How Do I Know If I Have PTSD? Signs You May Need Trauma Therapy
“How do I know if I have PTSD?”
“Is it possible that the thing that happened to me years ago is still affecting me today?”
“Could my reactions be because of unresolved trauma?”
These are pretty common questions, given that the majority of people experience some form of trauma over the course of their life. Sometimes the trauma is a life-threatening trauma, but sometimes it’s not. Sometimes we get stuck on a trauma, and sometimes we don’t. A situation that is traumatic to one person may not be traumatizing to another person.
Sometimes the connection between current struggles and something we went through in the past is clear. Other times, it can take years to realize that what you are experiencing may be related to a past trauma. Every person is different, and there are a lot of factors that may impact whether or not PTSD develops, including:
Type of trauma experienced (e.g., how threatening it felt, number of occurrences, etc.)
Prior trauma history
Current mental health struggles
Level of social support
Ongoing life stress
How a person’s nervous system responds to danger
Prior experience with feeling unsafe
Coping strategies
Genetics and temperament
What is important to understand is that PTSD isn't a sign that someone is weak or didn't cope well enough. Trauma affects people differently, and many factors can influence how the brain and nervous system respond after an overwhelming experience. PTSD is complex, and there is no way to predict with certainty how someone will respond to a traumatic event, regardless of the presence of risk factors or protective factors.
The good news is that you do not have to figure it all out on your own. A trauma specialist can help determine whether your symptoms meet criteria for PTSD, another trauma-related disorder, or a different condition such as an anxiety disorder, depressive disorder, or adjustment disorder. Once this is understood, a path toward healing can be formulated.
What Does PTSD Feel Like?
In PTSD, a person is typically “haunted” by a prior experience or experiences, but it can look different from one person to another. For some people, it may present as constantly feeling angry, unsafe, and on guard for potential threats. For other people, it may look more like social withdrawal, emotional numbing, and avoidance of activities previously enjoyed.
A person might logically know that they are generally safe in life today, but the body may still feel as though danger is nearby. The nervous system may react strongly to anything that reminds the brain of what happened.
This reactivity is part of the body's natural survival response. Anything present around the time of a traumatic event—a sound, smell, place, conversation, person, or even a feeling—can get linked to danger. When one of these “red flags for danger” is encountered today, the body’s nervous system may suddenly bring up fear and overwhelm and move us into fight-flight-freeze-fawn mode in an attempt to keep us safe.
This occurs when parts of the brain are stuck in “trauma time”—meaning parts of the brain are still interpreting events around us as if the original trauma and danger is ongoing.
What Are the Signs and Symptoms of PTSD?
PTSD symptoms generally fall into four groups. You do not have to experience every symptom in order to be struggling with the effects of trauma, and simply reading a symptom list cannot tell you whether you have PTSD.
Re-Experiencing the Traumatic Event(s)
Most people experience unwanted memories, distressing dreams, or flashbacks related to what happened. A reminder of the trauma can cause a sudden emotional reaction, such as anxiety, fear, shame, or anger, or a physical reaction, such as a racing heart, shortness of breath, or tension.
At times, these reactions seem to come out of nowhere because the trigger may not be obvious. These experiences can be confusing and frustrating, especially when the traumatic event happened a long time ago.
Avoiding Thoughts, Feelings, or Reminders of What Happened
Often, people don’t want to think about, talk about, or feel what happened because it’s painful. You may avoid certain places, people, conversations, activities, or situations that remind you of what happened. You might actively engage in activities, such as overworking, addictive behaviors, or staying constantly busy, that help you avoid thoughts and feelings related to what happened.
Avoidance is often helpful in the short term because it can provide immediate relief from distress related to the memory, feeling, or reminder. However, in the long run, avoidance can keep a person stuck in their trauma and even make anxiety and fear worse.
Changes in Mood, Thoughts, and Relationships
Trauma often leads to negative thoughts or expectations regarding ourselves, other people, or the world. You may begin to believe that you are broken, weak, or shameful, and that what happened was somehow your fault. You may begin to believe that people can’t be trusted and that the world is a very dangerous place.
