PTSD (post-traumatic stress disorder): symptoms and treatment
Post-traumatic stress disorder (PTSD) is a mental health condition in which a frightening event keeps replaying — through flashbacks, nightmares or unwanted memories — long after the danger has passed, along with avoiding reminders, feeling constantly on guard, and changes in mood and self-belief. Distress in the first weeks after a trauma is normal and usually fades. When symptoms last beyond about a month and disrupt daily life, trauma-focused CBT or EMDR is the first-line treatment, and most people improve with it.
Health writers · Aslam Clinic
Post-traumatic stress disorder (PTSD) is what happens when the brain's alarm system stays switched on after a terrifying event is over. The person keeps reliving what happened, goes out of their way to avoid reminders, and feels on edge as if the danger could return at any moment. It is a recognised medical condition, not a weakness of character, and it responds well to specific talking treatments.
Most people who live through something dreadful do not develop PTSD. The World Health Organization estimates that around 70% of people worldwide experience a potentially traumatic event in their lifetime, but only about 5.6% of them go on to develop PTSD. Feeling supported by family and friends afterwards lowers the risk. Knowing this matters: shock, poor sleep and replaying the event in the first days are a normal response to an abnormal event, not a sign that something has broken.
What counts as a traumatic event
Trauma here means an event that was, or felt, life-threatening or horrific — something that happened to you, that you saw happen to someone else, or that you learned happened to someone close to you. Examples doctors see in Pakistan include:
- Bomb blasts, terrorist attacks and armed robbery
- Floods, earthquakes and building collapses
- Serious road traffic accidents — as a driver, passenger or witness
- Physical or sexual assault, including within marriage
- Domestic violence that goes on for months or years
- The sudden, violent death of someone close
- A frightening childbirth, or a stay in intensive care
The main symptoms
Doctors group PTSD symptoms into clusters. You do not need all of them, and they usually begin within weeks of the event — though the NHS notes they can appear months or even years later.
| Cluster | What it looks like |
|---|---|
| Re-experiencing | where it feels as if the event is happening again; nightmares; sudden, vivid intrusive memories with a racing heart or sweating |
| Avoidance | Refusing to travel on the road where the accident happened, avoiding the news, not talking about it even with family, keeping busy so as never to think |
| Feeling on guard | — scanning every room, sitting with your back to the wall, jumping at loud noises, irritability, poor sleep and concentration |
| Changes in mood and thinking | Guilt or self-blame ('it was my fault'), feeling numb or cut off from people, losing interest in things, believing the world is completely dangerous |
PTSD often shows up in the body too: headaches, stomach problems and aches with no clear physical cause are common. In young children the signs may be re-enacting the event in play, nightmares about other frightening things, or going back to bed-wetting.
Normal reactions versus PTSD
The first month after a trauma is a period of adjustment. Most distress eases week by week, and the diagnostic manuals do not normally call it PTSD until symptoms have lasted for about a month.
| Usually normal in the first weeks | Suggests PTSD and needs assessment |
|---|---|
| Shock, crying, disbelief, feeling unreal | Symptoms still strong after about four weeks, or getting worse |
| Replaying the event, some bad dreams | Flashbacks or nightmares most nights, months on |
| Sleeping badly, jumpy, not wanting to go out | Avoidance that stops you working, studying or travelling |
| Needing family close by | Pulling away from everyone, feeling permanently numb |
| Gradual improvement | Using alcohol, sleeping pills or tranquillisers to get through the day |
Complex PTSD
is a diagnosis in the World Health Organization's . It usually follows trauma that was prolonged or repeated and hard or impossible to escape — years of domestic violence, childhood abuse, torture or captivity. People have the core PTSD symptoms plus three further problems:
- Difficulty managing emotions — intense anger or distress that is hard to settle, or shutting down and feeling nothing ( problems)
- A deeply negative view of oneself — feeling worthless, defeated or permanently damaged, often with shame or guilt
- Difficulty in relationships — struggling to trust, to feel close to others or to keep relationships going
Complex PTSD is treatable with the same trauma-focused approaches, but NICE advises building in extra time to develop trust and more sessions where needed, and attending to safety at home first — therapy is hard to use while the abuse is still happening.
