The Trauma Blind Spot: Could Unresolved Trauma Be Driving Your Anxiety, Depression, or Other Symptoms?
Did you know that more than 80% of people whose symptoms meet full criteria for PTSD also meet the criteria for at least one other diagnosis — most commonly depression, anxiety, or a substance use disorder? That's not four separate problems. It's often one nervous system response, given several different diagnoses.
My Own Blind Spot
I didn't have a diagnosis of depression or anxiety. But what I did have was ADHD and an autoimmune disease — Multiple Sclerosis.
The ADHD was likely my nervous system on high alert, because it’s difficult to focus when you are in flight or flight. The MS resulted from decades of elevated cortisol and stress hormones running unchecked, that resulted in physical inflammation and immune system dysfunction.
I'd been in therapy for most of my adult life. I was doing the work. I thought I understood my own trauma fairly well.
I figured I didn’t have any PTSD anymore, because I wasn’t having flashbacks or nightmares about the trauma anymore.
Then one day, I was sitting with my neurofeedback therapist, feeling about as relaxed as I ever feel. No crisis. No stress response I could point to. Just an ordinary day. The electrodes on my head told a different story.
He looked at my readings and told me something I didn't expect: I was in fight-or-flight. Not triggered into it. Not reacting to something in that moment. Living in it — as my baseline, every day, whether anything was happening or not.
On top of counseling, I’d spent years working as a licensed clinician and written a book on trauma in 2021. And I still had no idea my nervous system had been running on high alert for so long that it no longer felt like alert at all. It just felt like me—my norm.
That's the thing nobody tells you about chronic dysregulation: it doesn't announce itself. It doesn't feel like danger once it becomes constant. It becomes normal.
What Was Actually Happening
Trauma doesn't just live in memory — it changes how the brain actually functions, in ways that are well-documented and consistent from person to person. A few of the areas affected:
Amygdala — the brain's alarm system stays on high alert, increasing reactivity even when nothing is actually wrong
Prefrontal cortex — the part of your brain responsible for reasoning, regulation, and calm goes essentially offline
Hippocampus — memory becomes harder to process and store accurately
Anterior cingulate cortex — when you get upset, it takes longer to calm back down, and managing emotions in the moment gets harder
Insular cortex — connection to your own body's signals gets disrupted
Default mode network — instead of rest or ease, this is where intrusive thoughts and rumination live, replaying what happened on a loop
This isn't an exhaustive list — trauma's effects on the brain are more far-reaching than a handful of bullet points can capture. But it's enough to make the point: this is biology, not a personal failing.
Live in that state long enough, and the symptoms it produces can meet full diagnostic criteria for a wide range of things — again, not an exhaustive list, but common ones include depression, anxiety, bipolar disorder, borderline personality disorder, OCD, disordered eating, substance use disorders, and ADHD.
My symptoms weren't a rare case. They were an adaptive nervous system, presenting as something else. And that's commonplace.
Why the Words We Use Matter
When we say someone "carries multiple diagnoses," we're describing separate illnesses. When we say their trauma symptoms meet criteria for several diagnoses, we're describing one thing, read several different ways. It doesn’t mean a person doesn’t have depression, anxiety and PTSD. It simply means if there is PTSD the symptoms make sense.
The first pathologizes the presentation — it calls something that was adaptive, dysfunction. The second doesn't.
To be clear: living in a constant state of fight-or-flight isn't a functional way to move through the world. It costs something, and it's worth addressing. But someone isn't there because there's something wrong with them. They're there because something happened to them, and their system adjusted to survive it.
They are adaptive, not defective.
The Blind Spot
Here's an image that's stuck with me since: a blind spot in a car doesn't mean nothing is there. It means your mirrors don't show it. You can be a careful, attentive driver and still miss what's sitting just outside your field of view — because you didn’t take the extra step of leaning forward and looking over your shoulder. Simply looking into your mirrors doesn’t give you the whole picture.
The same thing happens in behavioral health treatment.
A landmark multi-site study of community mental health centers found that 42% of people with serious mental illness met full diagnostic criteria for PTSD. To be clear it didn’t account for those individuals who had symptoms of trauma, but didn’t meet the full criteria. Even so, only 2% had PTSD documented in their chart.
That gap isn't about anyone failing to care. It's about a system — and often, an individual — that was never built to check for it.
If You're a Client: A Question Worth Asking
If you're in therapy, or thinking about starting, here's a fair question to bring with you: has anyone actually assessed you for trauma, specifically — not just asked if anything hard has happened to you, but used a real tool to understand how it's still showing up in your body?
One example of such an assessment is the PCL-5, a brief symptom checklist that helps a clinician understand whether trauma-related stress responses are present, and how intensely. It's not the only tool, and it's not a diagnosis on its own — but it's a concrete way of asking the question directly instead of assuming the answer.
And here's the part that matters just as much: not everyone who as being impacted by living through something hard meets the full criteria for PTSD. Some people's nervous systems express chronic stress as anxiety. Some as depression. Some, like mine, found another presentation. Every nervous system adapts to what it's been through differently. For instance, some individuals develop protective factors from positive experiences they had that buffered the intensity of the impact. It can still explain how that person navigates life. It's just quieter.
If You're a Provider: What the Assessment Actually Buys You
Knowing a client has "experienced trauma" isn't the same as knowing whether that trauma is the active driver behind what's showing up in the room. Depression looks like depression. Anxiety looks like anxiety. A body that's been in fight-or-flight for years can look like almost anything.
That's why the assessment matters — not as a box to check, but as the thing that tells you where to actually aim. Once you know chronic dysregulation is part of the picture, it becomes the foundation the rest of the work gets built on, rather than one more symptom competing for attention alongside everything else. The PCL-5 becomes the blind spot alert. There won’t always be something showing up in your blind spot, but if there is, you make different decisions.
I won't get into the specific modalities here — that's a longer conversation, and the right approach depends on the person in front of you. But the sequence matters: find the foundation first, then build the plan on top of it. Skipping that step doesn't make the work faster. It just means treating the surface while the actual driver stays exactly where it was. And your client’s dysregulation continues to wreak havoc on them.
Not Defective. Adaptive.
If there's one thing I'd want anyone reading this to walk away with, it's this: whatever your nervous system has done to get you through something hard — however strange, however inconvenient, however it's been labeled along the way — it wasn't malfunctioning. It was protecting you, exactly the way it was built to.
That doesn't mean it still serves you now. It probably doesn't. But the starting point matters. You're not broken. You adapted. And adaptation can be understood, worked with, and eventually, changed — but only once someone actually knows it's there.
Continue the Conversation
Take the time to look over your shoulder, not just in your mirrors. It might change what you see. It might change everything that comes next.
This article is part of the Trauma Blind Spot series, exploring how trauma is often overlooked in behavioral health care—and why recognizing it changes everything.
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