Patient Education

Post-traumatic stress disorder (PTSD) PRINT BACK

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that can developafter a person is exposed to a frightening event or ordeal in which severe physicalharm occurred or was threatened. PTSD can affect those directly involved in atraumatic event in addition to those who witness or are closely affected by it.Approximately 8 million American adults age 18 and older suffer with PTSD eachyear. The disorder can affect anyone at any age, including children.

For most people, PTSD starts within approximately three months of the traumatic event. However,for some people, signs of PTSD don’t show up until years later. Some people even forget abouttheir traumatic experience for extended periods of time.

Traumatic events that can trigger PTSD include violent personal assaults, natural or human-causeddisasters, accidents, terrorist incidents, a loved one’s sudden death, military combat and similartraumas.


When symptoms of PTSD appear, they fall into one or more of three categories: re-experiencing,avoidance and hyper-arousal.

  • Re-experiencing: Thoughts, images and emotions associated with the traumatic eventcontinue to intrude into the person’s life in the form of memories, nightmares andflashbacks. These intrusions are terrifying and seemingly unavoidable. They can occur atany time of the day or night. Sometimes they’re triggered by sounds, smells, emotions orsituations that are reminiscent of the event.
  • Avoidance: People who’ve been traumatized tend to avoid reminders of the event.Certain situations, emotions and relationships can be reminders of the trauma, producingintense anxiety and fear. A combat veteran, for instance, may be unable to attendfireworks displays because they remind her of her war experience. Traumas almost alwaysgenerate grief and sadness, as well as anger. These feelings can cause someone to shutdown to avoid the intense pain. The "emotional anesthesia" that results may make it difficultfor someone with post-traumatic stress disorder to develop or maintain close relationshipswith others.
  • Hyper-arousal: Anxiety can become a real problem for people who suffer from posttraumaticstress disorder. Their nervous systems seem to be in a constant flurry. Their heartsrace and their blood pressure reaches unhealthy levels. They may have difficultyconcentrating or suffer from insomnia. They can be easily startled, irritated or angered,which can lead to deteriorating relationships.

The increased social and emotional withdrawal from others that PTSD tends to promote can leadto depression. Alcohol and substance use is a common way for PTSD sufferers to try to reduce theiranxiety or depression. But the relief is often temporary at best, and they may find themselvesstruggling with both PTSD and a substance abuse problem.

Sleep and PTSD

It is well known that sleep problems are one of many challenges for those suffering with PTSD. Sleepproblems such as difficulty falling asleep, waking frequently, and having distressing dreams ornightmares are common. Getting a good night’s sleep can be very difficult when a continuedstate of hyper-arousal or “watchfulness” is present. If you are having sleep problems due to PTSD,©2015 Magellan Health,’s important to let your doctor or mental health professional know that you have trouble sleeping.Describe exactly what the problems are. Also report any physical problems that may becontributing to your sleep problems. For example, chronic pain associated with traumatic injuriescan cause trouble sleeping.


It’s important to know that feeling depressed, guilty, angry and/or stressed out is common after atraumatic event. If such difficult symptoms are continuing, contact your physician or a mentalhealth professional who specializes in assisting people who have been traumatized. Treatment forPTSD can be quite effective, and can include some or all of the following components.

  • Cognitive-behavioral psychotherapy –Healing often occurs with reliving the memory of thetrauma in the context of a supportive therapeutic relationship and ultimately with achange in the personal meaning of the traumatic event. Treatment tends to focus onhelping people regain a sense of control and safety, while reducing feelings of anxiety.People are encouraged to talk about what happened, and examine feelings of rage, selfblameor guilt. Each person with PTSD is treated according to individual symptoms andneeds. A therapist teaches skills that can make the memory of trauma more tolerable.People may learn how to manage anger and rage, or how to express grief. Relaxation skillshelp people cope with anxiety.
  • EMDR - Eye movement desensitization and reprocessing (EMDR) is a treatment procedurethat involves using systematic eye movements to help someone with PTSD reduce thepower of emotionally charged memories of past traumatic events.
  • Family therapy – This can help close relatives understand and cope better with a familymember’s PTSD problems, which may include the apparent rejection of loved ones and/ordeteriorating communication.
  • Medication – A physician may prescribe an FDA-approved antidepressant such assertraline (Zoloft) or paroxetine (Paxil). These support psychotherapy by controlling PTSDsymptoms like sadness, worry and anger. Medication may only be required for a fewweeks, but in some cases it may be needed for several years.
  • Peer support – People struggling with PTSD meet with other survivors of traumatic events,benefitting from the shared experience and emotions as part of helping each other regainconfidence.

Learn more about PTSD

Anxiety and Depression Association of America

U.S. Department of Veterans Affairs – National Center for PTSD

National Institute of Mental Health


This article is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Blue Shield of California does not endorse other resources that may be mentioned here.