• Intrusive (Re-experiencing the trauma)
  • Recurrent recollections associated with distress
  • Intrusive emotions and memories
  • Dissociative states
  • Flashbacks
  • Nightmares and night terrors
• Avoidant
  • Avoiding emotions
  • Avoiding relationships
  • Avoiding responsibility for others
  • Avoiding situations that are reminiscent of the traumatic event
  • Inability to recall an important aspect of the trauma
  • Diminished interest or participation in activities
  • Restricted range of affect
  • Sense of foreshortened future
• Hyperarousal
  • Exaggerated startle reaction
  • Explosive outbursts
  • Extreme vigilance
  • Irritability
  • Difficulty concentrating
  • Panic symptoms
  • Sleep disturbance

Re-experiencing symptoms

One set of PTSD symptoms involves persistent and distressing re-experiencing of the traumatic event in one or more ways. In these symptoms, the trauma comes back to the PTSD sufferer in some way, through memories, dreams, or distress in response to reminders of the trauma. A more extreme example of this is "flashbacks," where individuals feel as if they are reliving the traumatic experience. For example, the sounds and images of combat often comprise the content of flashbacks experienced by military veterans. Flashbacks can be triggered by ordinary stimuli such as a low-flying airplane or a loud noise, anything that brings to mind an aspect of the event. PTSD is distinguished from "normal" remembering of past events by the fact that re-experiencing memories of the trauma(s) are unwanted, occur involuntarily, elicit distressing emotions, and disrupt the functioning and quality of life of the individual. PTSD may even give rise to dissociative symptoms including psychic numbing, depersonalization, and amnesia.

Avoidance and numbing symptoms

A second set of PTSD symptoms involves persistent avoidance of stimuli associated with the trauma, and numbing of general responsiveness. These symptoms involve avoiding reminders of the trauma. Reminders can be internal cues, such as thoughts or feelings about the trauma, and/or external stimuli in the environment that spark unpleasant memories and feelings. To this limited extent, PTSD is not unlike a phobia, where the individual goes to considerable length to avoid stimuli that provoke emotional distress. PTSD symptoms also involve more general symptoms of impairment, such as pervasive emotional numbness, feeling "out of sync" with others, or a lack of expectation for future goals being met, due to their trauma experiences.

Symptoms of increased arousal

This set of symptoms is represented by persistent symptoms of increased arousal not present before the trauma. These symptoms can be apparent in difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, a hypervigililant watchfulness, and/or an exaggerated startle response. Individuals suffering from PTSD experience heightened physiological activation, which may occur in a general way, even while at rest. More typically, this activation is evident as excessive reaction to specific stressors that are directly or symbolically reminiscent of the trauma. This set of symptoms is often, but not always, linked to reliving of the traumatic event. For example, sleep disturbance may be caused by nightmares, intrusive memories may interfere with concentration, and excessive watchfulness may reflect concerns about preventing recurrence of a traumatic event that may be similar to that previously endured.

Complications

Complications develop in people with chronic PTSD and delayed onset PTSD. These include the following:

• Alcohol and drug abuse or dependence
• Chronic anxiety
• Depression and increased risk for suicide
• Divorce and separation
• Guilt
• Low self-esteem
• Panic attacks
• Phobias
• Unemployment

Phobias of objects, situations, or environments that remind the person of the event often develop as complications of PTSD.

Panic attacks can be triggered by stimuli reminiscent of the event.

People with chronic PTSD and complications often become unemployed because severe symptoms interfere with their ability to perform their jobs and function socially in the workplace.

Next: Diagnosis