After a Traumatic Event: What Is Normal and When to Get Help

What reactions are normal after a traumatic event?

It is normal to think, act and feel differently than usual after a traumatic event. These stress reactions are not weakness, and they happen even to people trained for crises, such as service members and rescue workers. Many people say their first feeling was relief at being alive, followed by stress, fear and anger.

The National Center for PTSD lists many common reactions, which can show up in several ways:

• In your thoughts: being unable to stop thinking about what happened, trouble concentrating or making decisions, blaming yourself.
• In your emotions: feeling nervous, helpless, sad, numb, irritable or detached from other people.
• In your body: a pounding heart, sweating, an upset stomach, feeling very tired, or trouble sleeping.
• In your behavior: being jumpy or on guard, avoiding reminders of the event, having problems at work or school, or smoking, drinking or eating more.

How long do these reactions usually last?

Everyone's timeline is different, but here is a general pattern based on the National Center for PTSD and the National Institute of Mental Health.

1. 1The first few weeksStress reactions are common, and daily activities can feel difficult. Most people start to feel better after a few weeks. Recovery is usually gradual, and you may not forget what happened.
2. 2After about a monthIf symptoms last longer than a month and are very upsetting or disrupting your life, talk with a provider. To be diagnosed with PTSD, symptoms must last longer than 1 month and be severe enough to interfere with parts of daily life, such as relationships or work.
3. 3Months or even years laterPTSD symptoms usually start soon after the event, and usually within 3 months, but they sometimes appear later. They may also come and go over many years. A late start does not mean your reaction is not related to what happened.

What are the signs of PTSD?

There are four types of PTSD symptoms, and a diagnosis involves having each type. Everyone experiences them in their own way, and only a mental health provider can diagnose PTSD. A list like this can help you explain what you notice.

Why does avoidance matter so much?

After a frightening event, staying away from reminders can feel like the sensible way to get through the day. Sometimes it is a small change. Over time, though, some people change their routines around it: they stop driving, avoid crowds, keep constantly busy, or avoid getting help so they do not have to think or talk about what happened.

If your life has been getting narrower since the event, that is worth mentioning, even if you feel fine as long as you stay away from reminders. Some trauma-focused therapies, such as prolonged exposure, teach people to gradually approach what they have been avoiding.

Why are nightmares and poor sleep so common after trauma?

According to the National Center for PTSD, almost everyone with PTSD also has trouble sleeping, and both nightmares and insomnia are symptoms of PTSD. Nightmares may replay the event. Fear of them can make going to bed feel unsafe, and feeling on guard makes restful sleep hard. Some people start using alcohol or other substances to sleep, which can harm sleep quality and overall health over time.

Sleep problems can also become a problem of their own that needs specific care. The National Center for PTSD calls cognitive behavioral therapy for insomnia the best treatment for insomnia. Our guide on sleep problems and mental health and our page on sleep problems explain more.

When should I get help sooner?

You do not need to wait a month if something is getting in the way now. Reach out to a provider sooner if:

• Reactions are so strong that you cannot do your job, go to school or look after your family.
• You feel depressed, hopeless or very low on energy most days.
• You are drinking or using drugs to numb difficult thoughts and memories.
• Anger or aggression is causing problems with family, friends or co-workers.
• You blame yourself for what happened and cannot put it down.

How can care help, and what is it like here?

There are several helpful treatments for PTSD. Trauma-focused psychotherapies focus on the memory of the event or its meaning, and the National Center for PTSD names three as most effective: cognitive processing therapy, prolonged exposure, and eye movement desensitization and reprocessing. Certain medications, including SSRI antidepressants, can also help with symptoms, and some people combine medication and therapy. The National Center for PTSD says treatment can get rid of symptoms altogether for many people, while others have fewer or less intense symptoms. Results differ from person to person.

Trauma-focused therapy is often provided by a dedicated therapist. At DanShalom Behavioral Clinic, Victor Onodjacha, MSN, PMHNP-BC, a board-certified psychiatric-mental health nurse practitioner, can evaluate your symptoms and, with your permission, coordinate with your therapist. Ask us which therapy can be provided here. You can read more about our approach to PTSD and trauma. If you are worried about having to talk through the event, tell us when you request an appointment and ask what to expect.

Medication decisions are made with you after an evaluation. Not every medication can be prescribed at every kind of visit, and some may require an in-person appointment, so we explain what applies to you. See medication management for how follow-up works, and talk with your prescriber before starting, stopping or changing a medication. Visits take place in Sugar Land or by secure video if you are physically in Texas, Idaho, Arizona or Maryland.

We are not an emergency service. If you are in crisis or thinking about suicide, call or text 988, or call 911 if you are in immediate danger. Veterans and people concerned about one can call 988 and press 1. Our crisis resources page lists more options.