Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) after a single traumatic event

Traumatic events can include: 

• serious accidents 
• assaults 
• traffic accidents 
• natural disasters and wars 
• witnessing or experiencing domestic violence 
• bullying 

Common reactions you might have to a traumatic event include: 

• repeated, unwanted and upsetting memories of the event, which are sometimes called flashbacks 
• avoiding things that remind you of the event 
• feeling very alert, which is sometimes called hyperarousal 

Common reactions in children under 10 years

In younger children, PTSD symptoms can show themselves a bit differently. Children might repeatedly play out the trauma in their games. Rather than having nightmares about the trauma, young children might have dreams of monsters instead. They may become very clingy, develop a fear of the dark and not want to sleep alone. They may also become more irritable and have more difficult behaviour. 

Complex trauma

If you experience long-term or repeated traumas such as physical, sexual or emotional abuse, severe bullying or war, you are at risk of developing complex trauma. Complex trauma leads to a wider range of problems than PTSD caused by a single traumatic event. 

Complex trauma might cause you to have problems with: 

• managing your relationships with other people 
• managing your emotions 
• being able to pay attention 
• your memory 
• being able to recognise and manage bodily feelings such as pain, tiredness or relaxation 
• feelings of low self-worth 
• self-harm 

Risks for PTSD

Not everyone who experiences a traumatic event will develop PTSD. Whether you develop PTSD or not can be affected by things such as: 

• The amount of trauma: more traumatic experiences put you at greater risk of developing PTSD. 
• The type of trauma: physical or sexual assault are known as interpersonal traumas and these put you at greater risk of developing PTSD compared to non-interpersonal traumas (such as accidents or natural disasters). 
• The amount of social and family support you have. 
• How you coped with the trauma: you are at more risk of developing PTSD when you try to cope by pushing memories away, withdrawing, or distracting yourself. 
• If you thought you might die during the trauma you are particularly at risk of developing PTSD. 
• Girls are at greater risk of developing PTSD than boys. 

How can I get help?

If you are worried that you might have PTSD then you should ask about a referral to Child and Adolescent Mental Health Services (CAMHS). You can do this by seeing your GP, or in some areas by talking to someone at your school who can make a referral. In some areas you could also contact the CAMHS teams directly. 

If you were in an accident and needed medical care, then your doctor or nurse should explain about normal reactions to trauma and what to do if you are concerned. 

Children in care are also more at risk of having PTSD. If you are a young person in care you could talk to your carers or social worker and let them know you are worried about your mental health, and they should be able to support you to get help. 

You can find more information about mental health referrals here and more information about local mental health services here.  

Planning treatment

The initial step is having an assessment to understand exactly how your symptoms are affecting you and your family. This should include looking at whether you might have any other mental health conditions. 

Active monitoring 

If it has been less than a month since a single traumatic event, your professional should suggest active monitoring. This involves giving you and your parents or carers information about normal reactions to traumatic events, when to be concerned and how to seek help. They might ask you to monitor your reactions to the trauma, such as through keeping a diary and writing down how you are each day. 

This is usually the first step because people can often recover from traumatic events without treatment and there are concerns that providing treatment when it is not needed might lead to other problems. Your professional might also suggest that you monitor your symptoms while you are having other types of treatment. 

Individual trauma-focused cognitive behavioural therapy (TF-CBT) 

Some people experience a more severe reaction to traumatic events, which is called acute stress disorder. You might also have PTSD symptoms that don’t quite meet a diagnosis of PTSD. If this happens, even though it might be less than a month after the traumatic event, your professional might suggest that you try individual trauma-focused cognitive behavioural therapy (TF-CBT). If it is a month or more since the traumatic event and you have symptoms of PTSD, then you should also be offered individual TF-CBT. 

Eye movement desensitisation and reprocessing (EMDR) 

If it is more than 3 months since the traumatic event and TF-CBT hasn’t helped (or you did not want TF-CBT) then your professional might suggest eye movement desensitisation and reprocessing (EMDR) if you are over 7 years old. 

Treating complex trauma 

Individual trauma-focused cognitive behavioural therapy (TF-CBT) is also usually recommended to treat complex PTSD. 

