After something frightening or life-threatening, it’s normal to feel shaken for a while. But when the fear stays — weeks or months later, still running in the background — that’s worth paying attention to. Post-traumatic stress disorder (PTSD) is common, it’s not a weakness, and it responds well to treatment.

What PTSD is

PTSD is a condition that can develop after you live through or witness a traumatic event — a serious accident, violence, abuse, a disaster, combat, or the sudden loss of someone close. Trauma is not rare in Hawaiʻi or anywhere else. Most people who go through a traumatic event recover on their own within a few weeks. For some, the nervous system stays stuck in “danger mode” long after the threat has passed. That’s PTSD.

It helps to separate an ordinary stress reaction from the disorder. Feeling jumpy, sad, or having trouble sleeping in the days after a frightening event is expected. When those reactions last more than a month and start getting in the way of work, relationships, or daily life, it may have crossed into PTSD.

Signs and symptoms

Clinicians group the symptoms of PTSD into four kinds of experiences, described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), the manual used to define mental health conditions. You don’t need all of them, and this list is for understanding — not for diagnosing yourself:

• Reliving the event — unwanted memories, nightmares, or flashbacks that feel like it’s happening again.
• Avoiding reminders — staying away from people, places, conversations, or feelings that bring the event back.
• Changes in mood and thinking — persistent fear, guilt, or shame; feeling numb or cut off from people you love; losing interest in things that used to matter.
• Being on high alert — feeling constantly keyed up, easily startled, irritable, or unable to sleep or concentrate.

A picture of what this can look like

Consider someone who was in a bad car crash on the highway months ago. The injuries healed, but they still can’t bring themselves to drive that stretch of road. Sleep is broken by the same dream. A slammed door makes their heart race. They’ve started turning down invitations because it feels easier to stay home. Nothing about their day looks dramatic from the outside — but the trauma is quietly shaping every choice. This is a fictitious example, but it’s a familiar shape: PTSD often hides in the things a person has quietly stopped doing.

How it’s understood and evaluated

There’s no blood test for PTSD. It’s understood through a careful conversation with a clinician about what you experienced, what you’re feeling now, how long it’s lasted, and how much it’s affecting your life. According to the National Institute of Mental Health, an estimated 3.6% of U.S. adults have PTSD in a given year, and about 6% will experience it at some point in their lives. It’s roughly twice as common in women as in men.

A good evaluation also looks at what often travels alongside trauma — depression, anxiety, sleep problems, and sometimes alcohol or substance use that started as a way to cope. Treating the whole picture matters more than a single label.

How it’s treated — and how we approach it at OhanaPsych

Here is the message we most want people to hear: PTSD is treatable, and the treatments work. They fall into two main categories, often used together.

Trauma-focused talk therapy has the strongest evidence. Approaches such as cognitive processing therapy and prolonged exposure help you process the memory so it loses its grip, rather than avoiding it forever. The U.S. Department of Veterans Affairs National Center for PTSD identifies these trauma-focused therapies as first-line care.

Medication can also help, especially certain antidepressants (SSRIs). Two — sertraline and paroxetine — are FDA-approved specifically for PTSD. Medication and therapy are not either/or; for many people, the combination works best.

We approach trauma through lōkahi — balance across the connected parts of a person’s life: body, mind, spirit, and ʻohana (family). Trauma throws that balance off, and healing means tending to more than just symptoms. For many Native Hawaiian and Pacific Islander families, trauma also carries a collective, historical dimension. Papa Ola Lōkahi’s cultural healing work describes recovery as something that happens in connection to family, community, and ʻāina (land) — not in isolation. We try to hold that wider view, and we lean on pilina (relationship) as part of the work, because trust is where trauma treatment begins.

Getting care by telehealth

About 85% of our care at OhanaPsych is delivered by telehealth, and trauma care fits this format well. A first visit is a conversation — no exam table, no waiting room, just you and a provider talking through what’s been happening, from wherever you feel safe. That safety matters: for people who find it hard to leave the house or sit in a clinic, being at home can make it easier to start.

The evidence backs this up. A 2022 randomized trial published in BMC Psychiatry found that cognitive processing therapy delivered by telehealth reduced PTSD symptoms as effectively as in-person care, and patients were actually less likely to turn it down. Telehealth lets us reach people across the islands who otherwise might go without care. Most trauma treatment — therapy and non-controlled medications like SSRIs — works fully by video. If a medication ever requires an in-person step, we’ll tell you plainly and help arrange it. Language assistance is available if you need it.

When to seek help now

If trauma symptoms are making it hard to function, if you’re using alcohol or drugs to cope, or if you’re having thoughts of harming yourself, please reach out — you don’t have to wait until it’s “bad enough.”

If you are in crisis or thinking about suicide, get help right now:

• 988 Suicide & Crisis Lifeline — call or text 988, or chat at 988lifeline.org.
• Hawaiʻi CARES — call or text 988, or call (808) 832-3100 / toll-free 1-800-753-6879 for 24/7 crisis, mental health, and substance-use support statewide.
• In an emergency, call 911.

Medically reviewed by George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP

President & Owner, OhanaPsych

Date published: July 14, 2026

Last reviewed: July 14, 2026

Citations verified: July 14, 2026

Sources: see references below

This article is general health education from OhanaPsych. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. If you think you may have a medical or mental health condition, reach out to us or another licensed provider. In an emergency, call 911.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Morland, L. A., Wells, S. Y., Glassman, L. H., Grubbs, K. M., Mackintosh, M.-A., Golshan, S., Sohn, M. J., Thorp, S. R., & Savage, U. C. (2022). In-office, in-home, and telehealth cognitive processing therapy for posttraumatic stress disorder in veterans: A randomized clinical trial. BMC Psychiatry, 22, Article 41. https://doi.org/10.1186/s12888-022-03699-4

National Institute of Mental Health. (n.d.). Post-traumatic stress disorder (PTSD). U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd

Papa Ola Lōkahi. (n.d.). Ahupuaʻa – cultural healing model. https://www.papaolalokahi.org/program/ahupuaa-model

U.S. Department of Veterans Affairs, National Center for PTSD. (n.d.). PTSD and DSM-5. https://www.ptsd.va.gov/professional/treat/essentials/dsm5_ptsd.asp