Delayed-Onset PTSD: What Is It? Thumbnail

Learn about delayed-onset PTSD, its symptoms, typical triggers, and available treatments.

Post-traumatic stress disorder (PTSD) is a mental health disorder that occurs after a person witnesses or experiences a distressing event. A serious condition, PTSD causes persistent emotional and physical reactions to traumatic memories.

While it's common to experience shock, fear, or anxiety following a traumatic event, some people may not experience symptoms for months or even years. This is considered PTSD with delayed expression, also called delayed-onset PTSD.

Left untreated, PTSD can have severe long-term consequences, affecting school, work, relationships, and the ability to function normally. However, recognizing the signs and getting treatment can help individuals reduce their symptoms and regain control of their life.

What Is Delayed-Onset PTSD?

While sometimes referred to as delayed-onset PTSD, the technical definition is PTSD with delayed expression. PTSD is considered delayed if symptoms do not appear for at least six months following a traumatic event. In some cases, it can even take years for a trauma response to develop.

Examples of traumatic events that can cause PTSD include childhood abuse, motor vehicle accidents, natural disasters, warfare, losing a loved one, or witnessing a violent crime. People who develop PTSD with delayed expression can suddenly experience symptoms such as sleep disturbances, anxiety, or flashbacks without warning.

PTSD can occur among all genders, age groups, and ethnicities. While not every person who experiences a distressing event will develop PTSD, the following risk factors make PTSD more likely to occur:

  • Ongoing stress
  • Experiencing multiple traumatic events
  • History of abuse
  • Family history of mental illness
  • Substance abuse
  • Poor coping skills
  • Lack of social support

Left untreated, PTSD can have negative consequences on a person's mental, emotional, and physical well-being.

What are the Symptoms of PTSD?

PTSD can develop immediately after a traumatic event, or in some cases, months or years later. Symptoms may vary from person to person. However, the following symptoms are common.

  • Vivid memories, flashbacks, or nightmares
  • Difficulty falling asleep or staying asleep
  • Physical sensations such as dizziness or chest pain
  • Anxiety or panic attacks
  • Irritability or angry outbursts
  • Intense sadness
  • Mood or behavior changes
  • Self-blame or guilt for the incident
  • Memory loss related to the traumatic event
  • Feeling jumpy or easily startled
  • Social withdrawal
  • Feeling numb
  • Avoiding things that trigger your memory of the event
  • Concentration problems
  • Loss of interest in things previously enjoyed

What Causes Symptoms of PTSD to Show Up Later?

Although researchers do not fully understand why some individuals develop PTSD and others do not, the following factors may contribute to symptoms emerging months or years after a traumatic event.

Experiencing additional stress. When individuals experience significant stress, they may be more prone to anxiety, rumination, flashbacks, or nightmares. Events that can lead to increased stress include divorce, losing a loved one, changing jobs, having chronic medical conditions, or going through financial struggles.

Living through another traumatic event. An individual's ability to cope with events that have already occurred may be severely impacted by additional trauma. For example, after losing a spouse in a car crash, being in a car accident could trigger a traumatic response.

Existing PTSD symptoms worsen. Rarely does PTSD develop out of nowhere. Most people with PTSD already have some symptoms, which worsen over time. PTSD with delayed expression is more likely to occur in individuals whose symptoms did not quite meet the diagnostic criteria for PTSD after a traumatic event.

When to Seek Help

While it's normal to experience anxiety and stress after a traumatic event, symptoms that persist and worsen with time should be taken seriously. If you or a loved one is experiencing any of the following signs, it is recommended to seek professional help.

  • Your symptoms do not improve after two weeks
  • You frequently have anxiety or irritability
  • You constantly feel on edge
  • You are having difficulty performing tasks at home or work
  • You feel hopeless
  • Your sleeping and eating habits have changed
  • You have sudden changes in weight
  • You are avoiding people, places, or things that remind you of the event
  • Your relationships are being affected
  • You are experiencing physical symptoms
  • You are using alcohol or drugs to cope
  • You are having thoughts of harming yourself or others

The sooner you receive treatment for PTSD, the less likely your symptoms will get worse. If you or a loved one is having thoughts of self-harm or suicide, call 911 immediately.

How is PTSD Treated?

