What Are the 17 Symptoms of PTSD?

By: Josh Clark  | 
Soldier gestures in frustration while speaking to a doctor.
Agitation, anxiety, mood swings and depression are just a handful of the 17 symptoms that help doctors diagnose post-traumatic stress disorder (PTSD). SDI Productions / Getty Images

Thirteen years after he returned home to Las Vegas, Nevada, from fighting in Iraq, Adam Kelley, a specialist in the U.S. Army, took his own life. While fighting in the Persian Gulf during the first Iraq war, he watched as one of his friends died. He saw the killing of countless people on both sides. He killed others with the mortar rounds he fired. He was under heavy fire for days at a time.

After he returned home, he relived the terrifying events through nightmares and flashbacks. Ultimately, although he was treated with medications, he was unable to shake his demons [source: Rogers].


We now know that Kelley endured post-traumatic stress disorder (PTSD) for 13 years. What are the 17 symptoms of PTSD that may have allowed for an early diagnosis?

What Is PTSD?

Approximately 70 percent of Americans have endured traumatic experiences, and in many cases these have resulted in mental health disorders. Here, survivors of the 1999 Columbine High School shootings in Colorado remember one of the students killed that day.
Sisse Brimberg/National Geographic/Getty Images

Post-traumatic stress disorder is a mental health condition. In its simplest terms, it's a specific set of symptoms that result from a traumatic experience, such as witnessing an actual or threatened death, or experiencing severe emotional trauma.

The symptoms must present themselves in a certain way within a certain period of time and for a certain duration to be considered PTSD. Another criterion is how much of an impact the condition has on the patient's everyday life.


The cornerstone symptom of PTSD is reexperience of the trauma (also called intrusive recollection). This means the person is plagued with unwanted memories of the event that so badly scarred them.

These memories can come in the form of flashbacks, recollections, night terrors or nightmares. The nightmares of PTSD might not even be "dreams" — there's an idea that it's a neurobiological phenomenon that is interpreted as having been a dream upon awakening.

In each of these instances, memories of the event suddenly and unexpectedly flood the sufferer, and they feel like they're experiencing it all over again. This can be triggered by a cue (such as seeing or hearing a car accident similar to the one the person endured), or it can come unbidden.

The person's brain releases chemicals as if he is experiencing the trauma, creating a fear response that's both physical and mental.


17 Symptoms of PTSD

PTSD, or post-traumatic stress disorder, manifests in a variety of ways and causes both mental and physical symptoms. As our understanding of this disorder has evolved, researchers have identified 17 primary symptoms that may be exhibited by those with PTSD.

  1. Agitation: Individuals may feel restless or constantly "on edge," and can become easily upset or irritated.
  2. Nervousness and anxiety: A heightened sense of anxiety often plagues sufferers, making everyday situations feel threatening or overwhelming.
  3. Problems with concentration or thinking: Day-to-day tasks might become challenging as individuals struggle to focus or think clearly.
  4. Problems with memory: PTSD can lead to difficulty recalling certain events, whether related to the trauma or not.
  5. Headaches: Persistent or recurring headaches can be a physical manifestation of the disorder.
  6. Depression and crying spells: Feelings of hopelessness, sadness and frequent bouts of crying can be indicative of PTSD.
  7. Suicidal thoughts or attempts: The emotional weight of PTSD can sometimes become unbearable, leading some to contemplate or even attempt suicide.
  8. Mood swings: Rapid shifts in mood, from extreme happiness to deep sadness, can occur without obvious triggers.
  9. Obsessive-compulsive tendencies: Some may develop habits or rituals in an attempt to cope or regain control.
  10. Panic episodes or panic attacks: Sudden and intense feelings of fear or dread can strike without warning.
  11. Paranoia: Individuals may feel constantly wary or suspicious, even in safe environments.
  12. Shakiness: Physical tremors or shakiness can be a response to heightened stress or anxiety.
  13. Substance abuse: To cope with their trauma, some individuals might turn to alcohol or drugs as a means of escape.
  14. Flashbacks: Vivid and often distressing memories of the traumatic event can replay in the individual's mind, making them feel as if they're reliving the trauma.
  15. Hypervigilance: A state of heightened alertness and constantly scanning the environment for threats are hallmarks of hypervigilance.
  16. Nightmares: Disturbing dreams related to the trauma can disrupt sleep and heighten anxiety.
  17. Sleep disturbances: Beyond nightmares, this can include insomnia, frequent waking, night terrors or other sleep-related issues.

