Causes, symptoms and treatment of post-traumatic stress disorder

Author:  Dr Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)

Highlights

• Post-Traumatic Stress Disorder (PTSD) is a mental health condition triggered by experiencing or witnessing traumatic events.
• It presents with symptoms such as flashbacks, nightmares, irritability, and memory problems, which can disrupt daily life and relationships.
• Changes in hormones and brain function help explain the behavioural symptoms of PTSD.
• Many people with PTSD, particularly those in low-resource areas, face challenges in getting diagnosed and accessing care.
• Effective treatments include self-care, cognitive behavioural therapy (CBT), medications, and complementary therapies.
• Healing from PTSD is possible through a combination of these therapies

Introduction

Karibu had just returned to his family after spending eight months on the battlefield. Of the 88 personnel deployed, only 61 came back safely. He lost one of his close colleagues during the war and had many traumatic experiences.  His family welcomed him with joy, but it wasn’t long before they began to notice some strange behaviours. It was as if a different person had returned. He would sometimes wake up in the middle of the night shouting, "Fire! Fire! Fire!"

Rita’s case wasn’t so different. She survived a ghastly motor accident and, for months afterwards, experienced intense fear, anxiety, and restlessness, especially whenever she was near a vehicle. She couldn’t explain or control these symptoms.Since the early 20th century, abnormal psychological behaviours have been observed in soldiers exposed to war. However, it wasn’t until after the Vietnam War that the true magnitude of the problem became evident. Up to one-quarter of the soldiers deployed between 1964 and 1973 showed psychiatric symptoms that required treatment. 

This condition became known as Post-Vietnam Syndrome.Before this era, the condition was poorly understood and referred to by various names, such as "traumatic neurosis," "war nerves," and "shell shock."

A clearer understanding of the disorder after the Vietnam War led to the formal recognition of Post-Traumatic Stress Disorder (PTSD) as a diagnostic category in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), published in 1980.

In this article, we will explore the causes, symptoms, and treatment of Post-Traumatic Stress Disorder (PTSD).

Definitions

Stress: This was defined by Hans Seyle, a psychologist, as the nonspecific response of the body to any demand made upon it, whether that demand produces pleasure or pain.

Trauma: Defined by the American Psychological Association as an emotional response to a terrible event like an accident, crime, natural disaster, physical or emotional abuse, neglect, experiencing or witnessing violence, death of a loved one, war, and more.

Post-Traumatic Stress Disorder: PTSD is a mental health condition caused by an extremely stressful or terrifying event, either witnessed or experienced.

How does the body respond to trauma?

When a person experiences trauma, the initial response is a rise in some hormones and chemicals in the body. These include adrenaline and cortisol. These lead to physical changes like an increase in heart rate, blood pressure, and respiratory rate. These changes usually return to normal after the event [1].

When trauma becomes repeated or continuous, a behavioural response develops. In PTSD, some parts of the brain are affected in addition to hormonal changes. These include the hippocampus, which controls memory and becomes reduced in size. The amygdala, the part of the brain that deals with emotions and fear, becomes overreactive in people with PTSD [2].These changes lead to the abnormal behavioural patterns seen in people with PTSD.

What events lead to PTSD?

 Stressful events that can lead to PTSD include: [1]

• Wars
  
  
• Accidents
  
  
• Natural disasters
  
  
• Sexual violence
  
  
• Terrorist activities
  
  
• Political violence
  
  
• Intimate partner violence
  
  
• Bereavement
  
  
• Severe illness
  
  

What are the risk factors for PTSD?

Some factors influence who is affected by PTSD [1,3]. These include:

• Gender: Females are more likely to develop PTSD than males
  
  
• People with a history of childhood trauma
  
  
• The type of trauma influences the development of PTSD, i.e., people with intentional trauma and those who have been exposed to wars are at higher risk
  
  
• Those with a lack of social support are at a higher risk
  
  
• Poor educational status
  
  
• Younger age
  
  
• Family history of mental diseases
  
  
• Trauma associated with physical injury, e.g., brain injury
  
  

Who is affected by PTSD?

The good news is that not everyone exposed to severe trauma experiences PTSD. According to the World Health Organisation, only 5.6% of persons exposed to trauma develop PTSD. Up to 40% will recover within a year. The chance of developing PTSD depends on the type of precipitating event. 

