In short
Post-traumatic stress disorder (PTSD) is a mental health disorder that develops after a person has gone through a threatening or horrifying event. Its main symptoms are intrusive re-experiencing of the trauma (flashbacks, nightmares), avoidance of anything that reminds the person of it, and a constant sense of threat: hypervigilance, being easily startled, sleep problems, and irritability. Symptoms can appear right away or months later. PTSD responds well to trauma-focused psychotherapy and, when needed, to medication prescribed by a psychiatrist.
Key points in one minute
- PTSD develops after events that threatened a person’s life or safety: violence, accidents, military combat, disasters, or the sudden death of a loved one.
- The disorder has three core features: re-experiencing the trauma, avoiding reminders, and a constant sense of threat.
- Symptoms may not appear immediately: with delayed onset, they show up months after the event.
- Many people try to dull their symptoms with alcohol or drugs, which often leads to addiction.
- Trauma-focused psychotherapy is the most effective treatment; medication helps when symptoms are severe.
What PTSD Is and Which Events Can Cause It
In ICD-10, PTSD is coded as F43.1 and belongs to the group of reactions to severe stress. In ICD-11 and DSM-5, it is described as a disorder that develops after exposure to an extremely threatening or horrifying event. This may be a threat to life, a serious injury, or sexual violence, whether experienced by the person directly, witnessed, or happening to a loved one. In high-risk professions (medical workers, rescuers, police), PTSD can also develop from repeated exposure to the grim aftermath of other people’s tragedies.
It is important to understand that after a severe event almost everyone experiences anxiety, poor sleep, and intrusive memories in the first days and weeks. This is a normal reaction of the mind, and in most people it gradually fades. PTSD is a situation in which the symptoms do not go away, persist for longer than a month, or sometimes even grow stronger and seriously interfere with life. Developing the disorder is not a sign of weakness; it is the result of how the mind processed an overwhelming experience.
Complex PTSD
ICD-11 recognizes complex post-traumatic stress disorder. It more often develops after prolonged or repeated trauma from which escape was difficult: domestic violence, abuse in childhood, or captivity. In addition to the core PTSD symptoms, it is characterized by difficulty regulating emotions, a persistent sense of worthlessness and guilt, and problems in close relationships.
What the Symptoms of PTSD Are
PTSD symptoms are grouped into several clusters. The first is re-experiencing: the trauma comes back as vivid intrusive memories, nightmares, and flashbacks, when the person feels the event is happening right now, with the same sounds, smells, images, and bodily sensations. Any reminder can set it off: a loud bang, a particular street, a smell, a date.
The second cluster is avoidance. The person tries not to think or talk about what happened and steers clear of places, people, and situations that remind them of the trauma. The third is a constant sense of threat: hypervigilance, an exaggerated startle response, difficulty falling asleep, irritability, angry outbursts, and trouble concentrating. DSM-5 also identifies negative changes in thoughts and mood: guilt, detachment, and an inability to feel joy.
- Intrusive memories and flashbacks, as if the event were happening again in real life
- Trauma-related nightmares and frequent waking at night in fear
- A strong physical reaction to reminders: a pounding heart, sweating, trembling
- Avoiding places, people, conversations, and thoughts linked to the event
- Constant hypervigilance and a feeling that danger is close by
- Jumping sharply at sounds or unexpected touch
- Irritability, angry outbursts, and difficulty concentrating
- Guilt, shame, detachment, and emotional “numbness”
| Feature | Normal reaction to trauma | Signs of PTSD |
|---|---|---|
| Duration | Eases over several weeks | Lasts longer than a month or gets worse |
| Onset | Immediately after the event | Immediately or delayed, months later |
| Memories | Painful but gradually fade | Vivid flashbacks, as if the event were happening again |
| Avoidance | Temporary, with a gradual return to life as strength allows | Persistent; narrows the range of places, people, and activities |
| Daily life | Gradually returns to normal | Sleep, work, and relationships are disrupted |
Why PTSD Symptoms Can Appear Months Later
Most often, symptoms begin in the first weeks or months after the event. However, delayed onset also occurs: DSM-5 specifies it when the full set of criteria is not met until at least six months after the trauma. At first, a person may hold up thanks to mobilization: there are practical problems to solve, a family to take care of, a job to do. When the tension eases, the mind seems to “catch up” with what happened.
