PTSD Impact Statement Example: How to Write One + Sample Template

What a PTSD Impact Statement Is (and Why It Matters)

A PTSD impact statement is a structured, personal explanation of how trauma has affected your daily life—emotionally, physically, socially, and financially. It gives decision-makers what legal documents often don’t: human impact in plain language.

Think of it as the bridge between:

If your statement is going to court, it helps to understand where it fits in the process. You can reference this for courtroom context and timing: 15 Powerful Sample Letters to a Judge for Every Situation

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When You Might Need a PTSD Impact Statement

A PTSD impact statement can be used in many situations. The structure stays mostly the same; the “ask” changes.

Common use cases

• Court sentencing (or victim impact statement submission)

• Victim compensation (therapy costs, lost wages, relocation/security expenses)

• Workplace or school accommodations

• Insurance or disability claims

• Personal injury negotiations (showing long-term emotional harm alongside physical injury)

If your PTSD is connected to an injury claim or settlement discussion, this companion guide can help you align your “damages” language: Personal Injury Demand Letter: How to Write

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The 8-Part Structure That Makes Your Statement Strong (and Believable)

Most weak impact statements fail for one reason: they’re emotional but not specific. The structure below keeps your statement human and credible.

1) Start with “before vs. after”

This is your strongest credibility move because it gives a baseline.

Before: job performance, routines, social life, confidence, sleep, independence
After: changes in behavior, safety habits, mood, relationships, work ability, health

2) Provide brief trauma context (non-graphic)

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You do not need disturbing details. One or two sentences is enough:

• When it happened (month/year)

• General nature of the event

• Why it impacted your sense of safety

3) Describe PTSD symptoms in real-life language

Avoid only clinical labels. Use lived examples:

• Nightmares, flashbacks, intrusive thoughts

• Panic, racing heart, shaking, dissociation

• Hypervigilance (constant scanning, fear response)

• Avoidance (places, people, conversations)

• Emotional numbing, anger, guilt, shame

• Concentration and memory issues

4) Identify triggers and patterns

Triggers prove your symptoms aren’t random.
Examples:

• Sirens, certain smells, anniversaries, crowded spaces, unexpected touch, nighttime, specific streets, courtrooms

5) Show functional impact (this is your “proof” section)

This is where your statement becomes hard to dismiss.

Break it into life categories:

• Sleep: hours per night, nightmares, insomnia patterns

• Work/school: attendance, performance, accommodations needed

• Relationships: isolation, conflict, fear, trust issues

• Health: headaches, stomach issues, panic symptoms, fatigue

• Safety: locks, alarms, avoiding places, needing escorts, fear of retaliation

If your statement is being submitted to a judge and you want the right tone (impact without arguing evidence), model your language after the court-focused structure here: Writing a Powerful Victim Impact Statement (Free Sample)

6) Explain financial impact (with numbers if possible)

Even small details strengthen credibility:

• Therapy co-pays, medication costs

• Lost wages from missed work or reduced hours

• Transportation costs, childcare, security upgrades

• Relocation expenses (if applicable)

If you’re asking for money or reimbursement (outside of criminal restitution), this guide can help you phrase your request professionally: Letter Asking for Compensation (Free Sample)

7) Document treatment and coping efforts

Mention what you’ve done:

• Therapy (individual/group), crisis support, journaling, coping tools

• Medication (if applicable)

• Lifestyle adjustments

• What helps vs. what still doesn’t

8) End with a clear request

Don’t hint. State it plainly:

• “I respectfully request the court consider…”

• “I am requesting accommodations including…”

• “I am requesting reimbursement for documented expenses…”

• “I am requesting protective conditions (no contact, distance requirements)…”

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Copy/Paste PTSD Impact Statement Template (Fill-In)

[Your Name]
[Case/Claim Number, if applicable]
[Date]
To: [Judge/Board/Claims Examiner/HR/School Office]

1) Why I am submitting this statement

I am submitting this impact statement to explain how the trauma I experienced has affected my daily life and functioning, and to request appropriate support moving forward.

2) Brief context (non-graphic)

In [month/year], I experienced [one-sentence description]. Since then, I have had ongoing symptoms consistent with post-traumatic stress that have significantly changed how I live day to day.

3) Before vs. after

Before this happened, I was [job/school role], I [routine/social life], and I felt [baseline safety/confidence]. Afterward, I became [key changes], and my daily functioning declined in ways I never experienced before.

