Trauma is not rare and it does not always begin with a dramatic event. For many teens and young adults, trauma takes shape in the hallways of a high school, in a college dorm, or on a phone screen at midnight. Bullying, in particular, is one of the most underrecognized sources of trauma in adolescence: research shows that victims of bullying are at significantly elevated risk for depression, anxiety, PTSD symptoms, and in some cases psychotic-like experiences (Wolke & Lereya, 2015). Academic pressure, social exclusion, identity-related stress, and the compounding weight of life transitions — from high school to college, from adolescence to adulthood — can all overwhelm a young person's ability to cope in ways that leave lasting marks on the brain and body.
More than 80% of people in the United States will experience at least one traumatic event in their lifetime (Kilpatrick et al., 2013), and for many, that first experience happens far earlier than anyone around them realizes. At Pand Health, we treat trauma not as a side note to other diagnoses, but as a central piece of the clinical picture. This month, in recognition of PTSD Awareness Month, we want to share what we know about how trauma develops, how it presents, and how it intersects with the conditions we treat every day.
The word "trauma" refers to experiences that overwhelm a person's ability to cope. These can include abuse, neglect, violence, accidents, sudden loss, natural disasters, or any deeply distressing situation that exceeds a person's internal resources in the moment.
When the effects of trauma persist, we often talk about Post-Traumatic Stress Disorder (PTSD), a diagnosable condition characterized by four core symptom clusters: intrusive memories or flashbacks, avoidance of trauma-related triggers, negative changes in mood and thinking, and heightened arousal or reactivity (American Psychiatric Association, 2013).
But trauma-related disorders exist on a spectrum. Beyond classic PTSD, clinicians also recognize:
Acute Stress Reaction (ASR): a short-term response to a singular traumatic event, typically resolving within days to weeks.
Complex PTSD (C-PTSD): resulting from prolonged or repeated trauma such as childhood abuse, neglect, or chronic adversity. C-PTSD often includes additional features such as emotional dysregulation, identity disturbances, and deep difficulties in relationships.
Trauma with Co-occurring Conditions: mixed presentations that involve depression, anxiety, psychosis, substance use, or personality-related symptoms alongside trauma responses.
Understanding which type of trauma response is present matters enormously because different presentations call for meaningfully different approaches to care.
One of the most important things families and caregivers can understand about trauma is that it does not always look like what we expect. Not everyone with PTSD cries or has visible flashbacks. Trauma hides in plain sight, expressing itself through patterns that are easy to misread.
Common presentations include:
Intrusive symptoms: unwanted memories that surface without warning, nightmares about the traumatic event, or the sudden felt sense of being "back there" even years later.
Hypervigilance and heightened startle response: being constantly on edge, scanning for danger, difficulty relaxing or sleeping, and physical symptoms like a racing heart or tense muscles.
Emotional numbness and avoidance: shutting down feelings to avoid pain, withdrawing from people and places that trigger memories, difficulty trusting others or forming close relationships.
Mood changes: overwhelming guilt or shame, persistent sadness or hopelessness, difficulty concentrating or regulating emotions.
Dissociation: feeling disconnected from one's body or surroundings, episodes of confusion or altered perception, difficulties distinguishing internal thoughts from external reality.
Hidden trauma responses: sometimes trauma expresses through what looks like "everyday" struggles: chronic stress, persistent anxiety, substance use, or difficulty functioning, even when the original traumatic events feel distant or resolved.
This last category is especially important. Many people who are living with the effects of trauma do not connect their current struggles to past experiences, and neither do the people around them.
The numbers help put trauma's reach into perspective:
These are not marginal findings. They represent a well-established, research-backed relationship between trauma and serious mental health conditions.
Perhaps the most clinically significant aspect of trauma is its relationship to psychosis. This is not a coincidence or a correlation that can be dismissed. Research consistently shows that trauma — especially early-life or repeated trauma — is one of the strongest known environmental risk factors for the development of psychotic disorders (Varese et al., 2012).