If you suffer from PTSD, you may think your life will never return to normal. Fortunately, PTSD is highly treatable. When symptoms of PTSD become overwhelming and affect your everyday life, working with a mental health professional can help reduce your trauma symptoms and improve your quality of life. PTSD symptoms are usually treated with a combination of psychotherapy and medications.


Also known as talk therapy, psychotherapy is a form of treatment used to help people overcome post-traumatic stress disorder and other mental illnesses. During treatment sessions, individuals will meet with a mental health provider and work to identify and change unhealthy thoughts and behaviors. Psychotherapy can be delivered using a variety of methods, but the following are the most common for treating PTSD.

Cognitive Processing Therapy

Cognitive Processing Therapy (CPT) involves 12 weekly sessions lasting 60 to 90 minutes each. In CPT sessions, individuals learn how to examine their thoughts and feelings related to a traumatic event. A therapist will then assist the individual in changing their perceptions and feelings about the traumatic event in order to move forward.

Prolonged Exposure Therapy

Prolonged exposure therapy is beneficial for individuals avoiding objects, activities, or environments that cause fear or trigger a trauma response. In this technique, a therapist will gradually expose the unpleasant stimuli to the patient in a safe environment. With time, the emotional and physiological reactions to the stimuli lessen.

Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing (EMDR) therapy helps individuals change their feelings, thoughts, and behaviors resulting from distressing memories. In this technique, individuals activate painful memories while their therapist integrates bilateral stimulation.

Bilateral stimulation helps create a soothing effect that reduces the intensity of the memory. The therapist will then work to replace negative emotions and thoughts with positive ones. EMDR does not erase memories but rather alters how people react to them.

Stress Inoculation Training

Stress inoculation training is commonly used to treat people with high levels of stress and anxiety associated with PTSD. With this technique, individuals will learn to identify and modify negative thought patterns that influence their perception and response to a traumatic event.

They will also develop coping skills to manage stress and anxiety effectively. Exercises such as breathing exercises, deep muscle relaxation, and guided self-dialogue can be included in this training. Stress inoculation training often works well in conjunction with other therapies.

Group Therapy

Individuals who suffer from PTSD may also benefit from group therapy. In group therapy, patients meet with a mental health provider and other patients who also suffer from PTSD. In this setting, patients can discuss their experiences and learn from each other.


Psychotherapy is typically the first line of treatment for PTSD. However, medication can be prescribed to assist individuals in managing their symptoms. These can include:

  • Antidepressants: These medications can help alleviate symptoms of depression and anxiety. Additionally, they can help with sleep problems and poor concentration.
  • Anti-anxiety medications: These medications are commonly prescribed to treat severe anxiety from PTSD. Some anti-anxiety medications are limited to short periods due to their potential for abuse.
  • Alpha-1 blockers: These medications help reduce disrupted sleep and nightmares associated with PTSD.
  • Mood stabilizers: Patients with PTSD who don't respond to antidepressants may benefit from mood stabilizers. These medications are commonly used to treat agitation, anger, and irritability associated with PTSD.

What are the Benefits of PTSD Treatment?

Deciding to seek treatment for PTSD can sometimes be challenging. If you have PTSD, it may be hard to open up and talk about it. You may be concerned about the stigma associated with mental health treatment. However, treatment for PTSD can be highly effective and offers several benefits, including:

  • Reduced feelings of sadness, stress, anxiety, and anger related to PTSD
  • A better understanding of the traumatic event
  • Improved ability to cope with negative emotions and thoughts
  • Healthier perception of self
  • Improved relationships with friends and family
  • Goal setting for work, school, and personal life
  • Greater appreciation for life and loved ones

Trauma-Informed Care at CHE

If you or a loved one is experiencing symptoms of PTSD, do not delay treatment. Left untreated, prolonged PTSD can be severe and limit an individual's ability to function in everyday life.

CHE Behavioral Health Services offers specialized and effective care for individuals with PTSD and other mental health conditions. Not only can our treatment programs reduce your symptoms, but they can also help you understand the source of your fear and assist you in developing coping strategies for greater peace of mind.

For more information about delayed-onset PTSD and treatment options offered by CHE Behavioral Health Services, please call 888-515-3834. We are ready to talk, and ready to listen.