By Vanessa H. Roddenberry, Ph.D. | Breyta Psychological Services, P.A.
A Wound That Doesn’t Bleed
Posttraumatic Stress Disorder (PTSD) isn’t just about war zones or natural disasters. It’s a silent, often invisible wound—one that lives in the nervous system and rewrites how people see the world, their relationships, and themselves.
At Breyta Psychological Services, we specialize in trauma-informed therapy because we know that understanding PTSD is essential to treating it well. Whether you’re a clinician, survivor, or someone who loves someone living with trauma—this is for you. We understand how overwhelming it can be to make sense of this experience, let alone to find a PTSD therapist near you. We hope this serves as a helpful resource and guide that can provide clarity and hope. So, let’s dive in as we explore the question, “What is PTSD?” as well as common symptoms and information of treatment that works.
PTSD: A Psychological Injury, Not a Weakness
PTSD is a mental health condition that can develop after experiencing or witnessing a traumatic event. According to the DSM-5-TR, PTSD symptoms fall into four primary categories.
PTSD Symptoms:
- Intrusion – Flashbacks, nightmares, and unwanted memories.
- Avoidance – Efforts to steer clear of difficult reminders, people, places, or feelings.
- Negative changes in cognition and mood – Numbness, guilt, shame, or persistent negative beliefs.
- Arousal and reactivity – Hypervigilance, insomnia, irritability, or exaggerated startle response.
It’s important to remember that these are normal responses to abnormal events. PTSD is not a character flaw—it’s an adaptation that has outlived its survival function.
Physical Components of PTSD
When the traumatic experience was occurring, your mind and body were doing just what they were wired to do to increase your chance of survival. Your amygdala sounded the alarm, which prompted your hypothalamus to release stress hormones (cortisol and adrenaline). This kicks off what we refer to as the “fight, fight, or freeze” response. Blood flows to your extremities in order to help you defend yourself or flee, and processes like higher order cognitive function or digestion temporarily go offline as your prefrontal cortex lets your limbic system take the wheel. At that time, your hippocampus struggles to encode in its usual way, meaning that some memories may feel crystal clear and others my be intangible or murky, as your ability to construct a clear narrative is negatively impacted by this temporary deficit in memory.
Emotions and PTSD
While your body’s undergoing these changes, you are experiencing what we call primary (basic) emotion in response to the event. For example, when our life is threatened we may feel fear, anger, or sadness. However, these primary emotions are tied to the event. When it’s no longer happening, the primary emotions burn off and you no longer experience them. The catch is, after the event, we start making meaning about what happened and what it means for us. We have thoughts about the event(s) that lead to feelings. As long as those thoughts are in play, the corresponding feelings move forward on the timeline with us. We call these emotions secondary emotions. These are more complex, such as guilt, shame, disillusionment.
Cognitions (Thoughts) and PTSD
We may find that our pre-trauma view of the world is shattered, or that an event seemed to confirm already held negative beliefs. It’s common to have trouble processing a traumatic event because it’s anathema to your expectations of the world and your experience (this is why it’s traumatic in the first place). There is often a subconscious desire to hold on to your pre-trauma view of the world and, in doing so, you start questioning or blaming yourself. While this may not be fair or rational, it’s related to a sense of perceived control that feels comforting when something unexpected or out of your control occurred. For example, we often “Monday morning quarterback” our choices and think, “if I just hadn’t ______, then _______ wouldn’t have happened.”
Another common cognitive change is extreme thinking that greatly overgeneralizes ideas. If someone is attacked by a man, the person may start to associate “men” with “danger”; developing the thought that “all men are dangerous.” Over time, if this fear motivates them to avoid men more and more, there is no new data or opportunity to disprove the fear and it becomes heightened. In this way, avoidance is the “glue” of PTSD.
PTSD is a Problem in Recovery
When the initial trauma was occurring, your body made paired associations with everything associated with what it perceived as a threat. This is based in our evolutionary biology. It makes perfect sense that, if you encountered a certain type of animal and it attacked you, you would want to remember everything related to it (environment and sensory data, etc.) so that you can avoid that aversive or risky experience in the future. In our modern era, we don’t encounter the need for this skill in such a literal manner, but the concept holds.
