What are the 4 Major Clusters of PTSD?

Symptom Clusters of PTSD

Trauma touches our lives more than we know. An untimely death of a parent or loved one, a car accident, a natural disaster, a life-threatening health diagnosis, an assault, or combat exposure—these are examples of traumas that happen every day around the world. While most people fully recover from trauma, some do not. In some people, trauma-related symptoms persist—or show up months or years later—and develop into posttraumatic stress disorder (PTSD). But PTSD is not one single disorder. There are four groups or “clusters” of symptoms that indicate a problem. Gaining a basic understanding of them may help you or someone you love get treatment sooner.

PTSD is not one single disorder. There are four groups or “clusters” of symptoms that indicate a problem. Gaining a basic understanding of them may help you or someone you love get treatment sooner. Click To Tweet


PTSD is defined as a psychiatric disorder that involves intense distress and disruption in one’s life after exposure to a traumatic experience. Anyone, including children, can be exposed to trauma and potentially develop PTSD, whether they experience the trauma themselves, personally witness it happen to someone else, or learn that a loved one had a traumatic event. First responders (firefighters, police, and EMTs) and combat veterans, who are routinely exposed to trauma, are at the highest risk of PTSD.

Immediately following a traumatic event, most people experience any number of stress-response symptoms, including sadness, anxiousness, agitation, fatigue, numbness, confusion, physical arousal (high adrenaline), and more.

Normally, these feelings subside with time. The body slowly comes down out of its heightened arousal in the days and weeks following the event. The internal alarms turn off and the body can reset itself to a normal state of balance. However, with PTSD persistent symptoms or clusters of symptoms can occur for a month or longer—or they can appear sometimes months or years later.

PTSD can develop in anyone as a response to traumatic events; it is not a sign of personal weakness. Research indicates that women are twice as likely as men to develop PTSD, in part, due to a higher likelihood of being victims of adult and child sexual abuse. People who struggle with depression or anxiety, or who have little social support may be more likely to develop PTSD—and some may be genetically predisposed.


It’s estimated that 70 percent of people worldwide will experience a trauma in their lifetime, according to one published world survey. In the U.S., the National Center for Post-Traumatic Stress Disorder (PTSD) estimates that roughly 60% of men and 50% of women experience at least one trauma in their lives. It’s estimated that roughly 6% of Americans suffer from PTSD. When PTSD goes untreated, it can affect all aspects of an individual’s functioning causing a wide array of serious symptoms and even leading to suicide.


PTSD is a serious disorder with far-reaching consequences. Indeed, studies have shown that PTSD puts one at greater risk for substance use disorder, anxiety, suicidal behavior, high-risk behaviors, depression, and a number of serious health issues and mental health disorders. Work performance and social relationships in the family, workplace, and community can also be adversely affected, according to research.  It can affect loved ones too. It’s not uncommon among spouses of veterans with PTSD, to experience PTSD symptoms as well. It’s vital to be able to recognize the symptoms of PTSD.


With PTSD diagnosis, individuals typically experience one or two or more of the symptoms listed in each group or cluster listed below for one month or longer (and not as a result of medication, substance use, or illness). The symptoms are usually pronounced enough to cause considerable distress or difficulty in multiple areas of one’s life.

1. Intrusive Thoughts or Memories

An individual with PTSD will experience one or more of the following symptoms:

  • Involuntary, reoccurring, intrusive, and distressing memories of the trauma
  • Upsetting dreams or nightmares related to the event
  • Reliving the traumatic event as if it were happening again (flashbacks)
  • Intense emotional or physical reactions to a “trigger” (a reminder of the traumatic event)

For example, an individual who experienced a head-on collision in their car might describe intrusive images of seeing smoke, glass, and debris scattered everywhere and hearing the loud bang of the airbag release.

2. Avoidance

An individual with PTSD will show at least one avoidant-type symptom such as:

  • Actively avoiding people, places, conversations, activities, objects, physical sensations (like smells or sounds) or situations that stir up memories of the trauma
  • Avoidance of thoughts or feelings that trigger memories of the event

For example, a car accident survivor may avoid driving near the accident site—or may stop driving altogether. Or a first responder may try to shut down feelings of sadness about a tragic event or series of tragic events they had to attend to.

3. Negative Thought Patterns and Mood

An individual with PTSD will show at least two of the following negative thought patterns or moods:

  • Having a persistent negative emotional state such as having feelings of shame, anger, or fear—and having negative feelings about others and the world in general
  • Feeling hopeless about the future
  • Experiencing memory issues related to the event, unable to recall significant aspects of the trauma
  • Trouble maintaining close relationships
  • Being emotionally “numb”
  • Losing interest in activities once enjoyed
  • Difficulty feeling positive emotions such as love, joy, and humor
  • Feeling detached from others

For example, someone with exhibiting this cluster of symptoms might have a persistent thought of “I’m a bad person” or “You can’t trust anybody.”

4. Changes in physical and emotional reactions

An individual with PTSD will have at least two of the following changes in physical and emotional reactions (also called “arousal” systems):

  • Being “jumpy,” easily startled, or frightened
  • Always on guard for danger (hypervigilance)
  • Exhibiting self-destructive or impulsive behavior
  • Being irritable, or exhibiting angry or aggressive behavior or outbursts
  • Difficulty concentrating
  • Trouble sleeping
  • Feeling an overwhelming sense of guilt or shame

For example, common self-destructive behavior might be starting to drink too much or drive too fast.


If you recognize symptoms from each cluster in yourself or a loved one, reach out to a mental health professional for an evaluation. Be aware that PTSD symptoms overlap with many other conditions, including traumatic brain injury (TBI), so it’s important to find a professional who understands this. A 2015 neuroimaging study at Amen Clinics published in Plos One shows that brain SPECT imaging can distinguish PTSD from TBI and identify co-occurring disorders. An accurate diagnosis is key to getting the most effective treatment.

Treatment recommendations for PTSD include several types of cognitive behavioral therapy (CBT) as well as eye movement desensitization and reprocessing (EMDR) therapy. People who get treatment for PTSD can improve the quality of their lives. They learn skills to better cope with their condition, and in many cases, symptoms can improve or resolve completely.

PTSD and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.


  1. Could PTSD symptoms show 40 years after learning of a spouse’s infidelity?

    Comment by Gary — March 10, 2023 @ 7:50 AM

  2. What supplements do you recommend for people who suffer from PTSD?

    Comment by Ashley — March 10, 2023 @ 8:20 AM

  3. I've got a major case of multiple chemical sensitivities so I feel better at home. I'm trying to dial down my various health problems, but my body had 64 years of accumulation of chemicals and toxins before I learned that I have the one MTHFR genetic variant combined with use of glutathione-depleting Tylenol. I go out when I can or absolutely have to so that is minimal for physical reasons as well as some lingering emotional reasons. EGN

    Comment by Elinor Nosker — March 10, 2023 @ 1:08 PM

  4. Hello Ashley, thank you for reaching out. For more information about Dr. Daniel Amen's recommended, brain-directed supplements, visit https://brainmd.com/.

    Comment by Amen Clinics — March 14, 2023 @ 8:50 AM

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