Two people experience the same traumatic event. After a few weeks, one gradually returns to normal life, although still experiencing anxiety. The other suffers from nightmares, avoids reminders of the experience, and constantly feels in danger.
Why do reactions vary so much? And is it possible to predict who will develop PTSD?
Points of attention
- Post-traumatic stress disorder, or PTSD, is a mental disorder that can develop after experiencing an extremely threatening or terrifying event or series of such events.
- However, not every repeated stressful situation meets the diagnostic definition of a traumatic event.
- Instead, accusations, mistrust, and forcing people to tell the details of their experiences can make things worse.
PTSD is caused by a complex interaction of psychological, biological, and social factors. The nature of the traumatic event, the person's previous experiences, their health, and the support they received after the experience are all important.
However, even a very severe trauma does not mean that PTSD will necessarily develop.
According to data from the World Health Organization, released in September 2026, approximately 70% of people in the world experience potentially traumatic events during their lifetime. However, only a fraction of those affected develop post-traumatic stress disorder.
The WHO estimates that about 5.6% of people who have experienced potentially traumatic events experience PTSD at some point in their lives.
This topic is especially important for Ukraine due to the long-term war, shelling, loss of loved ones, forced displacement, and other difficult circumstances.
Let's consider what factors increase the risk of developing PTSD, how to recognize possible symptoms, how a normal reaction to trauma differs from a mental disorder, and what help experts recommend.
What is PTSD and how does it occur?
Post-traumatic stress disorder, or PTSD, is a mental disorder that can develop after experiencing an extremely threatening or terrifying event or series of such events.
Potentially traumatic situations include combat, serious accidents, physical or sexual violence, disasters, and other events involving a threat to life or serious injury.
The person may be a direct participant in the event or a witness. In certain diagnostic circumstances, obtaining information about the violent or accidental death of a loved one may also be important.
After a traumatic experience, the psyche and body may remain in a state of heightened alertness to danger for a certain period of time.
The person reacts sharply to loud sounds, sleeps poorly, often recalls the experiences or tries to avoid situations that remind them of the event.
In many people, such reactions gradually weaken.
However, sometimes symptoms persist, become intense, and significantly affect daily life.
That's when a professional evaluation for possible PTSD is needed.
Do all people develop PTSD after trauma?
No. Most people who experience a potentially traumatic event do not receive a diagnosis of PTSD.
This is one of the key findings of modern research on traumatic stress.
For example, after a dangerous situation, a person may feel intense fear for several days, cry, have difficulty sleeping, or constantly relive the experience.
Such reactions in themselves do not indicate the presence of a mental disorder.
At the same time, the absence of pronounced symptoms immediately after the event does not guarantee that psychological difficulties will not appear later.
The US National Institute of Mental Health (NIMH) notes that PTSD symptoms usually appear within the first three months after the trauma, but can sometimes appear much later.
The risk of developing PTSD cannot be reliably determined by a single sign or pattern of a person's behavior after a traumatic event.
10 factors that may increase the risk of developing PTSD
Scientists identify factors that existed before the injury, accompanied it, and arose after the dangerous event.
Each of them affects risk differently.
1. Particularly severe or prolonged threat to life
One important factor is the intensity of the traumatic experience.
For example, the risk may increase if a person has been in danger for a long time, has experienced a serious injury, or has witnessed the death of others.
According to the National Center for PTSD of the US Department of Veterans Affairs, intense and prolonged traumatic events are more likely to be associated with the subsequent development of the disorder.
However, there is no universal scale by which to determine what injury is serious enough.
Personal reactions to experiences also matter.
2. Repeated traumatic events
An important factor is not only the severity of a single event, but also the repeatability of the dangerous experience.
For example, a person may experience multiple shellings, prolonged exposure to war zones, or multiple incidents of violence.
When a hazard recurs, opportunities for recovery may be limited.
However, not every repeated stressful situation meets the diagnostic definition of a traumatic event.
It is necessary to distinguish between ordinary, even very severe stress, and an experience that meets the criteria for traumatic exposure.
3. Traumatic childhood experiences
Previous exposure to violence or other severe traumatic events may influence the risk of PTSD in adulthood.
Repetitive childhood traumas are of particular importance.
According to the NIMH, previous traumatic experiences, particularly in childhood, are among the established risk factors.
At the same time, this does not mean that a person who experienced a difficult childhood will necessarily have PTSD in the future.
Many people do not develop this disorder after a difficult experience.
4. Violence from another person
Sexual violence, torture, severe physical assault, and other forms of interpersonal violence are associated with an increased risk of PTSD.
According to WHO estimates, the disorder occurs particularly frequently after sexual violence compared to many other categories of traumatic events.
