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PTSD symptoms and diagnosis

PTSD shows up in four groups of symptoms that affect memories, feelings, the body, and everyday life. Knowing the signs is the first step toward the right help.

Mist rising over a quiet lake

Everyone reacts to trauma differently. PTSD is diagnosed when certain symptoms last more than a month and cause real distress or get in the way of work, school, relationships, or daily life.

1. Reliving the trauma

Doctors call these intrusion symptoms. Memories of the event push their way in when you least expect them.

  • Upsetting memories that pop up without warning
  • Nightmares about the event or its themes
  • Flashbacks, where it feels or seems like the event is happening again
  • Intense distress when something reminds you of the trauma
  • Physical reactions to reminders, such as a racing heart, sweating, nausea, or shaking

2. Avoidance

Avoiding reminders brings short-term relief, but over time it keeps PTSD going and makes life smaller.

  • Working hard not to think, feel, or talk about what happened
  • Staying away from places, people, activities, or situations that bring back memories

Some people also stay constantly busy, or turn to alcohol or drugs, to keep the memories away.

3. Negative changes in thoughts and mood

  • Trouble remembering important parts of the event
  • Ongoing negative beliefs such as "I am bad," "No one can be trusted," or "The world is completely dangerous"
  • Blaming yourself or others for what happened in ways that do not fit the facts
  • Constant fear, horror, anger, guilt, or shame
  • Losing interest in activities you used to enjoy
  • Feeling detached or cut off from other people
  • Struggling to feel positive emotions such as happiness, love, or satisfaction

4. Feeling on edge

Doctors call these arousal and reactivity symptoms. The body stays on high alert, as if danger could return at any moment.

  • Irritability and angry outbursts
  • Reckless or self-destructive behavior
  • Being constantly on guard and watchful
  • Being easily startled
  • Trouble concentrating
  • Trouble falling or staying asleep

PTSD in children and teens

Children can develop PTSD after abuse, violence, accidents, disasters, or the sudden loss of a caregiver, and their symptoms can look different from an adult's.

Young children may act out the scary event during play, wet the bed after being toilet trained, forget how to talk or stop talking, or become unusually clingy with a parent.

Older children and teens usually show symptoms closer to an adult's. They may also become disruptive or disrespectful, feel guilty for not preventing what happened, or think about revenge.

Worried about a child?

Talk with their pediatrician or a mental health professional who works with young people. Trauma-focused cognitive behavioral therapy (TF-CBT) is a proven treatment for children and teens.

PTSD rarely travels alone. Many people also deal with one or more of these, and treating them together works best.

Depression

Lasting sadness, hopelessness, or loss of interest in life.

Anxiety and panic

Constant worry or sudden waves of intense fear.

Alcohol and drug use

Often an attempt to numb memories or get to sleep.

Sleep problems

Insomnia and nightmares that leave you exhausted.

Physical health

Headaches, stomach trouble, chronic pain, and a higher risk of heart disease.

Relationships and work

Irritability, withdrawal, and trouble trusting people.

Thoughts of suicide

PTSD can bring thoughts of death or suicide. You are not alone, and help works. Call or text 988 any time (Veterans press 1), or call 911 if you are in immediate danger.

How PTSD is diagnosed

A qualified health care provider, such as a psychologist, psychiatrist, licensed counselor, clinical social worker, or primary care doctor, can assess you for PTSD. It usually starts with a conversation about what happened and how you have been feeling, and may include questionnaires such as the PCL-5 or a structured interview such as the CAPS-5.

Under the DSM-5-TR, the manual U.S. clinicians use, a PTSD diagnosis in adults requires:

  • Exposure to actual or threatened death, serious injury, or sexual violence
  • At least 1 reliving symptom and at least 1 avoidance symptom
  • At least 2 negative changes in thoughts and mood
  • At least 2 arousal and reactivity symptoms
  • Symptoms lasting more than 1 month
  • Symptoms that cause significant distress or problems in daily life and are not caused by medicine, substances, or another illness

Your provider may also check for conditions that can overlap with PTSD, such as depression or a traumatic brain injury.

Getting ready for your appointment

  • Write down your symptoms, when they started, and how often they happen
  • Note what makes them better or worse
  • List the medicines, supplements, alcohol, and other substances you use
  • Bring a trusted person if that helps you feel more comfortable
  • Ask which treatments are available and how long they usually take

Not sure where to start? Take the free self-check and bring your results, or read about the treatments that work.

Sources

National Institute of Mental Health. Post-Traumatic Stress Disorder.

U.S. Department of Veterans Affairs, National Center for PTSD. PTSD and DSM-5.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), 2022.