Delayed-Onset PTSD

What Is Delayed-Onset PTSD?

Delayed-onset PTSD is when a person experiences a life-threatening trauma and develops symptoms of post-traumatic stress disorder (PTSD) at least 6 months after the traumatic event. In some cases, it may take years for people to develop symptoms diagnostic of PTSD.

Delayed-onset PTSD can be difficult to recognize and diagnose due to its overlapping symptoms of PTSD. However, studies have shown that nearly 25% of people diagnosed with PTSD have delayed-onset PTSD.

Traumatic events associated with delayed-onset PTSD are the same types of traumatic events that are associated with the full spectrum of PTSD and all of its subtypes, including:

• Sexual assault
• War and combat
• Natural disasters
• Car accidents
• Violence
• Refugee camps
• Slavery
• Genocide
• Torture

Most people who experience a life-threatening traumatic event have some symptoms of PTSD but they dissipate within a certain time, or there are not enough symptoms to meet the diagnosis criteria, as PTSD is diagnosed based on a timeline of specific symptoms.

Delayed-onset PTSD is common in older adults who experienced a traumatic event in their younger years, and symptoms are often triggered by a major life change.

Delayed-Onset PTSD Symptoms

Delayed-onset PTSD symptoms are the same symptoms of PTSD and acute stress disorder, though they take longer to present. In delayed-onset PTSD, symptoms do not appear until after 6 months from the traumatic event. The timing of the appearance of symptoms and their resolution are essential diagnostic criteria to differentiate these disorders. It is important to note that some symptoms do appear right away, but they may not meet the diagnostic criteria for PTSD at that time. 

Delayed-onset PTSD symptoms include symptoms from different criteria:

Re-experiencing symptoms (at least one symptom)

• Distressing nightmares related to the traumatic event
• Intrusive thoughts throughout the day related to the trauma.
• Flashbacks: A reenactment of the events
• Physical signs of stress such as rapid heart rate, headache, gastrointestinal upset

Negative changes in mood and cognition (at least two symptoms)

• The inability to experience positive emotions such as laughter, joy, or humor
• Loss of interest in previous enjoyable activities
• Social isolation
• Difficulty concentrating
• Feelings of guilt and blame
• Depression
• Trouble remembering key features of the traumatic event (blocking)

Avoidance symptoms (at least one symptom)

• Efforts to avoid emotions, feelings, people, or thoughts associated with the traumatic event.
• Changing your routine to avoid anything that reminds you of the trauma

Hyperarousal and reactivity symptoms (at least two symptoms)

• Sleep disturbances
• Irritable or aggressive mood or behavior
• Always on edge
• Engaging in reckless behavior
• Increased startle response
• Extremely sensitive to potential danger (hypervigilance)

Dissociation (not necessary for diagnosis but can be present)

• Having an out-of-body experience
• Altered sense of reality
• Inability to remember important details about the traumatic event (dissociative amnesia)

Causes and Risk Factors for Delayed-Onset PTSD

As previously mentioned, most people who experience a traumatic event have symptoms associated with PTSD but do not meet the diagnostic criteria either because of the duration of symptoms or not enough symptoms.

However, a person who later experiences another traumatic event or who has a major life stressor is at risk of developing delayed-onset PTSD because they may have a re-emergence of previous symptoms in addition to new symptoms. Therefore, risk factors for delayed-onset PTSD include a person who has experienced a life-threatening traumatic event early on in life and who also experiences the following later in life:

• Divorce
• Loss of a loved one
• Job loss or retirement
• Major medical diagnosis
• Financial stressors
• Relocation

Prevention and Early Intervention

Prevention for delayed-onset PTSD is focused on seeking therapy immediately after the traumatic event occurs to prevent PTSD as well as delayed-onset PTSD. Most people will experience symptoms after a traumatic event but also assume their symptoms will improve over time; however, seeking therapy and attending support groups are the only sure ways to prevent the worsening of these symptoms.

