June is PTSD Awareness Month, designated to push the conversation past the narrow military image and into the everyday. Roughly six in every hundred Americans will meet criteria for PTSD at some point in their lives, and the rate is roughly twice as high in women as in men. Many of these individuals never connect their symptoms to a past event because the event “wasn’t that bad” or “happened a long time ago.”

This week’s column is meant for the person who lives with sleep problems, irritability, hypervigilance, or unexplained anxiety and has never seriously considered that an old experience might be the source. We’ll cover what PTSD actually is, what it isn’t, and what to do if any of it sounds familiar.

Q: I was in a serious car accident two years ago. I’m physically fine, but I get panicky every time I drive past the intersection. Is that PTSD?

A: It might be. Avoidance and physiological reactivity to reminders of a traumatic event are two of the four symptom clusters in PTSD, alongside intrusive memories and changes in mood and thinking. A single localized fear response is not necessarily a disorder, but if the avoidance has expanded — different routes, less driving, tension whenever you are in a car — it warrants evaluation. Effective treatments exist and tend to work quickly.

Q: My trauma happened in childhood. Can something from thirty years ago still be the cause of how I feel now?

A: Yes, and this is one of the most underrecognized presentations of PTSD. Childhood trauma frequently does not produce textbook flashbacks; it produces chronic difficulty with relationships, emotion regulation, and self-concept. Some clinicians use the term “complex PTSD” to capture this presentation. The good news is that even decades-old trauma responds to treatment when the right approach is used.

Q: I’m a nurse who worked through the pandemic. Is what I have PTSD or just burnout?

A: The two overlap and often coexist. Medical providers, first responders, and other front-line workers can develop what is sometimes called secondary or vocational trauma — repeated exposure to others’ suffering combined with moral injury when systems prevent ideal care. A careful evaluation can distinguish PTSD, burnout, depression, and adjustment difficulties, which matters because the treatments are different.

Q: I don’t have flashbacks. Doesn’t that rule out PTSD?

A: No. Flashbacks are dramatic and well-publicized, but they are not required for the diagnosis. Many people with PTSD experience intrusion in the form of unwanted thoughts, distressing dreams, or intense emotional reactions to reminders without ever feeling like they are “back there.” Intrusive thoughts in particular are easy to dismiss as “just my brain being weird.”

Q: I’ve heard there’s a treatment called EMDR. Does it actually work?

A: Eye Movement Desensitization and Reprocessing has substantial research support and is recommended in major treatment guidelines for PTSD. Other front-line treatments include Prolonged Exposure and Cognitive Processing Therapy. The honest answer is that all three work for many people, none works for everyone, and matching the treatment to the person matters. A good clinician will explain the options rather than insist on one.

Q: Can PTSD cause physical symptoms?

A: Yes. Chronic activation of the body’s stress system is associated with sleep disturbance, gastrointestinal problems, headaches, and chronic pain. Patients with PTSD have measurably higher rates of cardiovascular disease and autoimmune conditions over time. This is not “in your head”; it is the predictable downstream effect of a nervous system stuck in alarm mode.

Q: My spouse has PTSD and refuses to talk about what happened. Should I push?

A: No. Pressure to disclose tends to backfire and can feel like a re-enactment of the original loss of control. Far more useful is creating an environment in which talking is possible but not required — stable routines, low-conflict communication, respect for triggers, and openness to professional help when the person is ready. Couples therapy with a trauma-informed clinician can help when communication has broken down.

Q: I think I might have PTSD, but I don’t want to relive everything in therapy. Are there options?

A: Modern trauma treatment is not the cinematic image of someone weeping through every detail for years. Evidence-based approaches are typically structured, time-limited (often eight to sixteen sessions), and pace exposure carefully. Some approaches involve very little detailed retelling at all. A good first session should include a clear explanation of what the treatment involves before any deep work begins.

Q: I drink to manage my anxiety, and I think the anxiety might be from old trauma. Where do I start?

A: With both, in coordination. Substance use and PTSD frequently co-occur, and treating only one often fails because the untreated condition reinforces the other. The current standard is integrated treatment in which trauma and substance use are addressed together rather than sequentially. An evaluation can clarify what is driving what and what order makes sense for you specifically.

Conculsion

The cultural narrowing of PTSD to combat has cost millions of civilians the recognition that their symptoms have a name, an explanation, and a treatment. The condition is more common, more varied, and more treatable than the public image suggests.

The single most useful step for someone who suspects they might have PTSD is a thorough evaluation. Self-diagnosis from internet checklists tends to be imprecise; trauma is not the only cause of these symptoms, and it is not always the main cause when it is present. A structured assessment clarifies what is going on and what intervention is most likely to help.

PTSD is not a permanent condition. With the right treatment, most people recover substantial functioning, and many recover fully.

For those experiencing intrusive memories, persistent avoidance, hypervigilance, or unexplained mood changes that may trace back to a difficult past event, professional evaluation can clarify the diagnosis and open the door to treatment that actually works. Comprehensive Psychological Services (WeCanHelpOut.com) offers comprehensive psychological evaluations and trauma-informed therapy to help patients understand and address what they’re carrying.