It's important to note that while these symptoms are commonly associated with PTSD, not every individual will experience all of them, and the intensity can vary. Moreover, children with PTSD may manifest these symptoms differently. As they age, their symptoms may evolve to more closely resemble the typical adult presentations.


Recognizing these symptoms is crucial for timely intervention and support. Always consult a mental health professional, rather than attempting to diagnose and/or treat someone yourself.


The Evolution of Understanding PTSD

Previously called soldier's heart, PTSD was first described by Jacob Mendes Da Costa, a doctor during the American Civil War. Marked by chronic tachycardia (high heart rate) and reactivity (increase in heart rate due to a stressor), it looked very much like cardiac disease, but Da Costa recognized the possibility that it was brought on by wartime trauma.

PTSD was first noticed on a massive scale during World War I, when it was called shell shock and was described by physician Charles Myers in the medical journal The Lancet in 1916. Interestingly, Myers believed that, at least in part, the symptoms were caused by subtle injury to the brain resulting from the overpressure of exploding artillery rounds.


It turned out he was prescient; this is what experts now believe is the cause of mild traumatic brain injury (mTBI). Many symptoms of mTBI overlap with PTSD [source: Myers].

Modern Research and Discoveries

The first diagnosis of the modern view of PTSD came in 1980. Research into this anxiety disorder began intensely after Congress requested a study of how Vietnam veterans were adjusting back to civilian life in 1983. The National Vietnam Veterans' Readjustment Study turned up a wealth of statistics and provided rare, large-scale insight into the nature of PTSD.

But there's still much to learn. For instance, there's still relatively limited data on the number of people with PTSD who, like Adam Kelley, commit suicide. And there's debate over how many soldiers fighting in the second Iraq war are vulnerable to developing the disorder later on.

Also, many health care professionals are still exploring the best type of counseling and medication to most effectively treat PTSD. But the findings from the Vietnam study helped to advance human understanding of the effects of PTSD by leaps and bounds.

We now realize, for example, that the part of the brain that stores memories of fearful incidents can be directly related to the development of the disorder. We also now know that some people are more prone to develop PTSD after experiencing a trauma than others.


Risk and Protective Factors for PTSD

Although natural disasters like Hurricane Katrina can have an impact on the development of PTSD, the chances are increased when the trauma is man-made.
Photo courtesy EPA

Around 70 percent of Americans have endured some traumatic experience within their lifetimes [source: PTSD Alliance]. These may come in the form of a bad car wreck, a rape or an assault. It can be surviving a natural disaster, experiencing a loved one dying unexpectedly or even killing another person, as in war. Up to 20 percent of those who've suffered such traumas go on to experience PTSD.

Early researchers believed that all people were at equal risk of developing PTSD after experiencing a trauma. However, further study has revealed that some risk factors may make one person more likely to develop PTSD than another.


One of the biggest risk factors is a prior trauma. People who have already undergone one traumatic experience and then suffer another are more likely to develop PTSD than a person who experiences a single trauma.

Why? A class of hormones in the brain called glucocorticoids help control our response to stress, and after a traumatic experience, this hormone can become depleted.

When another trauma occurs, and the glucocorticoid levels are already low, the stress response to the experience can be more intensified. This condition can increase the likelihood of the person developing PTSD.

Personality Traits and PTSD Development

Personality traits have also been shown to play a part in the development of PTSD. People who have an optimistic outlook on life — a belief that there's order to the universe, and that other people are generally good — have less of a chance of developing PTSD after suffering a trauma. So, too, do people who are resourceful, who tend to take obstacles and challenges head-on.

Conversely, those with problem-avoidance behavior have been shown to have an increased risk of developing PTSD. This indicates that part of the development of PTSD is increased by the avoidance symptom — the desire to ignore the trauma rather than address it.

