Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. In this article, we will describe how PTSD is diagnosed and treated.
Diagnose post-traumatic stress disorder (PTSD)
To diagnose post-traumatic stress disorder, your doctor will:
- Perform a physical exam to check for medical problems that may be causing your symptoms
- Do a psychological evaluation that includes a discussion of your symptoms and the event that led up to these symptoms
- Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders
Diagnosis of PTSD requires exposure to an event that involved the actual threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:
- You directly experienced the traumatic event
- You witnessed, in person, the traumatic event occurring to others
- You learned someone close to you experienced or was threatened by the traumatic event
- You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)
You may have PTSD if the problems you experience after this exposure continue for more than a month and cause significant problems in your ability to function in social and work settings and negatively impact relationships.
Treating post-traumatic stress disorder
Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but can also include medication. The treatment will help improve your symptoms by:
- Teaching you skills to address your symptoms
- Helping you think better about yourself, others and the world
- Learning ways to cope if any symptoms arise again
- Treating other problems often related to traumatic experiences, such as depression, anxiety, or misuse of alcohol or drugs
You don’t have to try to handle the burden of PTSD on your own.
Several types of psychotherapy, also called talk therapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:
- Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative beliefs about yourself and the risk of traumatic things happening again. For PTSD, cognitive therapy often is used along with exposure therapy.
- Exposure therapy. This behavioral therapy helps you safely face both situations and memories that you find frightening so that you can learn to cope with them effectively. Exposure therapy can be particularly helpful for flashbacks and nightmares. One approach uses virtual reality programs that allow you to re-enter the setting in which you experienced trauma.
- Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to them.
Your therapist can help you develop stress management skills to help you better handle stressful situations and cope with stress in your life.
All these methods can help you gain control of lasting fear after a traumatic event. You and your mental health professional can discuss what type of therapy or combination of therapies may best meet your needs.
You may try individual therapy, group therapy or both. Group therapy can offer a way to connect with others going through similar experiences.
Several types of medications can help improve symptoms of PTSD:
- Antidepressants. These medications can help symptoms of depression and anxiety. These medications can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
- Anti-anxiety medications. These drugs can relieve severe anxiety and related problems. Some anti-anxiety medications have the potential for abuse, so they are generally used only for a short time.
- Prazosin. While several studies indicated that prazosin (Minipress) may reduce or suppress nightmares in some people with PTSD, a more recent study showed no benefit over placebo. But participants in the recent study differed from others in ways that potentially could impact the results. Individuals who are considering prazosin should speak with a doctor to determine whether or not their particular situation might merit a trial of this drug.
You and your doctor can work together to figure out the best medication, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks.
Tell your doctor about any side effects or problems with medications. You may need to try more than one or a combination of medications, or your doctor may need to adjust your dosage or medication schedule before finding the right fit for you.
Coping and support
If stress and other problems caused by a traumatic event affect your life, see a doctor or mental health professional. You can also take these actions as you continue with treatment for post-traumatic stress disorder:
- Follow your treatment plan. Although it may take a while to feel benefits from therapy or medications, treatment can be effective, and most people do recover. Remind yourself that it takes time. Following your treatment plan and routinely communicating with your mental health professional will help move you forward.
- Learn about PTSD. This knowledge can help you understand what you’re feeling, and then you can develop coping strategies to help you respond effectively.
- Take care of yourself. Get enough rest, eat a healthy diet, exercise and take time to relax. Try to reduce or avoid caffeine and nicotine, which can worsen anxiety.
- Don’t self-medicate. Turning to alcohol or drugs to numb your feelings isn’t healthy, even though it may be a tempting way to cope. It can lead to more problems down the road, interfere with effective treatments and prevent real healing.
- Relax. When you feel anxious, take a brisk walk or jump into a hobby to re-focus.
- Stay connected with your loved ones. Spend time with supportive and caring people — family, friends, faith leaders or others. You don’t have to talk about what happened if you don’t want to. Just sharing time with loved ones can offer healing and comfort.
- Consider a support group. Ask your mental health professional for help finding a support group, or contact veterans’ organizations or your community’s social services system. Or look for local support groups in an online directory.
Preparing for an appointment with a doctor
If you think you may have post-traumatic stress disorder, make an appointment with a doctor or a mental health professional. Here’s some information to help you prepare for your appointment with the doctor.
Take a trusted family member or friend along with you, if possible. Sometimes it can be difficult to remember all the information provided to you.
What you can do to prepare
Before your appointment, make a list of:
- Any symptoms you’ve been experiencing, and for how long.
- Key personal information, especially events or experiences — even in your distant past — that have made you feel intense fear, helplessness or horror. It will help your doctor to know if there are memories you can’t directly access without feeling an overwhelming need to push them out of your mind.
- Things you have stopped doing or are avoiding because of your stress.
- Your medical information, including other physical or mental health conditions with which you’ve been diagnosed. Also include any medications or supplements you’re taking, and the dosages.
- Questions to ask the doctor, so that you can get the most information from your appointment.
Some basic questions to ask the doctor or mental health professional may include:
- What do you believe is causing my symptoms?
- Are there any other possible causes?
- How will you determine my diagnosis?
- Is my health condition likely temporary or long term?
- What treatments do you recommend for this disorder?
- I have other health problems. How best can I manage these problems together with PTSD?
- How soon do you expect my symptoms to improve?
- Does PTSD increase my risk of other mental health problems?
- Do you recommend any changes at home, work or school to encourage recovery?
- Is there any benefits if I tell my teachers or co-workers about my diagnosis?
Don’t hesitate to ask any other questions during your appointment.
What your doctor may ask
Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:
- What symptoms are concerning to you or your loved ones?
- When did you or your loved ones first notice your symptoms?
- Have you ever experienced or witnessed a traumatic event?
- Do you have disturbing thoughts, memories or nightmares of the trauma you experienced?
- Do you avoid certain people, places or situations that remind you of the traumatic experience?
- Have you been having any problems at school, work or in your personal relationships?
- Have you ever thought about harming yourself or others?
- Do you drink alcohol or use recreational drugs? How often?
- Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most helpful?