Well-treated PTSD improves substantially in most patients: the symptoms that dominated your life stop doing so, functioning is regained and the sense of connection returns. Some people reach full remission; in others, PTSD becomes something you know and manage. The response is individual and cannot be guaranteed in advance. What is demonstrated is that treatment works better than not being treated, even in long-standing presentations.

Do I have to tell everything that happened in the first consultation?

No. The first consultation is to understand the general situation, assess the symptoms and build a plan. The detailed content of the trauma is addressed later, at the right time, within trauma-focused psychotherapy. Psychiatry provides the diagnosis and medical management; working through the traumatic content is done in psychotherapy.

Who finds out what I say?

What is discussed in consultation is covered by professional confidentiality: it is not shared with your family, your partner or your workplace. The only exceptions are situations of serious risk —suicidal intent, risk of serious harm to others, situations of abuse—, and if it ever became necessary to involve someone else, it is discussed with you first. I explain this in detail in the first consultation so you know exactly how it works.

What if the trauma was many years ago?

PTSD can stay active for decades after the original event, especially if it was not treated. There are patients who come to the clinic at 40, 50 or 60 with symptoms they link to something from childhood or youth. It can still be treated, often with a very good response: the nervous system keeps its capacity for change (neuroplasticity) throughout life.

Does medication erase the memories of the trauma?

No. No medication erases memories. When it is indicated, its role is to reduce the intensity of the physiological and emotional activation linked to the memories, so that when they surface they do not overwhelm you. Working through the content is done in psychotherapy, which is the first line.

Is the consultation online or in person?

Whichever you prefer. All care —including the first assessment— can be delivered online (telepsychiatry) or in person at the Miraflores practice, and you can switch between them during treatment. For a sensitive matter like this, if you choose the online option what matters is that you have a private, quiet space free of interruptions during the hour-long consultation. If you do not have such a place, say so when booking: we can look at seeing you in person or finding a time when you can be alone.

I live outside Peru — can I still be seen?

Yes: online care does not depend on where you are. Prescribing, however, has its own framework. If medication is indicated, the prescription is issued from Peru and under Peruvian regulations, and whether it is valid where you live depends on local law: in most countries a Peruvian prescription cannot be dispensed by a local pharmacy. Restricted or controlled medicines, moreover, cannot be managed remotely from Peru to another country: that treatment stays with a professional licensed in your country of residence, with whom the plan can be coordinated. All of this is discussed in the first consultation, before you make any decision.

Do you see expatriates or English-speaking patients in English?

Yes. I regularly see patients in English —expatriates living in Lima, Peruvians abroad, or people who prefer to talk about intimate matters in English— with the same fluency as in Spanish.

PTSD (Post-Traumatic Stress)

What you went through happened — how you carry it today can change.

Psychological trauma does not always "heal with time" on its own. PTSD is the brain's response to experiences that exceeded your capacity to process them at the time, and it can stay switched on, like an alarm that will not turn off. There are treatments with solid evidence that allow that system to regulate itself again — even years after the event.

In person in Miraflores (Lima) or online, whichever you prefer · Spanish and English · WhatsApp reply, usually the same day

Book a consultation on WhatsAppDra. Daniela Málaga · CMP 76202 · RNE 42512

What is PTSD?

Post-traumatic stress disorder (PTSD; in Spanish, TEPT) is a clinical condition that can appear after living through, witnessing or being closely exposed to a serious traumatic event: accidents, violence, abuse, sexual assault, disasters, the violent or accidental death of a loved one, a sudden and catastrophic medical emergency, or repeated exposure to others' suffering (common in healthcare workers, first responders or journalists).

Exposure to traumatic events is common: more than 70% of adults live through at least one potentially traumatic event in their lifetime. Yet most people do not develop PTSD: the risk after a traumatic event is estimated at around 4% on average, and rises sharply —to between 11% and 19%— after sexual or intimate partner violence. Lifetime prevalence is around 6.8% in US reference studies —estimates vary by region— with consistently higher figures in women. That most people do not develop it does not mean that those who do are "weaker": the intensity and type of event, prior vulnerability, social support and the immediate response all play a role.

