There are a number of effective treatments for PTSD. However, some clients are left with residual symptoms even after successful treatment. This also appears to be associated with the common comorbidity of depression. These are important considerations for treatment and client quality of life.
Residual posttraumatic stress disorder symptoms after provision of brief behavioral intervention in low‐ and middle‐income countries: An individual‐patient data meta‐analysis. In this article, we shall discuss residual symptoms of post-traumatic stress order.
Imagine going about your day when you’re suddenly hit with the memory of past trauma. You drive down the road where your accident happened, and even though you’ve been down this road many times before, those feelings of angst and fear return.
But you thought the treatment for your post-traumatic stress disorder (PTSD) worked, and your symptoms were better. So, why are you having symptoms again?
PTSD is a complex condition. Symptoms don’t simply turn “on” and “off” like a light switch. It’s not as simple as that. Recovery is a gradual process. Even after treatment ends, some people with PTSD find themselves having residual symptoms. If this is you, know that you are not alone, and there are ways to help manage those symptoms.
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What are residual symptoms?
Researchers still don’t know a lot about residual symptoms of PTSD, because most of the literature focuses on active PTSD and treatment methods.
However, one thing is clear: residual symptoms are somewhat different from PTSD symptoms, which include distress, flashbacks, nightmares, and unpleasant memories about the traumatic experience.
Residual symptoms can be more gradual, though just as pervasive in day-to-day life. They may also appear well after PTSD treatment is over — even months or years later — blurring the lines between “active” and “recovery” states.
In one study, 59% of those who had been treated for PTSD reported “subthreshold levels” of symptoms. As in, not enough to warrant full-on treatment, yet not completely back to a “normal” baseline either.
In that same study, 1 in 3 participants reported clinical-level symptoms after treatment, meaning that further treatment would be a good idea.
Why does it happen?
To understand the long-term impact of PTSD on the body, we have to recall what happens when an episode or flashback strikes.
As the limbic system kicks into high gear, your body experiences the fight, flight, or freeze response. A surge of stress hormones, like cortisol, rush through your body to prepare you for danger, whether real or imagined. If this occurs often enough, it creates a consistent state of hypervigilance.
Over the long term, this state leads to lasting changes in the brain, particularly in the amygdala, which deals with emotional regulation, and in the hippocampus, which is related to learning, processing, concentration, and memory.
Even with PTSD treatment, the effects of inflammation and oxidative stressTrusted Source in the brain can be difficult to undo.
Who is likely to have it?
Not everyone who has been treated for PTSD will have residual symptoms. There are some contributing factors that might make you more likely to have them. These include:
- military service
- high-stress environments
- lack of support network
- substance use
- dropping out of treatment
People who regularly encounter potential trauma events (PTE) at work — like firefighters, first responders, and police officers — may also have an increased likelihood of having residual symptoms.
What are the symptoms?
Residual symptoms can persist for months, or even years after someone with PTSD is considered “in recovery.” Some of these symptoms include:
- poor quality of life
Research also shows that sleep disturbances, like insomnia and nightmares, are common even after people no longer meet the diagnostic criteria for PTSD. In one studyTrusted Source of Veterans, 57% reported insomnia and 13% reported nightmares after treatment ended.
Other research suggests that hyperarousal symptoms can be difficult for veterans to overcome as well. The hyperarousal cluster of symptoms includes:
- feeling on edge
- difficulty concentrating
- heightened startle response
- outbursts of anger
The type, severity, and frequency of residual symptoms of PTSD may vary according to the type of trauma that occurred.
For example, in one studyTrusted Source of women who had experienced sexual assault, residual symptoms included detachment, insomnia, depression, and guilt.
In an older studyTrusted Source, those who had experienced sleep-related trauma were more likely to have residual insomnia after treatment, while those with childhood abuse or depression were not.
If left untreated, residual symptoms may even lead to a recurrence of PTSD. In another older studyTrusted Source, sleep disturbances were a common predictor of reactivation of PTSD, 14 months or 5 years after a major disaster occurred.
How is it treated?
There is some older research to show that cognitive behavioral therapy (CBT) may reduce residual symptoms of PTSD, even if that’s how you treated your PTSD the first time around.
In one studyTrusted Source, 4 out of 5 research participants reported improved insomnia after undergoing five sessions of cognitive behavioral therapy. Other than that, more research is still needed.
The American Psychological Association (APA) Clinical Practice Guideline recommends CBT for PTSD, along with a few other options:
- cognitive processing therapy (CPT)
- prolonged exposure therapy (PE)
- eye movement desensitization and reprocessing therapy (EMDR)
The APA recommends four medications for treating PTSD. These include:
- sertraline (Zoloft)
- paroxetine (Paxil)
- fluoxetine (Prozac)
- venlafaxine (Effexor)
However, it’s unknown whether these medications will have any impact on residual symptoms of PTSD, as more research is needed.
Each person is unique, so each treatment plan will be tailored specifically for that individual. What works for one person might not work for another.
When you feel up to it, explain to your loved ones what you’re experiencing. You can also try to incorporate as many healthy habits into your everyday routine as possible, including:
- eating a healthy diet of nutrient-dense, unprocessed foods
- spending time in nature — preferably one hour a day
- exercising or getting some type of movement
- developing a meditation practice
- avoiding substance use
- developing a healthy sleep hygiene
In summary, living with residual symptoms of PTSD may be challenging, but know that you’re not alone.
If symptoms are interfering with your everyday life, consider reaching out to a mental health professional you trust. Through a combination of therapy and lifestyle changes, residual symptoms of PTSD are manageable.
The sooner you get treatment, the sooner you’ll be on the path to recovery. You can find a professional who specializes in trauma by using the following find-a-therapist tools:
- American Psychological Association
- Anxiety & Depression Association of America
- International Society for Traumatic Stress
When residual symptoms of PTSD surface, it can be downright confusing, scary, or depressing, among other things — especially if you thought you were “over it.”
Don’t worry, you haven’t done anything wrong in your treatment. Sometimes, this is just how PTSD goes. The brain is complicated, and we’re still learning all there is to know about trauma.
Most importantly, be patient with yourself. Recovery takes time, but it is possible.