Contents
Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after someone experiences or witnesses an event that overwhelms their capacity to cope with it at the time. It is recognised in both the DSM-5 and the ICD-11, the diagnostic manuals used by psychologists and psychiatrists, and describes a persistent pattern of symptoms tied to that event, distinct from stress or anxiety that eases once a traumatic situation has passed. PTSD is marked instead by its persistence beyond a month and by a particular set of symptom patterns. It is typically treated with trauma-focused psychological therapy, most commonly trauma-focused Cognitive Behavioural Therapy (CBT) or Eye Movement Desensitisation and Reprocessing (EMDR).
How Does PTSD Differ From Trauma More Broadly?
Trauma is the broader term, covering the difficult or overwhelming experiences someone can go through and the different ways these can affect a person afterwards. Understanding trauma more broadly is therefore a separate subject from PTSD itself, which is one diagnosable response trauma can produce rather than a synonym for it. Not everyone who lives through a traumatic event develops PTSD, and the difference often comes down to the event itself, the support available afterwards, and a person’s own history and coping style.
Complex PTSD is recognised as a distinct diagnosis in the ICD-11, used where prolonged or repeated trauma has left someone with lasting difficulties in emotional regulation, self-perception or relationships, alongside the core features of PTSD. The DSM-5 does not list it separately, which accounts for some of the inconsistency in how the two terms are used.
How Is PTSD Diagnosed?
A diagnosis of PTSD is made by a professional rather than by the person experiencing the symptoms, and in the UK the process usually begins with a conversation with a GP, who refers the person for a fuller assessment where appropriate, following NICE’s recommended pathway. That assessment is carried out by a psychologist or psychiatrist with training in trauma-related presentations, and considers the person’s history alongside the criteria set out in the DSM-5 or the ICD-11. Those criteria cover how long symptoms have lasted, how closely they tie to a specific event, and the extent of their effect on daily functioning. They guide a professional’s assessment rather than functioning as a self-test.
How Can PTSD Present?
The symptoms of PTSD can present in different ways, though four broad patterns tend to recur. The first is the event intruding on the present, through unbidden memories or a sense of reliving rather than remembering it. Alongside this there is often avoidance of places, people or situations that recall the event, sometimes to the point of narrowing someone’s social or working life. The pattern can also include changes in mood and thinking, such as a negative view of oneself or the world, or a flattened and detached emotional life. Heightened arousal completes the picture: a readiness to startle, disproportionate irritability, and difficulty concentrating or sleeping.
These patterns typically overlap and rarely sit in clean, separate categories. Their effect on daily life is often concrete, with concentration at work becoming harder to sustain and sleep becoming unreliable, while relationships can come under strain when avoidance or irritability go unexplained to the people living alongside them. None of this functions as a list to measure a diagnosis against, which remains a matter for professional assessment.
Does PTSD Ease Without Treatment?
Whether PTSD eases without treatment depends on the individual and on what has happened to them, and no single answer applies across every presentation. NICE guidance (NG116) recommends watchful waiting, rather than active treatment, only where symptoms are mild and have lasted less than four weeks. Beyond that point the guidance moves toward offering trauma-focused psychological therapy rather than continuing to wait.
How Is PTSD Treated?
PTSD is typically treated with one or more trauma-focused psychological therapies. The three approaches most relevant to an adult presentation, trauma-focused Cognitive Behavioural Therapy (CBT), Eye Movement Desensitisation and Reprocessing (EMDR) and Schema Therapy, are all evidence-based models of therapy for PTSD. Each addresses a different aspect of what a presentation can involve, and the choice between them tends to depend on what the person is bringing, rather than on one approach being more effective than another for a given situation.
Trauma-Focused Cognitive Behavioural Therapy
Trauma-focused CBT, as NICE recommends it for adults, works directly with the traumatic memory, helping someone process what happened and address the beliefs formed around it, such as self-blame or an ongoing sense of danger. This is distinct from the model developed for children and adolescents, which involves caregivers directly; the adult approach works with the person one-to-one, supported by a psychologist or psychotherapist trained in the method.
EMDR
EMDR is recommended by NICE and the World Health Organization as a first-line option for adults, alongside trauma-focused CBT. Other bodies, including the American Psychological Association, position it as a second-line treatment to be tried after other therapies, a divergence that reflects differing interpretations of the same evidence rather than a settled consensus. EMDR uses a structured, phased process in which a psychologist or psychotherapist guides bilateral stimulation, such as directed eye movements, while the person recalls aspects of the memory, with the aim of making it less distressing to recall.
Schema Therapy
Where trauma-focused CBT and EMDR address the traumatic memory directly, Schema Therapy takes a longer-term approach, addressing patterns rooted in earlier experience, such as persistent beliefs about being unsafe, unworthy or responsible for what happened, which can sit alongside a PTSD presentation without being part of it. NICE does not specifically recommend it for standard PTSD. It is more often considered where PTSD symptoms exist together with longer-standing relational patterns predating the traumatic event, including some presentations of Complex PTSD, rather than as an alternative for processing the memory itself.
Medication
Medication, prescribed and monitored by a GP or psychiatrist, is generally considered only where trauma-focused therapy has not helped or has not been taken up, and sits outside the psychological therapies we provide.
How Can Someone Support a Person They Are Worried About?
Where someone close to us may have PTSD, the most useful starting point is usually to listen without pressing for detail or trying to establish what happened. Many people in this position want space to talk when ready rather than advice, and pushing for disclosure, however well meant, can feel like another demand on someone already overwhelmed. Avoidance, irritability or withdrawal are often symptoms rather than choices, which does not mean indefinite patience is the only option, but does mean that taking a reaction personally is rarely useful. Encouraging someone to seek a professional assessment, rather than attempting to diagnose or treat what they are going through, remains the most constructive role available.
Deciding which of these approaches might suit a particular situation, or whether what someone is experiencing meets the criteria for a PTSD diagnosis at all, is exactly the kind of question an initial assessment is designed to answer. Our Clinical Psychologists, Counselling Psychologists and Expert Integrative Psychotherapists at Borough Townhouse carry out that assessment before any commitment to ongoing work, matching each person to a practitioner on clinical fit. If this is something you are weighing up, you are welcome to book an initial consultation.
