PTSD and Anxiety: How They Overlap and How to Treat Both

Ask someone living with PTSD if they feel anxious, and the answer is almost always yes. The hypervigilance, the avoidance, the constant low-level threat detection, the way ordinary situations can trigger an overwhelming fear response: these feel exactly like anxiety.

So why did the DSM-5 move PTSD out of the anxiety disorders category?

The answer to that question explains both the clinical distinction between PTSD and anxiety and why treating one without addressing the other often produces incomplete results. PTSD and anxiety are not the same condition. But they overlap in ways that matter clinically, and when they co-occur, they each need specific attention.

What This Page Covers

• What the DSM-5 reclassification of PTSD means
• How PTSD and anxiety disorders overlap
• How they differ, and why that distinction matters for treatment
• What happens when both co-occur
• How to treat PTSD and anxiety when they are both present
• When medication helps and what it does differently for each

What the DSM-5 Actually Says

Under the DSM-IV, PTSD was classified as an anxiety disorder. This made clinical sense at the time: PTSD produces intense fear, hyperarousal, and avoidance, all features shared by anxiety disorders.

The most substantial conceptual change in the DSM-5 for PTSD was the removal of the disorder from the anxiety disorders category. Considerable research demonstrated that PTSD entails multiple emotions outside the fear and anxiety spectrum, including guilt, shame, and anger, providing evidence inconsistent with inclusion of PTSD with the anxiety disorders.

In the DSM-5, PTSD was placed in a new diagnostic category named Trauma- and Stressor-Related Disorders, indicating a common focus of the disorders in it as relating to adverse events. This diagnostic category is distinctive among psychiatric disorders in the requirement of exposure to a stressful event as a precondition.

The reclassification was not merely organizational. It reflected a conceptual shift in how PTSD is understood: not as an anxiety disorder that happens to follow trauma, but as a distinct, trauma-anchored condition that produces a wider range of psychological disturbance than fear and anxiety alone can capture.

How PTSD and Anxiety Disorders Overlap

Despite the reclassification, the clinical overlap between PTSD and anxiety disorders is substantial and real. Understanding this overlap helps explain why the two are frequently discussed together and why they co-occur at high rates.

Hyperarousal. Both PTSD and anxiety disorders involve a threat-detection system running at elevated intensity. In PTSD, this hyperarousal is anchored to trauma reminders and trauma-related threat. In anxiety disorders like GAD, the hyperarousal is diffuse across multiple life domains. The physiological experience of being chronically on edge feels similar.

Avoidance. Both conditions involve systematic avoidance of feared stimuli. In PTSD, avoidance focuses on trauma reminders: places, people, conversations, or thoughts that could activate the trauma response. In anxiety disorders, avoidance targets perceived threats or discomfort. Both patterns maintain the underlying condition.

Fear-based responses. Exposure-based therapies work for both conditions precisely because both involve fear systems that have been calibrated to overestimate threat and that can be recalibrated through controlled exposure. This therapeutic overlap reflects genuine biological overlap in the fear and threat-detection systems.

SSRIs. The same class of medications, SSRIs, is effective for both PTSD and most anxiety disorders. This pharmacological overlap also reflects shared biological mechanisms in the serotonergic systems involved in emotion regulation and threat response.

How PTSD and Anxiety Disorders Differ

The clinical distinctions are equally important, particularly for treatment.

Trauma requirement. PTSD, by definition, requires exposure to a specific traumatic event involving actual or threatened death, serious injury, or sexual violence. Anxiety disorders do not require a traumatic precipitant. This distinction matters: PTSD is not an anxiety response to ordinary stressors. It is a response to events that exceeded normal adaptive capacity.

Re-experiencing symptoms. The flashbacks, intrusive memories, nightmares, and dissociative reactions characteristic of PTSD have no direct counterpart in anxiety disorders. These re-experiencing symptoms represent the traumatic memory intruding into present awareness with the full emotional and physiological force of the original event. This is the feature of PTSD that standard anxiety CBT does not directly address.

Negative alterations in cognition and mood. The DSM-5 added this as a fourth symptom cluster for PTSD, covering persistent distorted beliefs about self and world, diminished interest in activities, persistent negative emotional states, and estrangement from others. These features have a distinct quality in PTSD that reflects not generalized anxiety but the specific meaning a person has made of a traumatic event.

In the DSM-5, the symptom clusters were expanded from three to four, and the number of symptoms was increased from 17 to 20. The inclusion of a negative alterations in cognition and mood cluster reflects the research showing that PTSD involves emotions and psychological disturbances well beyond the anxiety spectrum.

When PTSD and Anxiety Co-Occur

Co-occurrence is the norm, not the exception.

About 80 percent of people with PTSD have at least one comorbid psychiatric disorder, with the most common being depression, anxiety, and substance use disorder.

PTSD and generalized anxiety disorder are a particularly common pairing. A person may have had GAD prior to their trauma, making them more vulnerable to PTSD development. Or the chronic hyperarousal of PTSD may create the conditions in which GAD grows. Or both may share common biological risk factors that were activated together by the traumatic event.

When both are present, several patterns emerge that complicate treatment:

The anxiety can make trauma-focused therapy more difficult to engage with. Starting Prolonged Exposure when background anxiety is already chronically elevated requires more preparation and scaffolding.

The PTSD can maintain the anxiety. If the underlying trauma is never processed, the trauma-related threat activation continues to provide ongoing fuel for anxiety. Treating anxiety alone, without addressing the PTSD, often results in partial or temporary improvement.

The shared avoidance patterns reinforce both conditions. GAD-related avoidance of uncertainty and PTSD-related avoidance of trauma reminders can become entangled in a comprehensive avoidance strategy that maintains both.

