Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) develops in some individuals following exposure to actual or threatened death, serious injury, or sexual violence. According to the NIMH, approximately 3.6% of U.S. adults have PTSD in any given year. Lifetime prevalence is substantially higher — approximately 6.8% of the population will meet criteria for PTSD at some point in their lives. Women are approximately twice as likely as men to develop PTSD following trauma exposure.

Symptoms of PTSD

The DSM-5 organizes PTSD symptoms into four clusters:

• Intrusion symptoms — Recurrent, involuntary, and distressing memories; nightmares; dissociative flashbacks; psychological and physiological distress in response to trauma cues
• Avoidance — Avoiding trauma-related thoughts, feelings, external reminders (people, places, situations, objects)
• Negative alterations in cognition and mood — Inability to remember aspects of the trauma; persistent negative beliefs; persistent negative emotions; feelings of detachment; inability to experience positive emotions
• Alterations in arousal and reactivity — Hypervigilance, exaggerated startle response, sleep disturbance, irritability, concentration difficulties, reckless or self-destructive behavior

Symptoms must be present for more than one month, cause significant distress or functional impairment, and not be attributable to substances or medical conditions.

PTSD and Substance Use Disorders

PTSD and substance use disorders co-occur at high rates. Research suggests that up to 40–60% of individuals seeking treatment for PTSD also have a substance use disorder, and the relationship is bidirectional — PTSD increases the risk of SUD (often through substance use as emotional avoidance), and substance use can maintain PTSD by preventing natural fear extinction. This is one of the most clinically important co-occurring presentations in behavioral health. See our article on PTSD and addiction treatment.

Evidence-Based Treatments

Trauma-Focused Psychotherapies

The most effective treatments for PTSD are trauma-focused psychotherapies that directly address the traumatic memories and their cognitive and emotional sequelae. The strongest evidence base belongs to:

• Prolonged Exposure (PE) — Developed by Edna Foa at the University of Pennsylvania. PE involves psychoeducation about PTSD, breathing retraining, and repeated systematic exposures to trauma memories (imaginal exposure) and avoided situations (in vivo exposure). Among the most extensively validated PTSD treatments across diverse trauma populations.
• Cognitive Processing Therapy (CPT) — Focuses on identifying and challenging "stuck points" — beliefs about the trauma and its meaning that maintain PTSD symptoms. Highly effective across populations and requires no direct exposure to trauma memories, making it accessible to patients who cannot tolerate PE.
• Eye Movement Desensitization and Reprocessing (EMDR) — Involves bilateral stimulation (eye movements, tapping, or tones) while holding trauma memories in mind. Multiple meta-analyses support its efficacy, though the mechanism of action remains debated.

The American Psychological Association, the VA/DoD, and NIMH all include PE, CPT, and EMDR in their clinical practice guidelines as first-line trauma-focused treatments.

Pharmacotherapy

Sertraline and paroxetine are the only FDA-approved medications for PTSD. Both are SSRIs and are moderately effective for the full symptom cluster. They are often used in combination with psychotherapy. Prazosin, an alpha-1 adrenergic antagonist, has evidence for trauma nightmares and sleep disturbance in PTSD, though recent trials have shown mixed results.

Related: PTSD & Addiction · Trauma-Informed Care · Anxiety Disorders