Signs of PTSD

After a frightening event, it is normal to feel shaken. You may feel anxious, sad or angry, sleep badly, or keep thinking about what happened. For most people, these reactions slowly fade over the following weeks.^1,11

Post-traumatic stress disorder (PTSD) is when those reactions do not fade. They last more than a month and get in the way of work, home life or relationships.^1,2 This page explains the signs of PTSD in plain words. It also covers acute stress, complex PTSD, and why symptoms sometimes appear years after the event.

Normal stress or PTSD?

Almost everyone has some stress reactions after a trauma (a frightening event that involves death, serious injury, sexual violence, or the threat of these).² Having them does not mean you have PTSD. Most people who live through a trauma never develop PTSD.^3,11

The timing and the impact help tell them apart.

The World Health Organization reports that up to 4 in 10 people with PTSD recover within a year.⁴ Many more get better with treatment.

The four kinds of PTSD symptoms

U.S. doctors use a manual called the DSM-5 to diagnose PTSD. It lists four groups of symptoms. A person needs at least one sign of reliving, one of avoidance, two of negative thoughts and mood, and two of feeling on edge.² These must be new or worse since the trauma.

1. Reliving the event

Memories of the trauma push into your mind when you do not want them. They can feel very real, as if the danger is happening now.¹ Signs include:^1,2

• Upsetting memories that pop up without warning
• Nightmares about the event or its feelings
• Flashbacks, when you feel or act as if you are back in the event
• Strong distress when something reminds you of it
• Body reactions to reminders, such as a pounding heart, sweating or shaking

A reminder is often called a trigger. It can be a sound like fireworks, a smell, a news story, a date, or a place.¹

2. Avoiding reminders

To keep the memories away, a person may avoid anything linked to the event.^1,2 For example, someone may:

• Stop driving after a car crash
• Stay away from crowds, stores or certain people
• Refuse to talk or think about what happened
• Keep very busy so there is no quiet time to remember

Avoidance makes sense in the short term. Over time, though, it can shrink a person's world and keep fear going.

3. More negative thoughts and feelings

Trauma can change how you see yourself, other people and the world.¹ Signs include:^1,2

• Not being able to remember important parts of the event
• Thinking "I am bad," "No one can be trusted," or "The world is totally dangerous"
• Blaming yourself or others in ways that do not fit the facts
• Ongoing fear, anger, guilt or shame
• Losing interest in things you used to enjoy
• Feeling cut off or distant from people you love
• Feeling numb, or being unable to feel happy or loving

Some people carry deep guilt, such as wishing they had done more to stop what happened.¹

4. Feeling on edge

The body's alarm system stays switched on. A person may feel tense and watchful most of the time.¹ Signs include:^1,2

• Being easily startled by a noise or a touch
• Always scanning for danger (doctors call this hypervigilance)
• Trouble falling or staying asleep
• Trouble focusing
• Irritability or angry outbursts
• Risky or destructive behavior, such as unsafe driving or heavy drinking

Feeling detached or unreal

Some people with PTSD also have strong dissociation (feeling disconnected from yourself or your surroundings).² They may feel as if they are watching themselves from outside their body. Or the world may seem dreamlike, foggy or not real. When these feelings are strong and come with trauma reminders, doctors may call it the dissociative subtype of PTSD.²

Brief "zoning out" can happen to anyone. It is worth mentioning to a doctor if it happens often or scares you. Simple grounding exercises can help you come back to the present.

Body signs and other problems

PTSD is not only in the mind. It can show up in the body and in daily habits.

• Body complaints. In some cultures, people with PTSD are more likely to report headaches, stomach problems or other body symptoms with no clear cause.⁴ They may see a doctor for these and not mention the trauma.
• Heart health. Constant physical tension is a known risk factor for heart disease.⁴ In a study of male twin Vietnam veterans, more than 1 in 5 with PTSD (23%) developed heart disease over 13 years, compared with about 1 in 11 (9%) without PTSD.¹²
• Other mental health conditions. Many people with PTSD also have depression, anxiety, or problems with alcohol or drugs.¹¹
• Using alcohol or drugs to cope. Some people drink, smoke or use drugs to calm down or sleep. The VA lists these as unhealthy ways of coping.¹ See alcohol and older adults.
• Sleep. Nightmares and feeling on guard make sleep hard. Read about sleep and mental health.

