PTSD: Evaluation and Therapy

Nightmares… avoiding certain streets… becoming easily startled or feeling on edge…  

Post-traumatic stress disorder (PTSD) can manifest in many ways. The National Center for PTSD defines PTSD as “a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.” Precipitating events can also include sudden loss of a loved one, or trauma to a loved one.

Prevalence and Risk Factors

More than 8 million adult Americans have PTSD. Between 7 and 8 percent of adults will develop PTSD at some point in their lives. Among children who experience trauma, it’s estimated that up to 16 percent will develop PTSD. Certain factors increase risk. Those who’ve experienced previous trauma have a higher risk of developing PTSD. Because one out of every six American women has been a sexual assault victim, women are more likely than men to develop PTSD. Being injured during the trauma or experiencing a prolonged traumatic event (such as war) can increase the chances of developing PTSD. 

“Stress can make PTSD more likely, while social support can make it less likely.”

The National Center for PTSD

Evaluating PTSD


Evaluating a person for PTSD starts with examining symptoms. In addition to nightmares and being easily startled, symptoms for adults include: 

  • Flashbacks (reliving the trauma, often with physical reactions like racing heart)
  • Sensitivity to triggers, such as loud noises or anniversaries that evoke the original trauma 
  • Avoiding people, situations or things that are reminders of trauma
  • Loss of positive feelings about self and others, even loved ones and the world as a whole
  • Loss of memory about the trauma
  • Sleeplessness, trouble concentrating or anger

Children’s Symptoms

In children and adolescents, PTSD manifests somewhat differently, depending on the child’s age. Symptoms include: 

  • Bedwetting (after learning to use the toilet)
  • Inability to speak
  • Nightmares
  • Using play to act out the trauma
  • Becoming clingy with a parent, teacher or other adult
  • Irritability
  • Fear, worry or sadness
  • Lack of trust or anger
  • In teens, destructive behaviors, withdrawal, depression or anxiety, along with self-harm and risky sexual behavior


Symptoms may begin soon after the event—or months or even years afterward. But whenever they appear, if symptoms last more than a month, it’s wise to be evaluated for PTSD. Especially if symptoms are interfering with relationships.

For an adult to be diagnosed with PTSD, guidelines stipulate certain criteria. These include a life-threatening or violent stressor (the traumatic event), in addition to “re-experiencing” symptoms (flashbacks, dreams and thoughts), trigger avoidance, arousal symptoms (anger, being on edge, trouble sleeping) and cognitive or mood-related symptoms (loss of memory, negative thoughts and feelings, loss of interest in activities). Criteria for children are similar, with increased attention to social withdrawal and negative emotions such as fear, shame or sadness. Fear of separation and excessive crying play a role in diagnosing very young children.

Practitioners must identify whether a medical condition, medication, substance abuse or illness is involved. In addition to a psychological assessment, it’s important to have a physical exam. Other mental health disorders, which often co-occur with PTSD, must be ruled out or evaluated as well.

“PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.”

The National Institute of Mental Health

Treatment with Therapy

Therapy is particularly effective in treating PTSD, whether it’s used alone or in conjunction with medication. 

Also known as “talk” therapy, psychotherapy takes place with a counselor in a group or individual setting. It often includes education about PTSD and symptom management skills, which may include relaxation, anger management and talking through feelings of guilt or shame. 

“Cognitive behavioral therapy focuses on the relationship among thoughts, feelings, and behaviors; targets current problems and symptoms; and focuses on changing patterns of behaviors, thoughts and feelings that lead to difficulties in functioning.” 

The American Psychological Association

Cognitive behavioral therapy, or CBT, is a form of psychotherapy often used to treat PTSD. CBT teaches skills to manage symptoms, skills that are practiced in and outside of therapy sessions. Focusing on the trauma is at the heart of treatment. Three forms of CBT employ effective, yet different, approaches:

Exposure therapy helps people revisit their trauma in a safe way with visualization, writing or visits to places or people that remind them of their trauma. The goal is gradual desensitization through exposure.

Cognitive restructuring helps people make sense of bad memories. Those with PTSD often remember trauma “incorrectly”—different than how it actually happened. People may assume a disproportionate responsibility for the trauma or remember only some parts of it. Cognitive restructuring helps people develop a more objective, realistic perspective.

Stress Inoculation Training (SIT) teaches skills to cope with stress through breathing exercises, relaxation techniques and assertiveness skills.

Non-CBT treatments include Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Processing Therapy (CPT). As its name implies, EMDR involves using eye movements to help people process trauma-related memories and emotions. CPT is designed to get people “unstuck” from their repetitive thoughts about the trauma they experienced, such as “I could have prevented this accident.”

PTSD in young children can be complicated by a parent’s trauma or feelings of guilt about the child’s trauma. If a child is angry with a parent, it can damage the caregiver-child relationship. Therapy designed for young children, such as child-parent psychotherapy (CPP), helps caregivers understand the child’s distress and needs. 

If you or your child has experienced trauma, recent or not, Best Day’s counselors can evaluate the situation. If our professionals diagnose PTSD, they will work with you to determine the best treatment to address the trauma and return to a full, productive life.

How We Can Help You?

Best Day Psychiatry and Counseling is here to help you have a better day and find a better way. We treat a wide range of psychiatric conditions for both children and adults. Contact us today, we’re ready to help:

Fayetteville: (910) 323-1543  Fuquay-Varina: (919) 567-0684  Raleigh: (919) 670-3939  Greenville: (252) 375-3322