This explains why, when we are presented with something that may be even loosely related to a trauma, our body sets off a chain reaction of the same physical process (fight or flight), memories called forth, and emotions that were present at the time it originally occurred. Your body can’t tell the difference between you mentally referencing the event in a memory vs. it actually happening, so the whole process unfurls. This is why, it feels so overwhelming to encounter triggers for trauma-related memories. Often this is sensory input like a certain smell or being touched, seeing images we associate with the event, or experiences that may be related (e.g., driving, walking at night, being in a crowd). As a result, you begin to avoid any triggers and watch out for perceived threats where there may be none in actuality.
PTSD is a problem in recovery. It’s like having your house alarm go off when it’s being broken into, but then it gets stuck in a range that is too sensitive so the alarm is constantly going off even when no threat is present.
Most people will experience some form of traumatic event in their lives. The majority of people will also experience posttraumatic stress symptoms as a result. For most, the symptoms will fade after several weeks. For those that have the symptoms stick around, there is likely some difficulty in processing what happened. It may be that there was not time of ability, such as events that happen in combat, or in childhood. It may also be that avoidance kept the wound fresh and it felt too scary to approach the memory on your own.
Trauma therapy helps you recover by doing just that; educating you about your PTSD symptoms and treatment options, helping put what happened in context, building your confidence in your ability to address it, assisting you in looking at it objectively to help you notice anywhere your thinking may have become “stuck”, and helping you regain a felt sense of safety in your body again.
Not All Trauma Is the Same: From PTSD to Complex Trauma (C-PTSD)
What Is Complex PTSD (C-PTSD)? Understanding Developmental and Relationship Trauma
Some trauma is acute. A car accident. An assault. A singular event. But for others, trauma is chronic—neglect, abuse, coercive control, or emotional abandonment over time. While most people have heard of PTSD as a response to a specific traumatic event, Complex PTSD (C-PTSD) describes a different kind of trauma: the kind that happens repeatedly over a larger time span.
This is often referred to as complex PTSD (C-PTSD). It shares core features with PTSD but includes persistent disturbances in self-concept, emotional regulation, and relationships. Many who live with C-PTSD have endured developmental trauma or attachment wounds during childhood.
Complex PTSD develops when a person experiences chronic, repeated trauma, often in the context of relationships where they felt powerless, afraid, or unseen. This includes childhood emotional neglect, ongoing abuse, sexual violence, domestic violence, or growing up in an unpredictable or chaotic household.
Unlike PTSD, which is often tied to a single incident (and recognized under Criterion A of the DSM-5), C-PTSD often goes unrecognized. The individuals who suffer from it may never have had a “big-T trauma” but instead grew up in an emotional landscape that was chronically unsafe. This includes people raised by emotionally immature, abusive, or absent caregivers—where the very people meant to nurture them caused harm.
Symptoms of Complex PTSD
In addition to the core symptoms of PTSD—re-experiencing, avoidance, hyperarousal, and negative changes in mood—those with C-PTSD often experience:
- Emotional dysregulation (intense shame, anger, or sadness)
- Negative self-concept (feeling defective, unworthy, or “too much”)
- Chronic relationship difficulties (fear of abandonment, people-pleasing, emotional numbing)
- Dissociation or feeling disconnected from oneself
- Persistent inner critic or perfectionism
- Deep sensitivity to perceived rejection or criticism
These patterns often take root in early attachment wounds and persist into adulthood—impacting careers, intimacy, friendships, parenting, and one’s sense of identity.
Why C-PTSD Is Often Missed:Subtle PTSD Symptoms
Because many C-PTSD survivors have high-functioning exteriors—they may be successful, articulate, and outwardly calm—their internal distress is overlooked. Many have been told “you had it better than most,” or “nothing that bad happened,” leaving them confused and ashamed of their symptoms.
But trauma is not defined by the event alone. Trauma is the impact of what happened—especially when you had to endure it alone. And in the case of C-PTSD, that impact can be life-altering.
