When the Past Won’t Stay in the Past: Understanding PTSD

Traumatic events—such as military combat, assault, an accident, or a natural disaster—can have long-

lasting negative effects.¹ Sometimes our biological responses and instincts, which can be life-saving

during a crisis, leave people with ongoing psychological symptoms because they are not integrated into

consciousness.¹ For most people, the intense emotions following trauma gradually fade with time. But for

others, the past refuses to stay in the past. Nightmares, flashbacks, and overwhelming fear persist long

after the danger has ended. This is Post-Traumatic Stress Disorder.

PTSD affects approximately 3.5% of the U.S. adult population—about 7.7 million Americans—in any

given year.¹ ² Women are more likely to develop the condition than men, and about 37% of those cases

are classified as severe.¹ While PTSD can occur at any age, the average age of onset is in a person’s early

20s.¹ Recent research has also found that young children aged 1-6 can develop PTSD, with symptoms that

look quite different from those of adults.¹

Here in Worcester and throughout Central Massachusetts, trauma touches lives in countless ways. At The

Horizon Behavioral Health, we specialize in helping people heal from traumatic experiences using

proven, compassionate approaches. PTSD is not a sign of weakness—it’s a normal response to abnormal

circumstances, and effective treatment can help you reclaim your life.

Recognizing PTSD: The Four Symptom Clusters

Psychosis is not an illness itself but a symptom, and similarly, understanding PTSD requires recognizing

its distinct symptom patterns. The symptoms of PTSD fall into the following categories:¹ ² ³

Intrusive Memories and Re-experiencing

Perhaps the most distressing aspect of PTSD is the way traumatic memories intrude into daily life.

Intrusive memories can include flashbacks of reliving the moment of trauma, bad dreams, and scary

thoughts.¹ These episodes can be triggered by reminders of the trauma—sometimes in ways you don’t

consciously recognize.

Flashbacks transport you back to the traumatic event, making you feel as though it’s happening again in

the present moment. These re-experiencing symptoms aren’t simply unpleasant memories; they carry the

full emotional and physical intensity of the original trauma.³

Avoidance Behaviors

Living with intrusive memories naturally leads to avoidance. This can include staying away from certain

places or objects that are reminders of the traumatic event.¹ A person may also feel numb, guilty, worried,or depressed, or have trouble remembering the traumatic event.¹

This avoidance extends beyond external reminders. Many people with PTSD feel emotionally

disconnected from activities and relationships that once brought joy. Some describe feeling detached from

their own lives, as though watching themselves from a distance.

Dissociation

Some trauma survivors experience dissociative symptoms—out-of-body experiences or feeling that the

world is “not real” (derealization).¹ These experiences, while disorienting, represent the brain’s attempt to

protect itself from overwhelming distress. Time may seem distorted; hours feel like minutes or moments

stretch endlessly.

Hyperarousal and Reactivity

PTSD keeps the nervous system on high alert, constantly scanning for danger. Hypervigilance can include

being startled very easily, feeling tense, having trouble sleeping, or experiencing outbursts of anger.¹

You may feel perpetually on edge, irritable, and unable to relax. Concentration becomes difficult when

part of your brain is always watching for threats. Sleep problems are extremely common, including

difficulty falling asleep, staying asleep, or sleeping restfully.³

PTSD in Children: Different Signs to Watch For

Over the last several years, research on children aged 1-6 has found that young children can develop

PTSD, and the symptoms are quite different from those of adults.¹ These findings have led to increased

PTSD diagnoses in young children by more than 8 times when using the newer criteria.¹

Symptoms in young children can include:¹

Acting out scary events during playtime

Forgetting how or being unable to talk

Being excessively clingy with adults

Extreme temper tantrums and overly aggressive behavior

Recognizing childhood PTSD requires understanding these developmental differences. Early intervention

is crucial—without treatment, childhood trauma can affect brain development, academic achievement,

and mental health across the lifespan.

What Causes PTSD?