You might struggle with anxiety, fear, guilt, shame, anger, sadness, or emotional numbness. You may feel disconnected from friends and family, unable to enjoy the activities that previously brought you pleasure, and may even struggle to experience positive feelings like love and happiness.
Feeling On Edge, Unsafe, or Unable to Relax
When a trauma occurs, your nervous system learns that the world can be dangerous, and sometimes it gets stuck in survival mode. The danger may be long gone, but parts of your brain involved in protecting you didn’t get that memo. So your body stays in a state of hyperarousal, with increased energy and alertness to be ready for the next threat.
You may even know logically that you are safe, but your body is telling you something different.
This state of hyperarousal shows up in the body in different ways. You may have difficulty concentrating or have trouble sleeping because your mind or body won’t “turn off.” You may be easily startled or constantly scanning your environment for potential danger. You may be unable to relax or sit still, and you may angrily overreact to stressors that previously you handled with ease.
These are signs that your nervous system is stuck in the “on” position, staying prepared for a threat that has long since passed. Learning how to calm and regulate these responses can become an important part of healing.
Can You Have PTSD Without Realizing It?
Yes, it is possible to experience trauma-related symptoms without recognizing them as PTSD. Some people assume they are simply anxious, overwhelmed, or overly sensitive. You may not experience typical flashbacks or nightmares. Instead, you might notice that you are always on edge, struggle with sleep, avoid certain situations, stay busy to avoid negative thoughts and feelings, or have strong reactions to things other people seem to handle easily.
PTSD symptoms can also have a delayed onset. While symptoms often emerge shortly after a traumatic event, they can sometimes show up months, years, or even decades later.
Could My Symptoms Be From Unresolved Trauma?
Yes, it’s possible, although not all people who experience trauma develop a trauma-related condition. The effects of trauma don’t always look the way we expect them to, and a traumatic experience does not have to result in PTSD to have a significant and lasting impact on your life. Additionally, an experience doesn’t have to be life-threatening to be experienced as traumatic, and you don’t have to remember every detail of an experience for it to affect you.
Are any painful life experiences “haunting” you? Are you struggling with anxiety, fear, panic, being easily overwhelmed, having reactions that seem bigger than the situation calls for, or behaving in ways that either don’t make sense to you or are getting in the way of living your best life?
Are you reacting strongly to situations that remind you of the past? Are you struggling with trust, boundaries, relationships, or feeling safe in your own body?
Sometimes, these symptoms can be connected to unresolved trauma or difficult experiences from the past. However, there are other reasons you may be experiencing these symptoms. A skilled therapist can help you explore whether unresolved traumatic experiences may be contributing to what you’re feeling.
What Types of Experiences Can Lead to Trauma?
According to Gabor Maté, a renowned expert on trauma and addiction, “Trauma is not what happens to you, but what happens inside you as a result of what happened to you.”
Two people can experience the same event and have very different reactions. One may move past the event with relative ease, while the other person becomes overwhelmed and stuck in the experience.
Trauma can result from many different experiences. Examples include:
Abuse or neglect
Sexual assault
Interpersonal violence
Accidents
Medical experiences
Natural disasters
Sudden loss
Witnessing something frightening or disturbing
Work-related trauma
Not every difficult or painful experience causes PTSD. What matters is how the experience affected you and what symptoms you are experiencing now.
PTSD vs. Anxiety: How Can You Tell the Difference?
PTSD and anxiety can look similar. Both can involve racing thoughts, worry, trouble sleeping, irritability, physical tension, difficulty concentrating, feeling on edge, and a strong sense that something is wrong.
One important difference is that PTSD is connected to trauma and involves a specific pattern of symptoms. Anxiety can have many different causes and does not necessarily involve a traumatic event.