A person's future state can be influenced by fear, the threat of repeated violence, shame, stigmatization, and the reaction of others.
It is important to emphasize: responsibility for violence always lies with the person who committed it.
The victim's behavior during the threat is not grounds for charges.
5. A strong feeling of helplessness during the event
How a person perceives danger at the time of injury can also influence their subsequent psychological state.
For example, during an accident or shelling, a person may be convinced that they will inevitably die.
Some sufferers describe feelings of detachment from themselves or the world around them. In psychology, such experiences may be called dissociative symptoms.
Studies link certain reactions during trauma to an increased risk of PTSD.
However, these signs are not a reliable way to predict the diagnosis in a specific person.
6. Previous mental disorders
The presence of depression, anxiety, or another mental disorder prior to a traumatic event may increase the likelihood of subsequent difficulties.
Scientific studies also consider the possible influence of hereditary factors and family history of mental illness.
However, genetic predisposition does not mean that PTSD will inevitably develop.
Similarly, a person with no prior psychological problems may experience post-traumatic stress disorder after a dangerous experience.
7. Lack of support after injury
Support from loved ones and social environment is one of the most important protective factors.
The WHO notes that feeling supported after a traumatic event may reduce the likelihood of developing PTSD.
However, the quality of care matters.
For example, a person who is affected may benefit from someone helping with household chores, listening attentively, or simply staying close.
Instead, accusations, mistrust, and forcing people to tell the details of their experiences can make them feel worse.
Support doesn't mean you have to constantly discuss the trauma.
8. Additional difficulties after a dangerous event
Sometimes the traumatic situation itself ends, but the person faces new problems.
For example, they lose their housing, job, familiar social environment, or the ability to independently provide for their basic needs.
Such circumstances create an additional burden.
The NIMH lists stressful events following trauma as factors that may increase the risk of PTSD.
Therefore, support for victims should not be limited to psychological conversations.
Sometimes safe housing, medical care, legal protection, and financial stability are of paramount importance.
9. Injuries, chronic pain and the consequences of trauma
Serious physical injuries during a dangerous event can increase the risk of PTSD.
For example, a person has experienced a car accident, prolonged treatment, and a difficult recovery.
Traumatic memories may be combined with pain, limited mobility, or fear of the event recurring.
However, PTSD and the physical effects of trauma need to be assessed separately.
If there is persistent pain, sleep disturbances, or neurological symptoms, comprehensive medical care is important.
10. Individual biological and social characteristics
Studies show that PTSD is more commonly diagnosed in women than in men.
However, this is a statistical pattern, not a sign of greater or lesser psychological resilience.
Differences may be influenced by the nature of traumatic events, previous experiences, social circumstances, and biological mechanisms.
WHO also considers age, family history of mental disorders, and other sociodemographic factors.
None of these indicators can diagnose or reliably predict the development of PTSD in an individual.
What events are most often associated with the development of PTSD?
PTSD can occur after a variety of potentially traumatic situations.
These include:
combat operations and exposure to shelling;
sexual and severe physical violence;
serious road accidents;
catastrophes and natural disasters;
life-threatening injuries or medical events;
observing the death or serious injury of other people.
The risk depends on the nature of the event and individual circumstances.
Can PTSD develop without personal injury?
Yes. You don't have to experience a physical trauma to develop PTSD.
For example, a person may witness an extremely dangerous event and subsequently experience re-experiencing memories, avoidance, and heightened alertness.
In some occupations, traumatic exposure may also be associated with repeated exposure to severe details of hazardous events.
But simply viewing disturbing news stories in and of themselves does not always meet the diagnostic criteria for traumatic exposure for PTSD.
It can cause significant stress and other psychological difficulties that also deserve attention.
What symptoms of PTSD should not be ignored?
According to the international classification of diseases ICD-11, the main manifestations of PTSD are divided into three groups.
Re-experiencing a traumatic event
A person may be troubled by intrusive memories, nightmares, or flashbacks.
A flashback is an experience in which it seems like a dangerous event is happening again.
For example, a sharp sound can cause an acute reaction if it reminds you of a perceived threat.
Not every unpleasant memory is a flashback.
Avoiding reminders of the experience
A person may avoid certain places, conversations, smells, sounds, or situations associated with the traumatic experience.
Sometimes this significantly changes the usual way of life.
For example, after a serious accident, a person may refuse to travel by car.
Constant feeling of threat
There may be excessive alertness, increased reaction to sharp sounds, and difficulty relaxing.
A person feels in danger even when there is no immediate threat.
Problems with sleep, concentration, mood, and relationships are also possible.
However, these symptoms also occur in other mental and physical conditions.
A diagnosis of PTSD is made based on a set of criteria, not on the presence of a single nightmare, anxiety, or fear of loud noises.