In a study done by Tesfaye and associates among internally displaced persons in Africa, they found that up to 51% had PTSD. They also found that the associated factors were being female, unmarried, repeated traumatic events, and the presence of physical injuries.

Barriers to accessing PTSD Care
There is limited access to care for PTSD patients, especially in low-resource settings. In some of these countries,  people exhibiting symptoms of PTSD are often considered to be mad or possessed by evil spirits [4].
 Some of these barriers include:

• Lack of awareness that PTSD can be treated
  
  
• Lack of disclosure; some people hide their symptoms, and relatives may not be willing to disclose
  
  
• Lack of availability of mental health services
  
  
• Beliefs and priorities
  
  
• Stigma from society
  
  
• The presence of other medical care needs
  
  
• Paucity of skilled mental health care providers
  
  
• A lack of adequate data on PTSD in low-resource countries
  
  

Symptoms of PTSD

It is normal to have some distressing emotional and psychological symptoms after a major traumatic event.
This is, however, not enough to make the diagnosis of PTSD. The symptoms must last more than one month for the diagnosis to be made.
PTSD manifests differently in different individuals depending on their background and peculiar circumstances.
The symptoms of PTSD are grouped into four: [1]

• Intrusive symptoms
  
  
• Avoidance symptoms
  
  
• Negative changes in thinking and mood
  
  
• Hyperarousal symptoms
  
  

Intrusive Symptoms

When people have experienced a traumatic event, they may continue to re-experience the symptoms.
 This can manifest as:

• Recurring, involuntary, and disturbing memories/thoughts of the traumatic event
  
  
• Flashbacks, when the person re-experiences the symptoms, e.g., hearing an imaginary gunshot
  
  
• Distressing dreams (nightmares)
  
  
• Severe physical and emotional responses when exposed to reminders of the event
  
  

Avoidance symptoms

• Avoiding talking about the event
  
  
• Avoiding thinking about the event
  
  
• Avoiding places, events, or activities that remind you of the event
  
  

Negative thinking and mood

• Withdrawal from family and friends
  
  
• Feeling shame about the event
  
  
• Self-blame or guilt feelings about the event
  
  
• Feelings of anger
  
  
• Forgetting significant aspects of the traumatic event
  
  
• Low positive feelings
  
  
• Not enjoying activities you once enjoyed
  
  

Hyperarousal/Hypereactivity

 These symptoms can be emotional or physical. They include:

• Easy aggressiveness
  
  
• Overly watchful
  
  
• Being easily frightened
  
  
• Difficulty sleeping
  
  
• Self-destructive behaviours like substance abuse
  
  
• Sweating
  
  
• Increased pulse rate
  
  
• Rise in breathing rate
  
  

In addition to these symptoms, the person with PTSD may also experience these symptoms: [1]

• Depersonalization: Feeling as if you are outside your body and disconnected from your body
  
  
• Derealization: Feeling as if the world is not real
   These symptoms are not compulsory for diagnosis.

The two symptoms must not be present for the diagnosis to be made.

Complications of PTSD

PTSD is not life-threatening in most cases, but when it is prolonged and untreated, there may be destructive or life-threatening sequelae.
 These include:

• Depression
  
  
• Substance abuse
  
  
• Suicide
  
  
• Dementia
  
  

How is PTSD diagnosed?
 For PTSD to be diagnosed, you need to visit a mental health practitioner (Psychiatrist/Clinical Psychologist) [1,5].
 Your doctor would ask you some questions and then do the following: 

• Psychiatric assessment (Mental status assessment included): Check your appearance, behaviour, and thought pattern
  
  
• Physical assessment: Check for evidence of physical injuries. There may also be increased heart rate and blood pressure
  
  
  

Diagnosis is made if:

• You have a history of exposure to a traumatic event
  
  
• Symptoms have lasted more than a month
  
  
• Symptoms are severe enough to cause dysfunction in daily life
  
  
• The symptoms are not attributable to substance abuse or medical illness
  
  

How is PTSD treated?

Early treatment is necessary to prevent long-term complications [1,6.7]. In most cases, PTSD can be treated without medications.
 Treatment involves:

• Self-care
  
  
• Cognitive behavioural therapy
  
  
• Medications
  
  
• Complementary therapy
  
  

Self-care

 Self-care involves beneficial behavioural and lifestyle modifications.
 These include:

• Returning to your usual activity
  
  
• Avoiding or cutting down on alcohol intake
  
  
• Exercise: 150–300 minutes of moderate exercise per week
  
  
• Sleep: Adults should sleep at least 7 hours at night.
  
