Can PTSD Surface Later in Life?

Depressed woman with flying hair stand in the choppy water.

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And why women may be especially at risk. 

Just like other mental health conditions, the symptoms of post-traumatic stress disorder don’t have an expiration date. Even though it may have been years since a traumatic event occurred, that doesn’t mean you’re in the clear when it comes to the effects of the experience.

For instance, some people may not experience PTSD symptoms immediately after the event that triggers it. This is considered delayed-onset PTSD, and it can surface at any point in one’s life. If you’re experiencing symptoms, such as difficulty sleeping or painful flashbacks, seemingly out of nowhere, this might be why. It also has a major impact on society at large, leading to increased rates of suicide, hospitalization, and substance use.

“The tragedy of mental illness is it affects more than just the person who has it,” Jain Shaili, MD, “It has downstream consequences because it really impacts the way those people love, live, and work.”

Just how many are impacted by delayed-onset PTSD? You might be surprised to learn that it’s relatively common: About 12 million Americans have PTSD during a given year and about 25 percent of these cases are thought to be delayed-onset. 

To better understand this little understood (and under-researched) condition, we turned to two PTSD specialists, Dr. Shaili and Elliott B. Rosenbaum, Psy.D. 

What’s delayed-onset PTSD? 

Post-traumatic stress disorder generally develops when a person has difficulty recovering immediately after experiencing or witnessing a traumatic event. But sometimes these symptoms take longer (at least six months) to surface, and that’s known as delayed-onset PTSD. 

Dr. Shaili says symptoms can even appear even decades later. Oftentimes, it’s triggered by other major changes or events in someone’s life, like retirement or divorce. 

The good news is that only a small minority of people who are exposed to trauma will develop PTSD (even though 90 percent of adults have experienced a stressful episode in their lifetime, only 15 percent of those exposed will go on to develop symptoms of this condition). But for those who experience any sort of PTSD, immediate or delayed, and don’t get the help they need, the consequences can be life-threatening. 

“Addiction is really common when PTSD is left untreated,” says Dr. Shaili. “People tend to turn to everything from alcohol and drugs to food and sex.” 

Who does delayed-onset PTSD affect?

Delayed onset PTSD affects people from all walks of life, including even children. But it tends to be more common among women, who are twice as likely to develop PTSD than men, according to the U.S. Department of Veteran Affairs. Dr. Shaili says this largely has to do with the types of trauma they experience.

“Women are a lot more likely to be the victim of intimate partner violence, much more likely to be a victim of childhood sexual abuse, and much more likely to be a victim of rape,” she tells KCM. 

There could even be genetic predisposition: People with a higher genetic risk for mental disorders, including schizophrenia and depression, are at a higher risk for developing PTSD, according to a 2017 study from the Psychiatric Genomics Consortium. Those who are poor, single, socially isolated, or experienced a traumatic or stressful childhood may also be more susceptible to this disorder. But that’s not all: Certain minority groups, specifically Latinos, are more at risk, according to the National Institutes of Health’s Library of Medicine.

What are the symptoms of delayed-onset PTSD?

Since delayed PTSD is a subtype of post-traumatic stress disorder, symptoms are very similar and can come in a variety of forms, including vivid nightmares, sleeplessness, and detachment or avoidance of people or feelings that remind them of the traumatic event. Another key indicator is emotional reactivity or overreacting to what otherwise might be everyday stressors like balancing responsibilities at work or getting stuck in traffic. 

These symptoms can also even have an impact on your health, often leading to memory loss or dizziness. But oftentimes, Dr. Rosenbaum says symptoms can seem like they’re coming out of nowhere because they’ve been suppressed through various coping mechanisms, such as drugs or compulsively working long hours. 

“The reason some people have delayed-onset is that they have psychological defense mechanisms that are working to protect them from the pain and discomfort of the trauma,” he tells KCM. “This eventually breaks down usually due to overload and the trauma symptoms emerge.” 

How’s it treated?

The treatments for PTSD and delayed-onset PTSD are similar. Both experts say the first step in getting help is finding a mental health care provider, preferably one who has experience with trauma and PTSD. Depending on how severe the symptoms are, treatment typically includes psychotherapy, medication, or a combination of the two.  

There’s also standard cognitive-behavioral therapy, which helps people identify and change the often negative thought patterns that stem from their trauma and deal with it more healthily. But Dr. Rosenbaum says other promising treatments have been developed in recent years, like what’s known as post-traumatic growth. Through various life coaching techniques, this approach focuses on helping people suffering from trauma find new purpose and meaning in their lives.

As with most mental illnesses, PTSD isn’t curable, but for most people, the condition can improve significantly and see their symptoms resolved. Sometimes just getting a diagnosis can be empowering for many who have lived with it their whole lives. 

“It’s a very manageable condition today,” says Dr. Shaili. “The quicker you get treatment, the better your prognosis.”