Since delayed-onset PTSD usually occurs after the traumatic event and is commonly triggered by a life-changing stressor, it is essential to seek help and support when you experience this life stressor. If you are undergoing treatment for a cancer diagnosis or you recently lost a loved one, going to support groups and attending therapy can help decrease and even prevent recurring PTSD symptoms that may arise during this difficult time.

What is the Difference Between PTSD and Delayed-Onset PTSD?

The only difference between PTSD and delayed-onset PTSD is the timing of symptoms.

PTSD is diagnosed when symptoms associated with a life-threatening traumatic event last longer than 30 days from the traumatic event. Delayed-onset PTSD occurs when diagnostic criteria of PTSD symptoms are met after 6 months of a life-threatening traumatic event.

Initial symptoms can occur immediately, but they may not meet full diagnostic criteria, and this is why delayed-onset PTSD can be tricky to diagnose. For example, an older person who was violently assaulted 30 years ago and experienced nightmares after the event her entire life but no other symptoms recently has been having other symptoms of PTSD. A mental health professional may miss the diagnosis because they may not mention the history of trauma that happened long ago, or they may not associate all the symptoms together. Therefore, a very detailed history is important to diagnose delayed-onset PTSD and often involves asking questions about the person’s childhood and early years to pinpoint any episodes of trauma and lingering symptoms.

Delayed-Onset PTSD in Veterans

Delayed-onset PTSD is quite common in veterans who served in their early years and experienced the trauma of combat. Life transitions and stressors can occur in their later years, which are known triggers for symptoms of delayed-onset PTSD.

Many veterans do not seek mental health care during or immediately after their service due to the stigma associated with mental health and veterans. As a result, veterans are at an increased risk of PTSD, not only because they experienced trauma but also because of this stigma. Delayed-onset PTSD is common because this population may use coping mechanisms such as avoidance or suppression to block out the trauma and numb feelings associated with this trauma. This can include using alcohol and drugs or entering a profession where they overwork themselves (often leading to burnout) or dedicate themselves to their family to the point that they do not have time to think or react to their trauma. As time passes, this can eventually catch up to them, and they start to re-experience symptoms associated with the trauma.

Treatment for Delayed-Onset PTSD

Treatment for delayed-onset PTSD involves the same psychotherapy approaches to treat PTSD.

Psychotherapy is focused on trauma therapy that involves overcoming the symptoms and developing healthy coping tools to prevent and minimize future symptoms. Types of therapy approaches used for treating delayed-onset PTSD include the following:

• Cognitive Processing Therapy (CPT)
• Prolonged Exposure Therapy (PE)
• Eye Movement, Desensitization, and Restructuring (EMDR)

Mental health medications can also be used to help with symptoms of depression and anxiety that often present with delayed-onset PTSD.

Living with Delayed-Onset PTSD

Delayed-onset PTSD can be a debilitating disorder, but with the right treatment plan and lifestyle modifications, it is possible to live a happy and healthy life with this disorder.

Seeking professional help is the most important part of living a fulfilling life with delayed-onset PTSD, but there are also steps you can take in your daily life aside from professional therapy. These include the following:

• Educating yourself on delayed-onset PTSD: There are books, podcasts, and blogs that provide information on PTSD and delayed-onset PTSD and how to cope. The more you understand the disorder and symptoms, the better you work to learn to cope with certain triggers and symptoms.
• Support groups: Whether it is virtual or in-person support groups, being around others who also have PTSD can help you feel supported in the community. You can learn from others, share your story, and lean on this community when needed. This can also prevent loneliness, which is common in PTSD.
• Self-care: Prioritizing adequate sleep, a nutritious diet, daily exercise, and doing things that bring you joy are types of self-care that can help you through your journey.
• Mindfulness practices: Meditation and journaling can help keep you centered and focused on your healing journey.
• Social interactions: Engaging with others who are there to listen to and support you is crucial. PTSD can breed loneliness, so staying connected and in touch with others can prevent loneliness and other PTSD symptoms.

If you have experienced a past traumatic event and are now noticing symptoms that affect your daily life, speak to a mental health professional as soon as possible. They will be able to provide you with more information about delayed-onset PTSD, perform an assessment, and give you access to resources and treatment options that can help you start your healing journey.