People who are college educated are less likely to develop chronic PTSD. So are people who have or had a good relationship with their fathers. At the same time, people who were raised in an abusive environment or have little education are more likely to develop PTSD. It also appears that women are more likely to develop the disorder.

Genetic Factors in PTSD

There is also some emerging evidence that PTSD may occur on a genetic level. One gene being looked at is the serotonin transporter gene.

A paper indicated that mutations in this gene can have an impact on attention to environmental threats, suggesting that if certain people have a hard time modulating attention to threat in the environment (for instance, through hypervigilance) they may be more prone to PTSD [source: Wald et al].

Another study suggests that PTSD may be the result of epigenetics – changes to the function of genes that can happen in a lifetime.

A 2009 study of Detroit residents showed that those who fit the criteria for a PTSD diagnosis had six to seven times the regular amount of epigenetic changes to their genes of those in the control group. Most of the genes that had undergone epigenetic change were responsible for immune system function.

The Role of Social Support

However, the most important factor in the development (or not) of PTSD is the existence of a strong social support network. Time and again, people who have close relationships with those around them have been shown to be much less likely to develop PTSD and more likely to recover from it.

Trauma counselor Jacob Lindy referred to this network as a trauma membrane, a group of people who form a protective cover over the person who has suffered the trauma and protect that person from undergoing further damage.

It should be noted that what's most important about this social network is how it's perceived by the sufferer. A well-intentioned but overbearing support network will have a less positive effect than one that allows the sufferer to grieve on their own terms.


PTSD and the Military

The military is the group of people most susceptible to PTSD.
Photo courtesy DVIC

The world is rife with potentially traumatic situations. Events like Hurricane Katrina, the Columbine High School shootings and the tsunami in Southeast Asia can all lead the people who experienced them to develop PTSD.

It's been shown, though, that man-made traumatic events (like Columbine or war) have a greater impact on the incidence of PTSD than natural disasters (like Hurricane Katrina) [source: Galea, et al].


This is just one reason that, on the whole, no other group is more vulnerable to developing PTSD than the military. Experiences like killing other people, handling corpses, being fired upon, witnessing others die and suffering life-threatening injuries can all create trauma in a combatant.

The development of PTSD has been shown to be directly related to the intensity of the traumatic experience, and soldiers are often faced with the most stressful of situations on a routine basis.

Comorbidity and its Impact on PTSD

Comorbidity (having another disease or disorder) can make someone more vulnerable to PTSD or make existing PTSD worse. Prior drug and alcohol dependency, an existing personality disorder, a family history of mental issues, and brain injuries are all examples of comorbidity.

These factors have been shown to directly and negatively affect the impact PTSD has on a person. PTSD can also aggravate an existing drug problem, as well as decrease the likelihood that a person will recover quickly from an injury or illness.

This is of particular concern for some researchers who are studying soldiers who fought in Iraq and Afghanistan. With brain injuries regarded as the "signature wound" of the Iraq war, and most of these injuries coming as the result of a traumatic experience like the explosion of a roadside bomb, the likelihood of these soldiers developing PTSD has been increasing.

What's more, the military experienced a plague of suicides among active and returning military. A Veterans Administration study found that 22 active and former military service people committed suicide each day in 2010 [source: Briggs]. These suicides were not necessarily linked to PTSD in the study, however.

Combatants enlisted today are at added risk due to guerilla warfare during fighting conflicts. In guerilla warfare, the chances for witnessing and taking part in abusive violence, atrocities and civilian casualties increases, and all of these factors have been shown to raise the likelihood that a person will develop post-traumatic stress disorder as a result [source: NCPTSD].


Counseling for PTSD

Findings from a comprehensive study in the '80s and '90s on the ability for Vietnam veterans to readjust to civilian life yielded a great deal of insight into PTSD.
Photo courtesy National Archives

Imagine sitting with your platoon, taking a break from patrol in the desert of Iraq. The sky is clear and blue. The sun is shining, and it's hot and dusty, but you and your buddies are cracking jokes. On the stereo, your favorite song is playing. You're still on guard, but for once you feel kind of relaxed.