Involving your parents, carers or family can be helpful, although it is important for your professional to recognize that trauma such as abuse or domestic violence could have been carried out by a family member or carer. In these circumstances their involvement would not be appropriate, although your professional may suggest that another parent or carer who was not involved in the trauma could be part of your therapy. 

Treating other mental health conditions 

If you have another mental health condition such as depression or anxiety which appeared to develop after you experienced the traumatic event, your treatment for PTSD using trauma-focused cognitive behavioural therapy (TF-CBT) should still focus on PTSD. Your symptoms of these other conditions might improve as you have treatment for PTSD. If your symptoms don’t improve, then your professional should arrange for you to have an assessment and treatment for these conditions. 

If you have complex trauma then you may have symptoms of a range of other mental health conditions. It is important for your professional to carefully assess these symptoms and consider whether you have another separate mental health condition, or whether your symptoms are part of complex trauma and will improve with treatment for complex trauma. 

What about my parents or carers?

Your professional should provide your parents or carers with information about trauma and possible treatments. Your professional should talk with you about how your PTSD affects your family to help support them and help your family understand how they can support you. 

If you think it would be helpful, your parents or carers can be involved in your treatment. If they are involved, your professional should give your parents or carers support and advice (e.g. direct them to health services, social services or peer support groups). 

Your professional should look out for effects that the trauma might be having on other members of your family, in case they also have PTSD. If another member of your family does also have PTSD, they should be offered an assessment and support. If another member of your family is experiencing PTSD following the same traumatic event, you could have some parts of your treatment together (such as psychoeducation). 

It is important for your professional to recognize that trauma such as abuse or domestic violence could have been carried out by a family member or carer, and that in these circumstances their involvement in your treatment would not be appropriate. 

Transitions between services

Your professional should make sure that you can stay with the same mental health team as much as possible. If you do need to move to another mental health team, you should be given information about the service you are moving to and who will be providing your care. Your professional should make sure that your new service has all the information they need. You and your parents or carers (if appropriate) should be involved in planning your transition. 

Your mental health professional should talk with you about any concerns you have, for example if you are worried about changes to your routines or meeting new people. If you need ongoing care for PTSD, you should not be discharged from your current mental health team until a care plan has been agreed with the service you are moving to. 

If you are in care, then you should be given extra support if you need to transition between different services or settings. You should also be given extra support during admission and discharge if you have been an inpatient in hospital because of other physical or mental health conditions. 

For more information about transitioning between services, please see Moving on.

Additional post-traumatic stress disorder support

The below organisations offer [diagnosis] specific support for children, young people and their families:

• AFC Crisis Messenger: a free, confidential, 24/7 text message support service for anyone who is feeling overwhelmed or is struggling to cope. If you need support, you text AFC to 85258
• CALM: Campaign Against Living Miserably’s website includes helpline and webchat for those who may be experiencing suicidal thoughts or affected by the suicide of someone else
• Childline: Childline is there to help anyone under 19 in the UK with any issue they’re going through. Whether it’s something big or small, their trained counsellors are there to support you.
• Freedom from torture: charity offering special psychological support to help asylum seekers and refugees who have survived torture
• No Grey Zone: website signposting to support services in Northern Ireland for those who been the victims of sexual assault and rape
• Rape Crisis: charity working to end sexual violence and abuse whose website includes a list of rape crisis centres across England and Wales
• Rape Crisis Northern Ireland: charity working to end sexual violence and abuse whose website includes a list of
• Rape Crisis Scotland: charity working to end sexual violence and abuse whose website includes a list of 17 support centres across Scotland
• Refuge: supporting victims of domestic abuse including children and young people
• Safeline: charity offering telephone support to victims of sexual violence
• The Mix: support and advice for children and young people under 25
• UK Trauma Council: series of animations produced with young people to help others recognise the signs of PTSD
• Victim Support: host You & Co, a youth programme to help young people cope with the impact and effects of crime

Treatments outlined on these webpages may not be available in every local area. It’s important that you discuss with your GP or mental health professional the treatment options available to you. You can also search for services near you on our Youth Wellbeing Directory and find out more about referral processes here.