How long after a trauma can PTSD appear?
Reactions to trauma can occur immediately or gradually.
According to the DSM-5 diagnostic criteria for PTSD, the symptoms must last for more than one month and significantly impact life.
ICD-11 uses a slightly different system of diagnostic criteria, so professional judgment takes into account the current classification and clinical circumstances.
You don't need to wait exactly a month if the symptoms are already very severe.
For example, if a person is barely sleeping, unable to perform normal tasks, or is in severe psychological distress, they need help sooner.
Sometimes symptoms appear several months after the dangerous event.
This also does not rule out the possibility of PTSD.
How PTSD differs from normal stress and acute trauma response
Not every experience of a dangerous event leads to a mental disorder.
After an injury, fear, anxiety, sleep disturbances, crying, confusion, or emotional numbness may occur.
In many people, these reactions gradually subside.
| State | Main feature |
| Normal stress response | Experiencing in response to difficult circumstances that does not necessarily meet criteria for a disorder |
| Acute reaction to trauma | Symptoms that occur shortly after an extremely threatening event |
| Acute stress disorder | A separate diagnosis in DSM-5 that can be made for specific symptoms within 3 days to 1 month after the injury |
| PTSD | A persistent set of characteristic symptoms following a traumatic event that causes significant distress or disrupts daily life |
The boundaries between states require professional assessment.
It is not worth self-diagnosing PTSD using an online test alone.
What is complex PTSD and how is it different from regular PTSD?
Complex posttraumatic stress disorder, or cPTSD, is identified as a separate diagnosis in ICD-11.
It includes the core symptoms of PTSD, as well as additional long-term difficulties.
In particular, the following may be observed:
significant disturbances in emotion regulation;
persistent negative self-image;
serious difficulties with close relationships.
Complex PTSD is more often associated with prolonged or repeated trauma, especially interpersonal trauma.
However, it can occur not only after such events.
It is also important to understand that in the American classification DSM-5, complex PTSD is not distinguished as a separate diagnosis.
Therefore, approaches to its classification differ in different systems.
Does war affect the risk of developing PTSD?
War creates many situations that can increase the risk of traumatic disorders.
These include fighting, the threat of death, injury, forced displacement, loss of loved ones, and prolonged uncertainty.
According to WHO estimates, the prevalence of PTSD among people who have experienced violent conflict or war is significantly higher than in the general population.
However, it is important to avoid generalizing that all military personnel, veterans, displaced persons, or civilians in Ukraine have PTSD.
People react to traumatic events differently.
Some require specialized treatment, others require practical support and time to recover.
You cannot diagnose a person with PTSD solely on the basis of having experienced war.
Can the development of PTSD after trauma be prevented?
There is no guaranteed way to prevent the disorder.
However, certain forms of support can help survivors and reduce the risk of long-term psychological difficulties.
First and foremost, it is important to ensure physical safety and necessary medical care.
Then, help the person get information, support from loved ones, and access to basic resources.
What do experts recommend after a traumatic event?
If possible, it is useful to:
provide a safe place to stay;
help with food, shelter, and other immediate needs;
maintain contact with people the victim trusts;
do not force her to talk in detail about the injury;
provide information about available professional help;
Pay attention to pronounced or prolonged symptoms.
National and international clinical guidelines advise against mandatory psychological debriefings, during which victims are forced to immediately recount the traumatic event in detail.
This approach has not proven effective for preventing PTSD, and some studies have shown adverse results.
At the same time, this does not mean that a person cannot talk about their experiences.
If she wants to share her experiences, it is important to listen to her carefully and without judgment.
How to properly support a person after psychological trauma
Sometimes loved ones try to help, but don't know what to say.
Common phrases like “Forget it,” “You have to be strong,” or “Others have had it worse” can devalue the experience of a traumatized person.
It is more useful to offer specific help.
For example: "I can be there for you or help with everyday tasks. What do you need right now?"
You should not demand a quick return to normal.
You also shouldn't touch or hug a person without their consent, especially if they have experienced violence.
If the victim does not want to talk about the trauma, it is important to respect their boundaries.
Help should take into account the needs of a specific person, not the expectations of others.
What treatments for PTSD have scientific evidence?
PTSD is treatable.
According to the recommendations of the WHO and the UK's National Institute for Health and Care Excellence (NICE), psychological methods with proven effectiveness play a leading role in treatment.
Trauma-focused cognitive behavioral therapy
This is a group of psychotherapeutic approaches aimed at working with traumatic memories, beliefs, and behavioral responses.
The treatment is carried out by a trained specialist.
The goal is to gradually reduce symptoms and restore daily functioning.
EMDR therapy
EMDR is the desensitization and reprocessing of traumatic experiences using eye movements or other forms of bilateral stimulation.