Suddenly, out of nowhere, you encounter enemy fire. As shells zip past you and you return fire, you catch glimpses of the enemy firing from behind a burned-out truck. A buddy takes a bullet in his stomach and falls beside you, and you pull him to safety behind your patrol's armored car. You return fire again, and this time it's clear to you that you killed one of the enemies. After a few more minutes, your patrol manages to flush the enemy from behind the burned-out truck, killing several more people.


You're alive, unhurt. Your buddy has died.

The Powerful Hold of Fear Memories

As time progresses, you find that you can't escape the experience. You're haunted by your friend who died and the man you killed. Hearing your favorite song now, the one that played on the radio just before the fight, reminds you of every detail. The still of the sunny day, one of the things that had calmed you just before the fight, comes to be remembered as ominous.

Our fear memories are among our most powerful. They can even become distorted and distort other memories associated with the experience. People with PTSD don't wish to be reminded of them, and they don't feel like anyone can understand what they've gone through, which leads to a sense of isolation.

This is what makes PTSD so difficult to treat. The intrusive memories of the traumatic event become so largely distorted that they become overwhelming in their importance and magnitude. Isolation keeps people with PTSD from their family, friends and counselors.

Approaches to Treating PTSD

Some treatments have been proven to combat these symptoms of PTSD. Two of the most widely accepted forms of psychotherapy for treating the disorder are cognitive processing therapy (CPT) and exposure therapy.

The aim of these treatments is cognitive restructuring. Through this process, exaggerated memories are reduced back to a manageable size.

In the experience of PTSD, the enemies in the above scenario be seen as faceless phantoms; the wounds of the friend may become gorier. Cognitive restructuring helps the patient remember the event on a more acceptable level.

In the CPT setting, the therapist may focus on the valor shown by the solider when he retrieved his friend in the attempt to save his life — adding balance to the memory of the experience and helping to develop perspective.

CPT also allows the person to gain control of his unwanted recollections by allowing these memories to occur at a designated time of day, or investing protective associations in an everyday object.

Exposure Therapy and Addressing Trauma

In exposure therapy, patients are asked to purposely reexperience their trauma over and over — either in a doctor's office or in the outside world in a setting similar to the one where they experienced their trauma.

This is called imaginal therapy. The soldier in the scenario may be asked to recount the experience in detail repeatedly. The song that played which reminds him so much of the incident may be played repeatedly as well.

Exposure therapy is based upon the idea that avoidance continues to fuel the symptoms associated with PTSD. By bringing these memories to the forefront and addressing them, this therapy aims to bring about fear extinction in the patient, a process that takes place in the amygdala (the part of the brain that allows us to create our fear memories) and normally allows people to stop having a full, physical reaction to stimuli associated with the traumatic experience.

Some find CPT more desirable than exposure therapy because the patient doesn't have to identify a specific trauma for it to work, which is of course required in exposure therapy.


Medication for PTSD

Antidepressants are often prescribed to people with PTSD, like this soldier.
Charles Ommanney/Getty Images

A combination of counseling and medication is often used to treat post-traumatic stress disorder.

Two versions of one type of drug, known as selective serotonin reuptake inhibitors (SSRIs), are already being used to treat some symptoms of PTSD. SSRIs have been shown to reduce depression and anxiety in patients, and two SSRIs — Zoloft and Paxil — are the only medications approved by the U.S. Food and Drug Administration for treatment of PTSD.


While SSRIs help to alleviate mood symptoms and can make people with PTSD more receptive to counseling, another drug, D-cycloserine (DCS), which is used to treat tuberculosis, may have an indirect effect on treating PTSD. DCS is known for its ability to enhance learning by affecting a type of receptor in the brain.

Researchers hope that when used in conjunction with exposure therapy the drug may help separate memories from their association to a stimulus (memory extinction) and diminish the fear response in PTSD patients [source: deKline]. Prazosin, a decades-old blood pressure medication, has impressive efficacy in reducing nightmares [source: WebMD].

Researchers are also studying propranolol, a beta-blocker, to determine its effects on PTSD symptoms like hyperarousal and their secondary effects like sleeplessness. The drug may also prove to be useful as an agent that can block the creation of fear memories from an event.


