PTSD Spirituality: When Does PTSD Happen? Types of PTSD Onset.

When can I expect PTSD to strike?  I have survived trauma, will I get PTSD?

PTSD can have behave in several ways.  While there are specific effects it can have on the structures of the brain and brain chemistry, it also affects our soul.  But what are some of the mechanics of PTSD onset?  At what point does it strike?  PTSD has a range of possible onset periods.  There is also the question of frequency of occurrence.  Let’s begin with PTSD onset periods.

Initial Onset and Delayed Onset of PTSD

Initial Onset PTSD:

This is pretty much exactly as it sounds.  You are a participant in trauma and the onset of PTSD symptoms begin immediately (or nearly immediately).

I am aware of several cases where a soldier witnessed one of his buddies get killed and then he was later found putting the barrel of his weapon into his mouth.  The sense of absolute despair where suicide seems to be the reasonable thing to do is part of the PTSD-Identity.  Fortunately, not everyone goes to that level.  In some cases a person might go mute or lose the use of one or more of their limbs as if they were paralyzed.  Sleep problems and nightmares are common.  They may vomit up most of their meals.  If a person begins to experience PTSD symptoms immediately or shortly after the event, then we understand that to be immediate onset PTSD.

Delayed Onset PTSD

This PTSD that begins to manifest itself some time after the initial traumatic events is called delayed onset PTSD.  I have heard anecdotally that 10 years and 20 years are anniversary dates that seem to summon forth PTSD.  It need not be so long as a decade to be considered as delayed onset, but the individual has had significant time between the traumatic event and the onset of PTSD. 

The exact period of time that must go by before one can label the PTSD onset as delayed or immediate is not agreed upon in the medical community.  My own personal rule of thumb, is that if symptoms manifest within six months, then it is immediate onset PTSD.  If after six months PTSD  manifests, then it is delayed onset PTSD.  In terms of trying to get a reluctant Veterans Administration (VA) to compensate for the soul wounds of PTSD, the sooner one can registered into the VA system with PTSD, the better.

Frequency of PTSD Occurrences

One should not think of PTSD necessarily as having an on and off switch.  It is not a situation where I am either manifesting every possible PTSD symptom, or when I am 100% symptom free.  There is a range in between.  I may be heavily symptomatic or I may be lightly symptomatic.  That said I would like to present some terms that I hope are not misunderstood.

Continual Manifestation:

In this case a trauma survivor experiences constant or near constant PTSD symptoms.  Just as there is such a thing as a functional alcoholic, that is, an alcoholic who manages to still function in society as they drink themselves to death.  It is possible for a person to have continual PTSD experiences and yet manage to function in society.  In both cases neither is functioning well or anywhere near their real potential.  They will also tend to have damaged their personal relationships as they refuse help and try to go it alone.

Intermittent, or Trigger-Based, Manifestation:

There will be periods of times where the survivor is doing fine and exhibits few or no PTSD symptoms and then there will be periods of time when they are highly symptomatic.  The period between onsets can be a short as a couple of months or as long as a decade. 

I tend to think of this kind of PTSD onset as being parallel to having bouts of malaria.  In World War II servicemen would contract an initial bout of malaria and be rendered combat ineffective, sometimes necessitating evacuation.  After a period of treatment they could return to duty.  However, at any time, they could be struck down again with malaria symptoms.  My experience and observation of PTSD fits this malaria model.  One can be cruising along fine for a while and then they get struck with symptoms.


These come into play because after the initial trauma there is often a new vulnerability built in to each of us.  We become vulnerable to certain triggers, stimuli, which cause us to begin re-experiencing the traumatic events that gave us PTSD.  It might be a primary trigger or a secondary trigger.  In either case, we can become freshly traumatized. 

The duration of the PTSD may be only a few seconds, such as a shudder or an involuntary exclamation, or it may be the beginning of a new long term bout of PTSD suffering with all of its attendant misery. 

A person may have had decades of continual PTSD and then recovered enough so as to only have brief, intermittent PTSD later in life.

Remember to Pray and Hope

While PTSD afflicts us as part of the human condition, it does not have to take us prisoner and destroy us.  Our souls can be restored and our relationships rebuilt.  It is never too late to pray and hope.  Just as having a broken leg can be recovered from and the leg may be a bit weaker than it used to be, or we might now have a limp, it does not mean we have to be controlled by the history of a broken leg.  Our souls have been damaged by PTSD and are sensitive to certain PTSD triggers, but that does not mean we are defeated nor that we must abandon hope. 

The more we understand we have inherent value and the more we learn about PTSD and how to defend ourselves from it, then the better our lives will become.  Then, we can live in relative peace.

Semper Pax, Dr. Z


  1. I think that knowing that PTSD symptoms may ebb and flow will help those suffering from this condition. It could assist those who are in a more symptomatic state to think, “This too shall pass.” Interesting that in my research on PTSD I have never come across this type of information. Dr Z, you provide such a unique and important perspective to the understanding of PTSD. So many could benefit from your wisdom and experience (and I know many already have.)

    • Hi Queta! Always a treat to have you visit!
      In my own experience I know that certain things (events, sounds, smells) can trigger my PTSD. Experience has taught me that I don’t have to resign myself to being always in an active state of PTSD. Just knowing that fact can give me the life preserver to know things will get better and to motivate me not to indulge my PTSD with negative coping behaviors. A friend of mine says, “Knowledge is Power,” and in this case it gives me power to not be bullied by my PTSD. Semper Pax, Dr. Z

  2. Hey bill krill:
    Can you give a few examples of how you incorporate spirituality in your practice?

  3. What a wonderful blog!

    As a Licensed Professional Counselor and Pastoral Counselor who treats children with PTSD as a result of child abuse, I searched for years for treatment modalities that were child-specific and and spiritually based, and found none. So, I developed my own approach. It has been the spiritual aspect of my approach that has the greatest impact.

    • Thank you for visiting and taking the time to comment. In my own experience, medical methods have their benefits in controlling some of the symptoms of PTSD, but they have not helped me actually heal or find meaning in my life. Finding the renewal of meaning on a spiritual level has helped sustain me and has helped my soul to heal. I wish you all success in your treatment of children suffering from PTSD. Semper Pax, Dr. Z

  4. Thank you for your kind words. By the way, I like the use of the various blues on your blog. Semper Pax, Dr. Z

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