Identifying delayed-onset PTSD

Delayed-onset post-traumatic stress disorder (PTSD) is typically viewed as PTSD that begins to develop at least six months after an initial traumatic incident occurs. PTSD symptoms can include flashbacks, nightmares, emotional numbness, detachment, sleeplessness, lack of focus, and more. Treatment options for both PTSD and delayed-onset PTSD generally consist of therapy, medication, or a combination of both. Online therapy, particularly cognitive-behavioral therapy (CBT), may be a helpful way to cope with and manage PTSD symptoms.

What is PTSD?

Post-traumatic stress disorder (PTSD) is a condition that may develop following a terrifying or harrowing experience, especially an event during which a person has feared personal harm or death. It may be more common among military veterans, rescue workers, and survivors of violent or dangerous situations. They could also be prone to developing delayed-onset PTSD.

Whether the post traumatic stress disorder (PTSD) occurs immediately following the trauma, or the traumatic stress is delayed, it is the same mental illness and effects a person’s health in the same way.

Traumatic events known to contribute to PTSD can include military combat trauma, serious vehicular or workplace accidents, and natural disasters like tornadoes and earthquakes. Physical violence, such as assault, rape, and child abuse, are also usually high on the list of contributing factors to this traumatic stress disorder. Delayed-onset PTSD was introduced in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), as soldiers often do not begin to see signs of PTSD until they return home from combat.

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According to the U.S. Department of Veterans Affairs, war veterans have been frequently diagnosed with PTSD due to combat trauma, assault, or military sexual trauma (MST) while in the military. At least 10 out of every 100 veterans who fought in the Vietnam War have been diagnosed with PTSD, and it’s estimated that seven out of every 100 veterans will have PTSD during their lifetime.

PTSD can affect anyone, even children, but research shows that it may occur more frequently in women than in men and in young adults more often than in children or older adults. Physical assault and rape are often the most common causes of PTSD in women, while war and combat may be the most common causes in men. This disorder may have some roots in genetics, as there is some evidence suggesting that PTSD may run in families.

PTSD often affects people in conjunction with other stressors and conditions, such as depression, substance use, and anxiety, so it may be more likely to affect people with a history of these conditions.

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What causes PTSD?

The exact reason that some people develop PTSD is currently undetermined, but several factors may contribute to the disorder. Experiencing a traumatic event may not always lead to PTSD. There can also be a disparity between the trauma experience and the severity of the delayed-onset PTSD symptoms. A person can experience a mild form of PTSD symptom onset resulting from a horrific previous traumatic experience, while another may live with extreme PTSD symptoms from a less severe stressor.

Certain people may be at greater risk of developing PTSD when confronted with a traumatic event. There appears to be a genetic predisposition for developing PTSD, and the risk is generally higher for those who are under-resourced, single, or socially isolated. This may be attributed to a lack of support and resources to help them cope. Someone who has experienced previous traumatic events or additional trauma, especially as a child, or someone who has additional life stressors may also be more likely to develop delayed-onset PTSD.

What are the symptoms of PTSD?

A number of stress disorders are identified in the DSM (Diagnostic and Statistical Manual of Mental Disorders), but are distinct from post traumatic stress disorder.  Symptoms of PTSD usually fall into three main categories:

• Flashbacks, nightmares, and realistic recollections of the traumatic event

• Emotional numbness and avoidance of thoughts, feelings, people, places, or activities that serve as reminders of the traumatic event

• Increased arousal, as evidenced by sleeplessness, lack of focus, and/or a short temper

Within these categories, a variety of symptoms may occur:

• Loss of current awareness

• Intense physical sensations

• Memory loss regarding the traumatic event

• Lack of interest in social activities

• Negative focus and outlook

• Trouble falling asleep or staying asleep

• Angry outbursts

• Hypervigilance

• A tendency to feel jumpy or easily triggered by sounds or sights

• Depersonalization

• A tendency to blame yourself or feel guilty

• Physical symptoms like chest pain and dizziness

PTSD can also be marked by significant mood swings or changes in behavior. Feelings of hopelessness, negativity, guilt, shame, and anger, as well as thinking badly about yourself or others, can all be signs of this disorder. At its worst, PTSD can make people feel suicidal.

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Those who live with PTSD may have trouble maintaining friendships and relationships, experience difficulty holding down jobs, and find day-to-day life challenging. Self-care may also be negatively impacted.