Hope and Healing Are Possible
The good news is that healing is possible, especially when working with a therapist who understands the nuanced impacts of developmental and relational trauma. At Breyta Psychological Services, we specialize in evidence-based therapies for trauma, including Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE)—which are endorsed in the 2025 APA Clinical Practice Guidelines for PTSD.
Recovery from C-PTSD is not about “going back”—it’s about moving forward with compassion, clarity, and support. It means learning to trust yourself again, setting healthy boundaries, and finally feeling safe in your own mind and body.
The Problem with Criterion A: What Happens When Trauma Isn’t “Big Enough”?
Criterion A in the DSM defines trauma as involving death, serious injury, or sexual violence. But research and clinical reality tell us something different:
People can meet all the symptom criteria for PTSDwithout a Criterion A event.
Trauma is about how the nervous system encodes threat, not just the event itself.
Medical procedures, emotional neglect, religious trauma, systemic racism, immigration experiences, infertility, or the loss of a parent to mental illness—these may not be seen as “trauma” in diagnostic manuals, but they often carry posttraumatic symptoms just the same.
How PTSD Affects the Whole Person—and the Whole System
PTSD doesn’t live in isolation. It impacts:
- The body – chronic pain, autoimmune disorders, sleep disturbance, digestive issues
- The mind – intrusive thoughts, memory lapses, attention problems
- Relationships – emotional distancing, conflict, fear of abandonment
- Society – increased healthcare usage, lost productivity, intergenerational trauma
According to the National Center for PTSD, approximately 6% of U.S. adults will develop PTSD at some point. Rates are significantly higher for those who’ve experienced childhood abuse, sexual assault, or racialized violence. This percentage is also a conservative number, given that many people may not recognize difficulty they may be having as such, or even if they did stigma or fear may prevent them from seeking care.
Treatments That Work: According to the APA’s 2025 PTSD Treatment Guidelines
Unfortunately, misinformation abounds—and not all trauma treatments are created equal.
According to the APA Clinical Practice Guidelines (2025) for PTSD, the treatments with the strongest evidence include:
- Cognitive Processing Therapy (CPT)
Focuses on identifying and shifting trauma-related beliefs. - Prolonged Exposure (PE)
Uses safe, structured exposure to trauma memories and triggers to decrease avoidance and rewire the brain. - Cognitive Behavioral Therapy (CBT) for PTSD
Helps patients reevaluate maladaptive thoughts related to the trauma.
CPT and PE are both forms of CBT that are specifically formulated to treat PTSD.
Note: While EMDR is popular, it was given an “Insufficient Evidence” rating in the 2025 APA guidelines. It’s not recommended as a first-line treatment.
At Breyta, we only use evidence-based trauma therapies rooted in research and adapted with compassion.
PTSD Is Treatable. Healing Is Possible.
It bears repeating: PTSD is not a life sentence.
With the right treatment, people recover. The brain rewires. Emotional regulation returns. Relationships repair. People rediscover joy, connection, and safety.
What makes trauma therapy successful? Here are some qualities of effective PTSD treatment:
- A trusting, attuned relationship with your therapist
- A structured, evidence-based treatment plan
- A pace that honors both your nervous system and your values
- Compassion for all parts of your story
PTSD Symptoms Won’t Last Forever With Effective Treatment
PTSD tells you that the world is dangerous, that people can’t be trusted, and that you’re not safe inside your own body.
Recovering from PTSD and trauma-related symptoms is about slowly unlearning those messages—not by force, but by choice, and in relationship.
At Breyta Psychological Services, we walk beside you with skill, care, and hope. Because trauma may shape you, but it doesn’t have to define you. And recovery is not only possible—it’s waiting.
We hope this guide has been helpful in answering the question, “What is PTSD?” If you’re looking for PTSD therapy in Raleigh, NC, or anywhere in North Carolina, our trauma specialists at Breyta Psychological Services are here to help. We offer both in-person and telehealth PTSD counseling to support your recovery journey.
Contact us today! We’re here to answer any questions you may have about treatment for PTSD. You can schedule a free consult or get started with a first appointment. You’re not alone. Recovery from PTSD is possible with help. We’re here when you’re ready.
