PTSD: symptoms, treatment and how to get help

The treatment that is recommended depends on how soon after the event you are and whether you are an adult or a child. The NHS says a mental health professional will help you learn and practise skills for managing symptoms such as flashbacks, and NICE guideline NG116 sets out the options.

For mild or recent symptoms, NHS inform describes watchful waiting with a follow-up within a month, and NICE says active monitoring can be considered for subthreshold symptoms within 1 month of a traumatic event. For adults with PTSD who present more than a month after the trauma, NICE recommends an individual trauma-focused CBT intervention, typically over 8 to 12 sessions but more if clinically indicated, for example after multiple traumas. Examples are cognitive processing therapy, cognitive therapy for PTSD, narrative exposure therapy and prolonged exposure.

NICE recommends EMDR (eye movement desensitisation and reprocessing) for adults who present more than 3 months after non-combat-related trauma, also typically over 8 to 12 sessions, and considers it between 1 and 3 months if the person prefers it. For children and young people aged 7 to 17 it recommends trauma-focused CBT, typically over 6 to 12 sessions, with EMDR considered only if they do not respond to or engage with it.

For people with additional needs, including complex PTSD, NICE says to build in extra time to develop trust by increasing the duration or number of therapy sessions according to need, and to take into account safety and stability in their circumstances.

Medicines are secondary to talking therapy. NICE says to consider venlafaxine or an SSRI such as sertraline for adults if they prefer drug treatment, with regular review, and not to offer drug treatments for PTSD to children and young people under 18. It advises against benzodiazepines to prevent PTSD.

The NHS stresses not stopping a PTSD medicine unless a doctor says so, even if you feel better, and says some medicines are unsafe in pregnancy, so tell your doctor if you are pregnant or planning a pregnancy.

The NHS describes symptoms in several groups. Avoidance includes staying away from people or places that remind you of the event. Mood and thinking can change, with negative beliefs about yourself, lost interest in usual activities, disconnection or dissociation, and difficulty controlling or feeling emotions. Hypervigilance means feeling very anxious and looking for danger all the time. Sleep is often disrupted, and some people have headaches, tummy problems or pain without a physical cause.

Children can show it differently. The NHS lists dreams about the event that become nightmares about monsters, re-enacting the trauma through play, sleep problems such as refusing to sleep alone, bedwetting they did not have before, loss of interest in things they enjoyed, talk of death or dying, and frequent tummy aches and headaches.

PTSD is a mental health condition that can follow very stressful, frightening or distressing events. The NHS says the main symptom is repeatedly having distressing thoughts about the event or experience, which may appear as flashbacks, vivid or intrusive images, and recurring dreams or nightmares. NHS inform describes a flashback as feeling like the event is happening now.

It is a recognised reaction rather than a sign of weakness. NHS inform notes that it is normal to have upsetting and confusing thoughts after a traumatic event, and that in most cases they improve after a few weeks. PTSD is the term used when the reactions persist or become disabling. The NHS also describes complex PTSD (CPTSD), which has largely the same symptoms but different causes.

The NHS lists a serious or life-threatening accident, physical or sexual assault, abuse including childhood or domestic abuse, certain jobs such as police, paramedic or healthcare work, serious health problems such as intensive care, a difficult birth or a baby dying, and war. You may have experienced the event yourself, seen it happen to someone else, or heard about it happening to someone close to you.

NHS inform adds examples such as kidnap, natural disasters, being diagnosed with a life-threatening condition and traumatic childbirth. NICE says that exposure can be to single, repeated or multiple events, and includes work-related exposure and remote exposure. The NHS says complex PTSD can follow child abuse or neglect, ongoing domestic violence or abuse, and repeatedly witnessing violence or abuse.

PTSD is not an emergency in itself, but crisis can happen. If you are at immediate risk of harming yourself, the NHS says to get urgent help for a mental health crisis; if you cannot keep yourself safe, call 999 or go to A&E.

NHS inform advises contacting your GP practice if you or your child are still having problems about 4 weeks after the traumatic experience, or earlier if symptoms are particularly troublesome, and the NHS advises seeing a GP if you have been diagnosed and treatment is not helping.

NHS inform says to contact your GP practice if you or your child are still having problems about 4 weeks after the traumatic experience, or if the symptoms are particularly troublesome. The NHS advises seeing a GP if you think you have PTSD or if you have been diagnosed and treatment is not helping. NHS talking therapies can help, and in many areas adults can refer themselves directly without a GP referral.

A GP will ask about symptoms and will usually refer to a mental health specialist such as a talking therapies service or psychiatrist. NICE guidance says GPs take responsibility for assessment and initial coordination of care, that assessment should be comprehensive and include a risk assessment, and that treatment should not be delayed solely because of court proceedings or compensation claims. If you are at immediate risk, the NHS says to get urgent help for a mental health crisis.

The NHS suggests talking to someone you trust or joining a support group, keeping a diary to spot triggers for flashbacks, trying breathing exercises, staying active, eating well and getting enough sleep. It advises avoiding recreational drugs, smoking and heavy alcohol use. Charities named by the NHS include Mind, Anxiety UK, the Mental Health Foundation and Combat Stress for veterans and their families.

These measures support professional treatment rather than replace it. The NHS says a mental health professional will help you learn and practise skills for managing symptoms such as flashbacks.