17 Symptoms of PTSD Everyone Should Know

Flashbacks and nightmares are common, but there are lesser-known signs and symptoms of post-traumatic stress disorder (PTSD) to watch for also.

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Post-traumatic stress disorder (PTSD) has had many names. It was "shell shock" and "battle fatigue" before it was PTSD and is known to affect not just military veterans but anyone who has gone through an intensely traumatic experience.

In fact, about six out of every 100 American adults (about 6% of the population) will have PTSD in their lifetime, according to the U.S. Department of Veteran Affairs. Eight out of every 100 women in the U.S. will experience it in their lifetime, compared to 4 out of every 100 men.

While anxiety symptoms are a huge part of PTSD, they're not the whole picture. People with PTSD often experience depression, negative thoughts, and impulsive or self-destructive behavior as well. Symptoms can vary in intensity and frequency.

Anyone at any age can get PTSD, but the symptoms listed below are most common in adolescents and adults. Additionally, the National Institute of Mental Health (NIMH) provides a list of child-specific symptoms, including wetting the bed after using the bathroom, forgetting how or being unable to talk, acting out the traumatic event while playing, and becoming unusually clingy to their parent or trusted adult.

PTSD also has its own treatments, which is why it's important to get the right diagnosis. After all, living with PTSD likely means you have difficulty at work, with friends and family, and with your relationship to yourself. You may have trouble leaving the house, talking to others, sleeping, or liking yourself. The good news is there are ways to manage your PTSD.

Watch for these17 signs and symptoms of PTSD.

01 of 17

Experiencing or Witnessing a Life-Threatening Event

PTSD can strike anyone who has gone through a life-threatening event. That means not just war, but sexual assault, natural disasters like earthquakes or hurricanes, mass shootings, motor vehicle accidents, witnessing death or injury, an unexpected loss, receiving a life-threatening diagnosis, and other events can cause PTSD.

"There has to be exposure to some sort of very extreme type of horrible event," said Jack Nitschke, Ph.D., associate professor of psychiatry and psychology at the University of Wisconsin School of Medicine and Public Health. "Something has to happen in the external world."

This includes illness-induced PTSD, also known as medical PTSD, where going through a traumatic medical event can cause PTSD. A study published in May 2018 in General Hospital Psychiatry found that the life quality of people with illness-induced PTSD to be similar to those who developed PTSD after an external event. Medical PTSD is not well researched but seems to commonly appear in patients with cancer, stroke, chronic pain and more.

According to the American Psychiatry Association's DSM-5 Diagnostic Criteria for PTSD, people may develop PTSD if they experience a trauma firsthand; witness a traumatizing event; learn about violence or tragedy that happened to someone else–like the murder of a family member or friend; or "experience repeated or extreme exposure" to details of traumatic events, the way a first-responder might. The American Medical Association (AMA) clarifies that this criterion does not apply to exposure to media unless that media is work-related.

Not everyone who has gone through trauma will develop PTSD. But that does not mean you are weak-minded if you do. PTSD is not an indicator of strength or resilience.

More research is needed to understand what causes some people to develop PTSD. Likely, it is a combination of factors. The National Institutes of Health (NIH) notes adults may be more at risk of PTSD after trauma if they have previously experienced a childhood trauma; do not have a support system after the traumatic event; are dealing with another stressor after the event like a death or job loss; or have a history of mental illness or substance misuse.

Researchers are trying to understand how genetics, brain structure, and hormones may play a role in developing PTSD.

02 of 17

Flashbacks

Flashbacks and unwanted, intrusive memories are known as "re-experiencing symptoms," which can make a trauma survivor feel like they are reliving the traumatic event. Smells, sights, and sounds–like a car backfiring, the whirring of a helicopter, a news report, or the sound of someone's voice–can all trigger flashbacks.

"Those [triggers] go to the deep part of your brain," said Elspeth Cameron Ritchie, MD, MPH, chair of psychiatry at MedStar Washington Hospital Center and a retired military psychiatrist. "Your instincts take over."

Flashbacks can be random and vivid. You may experience a racing heart or sweat profusely when they occur.

03 of 17

Nightmares

Nightmares, or upsetting dreams about the traumatic event, are also considered re-experiencing symptoms since they can make people with PTSD feel like they are back in the time and place of their trauma.

We still don't know the exact relationship between PTSD and recurring nightmares, but they seem to create a scary cycle. A review published in November 2018 in Nature of Science and Sleep noted that nightmares can occur through any stage of sleep but often happen at later points of the night. In most cases, PTSD-related nightmares occur at the scene of the trauma or re-enact the trauma altogether. In turn, the review said, recurring nightmares can exasperate more PTSD symptoms.

Understandably, this can lead to sleep disturbance or cause someone with PTSD to try to avoid sleep altogether. Sleep disturbances and disorders like insomnia have been linked to decreased daytime function, increased anxiety and depression, and suicide risk, according to a 2013 study published in Suicide and Life-Threatening Behavior.

