PTSD symptoms after accidents, war and violence, and how trauma is treated

What is PTSD, and when is fear after an accident no longer normal?

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after you go through or witness a frightening or life-threatening event, such as a serious accident, war or an assault. With PTSD, the event stays present long after the danger has gone: intrusive memories and nightmares, avoiding anything that reminds you of it, and a body that stays on constant alert. As the US National Institute of Mental Health (NIMH) explains, a professional diagnoses it when these PTSD symptoms last more than a month and affect your relationships or work.

But not all fear after trauma is a disorder. According to the same institute, fear is part of the "fight-or-flight" response that protects the body, and having some symptoms straight after the event is normal; most people recover from them with time. In short:

• A normal reaction: fear, anxiety and disturbed sleep in the first weeks, easing gradually with time and with support from the people around you.
• A sign of PTSD: symptoms that last more than a month and stop you from working, studying, going out or sleeping.

In a fact sheet published in 2026, the World Health Organization (WHO) estimates that around 70% of people go through a potentially traumatic event during their lifetime, yet only 5.6% of them develop PTSD, and that up to 40% of people with PTSD recover within a year.

PTSD symptoms: the four groups that help you recognize it

NIMH and Cleveland Clinic divide PTSD symptoms into four groups, and a diagnosis needs symptoms from each group that last more than a month:

• Reliving the event: memories that come back against your will, recurring nightmares, and "flashbacks", where for a few moments it feels as if the event is happening now, with a racing heart. WHO notes that the memory can return as an image, a sound such as gunfire, or a smell.
• Avoidance: staying away from places, people and conversations that remind you of the event; someone who survived a car crash may stop driving. WHO explains that avoidance can make intrusive memories worse over time and keep the disorder going.
• Tension and high alert: being startled by sudden noises, constantly scanning your surroundings, struggling to sleep and concentrate, getting angry quickly, and sometimes acting recklessly or turning to alcohol or drugs.
• Negative changes in thoughts and mood: blaming yourself or others too much, fear, guilt or shame that won't leave you, losing interest in things you used to enjoy, pulling away from people, and sometimes forgetting important parts of the event.

Symptoms usually begin within the first three months, according to NIMH, but the NHS says they can appear straight after the event or months, even years, later, and may come with headaches or stomach pains with no clear physical cause. And if sleep has become a battle every night, read our article on chronic insomnia.

Complex PTSD: when harm is repeated or goes on for a long time

Some trauma is not a single event but harm that repeats or lasts a long time and is hard to escape, such as repeated abuse in childhood, long-term domestic violence, war, torture or human trafficking, as the UK treatment guidelines from the National Institute for Health and Care Excellence (NICE) and Cleveland Clinic describe. This can lead to complex PTSD, which WHO added to the International Classification of Diseases in 2019. It brings the usual PTSD symptoms together with three lasting difficulties:

• Serious difficulty controlling emotions, such as outbursts of anger.
• A deeply negative view of yourself: feeling worthless or defeated, along with shame or guilt.
• Difficulty keeping relationships going and feeling close to other people.

The UK guidelines recommend allowing more time for treatment in this case, to build trust with the therapist, and taking into account how safe and stable the person's current circumstances are.

Who is at higher risk of PTSD? War, displacement and road accidents

PTSD can affect anyone, but how likely it is depends on the type of event and the circumstances around it:

• War and conflict: WHO (2026) reports that PTSD is more than three times as common among people exposed to violent conflict or war, at 15.3%.
• Displacement and seeking refuge: Cleveland Clinic counts being forced to migrate because of conflict as a risk factor, and a meta-analysis published in PLOS Medicine in 2020, covering studies from 15 countries, found that about 31% of adult refugees and asylum seekers had PTSD, with wide variation between studies.
• Road accidents: in a meta-analysis published in 2025 that brought together 82 studies measuring PTSD between one and six months after a crash, about 20.3% of road traffic accident survivors had it, and the rate was higher at one month (29.4%) than at three months (18.8%).
• Violence and assault: WHO notes that rates are especially high after sexual violence.
• Other jobs and situations: such as police, ambulance and healthcare work, or a stay in intensive care or a difficult childbirth, according to the NHS.