PTSD can develop following any event that involves actual or threatened death, serious injury, or

violence. Several factors can contribute to psychosis, and similarly, multiple factors influence PTSD

development:¹ ² ³

Types of Traumatic Events

Traumatic events that can lead to PTSD include:

Military combat exposure

Physical or sexual assaultChildhood abuse or neglect

Domestic violence

Serious accidents

Natural disasters

Witnessing violence or death

Sudden loss of a loved one

Life-threatening medical events

First responders, healthcare workers, and others who regularly encounter others’ trauma also face elevated

risk.³

Contributing Factors

Several factors can contribute to PTSD development:¹ ³

Genetics — Many genes are associated with the development of PTSD, but just because a person has a

gene doesn’t mean they will experience PTSD.¹

Trauma — A traumatic event such as a death, war, or sexual assault can trigger a psychotic episode.¹ The

severity, duration, and proximity of trauma exposure all influence PTSD risk.

Substance use — The use of marijuana, LSD, amphetamines, and other substances can increase the risk

of PTSD-related symptoms in people who are already vulnerable.¹

Physical illness or injury — Traumatic brain injuries, brain tumors, strokes, HIV , and some brain

diseases can sometimes contribute to trauma-related symptoms.¹

Not everyone who experiences trauma develops PTSD. Factors that influence vulnerability include

previous trauma history, existing mental health conditions, available social support, and individual coping

styles.³

Getting an Accurate Diagnosis

Symptoms of PTSD usually begin within 3 months after a traumatic event, but occasionally emerge years

afterward.¹ Symptoms must last more than a month to be considered PTSD.¹ The condition is often

accompanied by depression, substance abuse, or another anxiety disorder.¹

Because young children have emerging abstract cognitive and limited verbal expression, research

indicates that diagnostic criteria needs to be more behaviorally anchored and developmentally sensitive to

detect PTSD in preschool children.¹

At The Horizon Behavioral Health, we approach trauma evaluation with sensitivity, understanding that

discussing traumatic experiences requires trust and pacing that respects your readiness. Our clinicians use

structured interviews and validated assessment tools to ensure accurate diagnosis.

Evidence-Based PTSD Treatment in Worcester, MA

Identifying and treating PTSD as early as possible leads to the best outcomes.¹ Early intervention is

always the best approach to treating a mental health condition, because there is a chance of preventing theillness from progressing.¹ At The Horizon Behavioral Health, we offer comprehensive trauma treatment

tailored to your individual needs.

Trauma-Focused Psychotherapy

People with PTSD respond better to structured interventions than to unstructured, supportive

psychotherapy.¹ Research-supported approaches include:

Cognitive Behavioral Therapy (CBT) helps change the negative thinking and behavior associated with

depression and trauma. The goal of this therapy is to recognize negative thoughts and replace them with

positive thoughts, which leads to more effective behavior.¹ ⁴

Eye Movement Desensitization and Reprocessing (EMDR) is an eclectic psychotherapy intervention

designed for trauma that employs exposure to traumatic memories with alternating stimuli (eye

movements are one of several options) in structured sessions with a certified EMDR practitioner.¹ ⁴ Many

people find EMDR effective even when traditional talk therapy hasn’t provided sufficient relief.

Exposure therapy helps people safely face what they find frightening so that they can learn to cope with

it effectively. For example, virtual reality programs allow a person to experience the situation in which he

or she experienced trauma.¹ ⁴

Imagery Rehearsal Therapy (IRT) — Research is being conducted on dream revision therapy, also

known as Imagery Rehearsal Therapy, which specifically targets trauma-related nightmares.¹

Other forms of therapy include the use of service dogs and support groups.¹

Medication Management

There is no one medication that will treat all cases of PTSD.¹ The effective combination of psychotherapy

and medication should be used together to reduce symptoms.¹ Given the common co-occurrence of

depression, related anxiety disorders, aggression, and impulsivity, selecting medications that address

these related problems is recommended.¹

Common categories of medications include antidepressants, antipsychotics, and mood stabilizers.¹ Our

psychiatric providers work collaboratively with you to determine whether medication might benefit your

recovery and to find the most effective options.

