-800-273-TALK (1-800-273-8255).
• Spanish/Español 1-888-628-9454.
• Veterans, press “1” after you call.
• Go to Veterans Crisis Line website to chat live with a crisis counselor at any time of day or night.

The National Center for PTSD does not provide any direct clinical care. We can provide information, though, to help you locate mental health services in your area. Please see our fact sheet on Finding and Choosing a Therapist.

I am an American Veteran. Whom do I contact for help with PTSD?

You can contact your local VA hospital or Vet Center.

VA also has Community Based Outpatient Clinics (CBOC’s) around each state. Many of these clinics offer mental health services.

To find a VA medical center, CBOC, or Vet Center near you, use the online VHA Facilities Locator.

Other resources include:

• The VA Health Benefits Service Center toll free at 1-877-222-VETS (1-877-222-8387)
• The Vet Centers’ national number 1-800-905-4675
• The VA Office of Mental Health Returning Veterans page
• The VA Returning Service Members (OEF/OIF) page
• My HealtheVet

As an American Veteran, how do I file a claim for disability due to PTSD?

You must file a formal request (“claim”) using forms provided by the VA’s Veterans Benefits Administration. After the forms are submitted, you must complete interviews. Information about the application process can be obtained from Benefits Officers at any VA medical center, outpatient clinic, or regional office.

The process of applying for a VA disability for PTSD can be long and stressful. Veterans Service Organizations (VSOs) provide “Service Officers” at no cost to help Veterans and family members with VA disability claims.

For more information, please see our fact sheet Help for Veterans with PTSD.

Do you have brochures, handouts, or videos?

Our website contains many types of information. These materials were created by experts on PTSD and trauma: We have:

• Fact sheets
• Handouts
• Award-winning educational videos
• Online courses
• Manuals
• Guides

The resources are intended for Veterans, families, mental health care providers, other health care providers, and researchers. We cover topics such as war, natural disaster, terrorism, assault, and abuse.

Any material on our website is in the public domain. That means it is free for you to use, copy, and give out as needed.

How do I locate books on PTSD?

You can contact your local library for readings on trauma or PTSD.

Also, you can use our PILOTS database. PILOTS stands for Published International Literature on Traumatic Stress. PILOTS is an electronic index of articles and books related to trauma. You can search PILOTS for references to these publications. PILOTS also includes links to full-text articles by National Center for PTSD staff.

What can I do if I think I have PTSD?

If you think you have PTSD, it’s important to get assessed by a professional. Only a trained provider can determine if you have PTSD. If you think you may have PTSD, talk to your doctor or a mental health provider. Treatment can work, and early treatment may help reduce long-term symptoms.

If you think you have PTSD

• Talk to your family doctor.
• Talk to a mental health professional, such as a therapist.
• If you’re a Veteran, contact your local VA hospital or Vet Center.
• Talk to a close friend or family member. He or she may be able to support you and find you help.
• Talk to a religious leader.
• Fill out a PTSD questionnaire or screen (see below).
• Learn more about talking to your doctor about trauma.

Take a self-screen for PTSD

A screen is a brief set of questions to tell you if it is likely you might have PTSD. Below is the PC-PTSD Screen.

Instructions: In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you:

1. Have had nightmares about it or thought about it when you did not want to?
2. Tried hard not to think about it or went out of your way to avoid situations that reminded you of it?
3. Were constantly on guard, watchful, or easily startled?
4. Felt numb or detached from others, activities, or your surroundings?

If you answer “yes” to any three items, you should think about seeing a doctor for an assessment.

You can also take a longer PTSD questionnaire (screen) and take it with you to the doctor. (While this screen asks about military experiences, you can also answer the questions as they would apply to any other kind of trauma.)

Many people who might need assistance with something like the symptoms of PTSD are afraid to go for help.

• One out of five people say they might not get help because of what other people might think.
• One out of three people say they would not want anyone else to know they were in therapy.

A study that’s been done of soldiers coming home from Iraq found that only 4 in 10 service members with mental health problems said they would get help. Some of the most common reasons they gave were they might be seen as weak, or it might hurt their military career.

Why seek help?

