Supporting Someone With PTSD

Q: You have to have been in a war to get PTSD.

This is a myth. Most PTSD has nothing to do with combat. Car crashes, assaults, sexual violence, disasters, sudden loss and serious illness can all lead to it. The risk is highest after sexual violence.

Q: Most people who go through trauma get PTSD.

This is a myth. Most people do not. About 7 in 10 people go through a traumatic event at some point. Roughly 1 in 18 of them develop PTSD. Distress in the first few weeks is normal, and it usually fades.

Q: Talking it all through straight after an event prevents PTSD.

This is a myth. Formal debriefing straight after can make it worse. Guidelines advise against making people go over the event in the days after. Practical support, and checking in over the following weeks, is better.

Q: Traumatic memories get buried and can stay hidden for years.

This is a myth. The usual problem is the opposite. In PTSD the memory comes back too often, not too rarely. People may not remember parts of the event. But the idea of a whole trauma being locked away and later uncovered in therapy is not supported. Searching for hidden memories can create false ones.

Q: PTSD can start months or even years after the event.

This one is true. True. Most cases begin within three months, but late onset is part of the diagnosis. A new stress or a strong reminder can bring it on.

Q: Going back over the memory in therapy is one of the best treatments.

This one is true. True, when it is done properly. Some therapies work directly with the memory. Prolonged exposure, cognitive processing therapy and EMDR are the main ones. All the major guidelines offer them first.

Post-traumatic stress disorder (PTSD) is a condition following a traumatic event in which the memory keeps returning as though it were happening now, reminders are avoided, and the body stays on guard for more than a month.

Also called: Post-Traumatic Stress Disorder, Post traumatic stress disorder, Post-traumatic stress.

ICD-10 F43.1 · ICD-11 6B40

It gets read as weakness.

Most people who go through something terrible do recover. So people decide that the ones who do not must be weaker. Or dwelling on it. Or not trying. The evidence shows none of that. And the person with PTSD usually believes it more than anybody else.

START HERE

The same message, two replies

Tap any reply to see what it does.

sorry i left like that. the fireworks. i just had to go

Lands well

No need to say sorry. Are you somewhere ok now?

This puts safety first and demands no explanation. With an alarm that loud, leaving was the sensible thing to do.

yeah home. feel stupid

Not stupid. Want company, or would you rather be left alone for a bit?

This offers a choice. After trauma, feeling in control matters a great deal. Both answers are fine.

alone i think. thanks for asking

Ok. I will check in tomorrow. No need to reply.

This says you are still there. It asks for nothing back.

Lands badly

it was literally just fireworks

This is true, and they already know it. The alarm does not listen to facts in the moment. Hearing it said makes them feel judged as well as scared.

you need to move on from it at some point

This suggests it is a choice. PTSD does not go away because you decide to move on. Pushing memories away tends to make them come back more often.

yeah.

what actually happened to you anyway?

This is curious, and it is the wrong moment. Nobody owes anyone an account of their trauma. Being asked for one mid-crisis can set off the memory itself.

Seen. Does not come next time.

AND WHAT TO DO

If you are close to someone with PTSD

Let them decide how much to tell you, and when. Listening is enough. You do not need the details.
If they choose to share their reminders, learn them. Help plan around the big ones. Try not to make their world smaller than it needs to be.
Never grab or startle someone in a flashback. Speak calmly, use their name, and tell them where they are and what day it is.
Support treatment gently. Putting it off is part of the condition. It is not a sign that they do not want to get better.
Look after yourself too. Living alongside somebody else's trauma is heavy. There is support for partners and families.

MYTH CHECK

Six things people say. Two of them are true.

Answer before you read the answer. It sticks better.

You have to have been in a war to get PTSD.

Verdict: myth.

Most PTSD has nothing to do with combat.

Car crashes, assaults, sexual violence, disasters, sudden loss and serious illness can all lead to it. The risk is highest after sexual violence.

Most people who go through trauma get PTSD.

Verdict: myth.

Most people do not.

About 7 in 10 people go through a traumatic event at some point. Roughly 1 in 18 of them develop PTSD. Distress in the first few weeks is normal, and it usually fades.

Talking it all through straight after an event prevents PTSD.

Verdict: myth.

Formal debriefing straight after can make it worse.

Guidelines advise against making people go over the event in the days after. Practical support, and checking in over the following weeks, is better.

Traumatic memories get buried and can stay hidden for years.

Verdict: myth.

The usual problem is the opposite.

In PTSD the memory comes back too often, not too rarely. People may not remember parts of the event. But the idea of a whole trauma being locked away and later uncovered in therapy is not supported. Searching for hidden memories can create false ones.

PTSD can start months or even years after the event.

Verdict: true.

True.

Most cases begin within three months, but late onset is part of the diagnosis. A new stress or a strong reminder can bring it on.

Going back over the memory in therapy is one of the best treatments.

Verdict: true.

True, when it is done properly.

Some therapies work directly with the memory. Prolonged exposure, cognitive processing therapy and EMDR are the main ones. All the major guidelines offer them first.

WHAT THE MISUNDERSTANDING COSTS

1 in 4 — people with PTSD in low- and middle-income countries look for any treatment at all.

people with PTSD in low- and middle-income countries look for any treatment at all.

Shame stops people asking, and so does the fear of looking weak. Avoidance stops them too. Booking an appointment means thinking about the one thing the whole condition is built around not thinking about.

This gap is not only in poorer countries. Everywhere, many people wait years before they get trauma-focused therapy. Some are never offered it at all.

THE SAME ACT, TWICE

What it looks like, and what it is

Tap a card to turn it around.

Overreacts to a loud bang.

For a second, the body is back at the moment of the crash. The reaction happened before thinking could get a word in.

Always sits facing the door.

Watching for danger runs in the background all day. Facing the door turns the volume down a little.

Will not talk about what happened.

Talking about it can bring it all back. Not talking is a way of getting through the day, not a lack of trust.

Snaps over small things.

The alarm has been on since the morning. There is very little room left before it tips over.

Seems fine most of the time.

A lot of effort goes into seeming fine. Avoiding reminders is a full-time job that nobody sees.

Cancels plans at the last minute.

Something today was a reminder. Leaving the house felt like walking back toward it.

BACKGROUND

Where the stigma comes from

Most people recover

So the ones who do not get read as weaker. In truth the risk depends on things outside a person's control. The kind of trauma matters. So does the support that came afterwards, and differences that were there beforehand.

It cannot be seen

There is no cast and no scar. A person can look calm while their body is in full alarm. So other people underestimate what it is costing them.

Tough workplaces

In the military, the emergency services and medicine, needing help can feel like failing. People often wait years before saying anything.

The word trauma is used for everything

Everyday stress gets called trauma online. That makes real PTSD sound like an exaggeration. It also makes the people who have it less likely to be believed.