Someone may have PTSD if they experience symptoms in each of the four groups — intrusive thoughts, avoidance, reactivity, and cognition and mood. Symptoms must affect daily life and last a month or more.

Post-traumatic stress disorder (PTSD) is a mental health condition that begins sometime after someone experiences or witnesses a life threatening or traumatic event or series of events. It can present with various symptoms, including a heightened sense of threat or danger, and can affect all aspects of a person’s life.

PTSD can affect anyone and occur at any time in a person’s life.

This article explains the signs and symptoms of PTSD, diagnostic criteria, how to know if someone may have PTSD, and treatment options.

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PTSD affects people differently, and not everyone will display all of the signs. Typically, symptoms begin to present around 3 months after the traumatic event. However, they can appear much later.

Symptoms of PTSD can be classified into four categories:

  • intrusion
  • arousal and reactivity
  • avoidance
  • mood and cognition

Intrusion symptoms

Intrusion symptoms include:

  • nightmares or disturbed sleep
  • thoughts of fear, anxiety, or panic
  • flashbacks or feeling as though the event is happening again

Intrusive thoughts are the primary feature of what experts classify as “intrusion” symptoms. They are undesirable, involuntary, and sometimes unexpected thoughts, ruminations, or memories may be experienced regarding the event.

According to the Anxiety and Depression Association of America (ADAA), a person may experience intrusive thoughts as being “stuck” in their mind, in a way that the person finds distressing. Intrusive thoughts do not necessarily reflect a person’s conscious desires, and most people do not act on them. However, some people may feel shame or confusion about their intrusive thoughts.

According to older research from 2017, intrusive thoughts are a common symptom of PTSD.

Arousal and reactivity symptoms

This classification of symptoms concerns how a person responds to stimuli, including social interactions with other people, environmental stimuli or events, and their own thoughts or memories. Symptoms include:

  • difficulty sleeping
  • irritability
  • unprovoked angry outbursts
  • engaging in behavior that may be harmful or dangerous
  • constantly being on the lookout for danger or hypervigilance
  • an exaggerated startle response
  • hypersensitivity to possible threats
  • feeling anxious, pensive, or tense

Avoidance symptoms

Avoidance is one of the main categories of PTSD symptoms. Many people living with PTSD will consciously seek to avoid things that remind them of their trauma in any way. These avoidant behaviors may include:

  • refusing to discuss the event or their feelings around it
  • avoiding situations, people, activities, objects, or places that remind the person of the event or feelings and thoughts they associate with it
  • trying to avoid remembering or thinking about the event

People exhibiting avoidant behaviors may seek to distract themselves by focusing their attention on other interests or projects, such as their career or hobbies.

Mood and cognition symptoms

People with PTSD typically experience effects on their patterns of cognition and mood, including:

  • having trouble focusing
  • inability to remember an important aspect of the traumatic event
  • persistent, exaggerated negative beliefs about oneself or the world
  • consistent distorted thoughts about the event/s that cause someone to blame themself or others
  • frequently negative emotional state, such as feeling afraid, guilty, or angry
  • persistently feeling unable to experience positive emotions
  • not being able to recall the event or aspects of it thoroughly
  • feelings of detachment, isolation from others, and emotional numbness
  • no longer taking interest or pleasure in things that someone previously enjoyed
  • other mental health issues, such as depression or anxiety

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), in order to receive a diagnosis of PTSD, a person must have experienced a life threatening event, trauma, or event that threatened serious injury in one or more of these ways:

  • directly experiencing the traumatic event or events
  • discovering the traumatic event or events occurred to a loved one or close family member, if the traumatic event was an accident or was violent in nature
  • witnessing the traumatic event or events first-hand
  • repeatedly experiencing exposure to details of a traumatic event, such as experienced by emergency personnel or military members

In addition to this, mental health and healthcare professionals will only deliver a diagnosis of PTSD if a person experiences each of the following after the event or events occurred for a duration of more than 1 month:

  • one or more intrusion symptoms
  • persistent avoidance symptoms
  • two or more symptoms of negative alterations to mood and thought
  • two more arousal and reactivity symptoms

The symptoms must be causing the person distress or impeding their functioning in social, occupational, or professional situations.

As well as this, their symptoms must not be attributable to another health condition or the use of medications or other substances, such as recreational drugs and alcohol.

Anyone who believes they may have PTSD can take a self-screening assessment online. These questionnaires can help an individual understand if their symptoms may be the result of PTSD.

However, only a mental health or healthcare professional can give an official diagnosis of PTSD.

If a person believes they may be experiencing symptoms of PTSD, they should contact a mental health or healthcare professional.

A healthcare or mental health professional can assess a person’s symptoms and rule out any other underlying medical or mental health conditions that may be causing them.

Treatment options for PTSD typically involve psychotherapy, medication, or a combination of the two.


Specific therapy treatments available to help treat PTSD include the following types of cognitive behavioral therapy (CBT):

  • Cognitive processing therapy (CPT): CPT, or cognitive restructuring, encourages and instructs people to change how they view events in their minds. Intentionally creating mental imagery of the traumatic event or events may help someone to process trauma and manage their anxiety and discomfort.
  • Prolonged exposure therapy (PE): PE teaches those living with PTSD to form a relationship with their thoughts and feelings about a traumatic event by approaching them in a controlled manner.


Doctors may also prescribe medicines to treat symptoms of PTSD. According to the U.S. Department of Veterans Affairs (VA), the most common medications to treat PTSD are certain types of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs):

  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)
  • venlafaxine (Effexor)

The following are some questions people frequently ask about PTSD.

What are 5 signs of PTSD?

Signs and symptoms of PTSD include avoidant behaviors, intrusive thoughts, negatively altered mood and cognition, hypervigilance and reactivity to stimuli, and physical symptoms such as shaking, sweating, or disturbed sleep.

What to do when PTSD is triggered?

If a person experiences a flashback or intrusive thoughts when something triggers their PTSD, they can try to manage their emotional response until the feelings subside by:

  • establishing a safe and calm environment for themselves where they feel relaxed
  • practicing deep breathing
  • reaching out to loved ones for support
  • referring to their self-care plan, if they have developed one with their care team

PTSD can happen to anyone at any time after a traumatic event or series of events and can affect a person’s life significantly.

If a person displays one or more symptoms of each of the four groups of symptoms over a month and finds it makes it difficult for them to function in relationships or fulfill their daily responsibilities, they may meet the criteria for a PTSD diagnosis.

Anyone who thinks they may have PTSD should speak to a mental health or healthcare professional to receive a proper diagnosis and treatment.