Signs and Symptoms of PTSD
In a person with PTSD, symptoms can be triggered by anything that leads the person to feel threatened, whether it’s real or perceived danger. Triggers may include a noise, a smell, or a song.
There are four main symptom clusters associated with PTSD. All of these symptoms must be experienced for at least one month to receive a diagnosis.
1. Reexperiencing the Event
Intrusive memories, which are memories about the trauma that happen in response to a triggering stimulus (like a taste or a smell), can come back at any time, and an individual may feel as though they are reexperiencing the trauma again. Physical symptoms can include sweating and a racing heart.
In severe cases, one may reexperience the event by having flashbacks, in which the person may momentarily feel like they are back at the time when the event occurred.
People with PTSD can also experience dreams and nightmares about the trauma.
“These cause a lot of distress for people, and they often try to find ways to manage their emotions when this happens,” says Michele Pole, PhD, clinic director at West Chester University’s department of community mental health services in West Chester, Pennsylvania.
2. Avoidance
People with PTSD will actively try to avoid thoughts, feelings, people, places, or situations that remind them of the trauma. They may also avoid talking about their trauma with others.
For example, if the person was in a serious car accident, he or she may drive several miles out of the way to avoid the intersection where that traumatic event occurred.
Avoidance can lead to unhealthy behaviors. People may start to drink or use drugs or use either one more frequently, Pole says. “It’s a way to self-medicate [and] avoid feeling the feelings that come up after somebody experiences trauma,” she says.
3. Arousal and Reactivity
Feelings of hypervigilance or arousal occur when people with PTSD become stuck in fight-or-flight mode and their nervous system remains on high alert at all times.
“An individual scans the environment for danger because there’s this fear that danger is around any corner,” Dr. Pole says.
People with PTSD who experience the symptom of hypervigilance also may have an increased startle response, may have trouble with concentration, and may experience sleep problems. They may also engage in destructive behaviors or have aggressive outbursts.
4. Mood and Cognitive Changes
People with PTSD may have a shift in the way they view the world, themselves, and others. They may have more negative thoughts and feelings, and they may feel like they can’t trust other people or themselves. “They may decide the world is not a safe place,” Pole says.
It’s also common for people with PTSD to feel shame. In an effort to make sense of the event, they blame themselves. They may falsely believe that it’s their fault, or that they can make sure it doesn’t happen again, which may be particularly true of women who are victims of sexual assault.
People may feel shame because they believe they weren’t strong enough to stop the trauma. “It’s a way to feel that they have some control over what happened to them. But what that shame does is keep them stuck,” Pole says.
Other mood and cognition symptoms of PTSD include difficulty remembering certain parts of the trauma, feelings of isolation and detachment, decreased interest in activities you once enjoyed, and difficulties experiencing positive emotions. These symptoms can be especially challenging to cope with because they are not easy to diagnose.