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When Does PTSD Strike? The PTSD Onset Periods

Updated on February 13, 2010

There are generally three different onset periods for Post Traumatic Stress Disorder (PTSD). The types of onset are as follows:

a. Immediate Onset

b. Delayed Onset

c. Intermittent Onset

Immediate Onset PTSD

This type of PTSD onset occurs immediately or shortly after a traumatic event.

Some soldiers I have spoken with have experienced immediate onset PTSD after they watched one of their buddies get killed in Iraq. When the fire fight is over, or when they make it back to their hootch, they suddenly begin to have PTSD symptoms, such as a crying fit, going silent, or making a suicide attempt.

The same can occur to survivors of sexual assaults. They immediately manifest PTSD symptoms such as sleeplessness, trust issues, and in some cases a suicide attempt.

Delayed Onset PTSD

Not every case of PTSD will manifest immediately after the traumatic event. It is not unusual for a period of time to go by before the symptoms surface. In many military cases we are seeing symptoms at 6, 9, and 12 months after returning from deployment. I am also aware of many veterans who begin to show symptoms at the ten year mark after they left the service or after the traumatic exposure happened.

The first seven years of the Iraq war showed low reporting of PTSD for two reasons:

a. The perception, and sometimes the reality, that to admit to PTSD will damage your military career.

b. The military foolishly only asked about PTSD symptoms when soldiers and Marines were redeploying back to the States. Some soldiers reported that if you admitted to PTSD symptoms, then you had to stay two or three more weeks in Iraq while your buddies shipped home. That created a major incentive to not report symptoms. For a deployed service member, two to three more weeks in Iraq is an eternity.

The military was not doing follow up studies to see how often PTSD came up at the 6, 9, and 12 month intervals.

These practices artificially lowered the reported rates of PTSD in returning service members.

Delayed onset of PTSD can also surface in rape and clergy abuse survivors. PTSD does not have to begin immediately; sometimes it simmers for years before breaking out and ruining people’s lives.

Intermittent PTSD

This is a variant of sorts of Delayed Onset PTSD. In a nutshell it means that at times the PTSD symptoms and behaviors will bubble up and manifest themselves and then after a time subside again.

The periods of onset can be relatively brief, say a few hours, to a period of months.

Intermittent PTSD is associated with PTSD triggers that activate memories, fears, anxieties, and physical reactions to trauma. The sound of gunshots or screaming might bring a person back to when they were shot at or raped. The smell of a person’s cheap cologne may remind someone of being assaulted.

As one learns what their PTSD triggers are, they are able to be in better control and not be as vulnerable to PTSD.

There is No Shame in PTSD

PTSD is a normal response to trauma. While one of the symptoms is to possibly feel shame, there is no real shame to having PTSD. What we must remember is that everyone has value and to show the compassion to others who are vulnerable and hurting.

PTSD does not have to destroy your life. It is a hard journey to be on, but there is hope.

More information on the Spiritual Dimensions of PTSD and how it damages our spirit and soul can be found at

Semper Pax, Dr. Z


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