Delayed Onset PTSD: Symptoms, Causes, & Treatment

What Is Delayed Onset PTSD?

While delayed onset PTSD is a trauma-related disorder, its symptoms take longer to appear compared to immediate-onset PTSD. Delayed onset PTSD symptoms must be delayed beyond 6 months, which can also be seen as a delay on individuals meeting diagnostic criteria for a PTSD diagnosis.¹

Delayed onset PTSD differs from immediate-onset PTSD, and it’s usually based on the time frame that symptoms emerge. Immediate-onset PTSD, also known as PTSD, is a trauma-related disorder that typically develops shortly after an individual has been exposed to a traumatic or highly stressful life event. These symptoms typically appear within 3 months of exposure and lead to decrease in quality of life.

Memory & Trauma Processing

Memory deficit is linked to the development of PTSD, leading to also being linked to the development of delayed PTSD, as both diagnoses have similar symptoms. One of the main symptoms of delayed PTSD includes intrusive thoughts or memories about the trauma. These tend to be involuntary and may also feel uncontrollable for some individuals.²

Following exposure to a traumatic event, survivors may have difficulty remembering details of the event or they may be confused about the order of events that led to the trauma. Research reports that the overwhelming nature of the traumatic event may impede individuals from fully processing the aspects of the event at the time it originally occurred.²

Delayed Onset PTSD Diagnostic Criteria

Following the DSM-5 criteria, delayed onset PTSD is a diagnostic category that is met by those individuals who first meet full diagnostic criteria of PTSD at least 6 months after exposure to trauma. It is important to note that the expression or presence of some symptoms may be immediate. However, full diagnostic criteria of PTSD must be met in order to be categorized as delayed-onset PTSD.³

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a traumatic or stressful life event is defined as exposure to actual or threatened death, serious injury, or sexual violence. This can be by either experiencing the event directly, witnessing the event, learning about the event and/or experiencing repeated or extreme exposure to aversive details of the traumatic event (such as being a first responder, military personnel, etc.).³

Symptoms of Delayed Onset PTSD

Symptoms and signs that characterize delayed onset PTSD are generally the same that characterize immediate-onset PTSD. These may include intrusive thoughts and memories, nightmares, flashbacks, physiological reactions and negative impact on mood. These symptoms must last more than one month in order to meet criteria and cause significant distress in individuals’ quality of life, such as impaired social and occupational abilities.

Some symptoms of delayed PTSD include:

• Memory loss surrounding the event
• Avoidance (or efforts to avoid) memories, thoughts or feelings about the traumatic events
• Avoidance of external reminders of the traumatic event (avoiding certain places, situations, or people)
• Dissociative reactions (flashbacks; feeling as if the event was recurring)
• Recurrent intrusive thoughts or memories about the event
• Persistent and exaggerated negative beliefs about oneself or others
• Persistent negative mood (irritability, anger outbursts, fear) following the event
• Hypervigilance
• Sleep disturbances (difficulty falling or staying asleep)
• Feeling detached from others
• Decreased motivation

Triggers & Causes of Delayed Onset PTSD

There are potential triggers and causes that may lead to the delayed presentation of PTSD. Triggers may include exposure to additional life stressors, experiencing another traumatic event, repressed memories and substance abuse. Even though these situations may lead to delayed PTSD symptoms and can be recognized as triggers and causes, it is also possible that for some individuals there is no such effect.

As it has been mentioned before, the severity and presentation of delayed PTSD will vary by individual, as not everyone reacts the same under traumatic events. The presentation of delayed PTSD symptoms will also vary by individual.

