Can you have a PTSD flare up?

What is a PTSD flare up?

A PTSD flare up, also known as a PTSD trigger or relapse, refers to the re-emergence or worsening of post-traumatic stress disorder (PTSD) symptoms after a period of remission or control. PTSD is a mental health condition that can develop after exposure to a traumatic event. Symptoms include flashbacks, nightmares, severe anxiety, uncontrollable thoughts, and avoidance of traumatic reminders.

With PTSD, symptoms can fluctuate in severity. A flare up describes a time when symptoms temporarily get worse. Triggers or stressors often precipitate flare ups. Triggers can be sensory stimuli like sounds, smells or images that remind someone of their trauma. Internal states like stress, poor self-care, or substance abuse can also lead to flare ups by reducing one’s ability to cope with PTSD symptoms.

Flare ups can last for minutes, hours, days or weeks depending on the trigger and how it is processed. The frequency and duration of flare ups is different for every person with PTSD. With proper treatment and management, flare up periods typically become shorter and less severe over time.

What are the symptoms of a PTSD flare up?

PTSD flare ups or relapses involve a sudden worsening of both psychological and physical PTSD symptoms. Common symptoms during a flare up include:

– Panic attacks or intense anxiety
– Flashbacks to the traumatic event
– Nightmares or insomnia
– Heart palpitations, chest pain, dizziness or hyperventilation
– Detachment from reality or dissociation
– Worsened depression or suicidal thoughts
– Anger, irritability, aggression or violence
– Engaging in destructive behaviors like substance abuse
– Avoidance of work, school, socializing or other normal activities
– Difficulty concentrating or making decisions
– Hypervigilance or being easily startled

The same symptoms present in an initial PTSD diagnosis can recur during flare ups. However, symptoms may appear more severe and pronounced than usual day-to-day PTSD symptoms. This amplified symptom intensity signals the PTSD is flaring up again.

What triggers a PTSD flare up?

PTSD flare ups can be unpredictable, but they are often caused by identifiable triggers. Triggers are situational reminders of the original trauma that prompt a renewed stress response. Common PTSD triggers include:

– Sensory cues like sounds, smells, images, tastes or tactile sensations associated with the trauma
– Certain dates, seasons, months or times of year related to the trauma
– Locations, places or environments reminiscent of the traumatic event
– Milestones or anniversaries of the trauma
– Media coverage related to trauma or disasters
– Interpersonal interactions that provoke trauma-related emotions like fear, vulnerability or panic
– Witnessing violence or suffering, even unrelated to one’s trauma
– High stress emotional states like anxiety, depression, anger or grief
– Substance abuse
– Physical discomfort from injury, illness or poor self-care
– Insomnia, fatigue, sleep disturbances
– Hormonal changes or fluctuations

Triggers can be overt and obvious, like driving by the scene of an accident. But they can also be subtle, indirect everyday experiences that recall trauma memories or feelings. Because triggers accumulate stress, coping poorly with minor triggers can build up and cause a flare up later on.

Why do PTSD flare ups happen?

PTSD flare ups occur for several reasons related to the nature of PTSD itself:

PTSD is a cyclic condition – PTSD symptoms tend to recur over time, flaring up during periods of stress. Symptoms typically calm down again once trigger stress is removed.

PTSD worsens with trauma reminders – Situational triggers promptly revive trauma memories and feelings. This causes a temporary intensifying of symptoms.

PTSD impairs stress tolerance – PTSD reduces resiliency against stress. Smaller amounts of stress may therefore trigger bigger flare ups.

PTSD affects emotional regulation – Emotional control is compromised with PTSD, increasing reactivity to triggers.

PTSD brain activity is altered – Changes in brain regions involved in stress response, memory and emotion heighten sensitivity to triggering stimuli.

PTSD disrupts the body’s stress systems – Being in a perpetual state of high alert leads to chronically elevated stress hormones that may worsen symptoms.

Chronic PTSD can sensitize the nervous system – Neurological pathways that produce fear and anxiety become more sensitive over time through over-activation during PTSD.

PTSD coping abilities weaken without proper care – Avoiding treatment, therapy, medication, or self-care reduces one’s ability to manage symptoms that arise.

In summary, the very nature of PTSD as a disorder makes someone vulnerable to periodic worsening of symptoms. Triggers readily provoke flare ups by tapping into PTSD’s pathways. Ongoing treatment and maintenance of wellness helps stabilize symptoms over time.

How long do PTSD flare ups last?

The duration of a PTSD flare up or relapse depends on numerous factors:

Intensity of the trigger – More overt, powerful triggers can induce longer flare ups. Subtle triggers may only cause brief symptoms.

Duration of trigger exposure – Prolonged contact with a trigger provokes a more drawn-out flare up.

Whether trigger is resolved – Symptoms usually dissipate once removed from trigger. But lingering triggers prolong flare ups.

Resonance of trigger – Triggers closely associated with original trauma often produce worse flare ups.

Time since trauma – Flare ups tend to last longer the closer in time one is to their trauma.

PTSD severity – More complex, severe PTSD typically involves longer, more intense flare ups.

Mental health status – Poor general mental health and wellness can worsen and prolong PTSD flare ups.

Coping abilities – Stronger coping skills and emotional regulation tend to shorten flare up duration.

Social support – Good social support calms PTSD symptoms faster than isolation.

