PTSD, Complex Trauma, and How Stress Can Accumulate Over Time

A conversation with Dr. Audrey Shilander of Nevada Mental Health

PTSD is often discussed as though it always starts with one obvious event: a car accident, combat exposure, sexual violence, a violent assault, or another moment when a person’s life or safety was clearly threatened.

For many people, PTSD does begin that way. But trauma can also be more layered. Repeated stress, unsafe relationships, childhood neglect, community violence, food insecurity, military training, combat exposure, and other experiences can build over time. Later, when another difficult event happens, the response may be shaped by everything that came before it.

“PTSD is going to be different for every person,” said Dr. Audrey Shilander, a psychiatrist at Nevada Mental Health who specializes in mood, anxiety, and trauma disorders.

Two people can go through the same event, she explained, and only one may develop PTSD. That does not mean one person is stronger than the other. It means trauma, biology, support systems, early experiences, and current stressors all matter.

What PTSD Means Clinically

PTSD stands for post-traumatic stress disorder. In psychiatry, diagnosis is guided by the DSM-5-TR, which gives clinicians a shared set of criteria for mental health diagnoses. For PTSD, the first requirement is often called Criterion A. This means the person was exposed to actual or threatened death, serious injury, or sexual violence.

After that kind of exposure, PTSD symptoms may include intrusive thoughts, flashbacks, nightmares, avoidance of reminders, hypervigilance, sleep problems, irritability, difficulty concentrating, feeling detached, or difficulty trusting other people.

Dr. Shilander described hypervigilance as the feeling of being highly aware of one’s surroundings, such as sitting with your back to a wall in a restaurant so you can see the exits and plan an escape if needed.

For others, the story is more complicated.

Trauma Can Build Over Time

Dr. Shilander noted that a person’s vulnerability to PTSD can begin early in life.

“For a lot of individuals, if they’ve had what we call adverse childhood experiences, and that can be any host of things, abuse of some sort, maybe neglect, maybe living in an area where there’s a lot of violence or war, all of these experiences build up,” she said.

Those experiences may not always look like one single dramatic incident from the outside. But they can teach the brain and body that the world is unsafe.

Over time, people may learn coping strategies that once helped them survive. They may become extremely alert to other people’s moods, avoid conflict, have trouble trusting others, shut down emotionally, or feel intense fear or anger when a current stressor resembles something from the past.

Those patterns can affect work, school, home life, relationships, sleep, and physical health. They can also overlap with symptoms of anxiety, depression, insomnia, substance use, or other mental health concerns.

What If It Does Not Meet the Full PTSD Criteria?

This is where trauma can become confusing for patients. Someone may know that a past experience changed them. They may feel jumpy, disconnected, mistrustful, emotionally reactive, or unable to relax. But when they read about PTSD online, they may wonder whether their experience “counts.”

Dr. Shilander emphasized that not meeting the full DSM criteria for PTSD does not mean a person’s experience was harmless.

“Even if that Criterion A isn’t met, it doesn’t mean that they haven’t still had experiences that were traumatic or felt traumatic,” she said. “It impacts how you function in your world.”

In psychiatry, there may be other ways to understand what is happening, including adjustment disorder, anxiety, depression, trauma-related symptoms, or relationship patterns shaped by earlier experiences.

That is why self-diagnosis can only take a person so far. Reading about PTSD or complex trauma online can provide language for what someone is feeling, but a full psychiatric evaluation looks at symptoms, timeline, medical history, family history, medications, substance use, sleep, safety, functioning, and life context. Our guide to what to expect at Nevada Mental Health explains how the process begins.

Understanding Complex PTSD

Many people have also heard the term complex PTSD, sometimes written as C-PTSD. In everyday conversation, this usually refers to trauma that is repeated, prolonged, interpersonal, or difficult to escape, especially when it happens during childhood or in relationships where trust and safety should have existed.

Complex trauma can involve PTSD symptoms, but it may also include broader patterns such as difficulty regulating emotions, unstable relationships, shame, self-blame, dissociation, or coping behaviors that once served a purpose but now create harm. Clinically, the exact diagnosis may vary, but the concept can help patients and providers talk about how repeated trauma may shape emotion, trust, relationships, and self-protection.

How Psychiatric Care Can Help

PTSD and trauma-related symptoms are treatable. Care may include therapy, psychiatric medication when appropriate, support for sleep, coping skills, safety planning, or treatment for related conditions such as anxiety, depression, ADHD, or substance use concerns.

At Nevada Mental Health, adult psychiatry starts with understanding the full person. For some patients, medication may help reduce symptoms enough to make therapy and daily coping more manageable. For others, the first step may be diagnostic clarity, referral to trauma-focused therapy, or practical tools for sleep, stress, and emotional regulation.

If medication is part of the plan, a psychiatric medication evaluation can help determine what is appropriate based on symptoms, medical history, prior treatment, and the patient’s goals.

Trauma-informed care can also help patients make sense of patterns that may have felt like personal failures. A person who is guarded, reactive, avoidant, or disconnected may have learned strategies that once helped them survive. Treatment can help.

You Do Not Have to Wait Until Everything Falls Apart

Many people wait to seek help because they are not sure their trauma was “bad enough,” or because they are worried they will not meet the official criteria for PTSD. You do not need to diagnose yourself before asking for support.

If past experiences are affecting your sleep, relationships, work, school, sense of safety, or ability to feel present in your life, it may be time to talk with a professional.

Nevada Mental Health provides psychiatric care for patients in Las Vegas, Reno, and across the state through in-person and online psychiatry in Nevada. If trauma, anxiety, depression, or chronic stress is affecting how you function, support is available.

If you or someone you know is in immediate danger, thinking about suicide, or unable to stay safe, call 911 or call or text 988 for the Suicide and Crisis Lifeline.