PTSD: symptoms, causes, treatment and how long it lasts

NHS inform groups the symptoms into four areas. People may relive the event through nightmares, flashbacks, intrusive thoughts or images, or physical sensations such as pain, sweating, nausea or trembling. They may feel on edge, with panic when reminded, irritability, sleep problems, poor concentration and a jumpy, easily startled state.

They may avoid reminders: people, places, talking about it, or filling every moment with work and distraction. Some feel numb or cut off, or unable to recall details. Finally there can be difficult beliefs and feelings: that nowhere is safe, that nobody can be trusted, that it was their fault, with overwhelming anger, sadness, guilt or shame.

The NHS also lists repeated headaches, tummy problems or pain without a physical cause, and feeling disconnected from yourself and the world, known as dissociation. In children, NHS inform and the NHS describe bedwetting that is new, re-enacting the event through play, nightmares about monsters, extra anxiety about separation, loss of interest in favourite things and frequent tummy aches or headaches.

After a terrifying event, many people feel shaken, tearful, on edge or unable to sleep. For most these reactions ease within weeks. PTSD is diagnosed when the distress persists or returns and interferes with daily life. It is not a sign of weakness, and it does not depend on how strong or resilient someone is.

NICE guideline NG116 covers recognising, assessing and treating PTSD in children, young people and adults, including complex PTSD. The guideline describes events that may be single, repeated or multiple, and that can include serious accidents, physical and sexual assault, abuse including childhood or domestic abuse, work-related exposure to trauma, serious illness or childbirth experiences such as intensive care admission or neonatal death, war and conflict, and torture.

NHS inform says that if symptoms have lasted under 4 weeks or are mild, a GP may suggest watchful waiting, with a follow-up within a month. NICE similarly suggests considering active monitoring for subthreshold symptoms within a month of the event. A self-help guide for mild-to-moderate symptoms is also available through NHS inform.

For adults who present more than a month after a traumatic event, NICE recommends individual trauma-focused CBT, which can include cognitive processing therapy, cognitive therapy for PTSD, narrative exposure therapy or prolonged exposure therapy. NHS inform gives a typical course as 8 to 12 weekly sessions of 60 to 90 minutes with the same therapist, though fewer may be needed.

NICE recommends EMDR for adults more than 3 months after a non-combat trauma, and says it can be considered between 1 and 3 months if the person prefers it. In EMDR, rhythmic eye movements, or taps and tones, are used while the person describes the memory. Supported computerised trauma-focused CBT may be considered for some adults who prefer it and do not have severe dissociative symptoms or risk of harm.

• Children and young people are usually offered individual trauma-focused CBT adapted to their age, typically over 6 to 12 sessions according to NICE, with parents or carers involved where suitable.

• NICE says to consider venlafaxine or an SSRI such as sertraline if an adult prefers drug treatment, and to review it regularly.

• NICE says to consider an antipsychotic such as risperidone, started by a specialist, only for disabling symptoms that have not responded to other treatments.

• NHS inform says medicine is not regularly used and may be considered if someone cannot or will not try talking therapy, also has depression, or has sleep problems.

• The NHS stresses not to stop a PTSD medicine unless a doctor says so, even if you feel better, and to talk to your doctor if you are pregnant or planning a pregnancy.

The NHS says a GP will ask about your symptoms and will usually refer you to a mental health specialist, such as a talking therapies service or a psychiatrist. The specialist asks about mood, behaviour, health and family history.

NICE tells clinicians to ask specific questions about re-experiencing, avoidance, hyperarousal, dissociation, negative changes in mood and thinking, and the impact on daily functioning, and to ask about traumatic events that may have happened many months or years before. You do not have to describe the event in detail at a first appointment.

The NHS says symptoms may appear straight after the event, or many months or even years later. NHS inform says upsetting thoughts after trauma are normal and usually improve over a few weeks, and that problems continuing about 4 weeks after the event should be raised with your GP practice.

The NHS says PTSD usually gets better for most people, though symptoms can be more severe and last longer for some. NHS inform adds that it can be treated even if it develops many years after the event. Recovery rarely means forgetting what happened. It tends to mean the memories lose their grip, sleep improves and daily life opens up again.

Therapy may include planned booster sessions, particularly around dates such as anniversaries, according to NICE. If one treatment does not help, it is reasonable to ask about another. When PTSD and depression occur together, NICE says clinicians should usually treat the PTSD first because the depression often improves as PTSD treatment succeeds.

The NHS and NHS inform describe signs in children that differ from adults: new bedwetting, re-enacting the event through play, nightmares about monsters, extra anxiety about being separated from a parent, loss of interest in favourite things, and frequent tummy aches or headaches.

NICE says children and young people with PTSD are usually offered individual trauma-focused CBT adapted to their age, typically over 6 to 12 sessions, with parents or carers involved where suitable. NHS inform says medicine is not usually recommended for children. If you are worried about a child, speak to a GP or your child's school, which are the usual starting points for children's mental health support.

The NHS says complex PTSD (CPTSD) has symptoms that are largely the same as PTSD but different causes. It is linked with trauma that is prolonged or repeated, for example child abuse or neglect, ongoing domestic violence or abuse, and repeatedly witnessing violence or abuse.

NICE asks clinicians to be aware that people with PTSD, including complex PTSD, may have problems with emotional regulation, relationships and self-perception, such as feeling diminished, defeated or worthless. Because the picture can be broader, NICE also has a section on care for people who have PTSD together with other complex needs.

See a GP if you think you have symptoms of PTSD, or if you have been diagnosed and treatment is not helping. If you are worried about someone else, encourage them to speak to their GP. NHS talking therapies for anxiety and depression can help with PTSD, and eligible adults can self-refer.

If you or someone you know is in a mental health crisis or emergency, or at risk of suicide or self-harm, get urgent help. In an emergency call 999, or contact NHS 111 and choose the mental health option where it is offered. Children and young people under 18 have their own NHS routes for mental health support, usually starting with a GP or school.

The NHS suggests talking to a friend, a family member or an online support group, keeping a diary to spot triggers for flashbacks such as certain smells or sounds, trying breathing exercises, staying active, eating a balanced diet and getting enough sleep. A mental health professional can teach grounding and coping skills for flashbacks.

The NHS advises not using recreational drugs, not smoking and not drinking too much alcohol. NICE adds that benzodiazepines and other drugs should not be offered to prevent PTSD. Charities such as Mind, Combat Stress for veterans, Rape Crisis and Victim Support give information and support, and many run peer groups.

On the NHS, adults can self-refer to NHS talking therapies, or see a GP who may refer you to a mental health specialist. The NHS and NICE describe trauma-focused CBT and EMDR as the main treatments, delivered by trained therapists.

Private psychologists and therapists also offer trauma-focused CBT and EMDR. Check the therapist is registered with a professional body, ask whether they use a NICE-recommended trauma-focused approach, and ask how many sessions are expected and what the total cost would be.