  
• Diet: Ensure a balanced and plant-rich diet
  
  
• Speaking to trusted people within your circle
  
  

Behavioural therapy

The main behavioural therapy is trauma-focused cognitive behavioural therapy (CBT). This is also known as talk therapy and is administered by a clinical psychologist or stress therapist. It can be conducted individually or in a group format. 

In cognitive behavioural therapy, negative beliefs are identified, analysed, and corrected. Your therapist guides you through the process of recovery and helps you to restart your usual activities.
 There are many forms of CBT with some modifications. Some of these include:

• Cognitive processing therapy
  
  
• Trauma-focused (informed) therapy
  
  
• Eye movement desensitisation and reprocessing (EMDR)
  
  
• Prolonged exposure therapy
  
  

Drug therapy

 Medications may be needed in some cases of PTSD.
 These groups of medications are used:

• Antidepressants: The class that is mostly studied is the selective serotonin reuptake inhibitors (SSRIs) [6]. The most common examples include Sertraline and Paroxetine. Some of the drugs help in the growth of nerves in the brain (neurogenesis) [2].
  
  
• Antipsychotics/Psychedelics: Including ketamine, psilocybin, and MDMA (methylenedioxymethamphetamine Thse can be used if you do not respond to the first line of treatment. These drugs reduce anxiety and improve behavioural response by increasing the release of feel-good hormones like dopamine and serotonin [7].
  
  
• Prazosin: The blood pressure medication, Prazosin, is effective in the treatment of PTSD, especially when associated with nightmares
  
  

Complementary therapy

Apart from psychotherapy and the use of medication, other complementary approaches can be used to ensure holistic care [8]. Some of these include:

• Mindfulness
  
  
• Breathing exercises
  
  
• Animal therapy with pets
  
  
• Music therapy
  
  
• Spiritual care
  
  
• Yoga
  
  
• Acupuncture
  
  

When to see a doctor

 See your doctor if you’ve had distressing symptoms greater than four weeks after a stressful event, especially if the symptoms are severe.

Conclusion

Though PTSD is usually not life-threatening, it causes significant dysfunction. When ignored, it can result in destructive and life-threatening tendencies. Recognising the symptoms and seeking early help is fundamental in mitigating the effects. More mental health facilities and reorientation are needed in low-resource centres to improve access to care.

References

1. Mann SK, Marwaha R, Torrico TJ. Posttraumatic stress disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Jun 5]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK559129/
2. Bremner JD. Traumatic stress: effects on the brain. Dialogues Clin Neurosci [Internet]. 2006 Dec [cited 2025 Jun 5];8(4):445–61. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181836/
3. Ramanathan R, Desrouleaux R. Introduction: the science of stress. Yale J Biol Med [Internet]. 2022 Mar 31 [cited 2025 Jun 7];95(1):1–2. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8961711/ 
4. Smith JR, Workneh A, Yaya S. Barriers and facilitators to help-seeking for individuals with posttraumatic stress disorder: a systematic review. J Trauma Stress. 2020 Apr;33(2):137–50. Avaialble form: https://pubmed.ncbi.nlm.nih.gov/31697863/
5. Sartor Z, Kelley L, Laschober R. Posttraumatic stress disorder: evaluation and treatment. afp [Internet]. 2023 Mar [cited 2025 Jun 5];107(3):273–81. Available from: https://www.aafp.org/pubs/afp/issues/2023/0300/posttraumatic-stress-disorder.html 
6. Stein DJ, Zungu-Dirwayi N, van Der Linden GJ null, Seedat S. Pharmacotherapy for posttraumatic stress disorder. Cochrane Database Syst Rev. 2000;(4):CD002795. Available from: https://pubmed.ncbi.nlm.nih.gov/11034765/
7. Elsouri KN, Kalhori S, Colunge D, Grabarczyk G, Hanna G, Carrasco C, et al. Psychoactive drugs in the management of post traumatic stress disorder: a promising new horizon. Cureus [Internet]. [cited 2025 Jun 9];14(5):e25235. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9214830/
8. Niles B, Lang A, Olff M. Complementary and integrative interventions for PTSD. Eur J Psychotraumatol [Internet]. [cited 2025 Jun 9];14(2):2247888. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478588/

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published June 11, 2025