How to Treat Both

Treatment for co-occurring PTSD and anxiety requires addressing each condition specifically. The shared biology and therapeutic mechanisms create opportunities for efficient treatment, but not shortcuts.

For PTSD: Trauma-Focused Therapy

The APA’s 2025 Clinical Practice Guideline strongly recommends three trauma-focused psychotherapies as first-line treatment for PTSD: Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and EMDR. Trauma-focused therapies are the most highly recommended type of treatment for PTSD, focusing on the memory of the traumatic event or its meaning, with PE, CPT, and EMDR having the strongest evidence base.

These therapies directly address the re-experiencing symptoms, avoidance patterns anchored to the trauma, and the negative cognitions about self and world that PTSD produces. Standard anxiety CBT does not accomplish this. A person can learn to manage GAD symptoms while leaving the PTSD largely unaddressed, because the two conditions have distinct maintaining mechanisms.

For Co-Occurring Anxiety: CBT and SSRIs

For the anxiety disorder component, CBT targeting the specific anxiety patterns, worry, avoidance, safety behaviors, addresses mechanisms that trauma-focused PTSD therapy does not specifically target. The two treatments are complementary.

SSRIs are particularly useful when both PTSD and anxiety disorders are present. Sertraline and paroxetine are FDA-approved for PTSD. Both are also effective for GAD, panic disorder, and social anxiety disorder. Starting an SSRI can reduce the anxiety intensity underlying both conditions simultaneously, creating better conditions for the therapy work.

What to Do First When Both Are Present

When PTSD and anxiety co-occur with severe anxiety symptoms, some clinicians prefer to reduce anxiety intensity with SSRIs first, then begin trauma-focused therapy when the person has more psychological resources available. Others integrate the two approaches simultaneously. The right sequencing depends on severity, clinical judgment, and patient preference.

What is consistently true is that neither condition can substitute for treatment of the other.

About SiggyMD

SiggyMD provides clinician-supervised medication management for anxiety and depression, including the anxiety and mood components that frequently co-occur with PTSD. For PTSD-specific trauma-focused therapy, a CPT-, PE-, or EMDR-trained clinician is the appropriate resource.

For the anxiety and depression that co-exist with PTSD, continuous medication management with daily check-ins captures how symptoms are evolving between appointments. When a prescriber can see the actual mood and anxiety trajectory, adjustments happen before a developing problem deepens.

“The anxiety component of PTSD is often the part that gets treated while the trauma itself goes untouched,” says Shannon Carres, Psych P.A., of the SiggyMD clinical team. “Medication can reduce the chronic arousal that makes daily life difficult and that makes trauma-focused therapy harder to access. But the therapy still needs to happen. We focus on making that work more possible by addressing the anxiety and mood components on our end.”

The anonymous intake at SiggyMD requires no name, no email, and no account to start. A licensed prescriber reviews every clinical decision.

For more on PTSD, see our guides on what PTSD is and does PTSD go away. For more on anxiety disorders, see our guide on generalized anxiety disorder.

Start your anonymous intake at SiggyMD to connect with a licensed prescriber who can evaluate the anxiety and mood components of your picture.

What Members Are Saying

KJ

K.J., 45

PTSD, Generalized Anxiety

“I had anxiety for years before my trauma. After, I couldn’t tell where the anxiety ended and the PTSD began. My prescriber helped me understand that they needed to be treated separately, even though they felt like one thing. The medication addressed the anxiety baseline. The PTSD work with my trauma therapist addressed the underlying event. Both were necessary.”

DC

D.C., 38

PTSD, Panic Disorder

“I went two years treating panic disorder without anyone asking about the accident. The panic symptoms responded to medication but kept coming back. When we finally addressed the PTSD underneath it, the panic attacks stopped almost entirely. The PTSD was what was maintaining the panic.”

Member stories reflect real experiences. Names and identifying details have been changed to protect privacy. Results vary. You can begin anonymous intake without an account, name, email, or payment.

The Bottom Line

PTSD is not an anxiety disorder, as of the DSM-5 reclassification in 2013. But it shares significant features with anxiety disorders, they frequently co-occur, and many of their treatments overlap.

The distinction matters for treatment: PTSD requires trauma-focused therapy that addresses the traumatic memory and its meaning. Anxiety disorders require their own CBT-based approaches targeting the specific worry and avoidance patterns. When both are present, treating one alone while leaving the other unaddressed typically produces incomplete and unstable results.

SSRIs are useful for both. Exposure-based therapy principles apply to both, though through distinct protocols. And a clinical relationship that monitors both conditions between appointments changes the quality of care available to people navigating both.

If you are in crisis or having thoughts of self-harm, call or text 988. If you are in immediate danger, call 911.

Sources

1. Friedman MJ, Resick PA, Bryant RA, Brewin CR. PTSD in the DSM-5: Controversy, Change, and Conceptual Considerations. Behavioral Sciences. 2017;7(1):7.

2. Brewin CR, et al. Post-traumatic stress disorder: evolving conceptualization and evidence, and future research directions. World Psychiatry. 2025;24(1).

3. American Psychological Association. Clinical Practice Guideline for the Treatment of PTSD in Adults. APA, 2025.

4. National Institute of Mental Health. Post-Traumatic Stress Disorder. Revised 2023.

5. VA National Center for PTSD. PTSD and DSM-5. U.S. Department of Veterans Affairs. Accessed June 2026.

6. MedCentral. PTSD: DSM-5 Classification, Prevalence, and Treatments. Accessed June 2026.

7. American Psychiatric Association. DSM-5 Highlights of Changes from DSM-IV-TR. 2013.