A patient described waking up in the middle of the night, heart racing, covered in sweat, reliving a car accident from five years ago. "It feels like it's happening again," she said. This wasn't just a bad memory. This was PTSD—specifically, the re-experiencing symptoms that occur when trauma memories, stored in the amygdala without proper integration into the hippocampus, get triggered and flood the system as if the trauma is happening now.
Trauma disorders aren't just "remembering bad things." They're dysregulation of memory processing and threat detection—specifically, how the brain encodes, stores, and retrieves traumatic memories. When trauma occurs, the amygdala activates intensely while the hippocampus—responsible for contextualizing memories—may be suppressed. This creates memories that aren't properly integrated: they're stored as raw sensory and emotional data without temporal context, making them feel present rather than past.
What makes integrative psychiatry essential for trauma is recognizing that PTSD has multiple drivers. A patient might have classic PTSD with re-experiencing, avoidance, and hyperarousal, but also dysregulated HPA axis responses, sleep architecture disruption that prevents proper memory consolidation, and sometimes inflammatory activation from chronic stress. I've seen patients whose PTSD symptoms improved dramatically when we addressed their sleep architecture and optimized their stress response—not because trauma is "sleep-related," but because sleep disruption can prevent proper memory processing and maintain hyperarousal.
Patients don't need to understand the neurobiology of the amygdala and hippocampus to benefit from treatment. But they do need to understand that what they're experiencing isn't just "thinking about bad things"—it's a dysregulated memory system that's treating past trauma as present threat. The distinction matters because it changes how we approach treatment. If trauma symptoms are purely cognitive, you'd use cognitive interventions. But when they're neurobiological, you need interventions that target the underlying systems: trauma-focused therapy that processes memories, medications that reduce hyperarousal, and lifestyle modifications that support the nervous system's capacity for regulation.
Here's what I've learned treating hundreds of patients with trauma: PTSD isn't uniform. Some patients have classic PTSD with clear trauma history and classic symptoms. Others have complex PTSD from repeated trauma, affecting identity and relationships. Some have trauma symptoms without meeting full PTSD criteria. Some have trauma stored in the body—somatic symptoms without clear memory. Each requires different approaches. Classic PTSD might respond well to trauma-focused therapy like EMDR or prolonged exposure. Complex PTSD often needs longer-term therapy addressing attachment and identity. Somatic trauma might need body-based approaches.
There's a common misconception that treating trauma is just about talking about what happened. That's part of it, but not all of it. Trauma recovery requires more than processing memories—it requires restoring the nervous system's capacity for regulation, reducing hyperarousal, improving sleep architecture for proper memory consolidation, and often, addressing the attachment patterns and beliefs that trauma created. This is why I assess sleep patterns, autonomic function, stress response, and nervous system regulation alongside traditional psychiatric evaluation.
What I tell patients with trauma: understanding the mechanism matters. Trauma memories are stored differently than normal memories—they're stored in the amygdala as raw sensory and emotional data without proper hippocampal integration. This makes them feel present rather than past. Treatment involves processing these memories so they can be properly integrated—but this requires safety. The nervous system needs to be regulated enough to process trauma without retraumatization. This is why I often start with interventions that increase regulation—medications that reduce hyperarousal, techniques that increase parasympathetic tone, sleep optimization—before diving into trauma processing.
But here's what most articles don't tell you: trauma symptoms can also be a downstream effect of other conditions. Sleep disorders can mimic PTSD hyperarousal. Autonomic dysfunction can cause trauma-like symptoms. Sometimes patients have trauma symptoms but the trauma is stored somatically—in the body—without clear memory. I've worked with patients who had trauma symptoms without clear trauma history, where the trauma was preverbal or stored as body sensations. Proper assessment requires careful history-taking and sometimes body-based approaches—not just assuming trauma symptoms mean PTSD.
What I've learned after years of integrating multiple approaches is that trauma treatment requires safety first. Trauma processing is essential, but it happens best when the nervous system is regulated enough to process without retraumatization. This often means starting with interventions that increase regulation: medications that reduce hyperarousal, techniques that increase parasympathetic tone, sleep optimization, and stress reduction. Once regulation is improved, trauma processing can happen more safely and effectively.
If you're experiencing trauma symptoms, here's my practical guidance: get proper assessment—not just for PTSD, but for sleep disorders, autonomic dysfunction, and other conditions that can cause or maintain trauma symptoms. Treatment requires trauma processing, but it should also involve interventions that restore regulation: sleep optimization, stress reduction, techniques that increase parasympathetic tone, and sometimes medications that reduce hyperarousal. The goal isn't just to process trauma—it's to restore the nervous system's capacity for regulation and integrate traumatic memories so they feel past rather than present.