February 28, 2025 | Dana Harron

Do You Have to be Diagnosed with PTSD to Benefit from Trauma Treatment?

Absolutely not. PTSD is currently the only prolonged trauma response recognized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). However, and this is a big however, the DSM-5 is far from infallible.

In fact, it has significant shortcomings. Most specialists in any psychology subfield agree that the clinical presentations they encounter in real-world practice are not always accurately reflected in the DSM. This book has undergone many iterations and, until 1973, even classified homosexuality as a mental disorder. This limitation is especially true for trauma psychologists, who have been advocating for more inclusive diagnoses for years.

Understanding PTSD (Post-Traumatic Stress Disorder) and Its Diagnostic Limitations

How Your Body and Brain Respond to Trauma

PTSD is often understood as a trauma response triggered by a single event, such as a car accident or assault. According to the DSM-5, a PTSD diagnosis requires direct exposure to “death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence” through direct experience, witnessing, learning about it happening to a close friend or family member, or repeated exposure through professional duties (e.g., first responders).

The problem is that trauma responses aren’t solely defined by the event itself but rather by how your body and brain react to it. Some people experience highly distressing events without developing a trauma response, while others develop significant trauma symptoms from repeated or seemingly smaller incidents.

How Trauma Affects the Nervous System

A trauma response disrupts the body’s natural “alarm” system. You may have heard of the fight or flight response—your body’s built-in defense mechanism when facing danger. This involves a cascade of physiological reactions designed to increase your chances of survival. Another, lesser-known response involves the vagus nerve, which can cause immobilization—essentially freezing in response to a perceived threat so that a predator might miss that we’re there or assume we’re dead.

In a healthy system, these responses activate when needed and then subside. However, for those who have experienced trauma, these mechanisms become dysregulated. The body may sound false alarms in safe situations or fail to respond appropriately to real threats. Additionally, trauma can lead to emotional numbing, where not only fear and distress are suppressed, but positive emotions as well.

Many PTSD symptoms—such as flashbacks, nightmares, emotional numbing, and hypervigilance—stem from these nervous system disruptions. However, trauma responses vary widely, and the PTSD framework does not capture all trauma-related experiences. This diagnostic focus on specific traumatic events can also prevent many individuals from recognizing their own trauma and seeking the help they need.

Understanding Acute Stress Disorder

Another limitation of the PTSD diagnosis is the requirement that symptoms persist for at least a month. A lesser-known condition, acute stress disorder, describes trauma responses lasting between three days and one month post-trauma. While some individuals recover within this timeframe, the one-month cut-off is an arbitrary distinction that doesn’t reflect the complexity of trauma recovery.

Understanding Complex PTSD (C-PTSD)

Unlike PTSD, complex post-traumatic stress disorder (C-PTSD) arises from repeated or prolonged exposure to trauma rather than a single, isolated event. The trauma involved may meet PTSD criteria, or it may consist of smaller, cumulative experiences that collectively result in a trauma response.

C-PTSD is commonly associated with chronic abuse, neglect, or exposure to unsafe environments. For instance, growing up without emotional warmth or living in a high-risk area—even without directly experiencing violence—can contribute to complex trauma. Unfortunately, many people with C-PTSD struggle with self-doubt about whether their experiences “qualify” as trauma or warrant treatment.

Complex trauma is extremely common for people that live in violent or under-resourced places, and as such it has a strong social justice component.

When I was completing my dissertation on trauma interventions for children, I sent out an open call in the largely low-income neighborhood that I was in. Upon family interviews I discovered that only one child had not experienced a traumatic event out of a class of thirty. The children were eight years old.

Understanding Developmental Trauma Disorder

Developmental trauma disorder (DTD) is another term used to describe C-PTSD, with a specific focus on how trauma affects a person’s development. When trauma occurs in childhood, it not only causes distress but also disrupts crucial developmental processes. When you describe someone as having developmental trauma disorder, you are really thinking about the effect that traumatic experience has had on development.

If discrete or complex trauma happened in the context of childhood, a person not only has to deal with the fallout from the event itself but the fact that it disrupts the other things you’re meant to be dealing with. When the brain and body feel they are fighting for survival, they can not and will not spend energy on other things. A child facing chronic trauma may struggle with emotional regulation, distress tolerance, and interpersonal skills—areas often addressed in Dialectical Behavior Therapy (DBT). Since the brain prioritizes survival, these children may not have the capacity to develop the emotional and social skills necessary for adulthood.

Understanding Dissociative Disorders

Dissociative disorders often stem from trauma and manifest as disruptions in identity, memory, and perception. Many people with dissociation describe feeling as though they are in a movie.

Depersonalization – Feeling detached from one’s own body, as though observing oneself from the outside.
Derealization – Feeling disconnected from reality, as though the world around you is unreal.

At the extreme end of the spectrum, Dissociative Identity Disorder (DID)—formerly known as multiple personality disorder—involves distinct identity states as a response to severe trauma. However, dissociation exists on a continuum, and even mild symptoms (such as feeling emotionally disconnected or experiencing rapid mood shifts) can be indicative of trauma-related dissociation.

Seeking Trauma Treatment

Regardless of whether you have a formal PTSD diagnosis, trauma-informed therapy can be life-changing. Trauma is not just about what happened to you—it’s about how your body and mind have responded to it. If you experience distressing symptoms related to past events, you deserve support.

When seeking treatment, it’s crucial to work with a therapist who specializes in trauma. Consider interviewing multiple providers to find someone who makes you feel safe and understood. Effective trauma treatment can help you regain a sense of peace, security, and emotional freedom.

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Healing from Trauma: Why You Don’t Need a PTSD Diagnosis for Therapy