According to WHO and NIMH, the risk is higher with earlier trauma, especially in childhood, being injured during the event, having little support afterward, and later stresses such as losing a job or a home. Women are more likely to develop PTSD than men. The reassuring side is that support from family and friends after the event lowers the risk.

Why do alcohol and drugs make trauma symptoms worse?

Some people living with trauma turn to alcohol, drugs or sedatives to forget or to sleep. The US National Center for PTSD explains, on a page updated in 2026, that some people use them to deal with thoughts and feelings they would rather avoid, and that more than 4 in 10 US adults with PTSD (45%) also have problems with alcohol or drug use. But this short-term fix backfires:

• Worse sleep: alcohol may help you fall asleep at first, but it makes sleep less restful.
• Deeper avoidance and more irritability: drugs can increase irritability and the avoidance of feelings, and, as we have seen, avoidance keeps PTSD going.
• Greater risk: people who have both conditions are at higher risk of depression, anxiety and suicide, the same center notes. Read more about addiction alongside a mental health condition in our article on dual diagnosis.

Trauma treatment: trauma-focused therapy, EMDR therapy and the role of medication

The good news is that PTSD can be treated. WHO considers evidence-based psychological therapies the first choice, and two types have the strongest evidence:

• Trauma-focused cognitive behavioral therapy (CBT): teaches you to manage stress and intrusive memories, corrects painful thoughts such as blaming yourself for what was not your fault, then helps you face what you have been avoiding, gradually and safely.
• EMDR therapy (eye movement desensitization and reprocessing): you bring the memory to mind with your therapist's guidance while following certain movements with your eyes, to make it less intense. The UK guidelines recommend it for adults when more than three months have passed since a trauma that was not related to military combat.

According to the UK guidelines, each is usually given over 8 to 12 sessions, and more for people who have been through several traumas. Treatment includes explaining how people react to trauma and learning skills to calm yourself and handle intrusive memories, alongside working on the memories themselves.

The role of medication: a psychiatrist may suggest medication alongside psychotherapy, or when a person prefers medication, most often antidepressants from the SSRI and SNRI classes, and may prescribe medicines for specific symptoms such as nightmares. The UK guidelines do not recommend any medicine, including benzodiazepine sedatives, to prevent PTSD. Never start or stop a medicine on your own, even if you feel better; that decision is made with your psychiatrist.

At Oxygen Center, the path starts with a doctor's appointment to assess your symptoms, then psychotherapy sessions with a plan that fits you, for men and women aged 15 and over, with a parent or guardian's consent for anyone under 18. If symptoms are severe or come with a risk to your own safety, the doctor may decide that inpatient psychiatric treatment is more suitable; inpatient stays are for males only. Your family can also come alone first to learn how to help you.

First steps that can help from today

WHO, the NHS and NIMH suggest simple steps to take alongside treatment:

1. Keep your routine: regular times for sleeping, eating and working.
2. Talk to someone you trust when you feel ready, and tell them what sets off your symptoms.
3. Write down what triggers your memories, such as sounds, smells or places, and discuss it with your therapist.
4. Breathe slowly and keep moving: breathing exercises and walking, even a little, help you cope with stress.
5. Stay away from alcohol and drugs, and don't take sedatives without a doctor's prescription.
6. Be patient with yourself: improvement is gradual, so set small, realistic goals.

If you are close to someone who has been through trauma, listen without pressing them to talk about it, and gently encourage them to get an assessment if their symptoms continue.

When should you get help?

Don't wait for it to "pass on its own" if:

• Intrusive memories, nightmares or avoidance have lasted more than a month
• You can no longer work, study, drive or go out
• You have become quick to anger or cut off from your family
• You have started relying on alcohol, drugs or sedatives to sleep or to forget
• You have had thoughts of harming yourself or ending your life

WHO (2026) reports that only 1 in 4 people with PTSD in low- and middle-income countries seek any treatment, partly because they don't know it can be treated, and because of stigma. Asking for help is not a weakness; it is the first step in recovery.

You can book an appointment or contact us at any time; the first step is a doctor's appointment or an assessment session to understand what is happening to you.