Here are some of the reasons why you should seek help.

Early treatment is better

Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes.

PTSD symptoms can change family life

PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life.

PTSD can be related to other health problems

PTSD symptoms can worsen physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD, you could also improve your physical health.

It may not be PTSD

Having symptoms of PTSD does not always mean you have PTSD. Some of the symptoms of PTSD are also symptoms for other mental health problems. For example, trouble concentrating or feeling less interested in things you used to enjoy can be symptoms of both depression and PTSD. Since different problems have different treatments, it’s important to have your symptoms assessed.

While it may be tempting to identify PTSD in yourself or someone you know, the diagnosis generally is made by a mental health professional. This will usually involve an evaluation by a psychiatrist, psychologist, or clinical social worker specifically trained to assess psychological problems.

What you can do?

If you have PTSD or PTSD symptoms, you may feel helpless.

Here are ways, though, that you can help yourself:

• Learn more about PTSD from this website or from other places.
• Talk to your doctor or a chaplain or other religious leader.
• Go for a PTSD evaluation by a mental health professional specifically trained to assess psychological problems.

If you do not want to be evaluated, but feel you have symptoms of PTSD, you may choose “watchful waiting.” Watchful waiting means taking a wait-and-see approach.

• If you get better on your own, you won’t need treatment.
• If your symptoms do not get better after three months, and they are either causing you distress or are getting in the way of your work or home life, talk with a health professional.

In a few cases, your symptoms may be so severe that you need immediate help. Call 911 or other emergency services immediately if you think that you cannot keep from hurting yourself or someone else.

What treatments are available?

Today, there are good treatments available for PTSD. When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can help you get better.

Cognitive behavioral therapy (CBT) appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used for PTSD. Medications have also been shown to be effective. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.

Treatment of PTSD

Today, there are good treatments available for PTSD. When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can help you get better.

Cognitive behavioral therapy (CBT) is one type of counseling. Research shows it is the most effective type of counseling for PTSD. The VA is providing two forms of cognitive behavioral therapy to Veterans with PTSD: Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy. To learn more about these types of therapy, see our fact sheets listed on the Treatment page.

There is a similar kind of therapy called Eye Movement Desensitization and Reprocessing (EMDR) that is used for PTSD. Also, medications have been shown to be effective. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.

Types of cognitive behavioral therapy

What is cognitive therapy?

In cognitive therapy, your therapist helps you understand and change how you think about your trauma and its aftermath. Your goal is to understand how certain thoughts about your trauma cause you stress and make your symptoms worse.

You will learn to identify thoughts about the world and yourself that are making you feel afraid or upset. With the help of your therapist, you will learn to replace these thoughts with more accurate and less distressing thoughts. You will also learn ways to cope with feelings such as anger, guilt, and fear.

After a traumatic event, you might blame yourself for things you couldn’t have changed. For example, a soldier may feel guilty about decisions he or she had to make during war. Cognitive therapy, a type of CBT, helps you understand that the traumatic event you lived through was not your fault.

What is exposure therapy?

In exposure therapy your goal is to have less fear about your memories. It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event.

By talking about your trauma repeatedly with a therapist, you’ll learn to get control of your thoughts and feelings about the trauma. You’ll learn that you do not have to be afraid of your memories. This may be hard at first. It might seem strange to think about stressful things on purpose. But over time, you’ll feel less overwhelmed.

With the help of your therapist, you can change how you react to the stressful memories. Talking in a place where you feel secure makes this easier.

You may focus on memories that are less upsetting before talking about worse ones. This is called “desensitization,” and it allows you to deal with bad memories a little bit at a time. Your therapist also may ask you to remember a lot of bad memories at once. This is called “flooding,” and it helps you learn not to feel overwhelmed.

You also may practice different ways to relax when you’re having a stressful memory. Breathing exercises are sometimes used for this.

What is EMDR?

Eye movement desensitization and reprocessing (EMDR) is another type of therapy for PTSD. Like other kinds of counseling, it can help change how you react to memories of your trauma.

While thinking of or talking about your memories, you’ll focus on other stimuli like eye movements, hand taps, and sounds. For example, your therapist will move his or her hand, and you’ll follow this movement with your eyes.