Complementary and Alternative Approaches

Recently, many health care professionals have begun to include alternative treatments into their regimens.

Some methods that have been used for PTSD include:¹

Yoga

Aqua therapy, such as floatation chambers and surfing

Acupuncture

Mindfulness and meditation

These approaches can support primary treatment and help calm an overactive nervous system.

Supporting a Loved One with PTSD

Watching someone you love experience PTSD can be frightening and heartbreaking. Understanding thecondition and knowing how to help makes an enormous difference.

Remember that the person experiencing PTSD is not choosing their symptoms. They’re trapped in a cycle

of fear and hypervigilance that requires professional treatment to resolve. Express care and concern,

encourage professional evaluation without ultimatums, and learn about PTSD so you can be a more

effective support.

If your loved one is in crisis—expressing thoughts of harming themselves or others, or behaving

dangerously—seek emergency help immediately.

Frequently Asked Questions About PTSD Treatment

How long after a traumatic event can PTSD develop?

Symptoms of PTSD usually begin within 3 months after a traumatic event, but occasionally emerge years

afterward.¹ Sometimes symptoms develop gradually; other times they’re triggered by a new stressor or life

change that resurfaces unprocessed trauma.

Is PTSD only caused by military combat?

No. While combat exposure is one cause, PTSD develops following many types of trauma including

accidents, assaults, abuse, natural disasters, sudden loss, and medical emergencies.² Anyone who has

experienced or witnessed a life-threatening or deeply disturbing event can develop PTSD.

Can children really have PTSD?

Yes. Research has confirmed that children as young as one year old can develop PTSD.¹ Their symptoms

often look different from adult symptoms, manifesting through play, regression to earlier developmental

stages, clinginess, and behavioral changes.

How long does PTSD treatment take?

Treatment duration varies based on trauma history, symptom severity, and individual factors. Many

people experience significant improvement within 12-16 weeks of trauma-focused therapy.

⁴ Others,

particularly those with complex trauma histories, may need longer-term treatment. Our goal is lasting

recovery, whatever timeline that requires.

What if I’m not ready to talk about my trauma?

Effective trauma therapists understand pacing and won’t push you before you’re ready. Treatment

typically begins by building coping skills and establishing safety. Directly processing traumatic memories

happens when you and your therapist agree you’re prepared. You remain in control of your healing

process.

Healing Is Possible

Trauma may have written the opening chapters of your story, but it doesn’t have to write the ending. At

The Horizon Behavioral Health in Worcester, MA, our trauma-informed clinicians provide the

compassionate, expert care you need to heal. We understand how difficult it is to reach out when trust

feels impossible, and we’re committed to creating a safe space where recovery can begin.

PTSD

Post-Traumatic Stress Disorder develops when the mind cannot fully process traumatic experiences,

leaving survivors trapped in cycles of flashbacks, nightmares, and hypervigilance. Affecting

approximately 7.7 million Americans, PTSD responds well to evidence-based treatments like EMDR and

trauma-focused CBT. Whether your trauma is recent or decades old, our compassionate team specializes

in helping people reclaim their sense of safety.

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References

1. 2. 3. 4. 5. National Alliance on Mental Illness. (2015). PTSD Fact Sheet. NAMI.

https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Posttraumatic-Stress-

Disorder

National Institute of Mental Health. (2024). Post-Traumatic Stress Disorder. NIMH.

https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd

American Psychiatric Association. (2022). What Is Posttraumatic Stress Disorder (PTSD)? APA.

https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

U.S. Department of Veterans Affairs. (2024). PTSD Treatment Basics. National Center for PTSD.

https://www.ptsd.va.gov/understand_tx/tx_basics.asp

SAMHSA (Substance Abuse and Mental Health Services Administration). (2024). Trauma and

Violence. SAMHSA. https://www.samhsa.gov/trauma-violence

Word Count: ~2,000 words Last Updated: January 2025 Medical Review: Content based on current

clinical guidelines and peer-reviewed sources