With PTSD, you may also experience symptoms that are more closely tied to the trauma itself, such as unwanted memories or flashbacks, nightmares, avoiding reminders of what happened, or feeling emotionally numb or disconnected.
Because the symptoms can overlap, it is not always possible to figure out the difference on your own. It’s also possible to have both PTSD and an anxiety disorder at the same time.
A qualified mental health professional can help you understand what you are experiencing and determine what kind of support could help you begin to feel safer, calmer, and more like yourself again.
Learn more about therapy for anxiety and stress here.
When Should I Consider Trauma Therapy?
It is best not to wait until your symptoms become severe before seeking help. Trauma therapy may be worth considering if your symptoms are affecting your mood, relationships, work, sleep, daily activities, or sense of safety.
You don’t need a formal PTSD diagnosis before talking with a trauma therapist. A first conversation with a trauma specialist provides an opportunity to describe what you have been experiencing and learn whether trauma-focused therapy might be a good fit for you.
What Happens When You See a Trauma Therapist?
Starting therapy can feel scary, especially if you are worried that you will have to immediately talk about all of the details of your life. A first session, though, is typically about getting to know you, understanding what brings you to therapy, obtaining a bird’s-eye view of your history, and identifying your goals for therapy.
Your therapist may ask about your current symptoms, past experiences, relationships, and in what ways stressors are affecting your life. You should be given space to ask questions, share any concerns you have, and talk about what you are and aren’t ready to discuss.
Trauma therapy should provide a safe environment where you can work at a pace that works for you. You do not have to tell your entire story on the first day.
Based on the initial session or two, a trauma therapist will then give you their opinion on what is going on and whether or not a trauma-focused therapy appears to be a good fit for your symptoms and therapy goals. If trauma therapy looks like a good fit, your provider will then discuss with you the various treatment options available.
Learn more about trauma therapy here.
What Types of Therapy Can Help With PTSD and Trauma?
There are several evidence-based therapies for PTSD. The VA's National Center for PTSD identifies Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and Eye Movement Desensitization and Reprocessing (EMDR) as trauma-focused therapies with strong research support.
CPT, PE, and EMDR are different therapies but have some things in common.
All three are designed to reduce or resolve trauma symptoms through trauma processing rather than simply helping a person learn to cope with ongoing symptoms.
All three involve confronting the trauma in some way. Avoidance can actually prolong and worsen PTSD symptoms, so trauma-focused treatment involves engaging with trauma-related memories, emotions, thoughts, and/or reminders.
CPT, PE, and EMDR therapies approach this process differently:
CPT asks a person to revisit the trauma and examine the beliefs that developed as a result of the trauma, such as self-blame and issues related to trust, power/control, and safety. It focuses on understanding and changing unhelpful or inaccurate thoughts related to the trauma and its effects.
PE helps people gradually approach trauma-related memories, feelings, and situations they have been avoiding because of their trauma. This helps to desensitize the memories and reminders, and it helps the person learn that trauma memories and reminders can be experienced without the feared consequences and that distress can decrease without avoidance.
EMDR uses bilateral stimulation to jumpstart the brain’s information processing system, which allows the brain to reprocess or “digest” the traumatic memory. This allows the memory to become less emotionally overwhelming and to feel like something that happened in the past—like you are remembering something from the past rather than reliving it in the present.
No one treatment is right for everyone. The best approach depends on your symptoms, history, goals, preferences, and the therapist you are working with.
How EMDR Therapy Can Help With Trauma
EMDR therapy can help with trauma and PTSD by helping your brain and nervous system process experiences that still feel painful, overwhelming, or unresolved. EMDR helps you safely work through these experiences so they can become less emotionally charged and easier to remember without feeling overwhelmed.
One of the unique things about EMDR therapy is that you don't have to talk about every detail of your trauma over and over again. During trauma processing, your therapist guides you through brief periods of remembering while using bilateral stimulation, such as eye movements or alternating taps.