Treatment that works
The first-line treatments are talking therapies that work directly with the trauma memory. Both usually take 8 to 12 weekly sessions, sometimes more after multiple traumas.
- Trauma-focused — you learn how trauma affects the mind and body, practise ways to manage flashbacks and arousal, and then, at a pace you control, go back over the memory so that it can be stored as something that happened in the past rather than something still happening. It also tackles beliefs such as 'I should have stopped it'.
- (eye movement desensitisation and reprocessing) — you hold the memory in mind while following side-to-side movements or taps. NICE recommends offering it to adults whose PTSD follows non-combat trauma, such as an accident or assault, and has lasted more than three months.
Revisiting the memory sounds frightening, and it is the reason many people avoid therapy. A trained therapist builds up to it gradually, and it is this processing — not avoidance — that allows the fear to settle.
Where medicines fit
Medicines are not the first-line treatment for PTSD, but they have a role. If an adult prefers medication, NICE says an such as sertraline, or venlafaxine, can be considered, with regular review. Like all antidepressants they take 2 to 6 weeks to work, must not be stopped suddenly, and should only be started or stopped with a doctor. For children and teenagers, NICE advises therapy rather than medicines. In severe cases with very high arousal or psychotic symptoms that have not responded to other treatment, a specialist may add an antipsychotic such as risperidone.
PTSD in Pakistan
Pakistan has lived through decades of bombings, the 2005 earthquake and repeated floods, and road accidents are an everyday risk. A review of studies after earthquakes in Iran and Pakistan found a pooled rate of PTSD of about 49% among Pakistani survivors — mostly measured by questionnaires, which tend to give higher figures than clinical interviews, and falling as time passed. Worldwide, WHO estimates that PTSD is more than three times as common among people exposed to war or conflict.
Much trauma happens at home and is never counted. According to the Pakistan Demographic and Health Survey 2017–18, as reported by UNFPA, 34% of ever-married women have experienced physical, sexual or emotional violence from a husband, and more than half of women who experienced violence never told anyone or sought help. Men are often told to be strong and not speak of what they saw; women may not be allowed to attend appointments alone. WHO notes that only about one in four people with PTSD in low- and middle-income countries seek any treatment.
Prayer, dua and the support of a faith community can be a real comfort, and they sit comfortably alongside treatment — seeking therapy is not a lack of faith. Psychiatry departments at district (DHQ) and teaching hospitals can assess PTSD, and trauma-focused therapy is increasingly available online for those far from a big city.
When to get help
- Symptoms are still strong about four weeks after the event, or are getting worse
- Flashbacks, nightmares or avoidance are stopping you working, studying, travelling or caring for your family
- You are relying on alcohol, drugs, sleeping pills or tranquillisers to cope
- You feel numb, hopeless or cut off from everyone
- A child has changed markedly in behaviour, sleep or play since a frightening event
How to help someone after a trauma
- Make sure they are physically safe and that basic needs — food, sleep, a place to stay — are met.
- Let them talk when they want to, and do not push when they do not. Listening matters more than advice.
- Avoid 'bhool jao' (just forget it) as a way of closing the conversation; it is usually meant kindly, but it can make a person feel they must suffer in silence.
- Help them keep normal routines — meals, prayer, work, gentle exercise — as far as possible.
- Watch for heavy use of alcohol or tablets, and discourage it.
- If things are not easing after about a month, help them get an assessment, and offer to go with them.
Common questions
Still not sure what to do?
Reading about a symptom only goes so far. A doctor who can ask you questions and examine you will get further in ten minutes than any article can.