Treatment consistency – Maintaining regular therapy and medication as prescribed prevents lengthy flare ups.

In general, the more robust one’s coping abilities and the less intense the trigger, the shorter the resulting flare up. With proper PTSD management, flare ups may only last hours to days. Without treatment, flare ups can extend for weeks or months at a time.

Can a PTSD flare up appear spontaneously?

PTSD flare ups are usually sparked by identifiable triggers related to the original trauma. However, flare ups can also seem to occur out of nowhere with no overt triggering event. There are a few reasons spontaneous flare ups happen:

Forgetting or not recognizing triggers – Small triggers like sounds, sights or smells go unnoticed but spark symptoms.

Internal thought processes as triggers – Thoughts, memories or emotions act as internal triggers that aren’t always obvious.

Repressed emotions resurfacing – Buried feelings suddenly rising to the surface can spontaneously ignite flare ups.

Comorbid conditions worsening – Conditions like depression or anxiety disorders may prompt flare ups independent of PTSD triggers when these conditions worsen.

Poor self-care – Insufficient sleep, substance abuse, or lack of routine can leave one vulnerable to spontaneous flare ups.

Stress accumulation – Minor stress builds up over time, eventually erupting into sudden flare ups.

Hormonal changes – Shifting hormone levels related to menstruation, illness or other factors can trigger unexpected flare ups.

With proper tracking of symptoms, even flare ups that seem random often reveal subtle triggers upon closer inspection. However, some element of unpredictability is intrinsic to PTSD. Working to minimize vulnerability through self-care, maintenance of wellness, and avoidance of known triggers helps mitigate spontaneous flare up risk.

What should you do during a PTSD flare up?

When a PTSD flare up occurs, the following strategies can help calm symptoms faster:

– Go to a safe, comfortable place if possible and allow symptoms to run their course. Don’t fight against them.

– Use grounding techniques like deep breathing, counting, or naming surroundings objects. This helps reorient to the present.

– Contact a support person to talk through the experience. Social support activates calming brain pathways.

– Remind yourself symptoms are temporary and will pass. This helps reduce panic.

– Engage in small distractions like watching TV, reading or listening to music – nothing that requires prolonged focus.

– Avoid mood altering substances. They often worsen and prolong PTSD flare ups.

– Use prescribed PRN (as-needed) medication if available. These provide fast relief of acute symptoms.

– Draw on coping strategies from your therapist like mantras, visualization or cognitive approaches.

– Wrap up in a weighted blanket, which simulates a soothing hug.

– Drink water, eat something nourishing, take a shower or go outside. Meeting basic needs can help.

– Limit stimulation and interaction with others until the most intense symptoms pass.

– Write down what triggered the flare up and bring it to your therapist to process.

While flare ups feel disruptive and upsetting, they are ultimately opportunities for healing by facing trauma memories in a measured, supported way.

How to prevent PTSD flare ups

Certain lifestyle habits and wellness practices make PTSD flare ups less frequent and severe:

– Adhere to all prescribed therapy and medications. Stay consistent even when feeling better.

– Avoid known trauma triggers whenever reasonably possible.

– Develop skills for coping ahead of time with triggers that are unavoidable.

– Practice good sleep habits like keeping a consistent schedule. Poor sleep is a common flare up trigger.

– Eat a balanced diet and stay hydrated. Low blood sugar and dehydration leave one vulnerable.

– Reduce alcohol and recreational drug use which can destabilize mood.

– Incorporate regular exercise which boosts resilience against stress.

– Make time for enjoyable hobbies and social activities unrelated to trauma.

– Use relaxation practices like deep breathing, yoga, meditation, or prayer.

– Improve emotional regulation skills through therapies like CBT, DBT or ACT.

– Maintain a consistent daily routine to enhance stability.

– Ask family and friends for support around known triggers like anniversary dates.

– Keep a PTSD symptom journal to identify flare up patterns over time.

– Reach out quickly to your therapist or doctor if symptoms start to significantly worsen. Don’t wait until a crisis.

With work to stabilize daily functioning and mood, flare ups become more manageable over time. They may never disappear fully, but can be substantially minimized.

When to seek emergency help for a PTSD flare up

While most flare ups can be managed at home, emergency help is warranted if the following arise:

– Suicidal or homicidal thoughts

– Losing touch with reality

– Unable to care for oneself or children

– Symptoms lasting beyond one’s ability to cope

– Using substances in a risky manner

– Causing harm to oneself or others

– Experiencing violence or rage that feels out of control

– Physical health symptoms like chest pain, difficulty breathing, or feeling faint

– Medications ineffective at relieving severe symptoms

– Collapsing of social supports and inability to reach out for help

Seeking emergency care during dangerous flare ups reduces the likelihood of negative outcomes. Calling emergency services, going to the ER, admitting oneself to the hospital voluntarily, or contacting a crisis hotline provides lifesaving intervention.

Don’t hesitate to ask for emergency help when needed. Prioritize safety and get through the crisis first. Additional PTSD treatment can always occur after stabilizing.


PTSD flare ups are expected parts of the recovery journey. With compassionate self-care, social support, and consistent treatment, their intensity can be reduced over time. Flare ups allow opportunities to process trauma memories in manageable doses, helping rewrite the brain’s fearful associations. Meeting flare ups with resilience provides hope that healing from PTSD is possible.

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