Post-traumatic stress disorder (PTSD) is a complex, multi-faceted mental health condition that develops after experiencing or witnessing a life-threatening event. While trauma is always disruptive, PTSD can be debilitating, interfering with daily activities like going to work or school or spending time with friends and loved ones.

Mark, a 25-year-old male veteran, wakes up in the middle of night screaming and wide-eyed as he looks frantically about the room for something. His heart is pounding, and his face is sweating. He was dreaming of being in a foxhole again during his military service in the war. It felt so real, again.

Sally, a 52-year-old woman stops, paralyzed with fear as a large-hooded man walks by her on a quiet street in the late evening, recalling a night just like that many years ago when she was mugged and raped. It felt so real, again.

Ben, a 13-year-old boy is referred to the school counselor for trouble concentrating, poor grades, irritability, and aggressive outbursts in class. He struggles daily to stop thinking about his mother’s brutal beating by his alcoholic father. It felt so real, again.

What do each of these three people have in common?

Post traumatic stress disorder. Although they are different ages and genders, and from different causes, each suffers from recurring emotional distress even though the original physical stressor is gone. As a healthcare professional, could you recognize the symptoms? Do you know what qualifies for the diagnosis and what treatments are available for each of these patients? They need you, to help them feel real, again.

1.1 Defining PTSD

Traumatic events are defined as experiences involving actual or threatened death, serious injury, sexual violence or events that are extremely threatening or horrific in nature. People who suffer from PTSD re-experience traumatic memories, which are accompanied by avoidance, negative thoughts and emotions, and hyperarousal (a state of heightened anxiety that can manifest as irritability or paranoia) (APA, 2024).

While PTSD has long been closely associated with military combat, experts now recognize that a wide range of traumatic events can lead to a diagnosis, including sexual assault, child abuse, or surviving an accident or natural catastrophe. Even narrowly escaping severe harm, such as being threatened with a weapon, can have long-lasting effects.

Men, women and children can all suffer from PTSD. Experts estimate that women, who are subject to sexual violence more frequently than men, suffer PTSD at twice the rate of men. Civilian healthcare workers, volunteer firefighters and others who have witnessed the injury, illness or death of another person are all at risk of PTSD.

Ongoing research indicates that PTSD has long-lasting effects on physical as well as emotional health. It also has a huge social cost, in terms of economic and psychosocial burden. Adverse childhood experiences have been linked to problems with brain development, affecting cognitive processing speed and even healthy aging. One study even shows that women who have been exposed to trauma have higher rates of asthma (Lin et al., 2023).

1.2 Prevalence and Incidence of PTSD

The World Health Organization estimates that more than two-thirds of the world’s population will experience a potentially traumatic event during their lifetime. A majority of them will recover, but nearly 6% can be expected to develop PTSD. That rate triples among people who have been exposed to violent conflict or war and is especially high for survivors of sexual assault (WHO, 2024).

Estimates of the prevalence of PTSD vary widely and differ among various populations. In the United States, lifetime prevalence of PTSD among civilians ranged from 3.4% to nearly 27%. Elevated prevalence among is seen among emergency responders, refugees, American Indian/Alaska Natives, individuals with heavy substance use, individuals with a past suicide attempt, trans-masculine individuals, and women with prior military sexual trauma (Schein et al., 2021).

Rates of PTSD soared during the COVID pandemic, with nearly a quarter of public health agency employees and more than 1 in 5 adults reporting at least three symptoms of posttraumatic stress. Personal care and frontline service workers had 4 times the odds of reporting symptoms of posttraumatic stress than non-frontline workers (Schein et al., 2021).

1.3 Why Does It Matter?

PTSD can lead to a host of physical and psychiatric comorbidities, including suicide. One frequently cited Swedish study found that more than half of the suicides among Swedes with PTSD were related to this diagnosis (Fox et al., 2021).

In the U.S., the risk for suicide among military veterans with combat experience is especially high, with wounded combat survivors at greatest risk. Some veterans suffering from PTSD experience recurring memories of trauma and guilt over actions taken during war (NCPTSD, 2022).

Though they do not experience combat as frequently as their male counterparts, female military veterans are also subject to PTSD. Military sexual trauma (MST) is widespread among female military veterans, due to sexual assault and harassment from fellow soldiers. PTSD is the most common mental health issue associated with military sexual trauma, which rarely occurs in isolation, and may coincide with major depression, anxiety, eating disorders, substance use disorders, and increased suicidality. Physical health impacts can also include greater chronic disease burden, impaired reproductive health, and sexual dysfunction (Galovski, 2022).

There are indications that people suffering from PTSD are more likely to commit violent crimes themselves. It is linked to violent crime among veterans, though it is still unknown if such a link exists between PTSD and crimes committed by people in the general population. However, the diagnostic criteria for PTSD include increased arousal, reactivity, and irritable behavior that can turn into aggression. In one study, individuals with a PTSD diagnosis had a higher absolute risk of being convicted for violent crime than individuals with no PTSD diagnosis (Paulino et al., 2022).

PTSD also creates an economic burden. In 2018, the total excess economic burden of PTSD in the U.S. was more than $230 billion (Davis et al., 2022).