This can help:
Your brain digest and make sense of what happened
Your brain separate the past from the present
The memory become less distressing
To reduce reactions to trauma-related triggers
You feel less stuck in the past and thus calmer, safer, and more in control in the present
In this way, EMDR can support healing not just from the memory of trauma but also from the ways it may continue to affect your nervous system and daily life.
Learn more about EMDR Therapy here.
Can PTSD Get Better With Therapy?
Yes. PTSD is treatable, and many people experience significant improvements with evidence-based treatment. The goal is not to erase your past. It is to help you develop a healthier relationship with what happened so that the past does not continue to control your present.
Healing does not happen overnight, and you may experience some difficult days along the way, but it can happen with the right support.
What If I'm Still Not Sure Whether I Have PTSD?
You do not need to have an answer before reaching out for support. That uncertainty is okay. If something is interfering with your life or making it difficult to feel safe, calm, connected, or like yourself, that is enough reason to seek support.
A trauma specialist can help you understand what you are experiencing and explore whether trauma-focused therapy may be right for you. With the right support, it is possible to feel safer, calmer, and more in control of your life again.
If you are ready to take the next step, consider reaching out to a therapist who has experience working with trauma and PTSD. Remember, you don’t have to have everything figured out before you begin. Sometimes, the first step toward healing is simply having a safe place to talk about what you have been carrying.
FAQs About PTSD and Trauma Therapy
Can You Have PTSD Without Flashbacks?
Yes. Not everyone experiences flashbacks. They are just one possible PTSD symptom. People with PTSD can experience different combinations of symptoms. Nightmares, intrusive memories, flashbacks, strong reactions to reminders of the trauma, avoidance, feeling constantly on edge, emotional numbness, and negative changes in mood or thinking can also occur in PTSD.
Can Childhood Trauma Cause PTSD?
Yes. Childhood trauma can lead to PTSD and can also affect emotional and stress responses later in life. However, experiencing childhood trauma does not automatically mean someone will develop PTSD. A mental health professional can help determine whether current symptoms fit PTSD or another mental health-related concern.
Can PTSD Symptoms Appear Years Later?
Yes. Although PTSD symptoms often begin within a few months of trauma, they can sometimes appear months or even years after a traumatic experience. Some people initially cope by staying busy, avoiding reminders, or simply focusing on getting through the day. Symptoms may become more noticeable later when stress, life changes, or a reminder of the trauma brings the experience back to the surface.
If you are experiencing new or worsening symptoms related to something that happened in the past, a trauma-informed therapist can help you understand what is happening and explore options for healing.
Do I Need a PTSD Diagnosis to See a Trauma Therapist?
No. You can seek therapy because you are struggling with the effects of a difficult or traumatic experience, even if you do not know whether you meet the criteria for PTSD.
Also, a person can experience significant trauma-related symptoms even when their experience does not meet the specific (rather narrow) diagnostic definition required for PTSD.
Can Trauma Cause Anxiety or Panic Attacks?
Yes. Trauma can be associated with anxiety and panic symptoms, but anxiety and panic can have many causes. If you are experiencing frequent or intense symptoms, a mental health professional can help you understand what may be contributing to them.
Is Trauma Therapy Safe?
Trauma therapy should be provided by a qualified professional who specializes in the treatment of trauma-related conditions and who can help you do the work at a pace that is manageable for you.
A good therapeutic relationship should give you space to ask questions, express concerns, and develop a sense of safety as you move through treatment.
Ready to Learn More?
If you’re curious about how EMDR therapy might support your healing, the next step is simply starting a conversation. Schedule a consultation to learn more about how EMDR can help you process the past and move forward with greater clarity and ease.
About the Author
About the Author
Dr. Lisa Robinson, PhD. is a licensed psychologist in North Carolina and Texas who specializes in using EMDR with professionals in high stress environments who are struggling with trauma, anxiety, stress, or anger. She is an EMDRIA-Certified Provider and EMDRIA-Approved Consultant and has been providing EMDR therapy since 2014. Lisa lives in Asheville NC with her family. Learn more about Lisa here.