04 of 17

Avoiding People, Places, or Things

Many people with PTSD go out of their way to avoid anything that reminds them of the original trauma or could be a trigger. For example, someone with PTSD might stop driving after a car accident or avoid watching movies about hurricanes if they've been through one.

This avoidance can become broader than a specific person or setting, according to Nitschke. "If someone has been a victim of sexual assault, not only do they avoid that person who might still be at their university, but they might avoid men altogether, avoid going to classes," Nitschke said.

People with PTSD may also avoid their own feelings, thoughts, and memories. This type of internal avoidance may go unnoticed, according to the U.S. Department of Veterans Affairs. Some people will attempt to emotionally numb themselves with distractions or misuse of alcohol and drugs. A March 2014 systemic review published in Social Psychiatry and Psychiatric Epidemiology noted comorbid alcohol misuse in people with PTSD ranged from 9.8 to 61.3%.

A common fear is if you acknowledge your feelings, they will get worse or never go away. But support groups and different styles of talk therapies may provide you with a safe space to explore these scary feelings.

05 of 17

Being Constantly on the Lookout for Threats

This PTSD symptom is called hypervigilance. "You're scanning the environment all the time," said Dr. Ritchie, or on high alert constantly. This can be exhausting, stressful, and frightening.

That might mean always sitting with your back to the wall in restaurants or lecture halls so you can see everyone and everything taking place in front of you.

"They don't want anyone sneaking behind them," said Sonya Norman, Ph.D., director of the PTSD consultation program at the National Center for PTSD and psychiatry professor at the University of California San Diego. "They want to be ready to respond."

Like nightmares, this heightened awareness can contribute to sleep problems in people with PTSD. Falling asleep and staying asleep can be more difficult if any small noise or change wakes you up.

06 of 17

Getting Startled Easily

This symptom, sometimes called hyperarousal, is closely related to hypervigilance. People with PTSD often have an exaggerated reaction when they're surprised or startled, especially if the intrusion–a sound, smell, noise, or sight–reminds them of the original trauma. To put it lightly, this can make you extremely tense.

"Somebody comes up close behind you and you jump a mile," Nitschke explained. "Before the trauma, you wouldn't have reacted that way. Hyperarousal can interfere with sleep and concentration, and it may come out as outbursts of anger, Nitschke added.

Startling easily is a distinctive feature of PTSD and is not such a prominent symptom of other anxiety-related disorders.

07 of 17

Depression

The DSM-5, originally published in May 2013, added diagnostic criteria for PTSD that included mood-related symptoms like depression, anger, guilt, shame, and hopelessness about the future. It also noted that people with PTSD often disengage with people around them or show less interest in activities they used to love. You may feel like happiness is impossible or that no one cares for you.

"These aren't necessarily unique to PTSD, but I think there's a change after the trauma," said Norman. "Because of what they saw or what they did, or [because] they couldn't save the day, they feel a lot of guilt. It's very common to overestimate how much control they had and blame themselves."

Those emotions can lead to negative beliefs about yourself, like "It was my fault" or "If I hadn't taken that one drink," Nitschke said.

Survivors of sexual assault may also be dealing with shame. "They often feel very vulnerable and ashamed," Dr. Ritchie added. "They feel that they have contributed to it in some way."

08 of 17

Anger and Irritability

Along with guilt, shame, and sadness, adults with PTSD may feel irritable and angry. In fact, a specific type of arousal symptom is outbursts, sometimes with little or no reason behind them. This may manifest in verbal or physical aggression toward people and objects.

The U.S. Department of Veteran Affairs notes that anger can surface when you're in survival mode. People with PTSD often live constantly on edge and therefore react to even small stressors with full intensity. Adults who experienced childhood trauma may also feel anger toward what happened to them as kids.

Anger is not simply being mad. You may feel increasingly tense and alert, feel vindictive toward those around you, be late or work poorly on purpose, or even self-injure.

Cognitive behavioral therapy may help provide relief to your PTSD-related anger, or at least begin to help you learn coping mechanisms. Remember, your anger does not make you a bad person.

09 of 17

Feeling Reckless or Self-Destructive

A May 2017 study published in the Journal of Traumatic Stress found that reckless or self-destructive behavior—in this case exhibited by veterans—included substance misuse, self-harm, excessive gambling, and aggression. A study published in February 2015 in Annals of Epidemiology also noted that these behaviors could contribute to a higher risk of suicide.

Furthermore, the National Center for PTSD published research in 2017 that concluded the most common forms of "risky" behavior in people with PTSD were alcohol and drug use, drunk driving, gambling and aggression. These behaviors, researchers warned, could increase the chance for another traumatic event to occur.

10 of 17

Chronic Pain

Not everyone with PTSD has chronic pain, and not everyone with chronic pain has PTSD, but the two conditions do overlap. Between 15% and 35% of people with chronic pain also have PTSD, according to the U.S. Department of Veterans Affairs.

"We don't fully understand the relationship," said Norman. "Having your stress level in 'turbo' nonstop might just wear down your body after a while."

