Posttraumatic Stress Disorder?
Center for PTSD Fact Sheet
Posttraumatic Stress Disorder, or
PTSD, is a psychiatric disorder that can occur following the
experience or witnessing of life-threatening events such as
military combat, natural disasters, terrorist incidents, serious
accidents, or violent personal assaults like rape. Most
survivors of trauma return to normal given a little time.
However, some people will have stress reactions that do not go
away on their own, or may even get worse over time. These
individuals may develop PTSD. People who suffer from PTSD often
relive the experience through nightmares and flashbacks, have
difficulty sleeping, and feel detached or estranged, and these
symptoms can be severe enough and last long enough to
significantly impair the person's daily life.
PTSD is marked by clear biological
changes as well as psychological symptoms. PTSD is complicated
by the fact that it frequently occurs in conjunction with
related disorders such as depression, substance abuse, problems
of memory and cognition, and other problems of physical and
mental health. The disorder is also associated with impairment
of the person's ability to function in social or family life,
including occupational instability, marital problems and
divorces, family discord, and difficulties in parenting.
PTSD is not a new disorder. There
are written accounts of similar symptoms that go back to ancient
times, and there is clear documentation in the historical
medical literature starting with the Civil War, when a PTSD-like
disorder was known as "Da Costa's Syndrome." There are
particularly good descriptions of posttraumatic stress symptoms
in the medical literature on combat veterans of World War II and
on Holocaust survivors.
Careful research and documentation
of PTSD began in earnest after the Vietnam War. The National
Vietnam Veterans Readjustment Study estimated in 1988 that the
prevalence of PTSD in that group was 15.2% at that time and that
30% had experienced the disorder at some point since returning
PTSD has subsequently been observed
in all veteran populations that have been studied, including
World War II, Korean conflict, and Persian Gulf populations, and
in United Nations peacekeeping forces deployed to other war
zones around the world. There are remarkably similar findings of
PTSD in military veterans in other countries. For example,
Australian Vietnam veterans experience many of the same symptoms
that American Vietnam veterans experience.
PTSD is not only a problem for
veterans, however. Although there are unique cultural- and
gender-based aspects of the disorder, it occurs in men and
women, adults and children, Western and non-Western cultural
groups, and all socioeconomic strata. A national study of
American civilians conducted in 1995 estimated that the lifetime
prevalence of PTSD was 5% in men and 10% in women. A revision of
this study done in 2005, reports that PTSD occurs in about 8% of
How does PTSD develop?
Most people who are exposed to a
traumatic, stressful event experience some of the symptoms of
PTSD in the days and weeks following exposure. Available data
suggest that about 8% of men and 20% of women go on to develop
PTSD, and roughly 30% of these individuals develop a chronic
form that persists throughout their lifetimes.
The course of chronic PTSD usually
involves periods of symptom increase followed by remission or
decrease, although some individuals may experience symptoms that
are unremitting and severe. Some older veterans, who report a
lifetime of only mild symptoms, experience significant increases
in symptoms following retirement, severe medical illness in
themselves or their spouses, or reminders of their military
service (such as reunions or media broadcasts of the
anniversaries of war events).
How is PTSD assessed?
In recent years, a great deal of
research has been aimed at developing and testing reliable
assessment tools. It is generally thought that the best way to
diagnose PTSD-or any psychiatric disorder, for that matter-is to
combine findings from structured interviews and questionnaires
with physiological assessments. A multi-method approach
especially helps address concerns that some patients might be
either denying or exaggerating their symptoms.
How common is PTSD?
An estimated 7.8 percent of
Americans will experience PTSD at some point in their lives,
with women (10.4%) twice as likely as men (5%) to develop PTSD.
About 3.6 percent of U.S. adults aged 18 to 54 (5.2 million
people) have PTSD during the course of a given year. This
represents a small portion of those who have experienced at
least one traumatic event; 60.7% of men and 51.2% of women
reported at least one traumatic event. The traumatic events most
often associated with PTSD for men are rape, combat exposure,
childhood neglect, and childhood physical abuse. The most
traumatic events for women are rape, sexual molestation,
physical attack, being threatened with a weapon, and childhood
About 30 percent of the men and
women who have spent time in war zones experience PTSD. An
additional 20 to 25 percent have had partial PTSD at some point
in their lives. More than half of all male Vietnam veterans and
almost half of all female Vietnam veterans have experienced
"clinically serious stress reaction symptoms." PTSD
has also been detected among veterans of the Gulf War, with some
estimates running as high as 8 percent.
