What Is PTSD and What Causes It?
If someone you love has been diagnosed with PTSD — or if you suspect they may have it — you are probably dealing with a complicated mix of your own emotions. You may feel helpless watching them flinch at ordinary things, avoid people they used to love, or seem to disappear into a different time and place. You may feel grief for who they were before. You may feel guilty that you couldn't protect them from what happened. You may even feel frightened of them sometimes — and then feel guilty about that too. This guide is for you. It explains what PTSD actually is, why it doesn't just get better with time, and what you can do to support your loved one without making things harder.
Medically Reviewed by:
Dr. Darrin Mangiacarne
Chief Medical Officer
At Banyan Treatment Centers, Chief Medical Officer Dr. Darrin Mangiacarne leads our nationwide clinical team with over a decade of addiction medicine experience, helping ensure evidence-based, compassionate care across every level of treatment.
Author / Written by: Banyan Editorial Staff
Medically reviewed by: Dr. Darrin Mangiacarne, CMO
Updated on: June 2026
Family Resources Hub › Mental Health Resources › Common Diagnoses Explained
PTSD Is a Neurobiological Response to an Overwhelming Experience
Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition that can develop after a person is exposed to actual or threatened death, serious injury, or sexual violence — whether experienced directly, witnessed, or learned about in connection with someone close to them. It affects approximately 3.5% of U.S. adults in any given year and is significantly more common among veterans, survivors of assault, and people who experienced childhood abuse or neglect.
PTSD is not a sign of weakness. It is not a sign that the person is "stuck in the past" or choosing not to move on. It is a measurable neurobiological condition in which the brain's threat-processing systems have been altered by an overwhelming experience in ways that produce ongoing symptoms. Brain imaging research shows that people with PTSD have measurable differences in brain structure and function compared to people without PTSD — particularly in the amygdala (threat detection), hippocampus (memory processing), and prefrontal cortex (rational regulation).
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What PTSD Looks Like — The Four Core Categories of Symptoms
PTSD is organized in the DSM-5 around four clusters of symptoms. Understanding these clusters helps families make sense of behaviors that can otherwise seem baffling, alarming, or hurtful.
Intrusion Symptoms
Involuntary, unwanted memories of the trauma that intrude into daily life — flashbacks in which the person re-experiences the trauma as if it is happening again, nightmares, and intense psychological and physical distress in response to reminders of the event. These are not chosen; they cannot be turned off by willpower. The brain is replaying the traumatic event in a loop it has not yet been able to process.
Avoidance
Deliberate efforts to avoid trauma-related thoughts, feelings, people, places, objects, or situations. This can look like social withdrawal, refusing to talk about what happened, avoiding television content or news stories that relate to the trauma, and steering clear of any environment associated with the traumatic event. Avoidance provides short-term relief but prevents the brain from processing the experience.
Negative Alterations in Cognition and Mood
Persistent and distorted negative beliefs about oneself or the world ('I am permanently damaged,' 'No one can be trusted,' 'I deserved what happened'). Pervasive negative emotional states — shame, guilt, fear, horror, anger. Loss of interest in activities. Emotional numbing or feeling detached from others. Inability to experience positive emotions. This cluster is what produces much of the apparent personality change families observe.
Hyperarousal and Reactivity
Hypervigilance — being constantly on alert for danger. Exaggerated startle response — jumping at sounds, movements, or unexpected contact. Irritability and anger outbursts, sometimes seemingly out of nowhere. Difficulty concentrating. Disturbed sleep. Reckless or self-destructive behavior. This is the cluster that can most alarm or frighten family members — and it can feel like unpredictable aggression when it is actually a dysregulated nervous system.
The Events That Can Lead to PTSD
Not everyone who experiences a traumatic event develops PTSD — but many do, and the type of trauma, the degree of support afterward, and individual neurobiological factors all play a role. Families sometimes ask: "Why did PTSD develop from this event but not another?" There is rarely a simple answer, and the question can carry hidden implications of blame that are not warranted. PTSD is not a sign that the person is weak or that what happened wasn't "bad enough" for others.
Direct Trauma Experiences
Physical assault, sexual violence, combat exposure, serious accidents, natural disasters, life-threatening illness, witnessing violent death or injury. These direct exposure events are the most commonly identified causes of PTSD.
Childhood Trauma
Physical, emotional, or sexual abuse; neglect; witnessing domestic violence; growing up with a parent with untreated mental illness or severe addiction. Childhood trauma is particularly impactful on the developing brain and is associated with higher rates of PTSD and more complex presentations.
Vicarious Trauma
Learning about a traumatic event involving a close family member or friend — particularly sudden violent death, sexual assault, or serious injury. First responders and healthcare workers are also at elevated risk from repeated exposure to others' trauma.
Ongoing or Repeated Trauma
Chronic exposure to threat — ongoing domestic violence, prolonged childhood abuse, repeated workplace violence — can produce complex PTSD (C-PTSD), a presentation that involves all the features of PTSD plus significant disruption to identity, relationships, and emotional regulation.
How PTSD Is Treated — and What Families Should Know
Evidence-Based PTSD Treatments
The most well-researched treatments for PTSD are Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) — both of which are endorsed by NIMH and the VA. EMDR (Eye Movement Desensitization and Reprocessing) is also strongly supported and widely used. These therapies work by helping the brain properly process the traumatic memory rather than continuing to treat it as a current threat. SSRIs and SNRIs are effective pharmacological adjuncts.
How Families Can Support Without Triggering
Learn your loved one's specific triggers and gently avoid them without making their avoidance your avoidance — there is a difference between being considerate and accommodating a symptom. Communicate with warmth and patience rather than frustration. Understand that their hypervigilance and startle responses are not directed at you. Ask them what kind of support they need rather than assuming. And seek support for yourself — living with someone with PTSD is genuinely demanding.
Secondary Traumatic Stress in Families
Family members of people with PTSD are at elevated risk of secondary traumatic stress — a condition in which exposure to a loved one's trauma symptoms and history produces trauma-like symptoms in the family member. This is real and it is recognized clinically. If you are experiencing intrusive memories, hypervigilance, or emotional numbness related to your loved one's trauma, seek professional support for yourself.
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You Don't Have to Figure This Out Alone
Banyan's Family Program
PTSD changes the entire family system. Banyan's Family Program helps families understand what PTSD is, why their loved one behaves the way they do, and how to respond in ways that support healing rather than inadvertently triggering or reinforcing symptoms. Weekly family sessions with our clinical team provide a structured space for this work.
Trauma-Informed Clinical Care
Banyan's clinical approach is trauma-informed — meaning our treatment environment and staff are trained to recognize trauma's impact and to avoid inadvertently reactivating it. Every person in our care receives a trauma screening at intake, and trauma-specific therapeutic approaches are integrated into treatment planning.
Call Us Anytime
If your loved one has PTSD and you are trying to figure out what treatment options exist, call our admissions team. We can walk you through what a clinical evaluation involves and what treatment at Banyan looks like for someone with a PTSD presentation. 855-722-6926, 24/7.
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