The DSM-5-TR organizes the symptoms into four groups —intrusion or re-experiencing (flashbacks, nightmares, intrusive images), avoidance, negative alterations in mood and cognition, and hyperarousal (startle, hypervigilance, insomnia, reckless or self-destructive behavior)— which must persist for more than a month and cause impairment. There is also complex PTSD (recognized in the WHO's ICD-11, published in 2018 and in force since 2022), linked to prolonged or repeated trauma, which adds sustained difficulties in emotional regulation, self-image and relationships. The DSM-5-TR also recognizes a dissociative subtype —with a sense of unreality or of being disconnected from one's own body— which sometimes calls for a stabilization phase before working with the traumatic content.

It is not an exaggeration, weakness or lack of willpower. It is a neurobiological response to something real that happened — and, once it sets in, it frequently does not resolve on its own.

Common signs in practice

People with PTSD do not always arrive saying "I have trauma". Some signs that lead to a consultation:

Recurrent nightmares with content linked to the event, or variants of it.
Exaggerated startle at noises, an unexpected presence or physical contact.
Chronic insomnia difficulty sleeping, waking with sweating or a racing heart.
Silent avoidance you stopped doing things, going places or seeing people, "without quite knowing why".
Dissociative symptoms a sense of unreality, disconnection from the body, "watching yourself from outside", memory gaps.
Hypervigilance always on alert, choosing seats near exits, scanning your surroundings.
Emotional numbing difficulty feeling joy or connection with the people you love.
Alcohol or other substance use as a way to sleep or to "not feel".

PTSD often coexists with depression, anxiety disorders or problematic substance use. Treating only the comorbidity without addressing the underlying trauma is one of the most common mistakes in non-specialized care: it tends to give partial results.

You do not have to relive the trauma to start healing

It is the fear that most holds people back from seeking help: believing that treatment means retelling every detail of what happened, reliving it by force. It is not like that. Making the diagnosis and drawing up a plan does not require narrating the trauma at the first consultation — first an alliance and a safe space are built; the difficult content is addressed later, when you are ready and in the right setting.

Working with the traumatic content happens within trauma-focused psychotherapy, with a trained professional, at your pace and with regulation tools. No one pushes you to say more than you are ready to say. That there is a step-by-step plan is precisely what makes the process bearable — and effective.

So seeking help is not "reopening the wound": it is starting to have options over something that today feels like it controls you. The first step is not reliving anything; it is understanding what is happening to you and knowing there is a way forward.

When should you seek help?

A psychiatric evaluation is worthwhile when:

1
You lived through or witnessed a traumatic event and, more than a month later, still have symptoms that interfere with your life.
2
The event was less than a month ago and the symptoms are intense — acute stress disorder exists, and it is also assessed and treated.
3
You have recurrent nightmares or flashbacks of the event.
4
You have started to avoid places, people or situations linked to the trauma.
5
You notice sustained changes in how you relate to others — more distance, irritability or distrust.
6
You are using alcohol or substances to sleep or regulate emotions.
7
There is a suspicion of early trauma (childhood, adolescence) whose effect you are only now beginning to recognize.

Asking for help is not reliving the trauma by force — it is starting to have options over something that today feels like it controls you.

Is it PTSD… or something else?

These contrasts show why a professional makes the diagnosis — they are not a checklist for self-diagnosis. And PTSD often comes with depression, anxiety or substance use: part of the evaluation is telling apart what explains what and treating the underlying trauma.