4) Symptoms and triggers

My main symptoms include:

• [nightmares/flashbacks/intrusive memories]

• [avoidance behaviors]

• [panic/hypervigilance/startle response]

• [concentration/memory issues]

My triggers include: [sounds/places/anniversaries/situations].

5) Daily life impact (real examples)

• Sleep: [hours/night], [frequency], [what mornings look like]

• Work/School: [missed days, reduced ability, accommodations needed]

• Relationships: [withdrawal, conflict, parenting impact]

• Health: [physical symptoms, medical visits]

• Safety: [avoidance, home safety steps, fear patterns]

6) Financial impact

Because of these impacts, I have experienced losses including:

7) Treatment and steps taken

I have sought help through [therapy/support/medical care]. Some strategies help, but I continue to struggle with [symptoms], and I am continuing treatment to regain stability and functioning.

8) My request

Based on the ongoing impact, I respectfully request:

• [request #1]

• [request #2]

• [request #3]

I certify this statement is true to the best of my knowledge.

Signature: ____________________
Printed Name: __________________

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PTSD Impact Statement Example (Fictional, Realistic, Court-Ready)

Jordan M.
Case # 24-1987
February 3, 2026
To: The Court

I am submitting this statement to explain the ongoing impact the incident has had on my life. I want the Court to understand how trauma has changed my daily functioning, and what I need to feel safe and stable again.

In March 2024, I experienced a violent event that left me terrified for my life. I will not describe graphic details here, but I can say clearly that my sense of safety did not return when the incident ended.

Before this happened, I worked full-time, slept normally, and felt comfortable being out in public. I was independent and calm. Since then, I live as if danger is always nearby. I am not the same person I was, and the change affects nearly every part of my routine.

My symptoms include nightmares several nights a week, sudden panic when I’m startled, and intrusive memories that interrupt my day. My triggers include loud voices, footsteps behind me, and unexpected banging sounds. When triggered, my heart races, my hands shake, and I can’t think clearly.

My sleep is severely affected. I often get only 3–5 hours a night and wake repeatedly to check locks and windows. The next day, I’m exhausted, emotionally numb, and easily overwhelmed. My concentration has declined, and I’ve missed workdays after nights when symptoms were intense.

My relationships have changed. I cancel plans, avoid crowds, and isolate more than I ever did before. I feel embarrassed that I can’t “just move on,” but my body reacts as if the danger is still happening. I used to be patient and grounded. Now I feel like I’m bracing for something every day.

Financially, I have lost income due to missed work and reduced hours during the worst periods. I have also paid for counseling and other related care. I’ve spent money on safety measures at home because I cannot relax without them.

I respectfully ask the Court to consider the ongoing harm when determining sentencing and any protective conditions. I also request restitution for documented treatment costs and losses related to the impact of this trauma.

I certify this statement is true to the best of my knowledge.

Jordan M.

For more style and structure examples (including “impact without arguing evidence”), you can also reference: 15 Powerful Victim Impact Statement Samples

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Tips to Make Your Statement More Persuasive (Without Overexplaining)

Use specifics instead of intensity

• Strong: “I’ve missed 9 workdays in 2 months due to panic and sleep loss.”

• Weak: “Everything is terrible all the time.” (True emotionally, but less usable to a decision-maker.)

Keep your tone “human + focused”

Anger is valid. But clarity wins.

If you’re writing to a judge, these pages can help you match courtroom expectations:

Don’t write yourself into a spiral

If writing triggers you:

• Draft in short bursts

• Start with bullet points

• Step away and ground yourself (walk, breathing, cold water, call support)

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Checklists

PTSD Impact Statement Checklist

“Make It Stronger in 10 Minutes” Checklist

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Disclaimer

This article is for general information and educational purposes and is not legal or medical advice. If you feel unsafe or are in crisis, contact local emergency services immediately. In the U.S., you can call or text 988 for the Suicide & Crisis Lifeline.

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Sources

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Video Section

Here are video topics that match this article well (great for time-on-page and trust):

• “How to write a victim impact statement (step-by-step)”

• “What to include in a trauma impact statement (and what to leave out)”

• “How PTSD affects sleep and concentration (explained simply)”

• “How to ask for workplace accommodations for PTSD”

• “What judges listen for during sentencing statements”

If you want court-focused phrasing, you can also point readers to this related writing style: Letter to a Judge for Leniency (Free Sample)