What Is Delayed Onset PTSD?

Reviewed by Dawn Brown, LPC, NCC

Published 06/27/2022

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Unbeknownst to the majority of the population, post-traumatic stress disorder, or PTSD, does not only affect those who have been in war or combat. While everyone goes through some kind of stressful time in their lives, a small portion of the population experiences some traumatic incident that can be life-altering. And some may develop PTSD due to the trauma. In fact, eight million adults per year in the United States suffer from PTSD.

For a small portion of those people, up to 25%, PTSD can wait for a longer period before it shows itself. You may have had a serious accident or been in a natural disaster six months ago and think that everything is fine when suddenly you start having flashbacks of the incident and feel anxious all the time. This is delayed-onset PTSD.

What Is Delayed Onset PTSD?

Delayed onset PTSD is defined as PTSD that does not start occurring until six months after the traumatic incident. Most often, it can be nine months to over two years before you have any symptoms. While the symptoms are the same, they may seem more intense because you think that you are over it, and then one day it just hits you out of the blue. Some of the symptoms you may experience include:

  • You may have trouble falling asleep or staying asleep
  • Experiencing flashbacks or vivid memories of the incident is common
  • You could have extreme anxiety for no obvious reason at any time
  • You may often have recurring nightmares or night terrors
  • Avoiding people or places that remind you of the incident is common
  • You might not be able to recall certain parts of the event
  • Lack of concentration and memory are frequently reported
  • Some people blame themselves for the incident
  • You could feel numb or emotionally detached
  • Depression and sadness are normal
  • You may lose interest in activities you used to enjoy
  • Your expectations of yourself and others may often be negative
  • Being on edge all the time is common
  • You may feel paranoid or be unable to trust anyone
  • Irritableness, anger, and rage are typical
  • You may have panic attacks (fast heart rate, chest pain, dizziness or fainting, shaking, believing that you are going to die, sweating, nausea, shortness of breath, and extreme fear)

Case Studies On Delayed Onset PTSD

Researchers began studying delayed-onset PTSD in the 1980s when it was found that a large number of soldiers were developing PTSD over a year after they had been home. The rates reported by soldiers in several studies found that 39% of those who developed PTSD did not start seeing symptoms until almost a year after combat.

Traumatic Events That Can Cause Delayed Onset PTSD

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But this is not only reserved for those who were in the military. There are many those with PTSD (both delayed and acute) who have never been in the service. Other traumatic events that can cause PTSD to varying, but the most common include:

  • Experiencing a natural disaster like an earthquake, flood, tornado, or tsunami
  • Being in a major accident such as a vehicular, airplane, or other life-threatening accident
  • Loss of a loved one due to death or complicated divorce
  • Abuse such as sexual, physical, or emotional abuse
  • Being the victim of a crime like a kidnapping or assault
  • Working as a first responder or in a job where you see death and violence often
  • Witnessing the death of someone
  • Terrorist attack or war

Are Some People More Likely To Develop Delayed Onset PTSD?

The experts and researchers are still unsure of why some people develop PTSD while others do not. It has been documented repeatedly of groups who all suffered the same traumatic incident where only one-third of them developed PTSD. Those who developed delayed-onset PTSD were even fewer, at about one-quarter.

However, it has been found that women are more than twice as likely to be affected by PTSD than men. Those who experienced some other type of traumatic event in their lives are also at an increased risk of developing the disorder. Other risk factors include:

  • Having a relative with PTSD or other mental health conditions
  • Not having a good support system
  • Alcohol and drug use
  • A history of other mental health issues like anxiety or depression

Five Types Of PTSD

Although the experts are still not in complete agreement with this, many mental health professionals and researchers have found different types of PTSD. Any of these can be included in delayed onset PTSD as well. The types being explored include:

Normal Stress Response

This happens before the signs of PTSD start, and if caught early, treatment can prevent it from turning into acute or another form of PTSD. Normal stress response is common and is just an advanced type of typical anxiety. You may notice that you are more on edge than usual, you may have nightmares, and you may just not feel “like yourself.”

Complex PTSD

For those with long-term trauma or abuse such as domestic abuse, this type of PTSD is more severe than the others. It can usually be found in war veterans and those who were in an abusive household, whether they were victims or not. You may have severe flashbacks, mood swings, panic attacks, and lose interest in being social.

Acute Stress Disorder

Anyone who has been in a stressful situation where you feel like your life is threatened can develop acute stress disorder. This may be a prelude to delayed-onset PTSD. Some of the risk factors include losing a job, natural disasters, and losing a loved one. Severe anxiety and nightmares may occur with this disorder.

Comorbid PTSD

Any time someone has more than one disorder, it is referred to as comorbid. So, if you are struggling with an anxiety disorder or depression, PTSD can be a comorbid condition that occurs after being a victim of a troubling event. This is often a cause of delayed-onset PTSD as well. Symptoms may include drug or alcohol abuse, isolating yourself, and losing interest in activities you used to enjoy.

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Uncomplicated PTSD

This may sound like it is not a big deal, but any kind of PTSD is serious. It is called uncomplicated because it is caused by one single traumatic event like a car accident or assault. It typically causes nightmares, flashbacks, and mood changes. This is the easiest type to treat but is also prone to becoming delayed-onset PTSD. 

How Do You Know If You Have Delayed Onset PTSD?

If you are not sure whether you or your loved one is suffering from delayed onset PTSD or any of the other types of PTSD, there is a test you can take online that can help. It only takes a few minutes, it is completely anonymous, and you do not have to sign up for anything to do it. Still, no matter what kind of PTSD you have, they can all be treated. 

Treating Delayed Onset PTSD

Treating delayed-onset PTSD is the same as treating any other PTSD, but since it has been so long since your trauma, it may be more difficult to diagnose. Most of the time, therapists will suggest psychotherapy such as cognitive behavioral therapy, or CBT. Several types of CBT can help.

Cognitive Restructuring

Cognitive restructuring is a way to face your bad memories and sort them out rather than avoiding them. The therapist will likely encourage you to write in a journal or talk to others about your traumatic event to bring it to the forefront. This helps you to be able to remember the incident as it truly happened, which may not be as scary as you first thought. Once you can face your fears, it is easier to overcome them.

Exposure Therapy

Exposure therapy is done with your therapist as a way to gradually expose your mind to what you are afraid of. Your therapist may have you talk to them about your trauma, visit the place where it happened (if possible), or write in a journal. Another way you may face and control the fear is through virtual reality therapy, which includes using new technology to experience traumatic incidents that may be triggers. Eventually, being exposed to your fears, you can get over them.

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Trauma-Based CBT

Trauma-based CBT is a way to learn what your cognitive distortions are so you can get rid of them. Cognitive distortions are ideas that your brain makes up to avoid the pain you feel over the incident. Some of these include:

  • Filtering is a way to dwell on the negatives in situations and filter out the positives.
  • Overgeneralizations are when you draw conclusions from a single event and turn it into a repeating event. For example, if you lose a job, you may think you can never get another job because you will lose it again.
  • Emotional Reasoning is a way of assuming that your feelings are true even if they are unlikely. For example, you may think that since you feel bad, you must be bad.
  • Catastrophizing is when you believe that the worst is going to happen no matter what. All the time. You may exaggerate the details of a situation, which can make it worse than they are.

Online Therapy Can Help

Regardless of whether you or a loved one has delayed-onset PTSD or any other mental health issue, you can talk to a mental health expert online anytime you need to. 24/7/365. You do not need an appointment and do not even have to leave your house. If you wonder whether or not you may have PTSD of any sort, take this test online today.