Nightmares or Intrusive Thoughts? Could Your Anxiety Be a Trauma Symptom?
Written by Elizabeth Bird, PhDHave you been wondering why you keep having bad dreams or feel “on edge”? You might think it’s “just anxiety” but sometimes, those symptoms are actually your body’s way of saying, “Hey, something hard happened, and I’m not done processing it.”
Many people know that trauma can have lasting effects on mental health, but it’s common to seek help for symptoms like anxiety, irritability, or sleep problems without realizing they might actually be connected to past trauma. Understanding what trauma symptoms look and feel like can help you determine whether your experiences could be rooted in trauma and whether trauma-focused therapy could help.
Evidence-based treatments like Prolonged Exposure Therapy and Cognitive Processing Therapy are the gold standard treatments for posttraumatic stress disorder (PTSD), as recommended by the American Psychological Association (APA). These are the treatments we offer and the APA outlines other therapies that are available elsewhere.
What Is Trauma?
Trauma occurs when your life, physical safety, or bodily integrity is at risk or when you are physically harmed. It can also occur from witnessing these events, or even through the nature of one’s work (for example, first responders or healthcare professionals).
Common examples of traumatic events include:
Physical or sexual assault or abuse
Natural disasters and other accidents
Vehicle accidents
Traumatic childbirth and other serious medical events
Combat or war-related experiences
Some people experience a single traumatic event, while others endure chronic or repeated exposure to threat or harm, such as in unsafe relationships or environments.
We know now that people don’t “repress” memories. Sometimes people avoid thinking about these things so much that they don’t remember many details or they don’t think about it for a very long time but if you don’t have any memories of any traumatic events, then your anxiety is not PTSD. You can still get effective evidence-based help and if you aren’t sure if what you experienced was a trauma or aren’t sure if it could lead to PTSD, talking to an expert can be a good place to start.
When Trauma Symptoms Become PTSD
Many people experience anxiety, nightmares, or intrusive memories in the weeks following trauma. These symptoms often fade as long as safety has been restored.
When symptoms persist beyond a month and significantly disrupt daily life, they may indicate posttraumatic stress disorder (PTSD). Symptoms may be connected to trauma if they begin or worsen after the event.
The Four Categories of PTSD Symptoms
PTSD symptoms are grouped into four main categories. People experience them differently. Not everyone with PTSD looks or acts the same way.
1. Reexperiencing Symptoms
These include nightmares, intrusive thoughts, or flashbacks of the traumatic event. Nightmares don’t have to replay the trauma directly. They often carry themes of danger like being chased, trying to help others get to safety, or being trapped instead. Some people wake up startled or sweating without remembering the dream. This is different than stress dreams like showing up for a test without studying.
Intrusive memories may appear uncued (seemingly random) or triggered by something that reminds you of the trauma. Flashbacks are less common but can feel as though the event is happening again, which can be disorienting and frightening. When reminded of the event, people often feel physical symptoms of anxiety such as racing heart, sweaty, tight chest, etc.
2. Hyperarousal Symptoms
These symptoms reflect a body that remains “on alert,” such as:
Startling easily
Difficulty falling or staying asleep
Feeling on edge or irritable
Trouble waiting in lines or relaxing
Think of your nervous system as being stuck in survival mode like being in a haunted house where your body expects something bad to happen at any moment. Irritability often arises because constant anxiety leaves little capacity for patience.
3. Changes in Thoughts and Mood
Trauma often changes how you view yourself, others, and the world. Changes in how you think about trust, safety, power and control, intimacy, and esteem are common. Alternatively, you might already think this way and then experiencing trauma might reinforce these beliefs. Sometimes trauma happens when we are young and so we can’t differentiate very well between before and after trauma.
Examples of common beliefs after trauma are:
“The world is unsafe.”
“Other people/I can’t be trusted.”
“I’m broken.”
“If I don’t stay in control, something bad will happen.”
“If I get close to someone they will hurt me/I will lose them”
“If I let myself feel my emotions/think about what happened then it will break me”
People also experience symptoms of depression like losing interest in activities, withdrawing socially, or feeling disconnected from others. If depression starts or gets worse following trauma, then it might be part of PTSD.
4. Avoidance
Avoidance can involve pushing away thoughts and memories by keeping excessively busy or avoiding triggers like certain people, places, sensations, images, etc.
You might avoid your memories, feelings, and people/places/things for two reasons:
Because you think something is unsafe now (e.g., avoiding driving after a car accident).
Because you don’t want to be reminded of the trauma or feel anxious.
However, over time, avoidance can make life smaller and more constrained. Avoidance can also be sneaky. Sometimes we don’t realize we’re doing it but it can keep you from healing and eventually, symptoms often “leak out” despite your best efforts to suppress them.
When to Seek Help
If you recognize these experiences in yourself, it may be time to talk with a therapist who specializes in PTSD. Many people feel nervous about starting treatment, but trauma therapy can be profoundly healing.
Bottom Line
Nightmares, anxiety, or intrusive thoughts aren’t always “just stress.” Sometimes, they’re the lingering echoes of trauma that you haven’t had the chance to process. Evidence-based therapies like Prolonged Exposure therapy and Cognitive Processing Therapy can help you feel safe, grounded, and connected again.
Reach out to Dr. Bird or Dr. Enkema for a free 20-minute consult to explore what treatment might look like for you.