The trigger is often new stress, the anniversary of the event, a situation resembling the trauma, loss of support, illness, or retirement. Sometimes the first signs are put down to personality or tiredness for years: poor sleep, irritability, a tendency to drink. That is why, if a lot of time has passed since a traumatic experience but your condition is getting worse, it is worth telling your doctor about that event, even if it seems like it “was a long time ago.”
PTSD and Addiction: Why They Often Occur Together
People with PTSD are especially likely to start misusing alcohol, sleeping pills, cannabis, and other substances. The motive is understandable: the substance temporarily dulls the flashbacks, helps the person fall asleep, and stops them feeling constant anxiety. But this relief is deceptive. Alcohol worsens sleep quality, increases anxiety during withdrawal, and prevents the mind from processing the trauma, and over time addiction develops.
The combination of PTSD and addiction is a classic example of dual diagnosis. Current guidelines recommend treating both problems in a coordinated way: ensuring safe withdrawal from substance use, stabilizing sleep and anxiety, and then, or in parallel, carrying out trauma-focused therapy. The expectation that a person must first stay sober for years and only then work on the trauma is often unjustified and delays recovery.
How Narcology 24 Can Help
At Narcology 24, the addiction specialist and the psychiatrist work together: if a person drinks or uses substances to cope with the effects of trauma, the doctor assesses both the addiction and the post-traumatic symptoms, and then a psychotherapist joins the team. The initial consultation can be done online, and in an acute condition a doctor’s home visit is available.
How PTSD Is Diagnosed and Treated
The diagnosis is made by a psychiatrist based on a conversation: it is important to link the symptoms to a specific event and to assess how long they have lasted and how they affect the person’s life. Structured interviews and questionnaires are used, and other causes are ruled out: depression, anxiety disorders, the effects of a traumatic brain injury, and substance use. You do not have to describe the trauma in detail at the first appointment; the doctor will proceed gently and at a pace that is comfortable for you.
The foundation of treatment is trauma-focused psychotherapy. The strongest evidence base is for trauma-focused cognitive behavioral therapy and for eye movement desensitization and reprocessing (EMDR). These methods help process memories so that they no longer cause the same horror, and help change destructive beliefs about oneself and the world. When symptoms are severe, a psychiatrist may prescribe antidepressants from certain groups. Tranquilizers are not recommended as the main treatment for PTSD.
- Assessment of the person’s condition and safety, and identification of co-occurring depression and addiction
- Psychoeducation: explaining how PTSD works to the patient and their family
- Stabilization of sleep and anxiety, and self-regulation skills
- Trauma-focused cognitive behavioral therapy or EMDR
- Medication prescribed by a psychiatrist when symptoms are severe
- Treatment of addiction, if it has developed, and relapse prevention
How to Support a Loved One With PTSD
It is hard for loved ones to watch a person change: they become withdrawn and irritable, sleep badly, and refuse to talk about what happened. It is important not to press them with questions or demand that they “forget it and move on.” It is better to let them know you are ready to listen whenever they want, and that their reactions are understandable after what they went through. Predictability helps: a calm environment, clear agreements, and no sudden surprises.
You can gently suggest seeing a specialist, explaining that PTSD is treatable and is not a sign of weakness. If you notice that the person has started drinking more, talks about life being meaningless, or behaves recklessly, that is a reason to act more decisively. Take care of yourself as well: living with someone who has PTSD is exhausting, and support from a psychologist for family members can be very helpful.