Cutting-edge Research

The field that may yield the most possibilities for treating PTSD in the future is neurology.

Studying the brain's functions has already turned up some interesting facts about how we process our fear response. One chemical that has been studied is called stathmin, and it allows us to form fear memories from our experience.


In a laboratory experiment, researchers treated mice to diminish their levels of stathmin. Those mice with lowered levels were less likely to be affected by panic (and less likely to "freeze") when confronted with traumatic experiences later [source: NIMH].

Another chemical, gastrin-releasing peptide, has been shown to signal a response in the brain. Research suggests that a lack of this chemical could lead to an increased chance that a person will form stronger fear memories [source: NIMH].

Brain Structures and Fear Memories

How we create and maintain our fearful memories of experiences is at the heart of physiological research on PTSD. Investigation into the amygdala has shown that this part of our brain helps us to learn how to not fear, as well as to fear. The ventromedial prefrontal cortex (PFC) appears to maintain our long-term fear memories.

Researchers have found that the size of this part of the brain may be related to the likelihood a person keeps fear memories after a traumatic event [source: NIMH]. Of course, environmental and social factors have their parts to play in whether people with genetic predispositions to PTSD actually get it.

Emerging Treatments and Techniques

Researchers at Fort Bragg, N.C., have studied soldiers who handle stressful situations better than others and believe they have found a chemical that's responsible for the difference. Neuropeptide Y is thought to be the brain's own anti-anxiety drug.

As we're exposed to a stressful or traumatic situation, our levels of this drug become depleted. The more depleted it becomes, the more fearful we become. Scientists are trying to synthesize neuropeptide Y to restore a person's depleted levels after a traumatic situation, and possibly guard against the development of PTSD.

Stellate ganglion blocks have also been tested. This procedure uses a local anesthetic injected above the clavicle to block the function of sympathetic nerves (the same ones responsible for the fight-or-flight response).

A 2008 study found that seven of nine patients given the block experienced relief of their PTSD symptoms, including one patient who had been suicidal for the previous two years. However, the benefits appeared to fade after two months [source: Hicky, et al].

MDMA (also known as ecstasy) has also been shown to lessen the effects of PTSD. The majority of patients in a 2012 study of the drug showed relief from their symptoms; some of these patients hadn't experienced any relief from other courses of treatments they'd taken [source: The Guardian]. Transcranial magnetic stimulation (TMS) has been shown to improve PTSD conditions as well.

The authors of a 2004 study of 20 male and female patients suffering from PTSD as a result of events like combat, assault and sexual abuse believe that the effects were the result of the magnetic coil stimulating neurons in the brain [source: VA Research Currents].

Virtual Reality and Remote Counseling

Also, remember that study of Detroit PTSD sufferers that found they had epigenetic changes to their immune system genes? There is growing evidence that injecting a person who has recently undergone a trauma (within the first few hours) with a low dose of regular hydrocortisone, a corticosteroid that suppresses the immune response, can prevent PTSD from taking hold later on. The studies are small, but the results are encouraging [source: Delahanty, et al].

Virtual reality is also being used to help treat people with PTSD. It has reduced chronic PTSD symptoms in Vietnam veterans and is particularly useful for people who can't or won't access their emotions in therapy.

A case study used virtual reality simulations of the Sept. 11 attacks on the World Trade Center as part of exposure therapy to help one woman recover from PTSD. She was exposed to her traumatic memory not by her own recollections, but as an active observer (for instance, virtual planes flew into virtual towers). The result was very positive. Her PTSD symptoms decreased by 90 percent [source: HITL].

Research into the viability and usefulness of delivering counseling via the internet or by phone is also being conducted. This kind of counseling could be helpful in cases of mass disasters that affect large numbers of people by delivering counseling to many people at the same time.

Operation Battlemind

The military is investigating techniques for "inoculating" soldiers from PTSD. The Walter Reed Institute of Research has developed a program of Resilience Training (formerly called "Battlemind") that helps soldiers strengthen themselves mentally in order to lessen susceptibility to PTSD.

This program stresses the development of traits like social interdependency and openness among soldiers and attempts to root out risk factors like avoidance. The program also aids in the transition from deployment status to civilian life.


Lots More Information

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