The trauma itself can also cause pain: headaches from a brain injury or back pain from a spinal injury, for example. But even removing physical causes from the equation, there does seem to be a higher level of chronic pain in people with PTSD than without. "This suggests that there [may be] some common neurobiological pathways," said Norman. "We don't know for sure."

Unfortunately, chronic pain in some cases reminds a person of the traumatic event, which can increase further PTSD symptoms. A November 2019 review published in Current Pain and Headaches Reports noted people with both PTSD and chronic pain were more likely to experience anxiety, depression, and opioid use.

11 of 17

Feeling Panicked

In addition to pain, people with PTSD might experience panic and the physical symptoms that accompany it: Your heart races, you sweat, your blood pressure goes up, your muscles are tense. Some people get dizzy, develop blurry vision, or hear ringing in their ears. It's not that common, but some people with PTSD feel nauseous or even vomit in response to certain triggers, like a specific smell, said Norman.

People with PTSD may experience panic attacks or later be diagnosed with a co-occuring panic disorder, according to a study published in May 2019 in Social Psychiatry and Psychiatric Epidemiology. Panic disorder is different than PTSD in that the panic attacks that come with it are often spontaneous and unrelated to a past event. But a person with PTSD may experience a similar-feeling attack where their chest gets tight or they have shortness of breath.

12 of 17

Memory Loss

Flashbacks and nightmares may force someone with PTSD to relive their trauma over and over, but they may find themselves unable to a remember a significant aspect of their experience. The DSM-5 includes this inability to remember as another PTSD symptom.

This memory loss, if not caused by a head injury or substance, is called dissociative amnesia. It's different than ordinary forgetting. According to the American Psychiatric Association (APA), three types of dissociative amnesia exist:

  • Localized amnesia, the most common type, is when you can't remember an event or period of time
  • Selective amnesia is when you can't remember a specific aspect of an event
  • Generalized amnesia is when you can't remember your identity or history
13 of 17

Guilt or Shame

PTSD can leave you in a persistent negative emotional state of guilt or shame, according to the DSM-5. We use these terms together often, but they point to different feelings. Shame is often internalized: You feel ashamed of what happened to you, you may think of yourself differently or as "less than." Guilt occurs when you have negative feelings about a behavior or action (or inaction): Feeling guilty you didn't "do more" or like you could have prevented the trauma. In other words, you blame yourself. Understandably, guilt and shame often come together with PTSD.

In fact, a study of veterans with PTSD, published in 2019 in Psychological Trauma: Theory, Research, Practice, and Policy, found that when participants reported guilt, they also reported shame.

The National Center for PTSD also notes that people with PTSD often have trouble forgiving themselves.

Cognitive therapy may help you begin to address your feelings of guilt and shame. Furthermore, the effectiveness of trauma-informed guilt reduction therapy (TrIGR), a type of intervention that focuses on guilt and shame, is currently being assessed. Evidence published in 2022 in Current Treatment Options in Psychiatry suggests TrIGR could be effective in reducing trauma-related guilt.

14 of 17

Problems Concentrating

Another arousal symptom of PTSD is having problems concentrating, according to the DSM-5.

An analysis based on data from 60 studies, published in January 2015 in Psychological Bulletin found that people with PTSD reported deficits in verbal learning, speed of information processing, attention/working memory, and verbal memory. This means you may find yourself having trouble focusing, paying attention, or remembering details.

15 of 17

Suicidal Thoughts or Ideation

Going through a trauma or living with the ramifications of PTSD, especially if it has gone untreated, can lead to suicidal thoughts and ideation.

A study published in August 2020 in the Frontiers in Psychology indicated that people with PTSD had greater instances of suicide ideation than people without PTSD.

If you or someone you know is thinking about suicide, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

16 of 17

Feeling Like You're Observing Yourself

The DSM-5 notes that an indicator of PTSD can be when people experience depersonalization and/or derealization (without substance use).

Depersonalization is when you feel detached from yourself and your emotions, possibly like you're watching yourself out of your body. The DSM-5 explains this could mean feeling like you're in a dream or that time is moving slowly.

Derealization is when you feel like your surroundings aren't exactly real. The world around you may feel dreamlike or distorted.

17 of 17

Symptoms Lasting Longer Than a Month

When symptoms last anywhere from three days up to a month after trauma, it's usually called acute stress disorder or ASD, according to the DSM-5. If the symptoms last more than a month, they're more likely to be PTSD. In both cases, medical problems, and drug or alcohol misuse, must be ruled out as underlying causes of these symptoms befor a PTSD diagnosis.

ASD often comes before PTSD, but not always. Symptoms of PTSD can appear immediately following a traumatic event, or they can appear weeks, months, or even years later.

"In many people, you've got chronic symptoms that wax and wane," said Dr. Ritchie. "In some people, they go away and in others they stay bad."

Anyone with symptoms that last longer than a month should talk to a healthcare provider about what they're experiencing. Talk therapy, medications, or both can often help alleviate PTSD symptoms.

The Bottom Line:

If you're experiencing some of these 17 PTSD symptoms, consider talking to a healthcare provider to get the help and support that is best for you.

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