The method has scientific evidence of effectiveness for treating PTSD.
It must be applied by a specialist with appropriate training.
Drug treatment
In some cases, a doctor may recommend medication.
The choice depends on symptoms, underlying conditions, previous treatment, and individual medical circumstances.
It is dangerous to self-prescribe antidepressants, sedatives, or sleeping pills.
NICE guidelines specifically warn against the use of medications, particularly benzodiazepines, to prevent PTSD after a traumatic event.
When to see a doctor
Professional counseling is needed if symptoms persist or interfere with daily life after a traumatic event.
Particular attention should be paid to recurring nightmares, flashbacks, pronounced avoidance, severe anxiety, and sleep disturbances.
There is no need to wait four weeks if the condition is severe.
The first step may be to see a family doctor, psychiatrist, or mental health professional who has experience working with trauma.
In case of suicidal thoughts, intent to harm oneself, or other immediate threat, emergency help is needed.
Five myths about PTSD that prevent you from getting help
Myth 1: PTSD only occurs in the military. The disorder can develop in people of all professions and ages after potentially traumatic events.
Myth 2. If a person doesn't cry, they haven't experienced psychological trauma. Reactions can be very different, including without expressed external emotions.
Myth 3: PTSD always appears immediately after the event. Symptoms can appear later.
Myth 4: You need to tell everyone about the trauma immediately to heal. Forcing detailed discussions is not recommended as a way to prevent PTSD.
Myth 5: PTSD cannot be cured. There are effective methods of psychotherapy and, if necessary, medication.
Conclusion
The risk of developing PTSD depends on many factors: the severity of the traumatic experience, its recurrence, previous mental health status, and living conditions after the dangerous event.
Social support, access to safety and necessary assistance are of particular importance.
However, no single factor means that PTSD will necessarily develop.
It is also important to remember that psychological reactions after trauma can be natural and gradually fade.
If symptoms persist, worsen, or disrupt daily life, it is worth getting a professional evaluation.
PTSD is a treatable condition. With timely help and support, symptoms can be reduced and quality of life gradually restored.
FAQ: Frequently Asked Questions About the Causes and Symptoms of PTSD
What most often causes PTSD?
PTSD can develop after extremely threatening or terrifying events, including combat, serious accidents, sexual or physical abuse. The risk depends on the nature of the trauma, previous experiences, and the circumstances following the event.
Can PTSD occur without combat experience?
Yes. PTSD can occur after other traumatic events, including severe violence, dangerous accidents, or disasters. Military service is not a prerequisite for developing PTSD.
Why do some people develop PTSD after the same trauma, while others do not?
Risk is influenced by previous traumatic experiences, mental health status, intensity of threat experienced, social support, and other factors. There is no single trait that reliably predicts PTSD.
Can PTSD develop years after a trauma?
Yes, symptoms sometimes first appear or become clinically significant a long time after the event. A specialist evaluation is required to make a diagnosis, as similar symptoms may be associated with other conditions.
How do you know if a person may have PTSD?
Possible signs include intrusive traumatic memories, flashbacks, nightmares, avoidance of reminders, and a constant sense of threat. It is important to consider the duration, intensity, and impact of symptoms on your life. You should not self-diagnose.
Will all people who have survived war have PTSD?
No. Even after severe traumatic events, not everyone develops PTSD. However, war experiences can be associated with other psychological difficulties that also require attention and support.
How is complex PTSD different from regular PTSD?
Complex PTSD, according to ICD-11 criteria, includes the core features of PTSD and additional difficulties with emotion regulation, self-esteem, and relationships. It is more often associated with repeated traumatic experiences, but the diagnosis depends on clinical criteria.
Can PTSD be prevented after a traumatic event?
There is no guaranteed way to prevent it. However, providing safety, practical and social support, and access to medical care can help recovery. It is not recommended to force the person to immediately talk in detail about their experiences.
Can PTSD be completely cured?
There are effective treatments, including trauma-focused cognitive behavioral therapy and EMDR. Results depend on the severity of symptoms, underlying conditions, and individual circumstances. A specific treatment plan is determined by a professional.
When should you consult a psychiatrist or psychologist after an injury?
If symptoms are severe, worsening, do not improve within several weeks, or significantly interfere with your life, you should seek professional help. In severe cases, you do not need to wait a month. In cases of immediate life-threatening conditions, emergency care is necessary.
Important: This article is for informational purposes only and is not a substitute for professional medical advice. Self-medication for PTSD, depression, anxiety, or other mental health conditions can be harmful to your health. If you have experienced a traumatic event and are experiencing symptoms that are affecting your sleep, well-being, relationships, or daily life, please consult your doctor first. Do not self-medicate or attempt intensive trauma-focused therapies without professional guidance.