Experts are still learning how EMDR works, and there is disagreement about whether eye movements are a necessary part of the treatment.

Medication

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medicine. These can help you feel less sad and worried. They appear to be helpful, and for some people they are very effective. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft).

Chemicals in your brain affect the way you feel. For example, when you have depression you may not have enough of a chemical called serotonin. SSRIs raise the level of serotonin in your brain.

There are other medications that have been used with some success. Talk to your doctor about which medications are right for you.

Other types of treatment

Some other kinds of counseling may be helpful in your recovery. However, more evidence is needed to support these types of treatment for PTSD.

Group therapy

Many people want to talk about their trauma with others who have had similar experiences.

In group therapy, you talk with a group of people who also have been through a trauma and who have PTSD. Sharing your story with others may help you feel more comfortable talking about your trauma. This can help you cope with your symptoms, memories, and other parts of your life.

Group therapy helps you build relationships with others who understand what you’ve been through. You learn to deal with emotions such as shame, guilt, anger, rage, and fear. Sharing with the group also can help you build self-confidence and trust. You’ll learn to focus on your present life, rather than feeling overwhelmed by the past.

Brief psychodynamic psychotherapy

In this type of therapy, you learn ways of dealing with emotional conflicts caused by your trauma. This therapy helps you understand how your past affects the way you feel now.

Your therapist can help you:

• Identify what triggers your stressful memories and other symptoms
• Find ways to cope with intense feelings about the past
• Become more aware of your thoughts and feelings, so you can change your reactions to them
• Raise your self-esteem

Family therapy

PTSD can affect your whole family. Your kids or your partner may not understand why you get angry sometimes, or why you’re under so much stress. They may feel scared, guilty, or even angry about your condition.

Family therapy is a type of counseling that involves your whole family. A therapist helps you and your family to communicate, maintain good relationships, and cope with tough emotions. Your family can learn more about PTSD and how it is treated.

In family therapy, each person can express his or her fears and concerns. It’s important to be honest about your feelings and to listen to others. You can talk about your PTSD symptoms and what triggers them. You also can discuss the important parts of your treatment and recovery. By doing this, your family will be better prepared to help you.

You may consider having individual therapy for your PTSD symptoms and family therapy to help you with your relationships.

How long does treatment last?

CBT treatment for PTSD often lasts for three to six months. Other types of treatment for PTSD can last longer. If you have other mental health problems as well as PTSD, treatment may last for one to two years or longer.

What if someone has PTSD and another disorder? Is the treatment different?

It is very common to have PTSD at that same time as another mental health problem. Depression, alcohol or drug abuse problems, panic disorder, and anxiety disorders often occur along with PTSD. In many cases, the PTSD treatments described above will also help with the other disorders. The best treatment results occur when both PTSD and the other problems are treated together rather than one after the other.

What will we work on in therapy?

When you begin therapy, you and your therapist should decide together what goals you hope to reach in therapy. Not every person with PTSD will have the same treatment goals. For instance, you might focus on:

• Reducing your PTSD symptoms
• Learning the best way to live with your symptoms
• Learning how to cope with other problems associated with PTSD, like feeling less guilt or sadness, improving relationships at work, or communicating with friends and family

Your therapist should help you decide which of these goals seems most important to you, and he or she should discuss with you which goals might take a long time to achieve.

What can I expect from my therapist?

Your therapist should help you decide which of these goals seems most important to you, and he or she should discuss with you which goals might take a long time to achieve.

The two of you should agree at the beginning that this plan makes sense for you. You should also agree on what you will do if it does not seem to be working. If you have any questions about the treatment, your therapist should be able to answer them.

You should feel comfortable with your therapist and feel you are working as a team to tackle your problems. It can be difficult to talk about painful situations in your life, or about traumatic experiences that you’ve had. Feelings that emerge during therapy can be scary and challenging. Talking with your therapist about the process of therapy, and about your hopes and fears in regards to therapy, will help make therapy successful.

If you do not like your therapist or feel that the therapist is not helping you, it might be helpful to talk with another professional. In most cases, you should tell your therapist that you are seeking a second opinion.

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