What PTSD is

PTSD can develop after exposure to actual or threatened death, serious injury, or violence. That includes things that happened to you, things you witnessed, and learning that something terrible happened to someone close to you. It also includes repeated exposure to the details of trauma through work, which is relevant for physicians, first responders, and others in the helping professions.

It is common. Using current diagnostic criteria, a national survey estimated that about 8% of US adults will meet criteria for PTSD at some point in their lives (Kilpatrick et al., 2013). Combat is not required. Assault, accidents, medical emergencies, a traumatic birth, sudden loss, and childhood abuse or neglect are all common causes.

What it looks like

Symptoms fall into four groups, and they last for more than a month:

• Re-experiencing: nightmares, flashbacks, or intrusive memories that feel as if the event is happening again

• Avoidance: staying away from places, people, conversations, or thoughts that remind you

• Changes in mood and thinking: guilt, shame, numbness, feeling detached, losing interest, or a harsh and fixed view of yourself or the world

• Being on alert: startling easily, trouble sleeping, irritability, trouble concentrating, scanning every room

High-functioning people often cope by staying busy and in control. The alertness gets labeled as intensity or drive, and the numbness gets labeled as being practical. Alcohol or cannabis to sleep, or to switch off, is a very common pattern. Some people come to me for something else, like insomnia, anxiety, or relationship trouble, and the trauma comes out later.

How I evaluate it

You will not be asked to retell your worst experience in the first visit. I need to know enough to understand what happened and when, but not every detail. I use validated tools such as the PCL-5, a self-report checklist of PTSD symptoms, and I screen for the conditions that travel with PTSD: depression, anxiety, panic, substance use, sleep disorders, dissociation, and traumatic brain injury. I also ask about safety, both now and in the past.

Treatment

The VA/DoD clinical practice guideline, which is one of the most widely used in the field, gives its strongest recommendation to individual trauma-focused psychotherapy, specifically prolonged exposure, cognitive processing therapy, and EMDR (VA/DoD, 2023). A meta-analysis comparing treatments found that trauma-focused therapies produced larger effects than medication (Watts et al., 2013). If you take one thing from this page, it is that therapy for PTSD works, and that the people who do it well are worth finding.

Medication has a real role as well. The guideline supports sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor) for PTSD, and medication can make it much easier to sleep, concentrate, and engage in therapy. I pay close attention to sleep, because treating insomnia and nightmares often makes everything else more tolerable.

Nightmares deserve a note. Prazosin has been used widely for trauma-related nightmares, but a large trial in military veterans found it did no better than placebo (Raskind et al., 2018). Some people still respond to it, and there are other options, including imagery rehearsal therapy, a short behavioral treatment. I will tell you what the evidence shows and what is known to work for some individuals.

Guidelines advise against benzodiazepines for PTSD. They can feel like relief in the moment, but they do not treat the disorder, and they carry the risks I describe on my pages about anxiety and de-prescribing.

I work alongside a trauma-focused therapist of your choosing, or I can refer you to one.

Trauma and women’s health

A traumatic birth, pregnancy loss, sexual assault, and medical trauma can all lead to PTSD, and they can affect later pregnancies, medical care, and intimacy. I treat these with care and in coordination with your OB or other doctors when that helps.