Exposure to Additional Life Stressors

Research shows that experiencing additional life stressors in the period after being exposed to a traumatic event increases the risk of delayed PTSD.⁴ Stressors can include physical or neurological illnesses, reminders of the trauma and further situations that lead to one feeling emotionally overwhelmed with a sense of lack of control.⁵ Life stressors can increase the severity of already existing symptoms. During treatment, mental health professionals are encouraged to not only study the original trauma, but also other stressful experiences throughout survivors’ life cycle.⁶

Experiencing Another Traumatic Event

It is also possible that experiencing further traumatic events can reinforce previously seen symptoms, and lead to a diagnosis of delayed onset PTSD. Military combat exposure, for example, is associated with delayed PTSD due to the high risk of exposure trauma.⁷ When further traumatic experiences are added to one’s life cycle, without any prior knowledge of coping mechanisms nor processing of the first/original trauma, the chances of developing delayed PTSD are high.

Worsening of PTSD Symptoms

Individuals may experience PTSD-related symptoms following immediate exposure to trauma, but these symptoms may only be a few, low in severity or even go unnoticed, leading to them not meeting criteria for a formal PTSD diagnosis. However, if these worsen over time, become more intense and impactful, then one is at higher risk of developing delayed onset PTSD.

Repressing Memories

It is known that one of the symptoms of delayed PTSD is repressing memories about the event and suppressing emotions. When repressing continues to be reinforced, serving as a form of avoidance, it eventually only worsens the symptoms of delayed PTSD. Suppressing memories can be either unintentional or intentional.

Impact of Delayed Onset PTSD

Delayed-onset PTSD can have multiple effects and impacts in quality of life. The symptoms of delayed PTSD can lead to individuals isolating, which may then create a sense of loneliness and lack of support. It can have a negative impact on relationships because of the constant feeling of irritation and difficulty regulating emotions.

Within the work field, it may also impact performance because of lack of motivation and difficulty focusing while trying to complete tasks. This can be reflected in school related settings as well. Additionally, symptoms related to sleep disturbance can also lead to negative effects on one’s energy levels, increased irritability and increased symptoms of depression.

How to Cope With Delayed Onset PTSD

The best strategies to cope with delayed onset PTSD will vary by individuals, their needs, and preferences. Coping strategies are meant to help you decrease the intensity and severity of the symptoms of delayed PTSD and improve mood and quality of life over time. Some strategies include journaling about trauma, meditation, yoga, and other types of physical activity.

Journaling About Trauma

Some of the symptoms of trauma include suppressing or avoiding the emotions, thoughts, or memories about the traumatic experiences. Journaling about trauma can help with the healing process. This involves writing down thoughts or feelings about the events as a way to help with the release and processing of these same thoughts and feelings relating to the traumatic experience without inhibition while gaining clarity and improving well-being.

Meditation for PTSD

Practicing meditation for PTSD can enhance ability to focus and redirect thoughts while decreasing the intrusive ones. As one focuses on the here and now, remaining present and aware of thoughts and emotions, mindfulness can help improve mood and decrease stress levels as a grounding technique. There are also different forms of meditation that can help depending on one’s preferences.

Trauma-Informed Yoga

Another coping strategy that can help with symptoms of delayed onset PTSD is trauma-informed yoga. This is a specific yoga class provided by an instructor with experience in working with trauma survivors. It can help individuals build a sense of peace, confidence and self-awareness while decreasing trauma-related responses. In addition, physical exercise benefits mental health by improving mood and decreasing severity of mental health symptoms like anxiety, depression and trauma.

Avoid Substance Use

Consuming substances, which include alcohol and/or other drugs, can impede the progress towards healing. Substance use can be identified as a form of avoidance, as it may lead to the suppression symptoms. Long-term effects can include worsening of symptoms and/or develop into a substance use disorder.

Community & Family Support

Having a strong support system is of high importance when coping with symptoms of delayed PTSD. Family, friends, and support groups can have a positive impact on each individual’s progress by remaining consistently supportive and non-judgemental. Support groups are a great option for those looking to extend their support system, and these can vary by topic and location.

