How do you know if you need help?

During the past year the United States has suffered several tragedies, including the Oklahoma tornados, the Boston Marathon bombing, the Sandy Hook School massacre, Hurricane Sandy, and the Aurora, Colorado shooting. With each passing year these events will be pushed further into our country’s collective past, but our sadness will never diminish. Although less than 20% of those exposed to traumatic events are expected to develop Post-Traumatic Stress Disorder (PTSD), a large percentage of victims will suffer from distressing post-trauma reactions that interfere with life.

The American Psychiatric Association’s Diagnostic and Statistical Manual-V2 classifies PTSD as a trauma- and stress-related disorder that includes four symptom clusters: intrusion symptoms, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. While a mental health professional’s assessment is required for a diagnosis of PTSD, the first steps toward a diagnosis (and therefore treatment) are 1) an improved understanding of the signs of PTSD, 2) a self-evaluation of the post-trauma reactions negatively affecting you and those you love, and 3) a willingness to ask for help. After all, we cannot address problems we do not recognize!

Post-trauma reactions occur after exposure to traumatic events such as motor vehicle accidents, sexual assault, terrorist attacks, natural disasters, and many other tragedies. During these events individuals experience terror, and they often feel helpless to stop the event. In the weeks, months, and even years following a trauma, substantial changes in a person’s thoughts, emotions, and behaviors may occur. Because such changes can be warning signs of PTSD or other serious post-trauma reactions, it is crucial for trauma survivors to be aware of how the trauma has affected them. How do you know if you or someone you love might be suffering from post-traumatic stress? Eight of the most common cognitive and emotional indicators of PTSD include:

1. Sleep Difficulties: Problems may include falling asleep, staying asleep, or experiencing frequent nightmares.

2. Anger: The person may feel irritable, and may experience frequent anger outbursts that are difficult to control.

3. Numbness and Disconnection: Trauma victims may feel disconnected from others. They may also feel numb and have difficulty accessing the loving feelings they know they have for loved ones.

4. Depression: Depressed mood, hopelessness, and a loss of interest in previously enjoyed activities are common.

5. Chronic Anxiety: Individuals often report feeling on guard and hypervigilant, and they have difficulty relaxing and “unwinding.”

6. Reliving the Trauma: Highly distressing thoughts and memories of the event may repeat in the mind, despite the individual’s attempts to avoid or stop them.

7. Feeling Unsafe: The person may experience intense feelings of fear or impending doom even when no danger is present. They may also feel as though it is impossible to ever feel safe again.

8. Thoughts of Suicide: Suicidal thoughts may be active, with an intention and plan to commit suicide (“I will purchase a firearm to shoot myself”). Conversely, these thoughts may be passive (“Things would be better if I just weren’t around anymore”).

In addition, many trauma survivors exhibit significant behavioral changes after suffering a traumatic event. Such changes in behavior may become apparent in several domains of a person’s life, some of which include:

1. Relationships with Others: Increased conflict with others, withdrawal from relationships, and decreased trust and intimacy are common PTSD indicators.

2. Self-Esteem/Relationship with Self: Changes may also take place in an individual’s relationship with themself. Self-harm behaviors, thoughts of suicide, and reduced self-care and self-esteem can be signs of a serious post-trauma reaction.

3. Work Performance: Those suffering from PTSD often experience difficulty concentrating, sometimes due to thoughts about the trauma, or to lack of sleep. This in turn may compromise one’s ability to complete daily tasks or to perform well at work.

4. Lifestyle: After a trauma some individuals go to great lengths to avoid reminders of the event. For instance, they may isolate and give up hobbies or activities they used to enjoy. The purpose of this may be to feel safer and less vulnerable, and to reduce reminders of the trauma. For example, a combat veteran who was bombed in a crowd oversees may avoid concerts despite his love of music, in order to feel safe.

5. Coping: Ineffective coping strategies may be adopted after trauma. For instance, an individual may begin drinking alcohol or using drugs to cope with their symptoms. Often, these unhealthy ways of coping help the individual temporarily avoid reminders of the traumatic event.

In the first few weeks following a trauma, most people will experience at least a few post-trauma reactions and symptoms. However, if you experience these changes for more than one month, if they interfere with your daily life, or if you have thoughts of hurting yourself, it is important to seek professional help as soon as possible. The following websites offer assistance to those looking to connect with a mental health professional:

• Substance Abuse and Mental Health Services Administration, Disaster Distress Helpline:

• Psychology Today:


• A Mental Health Network:


1. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.

2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.