This does not mean trauma causes psychosis in every person who experiences it. Many people live full, meaningful lives with trauma histories and never develop psychotic symptoms. But the relationship is real, significant, and clinically consequential.
Trauma influences psychosis in several ways. It affects the content and severity of psychotic symptoms, hallucinations and paranoia in particular are often shaped by traumatic experiences (Hardy, 2017). It increases symptom severity in those already at elevated risk. And it frequently goes unaddressed in treatment settings that focus narrowly on psychosis without asking what came before it.
At Pand Health, ignoring trauma in psychosis care is not an option. The two are too often intertwined to treat separately.
Because trauma and psychosis so frequently co-occur, Pand Health builds integrated care plans that address both as part of a unified, personalized treatment pathway.
Our approach includes:
Comprehensive trauma-informed assessment: evaluation that incorporates a detailed trauma and life history, symptom interview covering intrusions, dissociation, hyperarousal, and mood, as well as screening for co-occurring conditions including psychosis, anxiety, depression, and substance use. Because trauma and psychosis can overlap, especially around dissociation and altered perception, our evaluations are both trauma-informed and psychosis-aware from the outset.
Trauma-focused therapies: including trauma-focused cognitive behavioral therapy (TF-CBT), EMDR, somatic therapies, grounding and stabilization approaches, and psychoeducation that helps individuals and families understand trauma reactions, triggers, and the mind-body connection.
Psychosis-informed interventions: when psychotic or schizophrenia-spectrum symptoms are present or at elevated risk, we incorporate careful psychiatric monitoring, CBT for Psychosis (CBTp), cognitive and social-cognitive remediation, and trauma-informed psychosis care that recognizes how psychotic symptoms can be intertwined with trauma memories and dissociation.
Family and caregiver education: because the people around a young person carry an enormous amount of the weight. We teach families how to respond with safety, grounding, validation, and compassion rather than argument or alarm.
Individualized treatment plans: we do not assume a cookie-cutter model. Recovery looks different depending on the type of trauma, the presence of co-occurring conditions, available supports, and where each person is in their journey. What helps one person may overwhelm another. We meet people where they are.
If you or someone you care about has a history of trauma, and you are also noticing shifts in perception, dissociation, unusual beliefs, or difficulty distinguishing internal thoughts from external reality, here is what we recommend:
One of the most important things we want families and individuals to hear is this: complexity is not a barrier to getting help, it is exactly what we are trained for.
Some clinics treat trauma. Others treat psychosis. Few treat both, and even fewer treat both with the individualized, compassionate, whole-person approach that real recovery requires. At Pand Health, integrated care is our baseline.
If you or someone you love is carrying trauma alongside confusion, fear, dissociation, or psychotic-like experiences, you are not too broken. You are exactly who Pand Health was created to help.
Call us at 888-710-PAND or visit pandhealth.com to request a free consultation.
References
Achim, A. M., Maziade, M., Raymond, E., Olivier, D., Mérette, C., & Roy, M. A. (2011). How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association. Schizophrenia Bulletin, 37(4), 811–821.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
Hardy, A. (2017). Pathways from trauma to psychotic experiences: A theoretically informed model of posttraumatic stress in psychosis. Frontiers in Psychology, 8, 697.
Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. Journal of Traumatic Stress, 26(5), 537–547.
Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989.
National Center for PTSD. (2023). How common is PTSD in adults? U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/understand/common/common_adults.asp
Okkels, N., Trabjerg, B., Aaby, P., & Pedersen, C. B. (2017). Traumatic stress disorders and risk of subsequent schizophrenia spectrum disorder or bipolar disorder: A nationwide cohort study. PLOS ONE, 12(8), e0183951.
Trauelsen, A. M., Bendall, S., Jansen, J. E., Nielsen, H. G., Lynggaard, H., Trier, C. H., & Simonsen, E. (2015). Childhood adversity specificity and dose-response effect in non-affective first-episode psychosis. Schizophrenia Research, 165(1), 52–59.