Serious Mental Illness: When Undiagnosed PTSD Blocks Real Recovery
If this sounds like you…
You live with severe anxiety, severe depression, bipolar disorder, schizophrenia or another serious mental illness (SMI).
You’ve survived extreme—or even repeated—trauma.
Your doctors focus on meds for mood, psychosis, or anxiety but rarely ask about your trauma
If that’s your reality, this post is for you.
The hidden numbers
A multi-site study of community mental-health clinics discovered a staggering gap:
42 % of people receiving care for SMI also met full criteria for post-traumatic stress disorder (PTSD)
yet only 2 % had PTSD written anywhere in their medical record.¹
When a diagnosis isn’t in the chart, it usually isn’t in the treatment plan. That means the trauma-driven symptoms continue on without intervention. And, yet there are so many effective treatments that can help.
Why PTSD often stays off the radar
The biggest reason this happens is the result of “diagnostic overshadowing” — the tendency to assume that any new emotional or behavioral symptom is just part of an already diagnosed mental illness, so the clinician stops short of asking about trauma.
The SMI Diagnosis & Common Reasons for the Miss (this is not an exhausting list):
Anxiety: Hyper-vigilance and hyper-arousal are called anxiety
Depression: Rumination, poor self-concept, and relationship difficulties get labeled as depression
Bipolar Disorder: Emotional dysregulation, negative mood, and manic energy look like bipolar disorder
Schizophrenia: Flashbacks or hyper-vigilance get labeled “paranoia” or “agitation”
How untreated trauma holds back recovery
When trauma is untreated it’s like putting a bandaid on an infected wound without treatment. The underlying issues continue to fester, unresolved. The changes that can happen in the brain cannot be reversed with medication and talk therapy alone. As a result, it may remain difficult to reduce certain symptoms completely, like anxiety, sleep disturbance, and flashbacks.
Meanwhile your nervous system remains hyper-aroused, increasing the inflammation and stress your body is dealing with day in and day out. As a result, people often experience without reprieve:
Emotional rollercoaster – mood swings, panic, irritability
Body in overdrive – tense muscles, headaches, gut issues
Sleep difficulties – nightmares, night sweats, early waking, difficulty going to sleep
Relationship strain – mistrust, push-pull dynamics, hyper-independence
Medical risks – higher rates of diabetes, heart disease, and auto-immune disease
And when symptoms like that persist, a person can start feeling like there is no hope for relief.
Four steps you can take right now
If this sounds like you, there are things you can do to address the disconnect and get going on your healing.
Ask the direct question
“Could post-traumatic stress be part of what I’m experiencing?”
Bring it up with your psychiatrist, therapist, or primary-care doctor.Request a trauma screening
Tools like the PCL-5 or Life Events Checklist take about 10 minutes.A positive screen should be documented in your chart and treatment should be changed to address it.
The results should be communicated to all of your providers.
Start with nervous-system calming
Before diving into memories, simple practices—slow breathing, grounding, gentle movement, or my GRACE-framework (in the Companion Guide)—help you feel safer.Seek trauma-informed therapy options
Evidence-based approaches such as EMDR, prolonged exposure, or cognitive processing therapy can be tailored for SMI. Sometimes these might feel like too much, EMDR can be done in various ways and if any of them feel like too much, embodied approaches like Trauma Sensitive Yoga or Somatic Experiences can be helpful.
Trust your response. If it feels like you aren’t ready for a particular intervention, tell your provider and expect that to be respected. If it isn’t, find a new provider. Your body knows!
Remember
PTSD isn’t “just another label.” It’s often the missing key that explains why traditional SMI treatments haven’t brought the relief you deserve. Naming it opens the door to therapies that address the root, not just the branches. You are not broken—you’re carrying an injury that can heal with the right care.
Want to Go Deeper?
If today’s post resonated with you, here are a few ways to take the next step:
🔹 Explore More Insights from Lilli – Browse articles on trauma, resilience, healing, and rising strong.
🔹 Work with Lilli One-on-One – Coaching to help you reclaim your life and move forward with clarity and strength.
🔹 Book Lilli to Speak – Bring powerful, trauma-informed insight to your organization or event.
Resources
For more information about PTSD and approaches, go to my website trauma & treatment videos.
¹ Frueh B.C., Cusack K.J., et al. “Trauma and PTSD in severe mental illness: Prevalence and clinical correlates in community mental-health settings.” Community Mental Health Journal 42 (6) (2006): 557-569.