Who is most likely to develop PTSD?
1. Those who experience greater
stressor magnitude and intensity, unpredictability,
uncontrollability, sexual (as opposed to nonsexual)
victimization, real or perceived responsibility, and betrayal
2. Those with prior vulnerability
factors such as genetics, early age of onset and longer-lasting
childhood trauma, lack of functional social support, and
concurrent stressful life events
3. Those who report greater
perceived threat or danger, suffering, upset, terror, and horror
4. Those with a social environment
that produces shame, guilt, stigmatization, or self-hatred
What are the consequences
associated with PTSD?
PTSD is associated with a number of
distinctive neurobiological and physiological changes. PTSD may
be associated with stable neurobiological alterations in both
the central and autonomic nervous systems, such as altered
brainwave activity, decreased volume of the hippocampus, and
abnormal activation of the amygdale. Both the hippocampus and
the amygdale are involved in the processing and integration of
memory. The amygdale has also been found to be involved in
coordinating the body's fear response.
Psycho physiological alterations
associated with PTSD include hyper-arousal of the sympathetic
nervous system, increased sensitivity of the startle reflex, and
People with PTSD tend to have
abnormal levels of key hormones involved in the body's response
to stress. Thyroid function also seems to be enhanced in people
with PTSD. Some studies have shown that cortical levels in those
with PTSD are lower than normal and epinephrine and nor epinephrine
levels are higher than normal. People with PTSD also continue to
produce higher than normal levels of natural opiates after the
trauma has passed. An important finding is that the neuro
hormonal changes seen in PTSD are distinct from, and actually
opposite to, those seen in major depression. The distinctive
profile associated with PTSD is also seen in individuals who
have both PTSD and depression.
PTSD is associated with the
increased likelihood of co-occurring psychiatric disorders. In a
large-scale study, 88 percent of men and 79 percent of women
with PTSD met criteria for another psychiatric disorder. The
co-occurring disorders most prevalent for men with PTSD were
alcohol abuse or dependence (51.9 percent), major depressive
episodes (47.9 percent), conduct disorders (43.3 percent), and
drug abuse and dependence (34.5 percent). The disorders most
frequently co morbid with PTSD among women were major depressive
disorders (48.5 percent), simple phobias (29 percent), social
phobias (28.4 percent), and alcohol abuse/dependence (27.9
PTSD also significantly impacts
psychosocial functioning, independent of co morbid conditions.
For instance, Vietnam veterans with PTSD were found to have
profound and pervasive problems in their daily lives. These
included problems in family and other interpersonal
relationships, problems with employment, and involvement with
the criminal justice system.
complaints, immune system problems, dizziness, chest pain, and
discomfort in other parts of the body are common in people with
PTSD. Often, medical doctors treat the symptoms without being
aware that they stem from PTSD.
How is PTSD treated?
PTSD is treated by a variety of
forms of psychotherapy (talk therapy) and drug therapy. There is
no definitive treatment, but some treatments appear to be quite
promising, especially cognitive-behavioral therapy, group
therapy, and exposure therapy. Exposure therapy involves having
the patient repeatedly relive the frightening experience under
controlled conditions to help him or her work through the
trauma. Studies have also shown that medications help ease
associated symptoms of depression and anxiety and help with
sleep. The most widely used drug treatments for PTSD are the
selective serotonin reuptake inhibitors, such as Prozac and
Zoloft. At present, cognitive-behavioral therapy appears to be
somewhat more effective than drug therapy. However, it would be
premature to conclude that drug therapy is less effective
overall since drug trials for PTSD are at a very early stage.
Drug therapy appears to be highly effective for some individuals
and is helpful for many more. In addition, the recent findings
on the biological changes associated with PTSD have spurred new
research into drugs that target these biological changes, which
may lead to much increased efficacy.
Related Fact Sheets
Information about rates of PTSD in
the United States among different populations
for veterans with PTSD
Answers to some questions about
PTSD and service-connected disability that are frequently
asked by veterans and their families
A fact sheet about the risk
factors for adverse outcomes in natural and human-caused
Information on available
treatments for PTSD