PTSD or a normal stress reaction?
In the first weeks after a serious event, symptoms such as startle, insomnia or intrusive images are an expected and often transient response (acute stress reaction). It points toward PTSD when it persists for more than a month and keeps interfering with life. The time criterion matters — which is why it is not labeled immediately.
PTSD or depression?
They share insomnia, numbing and loss of interest, and frequently coexist. What is distinctive about PTSD is that the symptoms revolve around an event: re-experiencing (flashbacks, nightmares) and avoidance of reminders. Telling them apart —or recognizing that both are present— changes the treatment.
PTSD or an anxiety or panic disorder?
PTSD can involve panic attacks, but these are triggered by trauma reminders, not "out of nowhere". The hypervigilance and avoidance are anchored to the lived experience. In primary anxiety, the worry is not organized around a specific traumatic event.
"Classic" PTSD or complex PTSD?
Complex PTSD (recognized in the ICD-11) is linked to prolonged or repeated trauma —especially in childhood or in relationships with a power imbalance— and adds, to the PTSD symptoms, sustained difficulties in emotional regulation, self-image and relationships. The approach shares its foundations but requires a more careful step-by-step plan.
PTSD or grief?
A loss —especially a sudden or violent one— can give rise to grief, to PTSD, or both. Grief revolves around longing and sadness for the absence; PTSD, around terror and re-experiencing the event. Telling them apart guides whether the focus is working through the loss, processing the trauma, or both.

How I approach treatment

The first consultation (one hour) calls for special care. Reliving the trauma in the first session is not necessary to make the diagnosis: first a therapeutic alliance is built that allows the content to be approached safely later, in the right space. The evaluation covers the history of the event or events, current symptoms, comorbidities and risk and protective factors.

An important and sometimes counterintuitive point: in PTSD the first-line treatment is trauma-focused psychotherapy, not medication. NICE, ISTSS and the VA/DoD guideline place it explicitly ahead of pharmacotherapy, and the APA reserves its strongest recommendations for these same psychotherapies. My role as a psychiatrist is diagnosis, medical management and coordinating the plan.

Coordination with trauma-focused psychotherapy (first line)
The best-evidenced modalities are trauma-focused cognitive-behavioral therapy, EMDR (eye movement desensitization and reprocessing, with solid evidence particularly in non-combat-related trauma) and prolonged exposure therapy. They are carried out by psychologists trained in these approaches, with whom I work.
Clinical psychoeducation
Understanding what the brain does in the face of trauma and why the symptoms persist reduces the guilt and confusion that are major barriers to treatment.
Pharmacological management when indicated (second line)
Medication is not the first line for PTSD: the guidelines place it as support, when psychotherapy is not available, is not enough, comorbidities justify it, or when you would rather start there and we discuss it. No drug "erases" the trauma; its role is to lower the intensity of activation so that the therapeutic work is possible. The choice is individualized; I do not prescribe over the web. Medication is never automatic: it is decided after the clinical assessment, together with you, and only when it is indicated — never simply because a specific drug is requested. As a matter of safety, restricted drugs or those carrying a risk of dependence are not started in the first consultation.
Management of comorbidities
Depression, anxiety or problematic use that run in parallel and are best treated in coordination with the underlying trauma. If you are using alcohol or sedatives to sleep or to calm down, do not stop them abruptly: doing so can be dangerous and should be medically supervised.
Sustained follow-up
Trauma treatment is usually medium-to-long term and not linear: there are advances and setbacks, and that is a normal part of the process.

I maintain specific, up-to-date training in this field —including the Posttraumatic Stress and Related Disorders continuing medical education course at Harvard Medical School (2026)—, to offer an approach aligned with the best available evidence.

My approach is evidence-based and respectful of your pace. I do not push anyone to say more than they are ready to say, nor do I start treatments you do not want to explore. We make the decisions together.