When to see a doctor
- More than a month has passed since a severe event, but the flashbacks, nightmares, and anxiety are not easing
- You avoid places, people, and conversations, and your life is shrinking as a result
- Symptoms first appeared or got worse months after the trauma
- You have started drinking or taking sleeping pills or other substances more often to sleep and stop remembering
- Persistent low mood, guilt, and detachment from loved ones have appeared
- Angry outbursts and irritability are damaging relationships at home and at work
When urgent help is needed
Urgent help is needed if the person talks about not wanting to live, harms themselves, loses touch with reality, or becomes aggressive, and also in cases of severe intoxication or withdrawal. Call 103 or 112. Teenagers and young people can get help from the helpline 150. The condition can be eased, and help is available.
How Narcology 24 can help
Round-the-clock home visits, inpatient care and detox, coding, rehab and online consultations with an addiction doctor or psychiatrist. Confidential, with no registry entry.
- PTSD treatmentfrom 12 000 ₸ · Online 24/7
- Online psychiatrist consultationfrom 15 000 ₸ · Online 24/7
- Dual diagnosis: addiction and mental illnessfrom 15 000 ₸ · Online 24/7
Questions and answers
How long after a trauma does PTSD appear?
Most often, symptoms develop in the first weeks or months after the event. But delayed onset is also possible, when the full picture emerges six months later or even after that. Sometimes the disorder shows up after a new stressful event or on the anniversary of the trauma. So the passage of time does not rule out a link between the symptoms and what the person went through.
How is PTSD different from ordinary stress?
An ordinary stress reaction gradually eases over a few weeks, and the person returns to their usual life. With PTSD, the symptoms last longer than a month: the flashbacks, nightmares, avoidance, and constant hypervigilance are so pronounced that they interfere with work, sleep, and relationships. A psychiatrist assesses the difference during a consultation.
Can PTSD be cured?
Yes, PTSD responds well to treatment. For many people, trauma-focused psychotherapy leads to a significant reduction or disappearance of symptoms. The memories of the event remain, but they stop causing the same horror and stop controlling the person’s life. The earlier treatment begins, the faster the results usually come.
Do I have to tell the psychotherapist about the trauma in detail?
No, especially not in the early stages. A good specialist first helps stabilize your condition and build self-regulation skills, and moves on to working with memories gradually and with your consent. You control the pace yourself and can stop if it becomes too hard.
Does alcohol help with PTSD?
No. Alcohol briefly dulls anxiety and helps you fall asleep, but it disrupts the structure of sleep, makes nightmares and anxiety worse during withdrawal, and interferes with processing the trauma. Regular drinking quickly leads to addiction. At Narcology 24, in such cases a psychiatrist and an addiction specialist draw up a joint treatment plan.
What medications are prescribed for PTSD?
When symptoms are severe, a psychiatrist may prescribe antidepressants from certain groups, and sometimes medications to improve sleep or reduce nightmares. Tranquilizers are not recommended as the main treatment because of the risk of dependence. Medications usually complement psychotherapy rather than replace it. Only a doctor selects the specific treatment plan.
Can children have PTSD?
Yes, children can also develop PTSD after traumatic events. Their symptoms show up differently: re-enacting the trauma in play, fears, losing skills they had already learned, whininess, and problems with sleep and at school. Children need help from a child psychiatrist or psychotherapist. Teenagers in a difficult situation can call the free helpline 150.
Sources and methodology
- ICD-10, category F43.1 “Post-traumatic stress disorder,” WHO
- ICD-11, Chapter 6, section “Disorders specifically associated with stress,” WHO
- DSM-5, American Psychiatric Association
- NICE guideline NG116 “Post-traumatic stress disorder”
- APA Clinical Practice Guideline for the Treatment of PTSD
- Clinical protocols for diagnosis and treatment, Ministry of Health of the Republic of Kazakhstan
This article was prepared by the Narcology 24 medical editorial team and reviewed by a doctor. It is for reference only and does not replace a specialist consultation. Editorial policy
Medically reviewed by
Zhanar Tulegenova, MDPsychiatrist and psychotherapist · experience 18 yearsDepression, anxiety and panic attacks, PTSD, OCD and insomnia; addiction psychotherapy and relapse prevention.
