What Are the Signs and Symptoms of Post-Traumatic Stress Disorder, or PTSD?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association, PTSD is characterized by a distinct set of signs and symptoms that are grouped into four major categories: intrusion; avoidance; changes in thinking and mood; and arousal. The person must be experiencing symptoms from each category to meet the criteria for PTSD.

Intrusion Symptoms

PTSD may cause many unwanted, intrusive thoughts and experiences, including: 

• Unwanted, upsetting memories of the trauma
• Nightmares related to the trauma 
• Flashbacks (re-experiencing the trauma: this can be accompanied by a dissociative state, in which the person feels as if they are reliving the trauma real-time)
• Extreme emotional distress such as terror, panic attacks and even hallucinations when exposed to reminders of the traumatic event (for example, a domestic abuse survivor who hears a man shouting at his spouse.)
• Intense physical reactions such as nausea, vomiting, tremors, tingling, shortness of breath or chest pain when exposed to reminders of the traumatic event. 

Avoidance Symptoms

A person with PTSD will often go to enormous lengths to avoid:

• Distressing memories, thoughts, or feelings about the trauma. They may refuse to talk about what happened or even admit that it occurred (for instance, a victim of sexual assault who denies that she was raped. )
• External reminders, including people, places, activities, or situations that remind them of the trauma or bring up distressing memories of the event. This can include the actual location of the trauma (for example, a street corner where an accident occurred), places similar to the location (for example, all hospitals) or any person or situation that evokes sounds, smells or visual cues associated with the traumatic event.  

Changes in Thinking or Mood

This category includes a wide variety of cognitive, emotional and behavioral changes, including:

• Inability to recall important details of the traumatic event
• Inappropriately blaming oneself or others for what occurred
• Withdrawing from friends and loved ones
• Persistent negative emotions, such as anger, fear, guilt or shame
• Inability to enjoy once pleasurable activity
• Persistently low self-esteem or feelings of worthlessness
• A persistently negative view of oneself and the world (e.g. feeling unsafe, powerless, distrustful and/or hopeless to affect what happens in one’s life. 

Arousal Symptoms

Symptoms or arousal and hyper-reactivity include:

• Inappropriate anger, irritability or aggression
• Hypervigilance — a state of always being alert to dangers around you, even when none exist
• Extremely risky of self-destructive behavior
• An exaggerated startle response
• Difficulty sleeping
• Trouble concentrating 

Importantly, these symptoms must be preceded by exposure to a traumatic event or events that involve the threat of death, actual or threatened serious injury; or actual or threatened sexual violence. This can occur in any of the following ways:

• Direct exposure 
• Witnessing a trauma
• Learning that a relative or close friend was exposed to a trauma
• Indirect exposure to the trauma, usually in the course of professional duties (e.g., first responders, doctors, and nurses)

Sources

“Trauma-Informed Care in Behavioral Health Services”. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/ 

“Dissociative disorders”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/symptoms-causes/syc-20355215 

“Hypervigilance: What you need to know”. MedNewsToday. https://www.medicalnewstoday.com/articles/319289