Acute stress disorder: the first month

Acute stress disorder (ASD) is a short-term condition. It can start 3 days to 1 month after a trauma.⁵ A person has at least 9 of 14 possible symptoms. These include reliving the event, avoiding reminders, feeling on edge, and dissociation, such as feeling dazed or not remembering parts of the event.⁵

ASD is fairly common. In a review of 70 studies, about 1 in 5 people (20%) developed it after a trauma. It was more common after an assault or other violence by another person, at about 1 in 3 (36%).⁵

Having ASD raises the chance of later PTSD, but it does not guarantee it. Some people with ASD recover fully, and some people get PTSD without ever having ASD.⁵ Getting support early can still help.

Complex PTSD

Complex PTSD (often written CPTSD) is linked most often to trauma that is long-lasting and caused by another person. This is often someone the person trusted, as in child abuse.⁶ Being held captive, such as a prisoner of war, is another example.⁷ But any trauma can lead to it, and not everyone with this kind of history develops it.^6,7

The World Health Organization's diagnosis manual, the ICD-11, lists complex PTSD as its own diagnosis. A person has the main PTSD symptoms plus three more kinds of problems:⁷

• Trouble managing emotions: very strong emotional reactions, self-harm, or dissociation
• A deeply negative view of self: feeling worthless, defeated, or full of guilt or shame
• Trouble with relationships: hard to feel close to others or to keep relationships going

The U.S. manual, the DSM-5, does not list complex PTSD separately. Its PTSD diagnosis is broad enough to include many of these symptoms.^6,7 In practice, many U.S. clinicians use the two terms almost the same way.⁶

How common is it? In a 2019 survey of about 1,800 U.S. adults, about 1 in 30 (3.4%) met the ICD-11 criteria for PTSD. Slightly more, 3.8%, met the criteria for complex PTSD.⁷

The good news is that the same trauma-focused therapies used for PTSD also help complex PTSD. Experts recommend them as the place to start.⁶ Moderate evidence Learn more on our trauma-focused therapies page.

When symptoms start late or come back

Symptoms usually begin soon after the trauma. But they may not appear until months or even years later. They can also come and go over many years.¹

Delayed-onset PTSD. A 2009 review pooled studies that followed people over time after trauma. About 1 in 4 PTSD cases (25%) were delayed, meaning full PTSD showed up later.⁸ People who had some milder symptoms early on were more likely to develop it. Combat exposure was also linked to delayed PTSD.⁸ This suggests that delayed PTSD often follows milder symptoms that were there earlier.

Later life. Older adults may notice old trauma memories more as life changes. The VA lists several reasons:⁹

• Retirement brings more unplanned, quiet time
• Health problems, pain or less mobility add stress
• The death of a spouse or friends brings loss and loneliness
• Looking back on life can stir up memories

Symptoms may return in someone who was treated years ago. PTSD can also start for the first time after a trauma in later life.⁹

Researchers who study aging combat veterans describe a process of re-engaging with old war memories in later life. It was first called late-onset stress symptomatology (LOSS) and is now called Later-Adulthood Trauma Reengagement (LATR).¹⁰ For some veterans, this leads to growth and acceptance. For others, it brings more distress, depression, drinking or PTSD.¹⁰ Read more in PTSD in older adults and veterans.

Signs in children and teens

PTSD can look different in young people.¹

• Under age 6: Children may be very upset when apart from a parent, sleep poorly, or act out the event in play.
• Ages 7 to 11: Children may replay the event in play, drawings or stories. They may have nightmares, be more irritable, or avoid school.
• Ages 12 to 18: Signs look more like adult PTSD. Teens may seem depressed, anxious or withdrawn, or take risks such as using drugs or running away.

Common questions

When to get help

Talk with a doctor or mental health professional if symptoms:¹

• Last more than about 4 weeks
• Cause you a lot of distress
• Get in the way of work, home life or relationships

You do not have to wait until things are severe. PTSD can be treated, even many years after the trauma.⁹ A short set of questions can help start the talk. See getting assessed for PTSD. For help finding care, see finding a therapist or our help page.

If someone you love shows these signs, see supporting someone with PTSD. For day-to-day coping, see coping with trauma symptoms.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.