Frequently asked questions

Can PTSD be cured?
Well-treated PTSD improves substantially in most patients: the symptoms that dominated your life stop doing so, functioning is regained and the sense of connection returns. Some people reach full remission; in others, PTSD becomes something you know and manage. The response is individual and cannot be guaranteed in advance. What is demonstrated is that treatment works better than not being treated, even in long-standing presentations.
Do I have to tell everything that happened in the first consultation?
No. The first consultation is to understand the general situation, assess the symptoms and build a plan. The detailed content of the trauma is addressed later, at the right time, within trauma-focused psychotherapy. Psychiatry provides the diagnosis and medical management; working through the traumatic content is done in psychotherapy.
Who finds out what I say?
What is discussed in consultation is covered by professional confidentiality: it is not shared with your family, your partner or your workplace. The only exceptions are situations of serious risk —suicidal intent, risk of serious harm to others, situations of abuse—, and if it ever became necessary to involve someone else, it is discussed with you first. I explain this in detail in the first consultation so you know exactly how it works.
What if the trauma was many years ago?
PTSD can stay active for decades after the original event, especially if it was not treated. There are patients who come to the clinic at 40, 50 or 60 with symptoms they link to something from childhood or youth. It can still be treated, often with a very good response: the nervous system keeps its capacity for change (neuroplasticity) throughout life.
Does medication erase the memories of the trauma?
No. No medication erases memories. When it is indicated, its role is to reduce the intensity of the physiological and emotional activation linked to the memories, so that when they surface they do not overwhelm you. Working through the content is done in psychotherapy, which is the first line.
Is the consultation online or in person?
Whichever you prefer. All care —including the first assessment— can be delivered online (telepsychiatry) or in person at the Miraflores practice, and you can switch between them during treatment. For a sensitive matter like this, if you choose the online option what matters is that you have a private, quiet space free of interruptions during the hour-long consultation. If you do not have such a place, say so when booking: we can look at seeing you in person or finding a time when you can be alone.
I live outside Peru — can I still be seen?
Yes: online care does not depend on where you are. Prescribing, however, has its own framework. If medication is indicated, the prescription is issued from Peru and under Peruvian regulations, and whether it is valid where you live depends on local law: in most countries a Peruvian prescription cannot be dispensed by a local pharmacy. Restricted or controlled medicines, moreover, cannot be managed remotely from Peru to another country: that treatment stays with a professional licensed in your country of residence, with whom the plan can be coordinated. All of this is discussed in the first consultation, before you make any decision.
Do you see expatriates or English-speaking patients in English?
Yes. I regularly see patients in English —expatriates living in Lima, Peruvians abroad, or people who prefer to talk about intimate matters in English— with the same fluency as in Spanish.

Consultation cost, payment and reimbursement

We coordinate the consultation cost and payment methods directly on WhatsApp. The first consultation lasts one hour; follow-ups, about 50 minutes. We issue the receipt for your insurance reimbursement, with experience in the Pacífico and Rímac formats.

If what I describe resembles your experience, there is treatment. You do not have to carry this alone.

Book a consultation on WhatsApp

References

Benjet C, Bromet E, Karam EG, et al. The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychol Med. 2016;46(2):327-343.
Kessler RC, Aguilar-Gaxiola S, Alonso J, et al. Trauma and PTSD in the WHO World Mental Health Surveys. Eur J Psychotraumatol. 2017;8(sup5):1353383.
Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602.
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048-1060.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Washington, DC: APA; 2022.
Brewin CR, Cloitre M, Hyland P, et al. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev. 2017;58:1-15.
World Health Organization. International Classification of Diseases, 11th Revision (ICD-11), 6B41 Complex post traumatic stress disorder. Geneva: WHO; 2019 (in force since 2022).
National Institute for Health and Care Excellence (NICE). Post-traumatic stress disorder. NICE guideline NG116; 2018.
US Department of Veterans Affairs / Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder; 2023.
Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev. 2013;(12):CD003388.
Lewis C, Roberts NP, Andrew M, Starling E, Bisson JI. Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. Eur J Psychotraumatol. 2020;11(1):1729633.
Hoskins MD, Bridges J, Sinnerton R, et al. Pharmacological therapy for post-traumatic stress disorder: a systematic review and meta-analysis of monotherapy, augmentation and head-to-head approaches. Eur J Psychotraumatol. 2021;12(1):1802920.

If you are in crisis or having thoughts of harming yourself or ending your life, do not wait for an appointment: Línea 113, option 5 (mental health) · 106 (SAMU) · or go to the emergency room. This page is informational and does not replace a medical evaluation.

Content by Dr. Daniela Málaga, medical psychiatrist · CMP 76202 · RNE 42512. Learn about her training