Post-traumatic stress disorder (PTSD)
A disorder after a traumatic event marked by intrusive re-experiencing, avoidance of reminders, negative changes in mood and beliefs, and heightened arousal, lasting more than a month and impairing life.
What drives it
The threat memory stays 'live' rather than being filed as past; the person's system keeps treating reminders as present danger.
How it shows
Work
Startles at a door slam; avoids certain routes, buildings, or types of meeting; concentration breaks; irritability; poor sleep showing as tiredness; sudden exits; unexplained absences around anniversaries. May overwork to avoid stillness.
Relationships
Emotional distance, outbursts, avoiding intimacy or crowds, needing to sit facing the door, nightmares affecting a partner, drinking to sleep. Partners walk on eggshells.
Self
Unwanted memories or images that feel like they are happening now, a body that reacts before you know why, avoiding anything that might remind you, a constant sense of being on guard.
What tells it apart
Complex PTSD: PTSD centres on fear and reminders of an event; complex PTSD adds persistent problems with emotion regulation, a deeply negative self-view and difficulty sustaining relationships.
Generalised anxiety: PTSD worry and arousal are tied to a specific past event and its reminders; generalised anxiety ranges across everyday future concerns with no traumatic anchor.
Major depression: Both bring low mood and withdrawal, but PTSD includes intrusive re-experiencing and startle; depression lacks the 'it's happening again' quality.
A test
Ask whether there is a specific event the person keeps re-living through memories or dreams and whether they avoid reminders; if yes and it impairs life, refer to a trauma-trained clinician.
Questions to carry
- Of all the reminders, which ones does the person steer around, and what happens in the body when one shows up anyway?
- Which memory still feels like it is happening now, and who knows that about me?
How strong the research is
strong
Where it comes from
Abram Kardiner, 1941; DSM-III, 1980; current criteria DSM-5-TR, 2022, and ICD-11, 2019
Sources
- Bessel van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (2014)