PTSD isn't always easy to identify or diagnose, especially because it can often mimic or be accompanied by other mental health concerns, such as depression. There can also be a stigma surrounding PTSD. Some people may make the unfair assumption that someone who has PTSD is just dwelling on a bad experience. However, PTSD is a disorder recognized in the DSM-5 and is generally not something that a person can just “get over.” However, there are evidence-based treatments available for PTSD, and many people have experienced improvement with treatment (see Treatment Options section below).

What is delayed-onset PTSD?

Unlike PTSD, which may affect young adults more often than individuals of other age groups, delayed-onset PTSD can be more common among the elderly, possibly due to a traumatic experience from when they were much younger.

About 25% of those diagnosed with PTSD may experience delayed-onset PTSD. While there may not be any definitive explanations as to why one person may begin to experience PTSD symptoms right away when another starts to see the signs later on, studies suggest there may be contributing factors. For example, researchers believe that individuals who have a traumatic brain injury (TBI) may experience additional stressful circumstances. Similarly, those subjected to long hospital stays following an initial traumatic event may be more likely to see signs of PTSD later on.

Researchers have also speculated that in some cases of delayed-onset post traumatic stress disorder (PTSD), individuals experienced some symptoms of PTSD immediately following a traumatic experience but didn’t meet enough criteria for a PTSD diagnosis until six months or longer after the incident. Research suggests that the occurrence of delayed-onset PTSD without any previous symptoms during the first year may be rare. Instead, most diagnoses may be marked by additional, worsening, or reoccurring symptoms.

The Veterans Administration has also identified a similar, but less severe condition known as late-onset stress symptomatology (LOSS), which seems to primarily affect older combat veterans during the aging process.

Treatment options for delayed-onset PTSD

The first step in treatment and recovery is typically to see a mental health care provider, preferably one who has experience treating PTSD. Treatment typically includes psychotherapy, medication, or a combination of the two. According to the American Psychological Association, cognitive-behavioral therapy (CBT) may be especially effective. This may include prolonged exposure therapy, which may help people mitigate the negative power of their experience by helping them to revisit the memory more safely.

CBT may also involve cognitive restructuring, allowing participants to see the experience from a different perspective. This can be conducive to the process of making sense of their memories and experiences. Stress inoculation training may also be utilized. This form of treatment may help individuals cope with stressful situations and potential triggers in healthier ways.

Group treatment may also be ideal for individuals living with PTSD and delayed-onset PTSD because they can receive support from people experiencing similar post traumatic stress. They can also offer support to others based on their own experience of the stress disorder. Group members often benefit from telling their stories and facing the memories of the trauma, rather than avoiding them.

Eye movement desensitization and reprocessing (EMDR) is another potential treatment for PTSD symptoms. EMDR usually involves concentrating reflectively on your traumatic experience while making rhythmic eye movements based on the guidance of a mental health professional. Watching your therapist do something like moving their hands or flashing a light may allow for positive thoughts while remembering your traumatic experience.

Tailoring treatment options to you

Treatments often vary from individual to individual because of the nature of PTSD and delayed-onset PTSD; everyone's experiences and situations can be different. There may also be several things you can do on your own that may alleviate PTSD symptoms. Below are several suggestions:

• Eat regularly and nutritiously

• Try to get some exercise on a regular basis

• Give yourself time and grace

• Talk to someone, such as a friend, a family member, a mental health professional, or someone at a support helpline

• Avoid drugs and alcohol

• Spend time outdoors

• Engage in social activities whenever possible

It may be beneficial to consult a mental health professional if you’ve lived through a traumatic experience that could potentially lead to PTSD at some point. It may provide some preparation if and when symptoms arise. Even though you might not meet all the criteria for a PTSD diagnosis, symptoms can still interfere with your daily life. Seeing a doctor or therapist may help you manage symptoms and develop effective coping strategies.

Online therapy may help you manage PTSD symptoms

Although therapy is often recommended as a treatment for delayed-onset PTSD, it may not always be convenient or affordable to attend therapy sessions in person. In addition, PTSD symptoms can sometimes make it uncomfortable to leave the house and visit new locations, and possibly exacerbate the feelings of stress. If this is the case, you may benefit from online therapy, which research has shown to be effective for treating post traumatic stress. 

In one study, participants experienced significant reductions in their PTSD symptoms with internet-delivered CBT. They also experienced positive impacts on depression and anxiety symptoms, as well as improved quality of life. Treatment gains were shown to be maintained one year after the conclusion of treatment.

With an online therapy service like BetterHelp, you can communicate with your therapist from home via phone, live chat, or videoconference. Also, if you experience traumatic stress symptoms in between sessions, you can contact your therapist at any time through in-app messaging, and they’ll respond as soon as they can.