How PTSD Develops

Distress felt more than a month after the time of a traumatic event may be PTSD. These signs can tell you whether or not you’re experiencing PTSD or another disorder.

Estimated watch time: 8 mins 


When someone experiences post-traumatic stress, it can then progress to post-traumatic stress disorder. PTSD is characterized as distress that lasts over a month after the traumatic event.

This video provides you with ways to evaluate your experiences for signs and symptoms of post-traumatic stress and different disorders along this spectrum.

Video Materials:


How Post-Traumatic Stress Can Lead to PTSD

In this lesson, we’re going to build on the concept of post-traumatic stress. And look at how post-traumatic stress can then progress into maybe more severe reactions to a trauma so that we can better understand how this may lead to PTSD.

As discussed in the previous lesson on post-traumatic stress, when we experience a trauma, it is appropriate and natural for us to have a strong reaction to that event.

There is a range of reactions to trauma in accordance to how long we’ve experienced that trauma and the severity of the distress.

We start with post-traumatic stress as that initial reaction. Over time that may progress to acute stress disorders or an adjustment disorder. And over a longer length of time or with continued exposure to trauma it may progress into post-traumatic stress disorder or complex post-traumatic stress disorder.

Just as a general overview, let’s go through what post-traumatic stress looks like. As stated before, post-Traumatic stress is a natural way in which we react to trauma. Our body and our brain will go into the fight, flight, or freeze response. So that can be characterized by a racing heart, shaky hands, worrying that the world isn’t safe. We’re also going to look out for danger soon after the event. We’re more likely to notice if something might be unsafe after we felt like we’ve been put in danger.

We’ll find that we are going to review the event in our mind over and over, we’re likely to feel upset, nervous, or scared. But the advantage here is that this reaction will help encourage us to find safer behaviors to engage in in the future.

So, I want to review 2 diagnoses very briefly, so that we can really focus on post-traumatic stress disorder itself. I want you to see how they fit in along this spectrum.

The first is acute stress disorder, which lasts anywhere from three days to a month following the traumatic event. The second one is an adjustment disorder, which does not necessarily require a trauma, but it does require a stressor.

In acute stress disorder, what you may see is similar to what we’ve discussed with post-traumatic stress. There may be some intrusive thoughts, avoidant behavior, mood changes, or feeling disconnected from the world.

In adjustment disorders, the distress that you’re experiencing with the event is out of proportion to how you would expect most people to react. Maybe going to a new school or moving. You’ll find that one child may react more strongly and have a harder time with getting good grades than another. And that could be considered an adjustment disorder. When we’ve experienced a difficult situation, we may find that we’re having a hard time just adjusting. And once we’ve resolved that stressor by making new friends or getting used to the environment, we’ll find that those levels of distress will even out.

When our distress lasts longer than a month, we are no longer experiencing an acute stress disorder, but rather PTSD, post-traumatic stress disorder. So our distress has become a greater problem than it was previously.

Similar to the acute stress disorder, we are still likely to experience intrusive symptoms such as nightmares and flashbacks, and avoidance symptoms where we are trying to stay away from those things that would remind us of the event itself. That could be people or places that remind us of the event, things you smell, or just even doing actions associated with the event.

We may also experience negative changes in our mood or the way we see the world. After experiencing this trauma, we may see the world as an unsafe place. We may feel more irritable or more sad or guilty, or a greater sense of shame.

We may have a hard time remembering key aspects of the event or have distorted beliefs about what actually happened. Who’s to blame? How it could have happened in the first place?

You may see a decrease in motivation, feeling detached from your environment or from the people around you and feeling maybe unable to experience anything positive.

You’ll also see a change in reactivity. So we’re going to be always looking for the next thing to go wrong. We’ll feel more irritable and react more quickly to things that feel threatening.

We may engage in reckless or self-destructive behavior or have an exaggerated startle response.

Having a hard time concentrating or having a hard time sleeping.

In contrast to the acute stress disorder diagnosis I mentioned earlier, PTSD requires that we are experiencing our distress for longer than a month from the time of that traumatic event.

Additionally, it needs to be causing clinically significant distress or impairment. What that means is maybe we’re unable to work effectively in our job. Or maybe we’ve strained our social support network by that irritability that we have been experiencing so much that we can no longer access their help. Or maybe we’re isolating ourselves so much that we’re unable to meet our daily obligations.

Additionally, we may just be failing to engage in effective self-care. Failing to sleep long enough to feel like we can function.

We may also have dissociative traits that we’re experiencing; being detached from the world or feeling like things are not real.

The severity of what we’re experiencing can go a little further with a diagnosis of complex PTSD. Now it’s characterized by the same traits as PTSD, but may also include an exposure to repeated traumas or prolonged trauma. So it’s not just a one time event. A lack of emotional regulation, more intensive dissociative symptoms, so maybe forgetting the traumatic event altogether or having an emotional or physical detachment from others around us.

Additionally, we may have difficulty in relationships, a preoccupation with the abuser if this is related to our trauma and maybe a loss of beliefs or a sense of meaning.

If we’re going to look at your experience of your trauma, the first thing I want you to understand is regardless of whether you have PTSD, if you’re experiencing distress from a traumatic event in your life, there is help. Many of the same supports for PTSD are helpful to anyone struggling with trauma.

If the label of PTSD is important to you, the first thing I would ask you to do is to look at the timeframe of when your trauma occurred and now. Have the stressors associated with the trauma also stopped?

As part of this lesson, there is an exercise for you to take and evaluate your own experiences to trauma.

In the next lesson we will review trauma in the brain.

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