Practice Self-Care

Self-care is all about caring for yourself in order to feel whole and aligned. It involves meeting your emotional, spiritual, and physical needs to feel at peace and wholesome. Self-care can look different for everybody, as it may involve different practices. Some self-care activities include journaling, practicing mindfulness, gratitude or meditation, healthy eating habits, going for a walk, etc. Engaging and prioritizing the practice of self-care has multiple benefits, such as increased self-esteem, decreased symptoms of anxiety and depression, emotional regulation, lower stress levels, increased self-awareness, and more.

Incorporate Physical Activity or Exercise

Incorporating exercise into your weekly routine is another option for coping with delayed onset PTSD. Physical activity can have positive impacts in both your physical and mental health. Exercising prompts the production and increase of endorphins levels, a type of hormone our body produces to help reduce pain, stress and improve mood. Physical activity helps alleviate symptoms of depression, anxiety and lower stress levels.⁸

Treatment Options for Delayed Onset PTSD

There are specific treatment options that focus on addressing delayed onset PTSD, often offered by professionals who have undergone specific training to target trauma. Some of the trauma treatments that can help cope with delayed PTSD include CPT, DBT and CBT. The best treatment approach will depend on individuals’ preferences and needs.

Psychotherapy

Psychotherapy that focuses on addressing trauma can create a sense of ‘release’ for those engaging in treatment. This is, of course, once the traumatic experience has been processed. With a strong therapeutic relationship, individuals can feel safe as they navigate and process the event. The overall aim of these is to help with processing the trauma in a healthy and adaptive way and alleviate symptoms.

Common therapy options for delayed onset PTSD include:

• Trauma-focused CBT: Trauma-focused cognitive behavioral therapy is a trauma-specific treatment (originally designed for children ages 3-18) that focuses on teaching individuals to modify negative thoughts, emotions and behaviors that result from trauma. Parents or family members are highly encouraged to be part of treatment.
• Cognitive processing therapy: CPT for PTSD focuses on challenging negative irrational thoughts, reframe thinking patterns into more realistic ones, and processing the events and trauma that led to the delayed onset PTSD diagnosis. The three main goals of CPT are: reflect, redefine, recover.
• Dialectical behavioral therapy: DBT for PTSD incorporates mindfulness, emotional regulation and distress tolerance to address and cope with symptoms of delayed PTSD. As with CPT and CBT, DBT also helps people identify and replace maladaptive behaviors.
• Eye movement desensitization and reprocessing (EMDR): EMDR for PTSD focuses on the memory centers of the brain, triggers and any other associations with the traumatic event. While people are asked to think about upsetting thoughts or memories, they are also focused on external stimuli and engaging eye movement exercises with the guidance of a clinician. This decreases the impact and severity of delayed PTSD symptoms.
• Narrative exposure therapy (NET): NET combines principles of behavioral exposure, neuroscience and narrative therapy. Clients are prompted to narrate their trauma, while prompted to remain fully present and encounter an experience of reprocessing and new meaning.

Medication

As with psychotherapy, there are different options of PTSD medication to help manage symptoms of delayed onset PTSD. These include anti-anxiety medication, antidepressants, and mood stabilizers. However, it is important to note that medication alone is not recommended to treat delayed PTSD. A multidisciplinary approach, with psychotherapy and other sources of support along with medication are preferred. It is important to discuss all options with a medical professional to better fit the needs of each individual.

Where to Find Professional Help for Delayed Onset PTSD

Seeking professional help is always recommended when facing PTSD-like symptoms or when dealing with any other mental health related symptoms. Even though there is stigma associated with delayed PTSD, mostly related to individuals being asymptomatic following trauma exposure until after a 6 month period (or beyond), it is still of high importance to seek help and support from a professional. You can choose a therapist based on your preferences and needs. This includes whether the therapist has specific certifications or specialized training, their location, approach or personality, etc.

Visiting an online therapist directory can aid you in the process of seeking a mental health professional to guide you in your healing journey, as it will provide you with options to help you find the right therapist for you.