Trauma and Compulsive Behavior

When Coping With Trauma Starts Causing Harm

Trauma can leave lasting effects after an experience felt physically or emotionally harmful or life-threatening. It can affect how you function and how you feel about yourself, other people, and the world. Those effects matter even when they do not fit a particular diagnosis.^[1][2]

Here, compulsive behavior means something you feel driven to repeat even when you want to stop. The question is not only what the behavior costs you, but what you turn to it for.

The Substance Abuse and Mental Health Services Administration (SAMHSA), a U.S. health agency, describes several ways people may try to manage trauma-related distress, including avoidance, alcohol use, compulsive overeating, and impulsive behavior. These are possible responses, not evidence that every repeated behavior comes from trauma or that everyone who experiences trauma develops addiction.^[2]

You can take both parts seriously: the harm a behavior is causing now and the experience you may be trying to cope with. When post-traumatic stress disorder (PTSD) and substance use problems occur together, treatment can address them at the same time.^[3]

What Counts As Trauma?

SAMHSA defines trauma through the harmful experience and its lasting effects. It may involve one event, repeated events, or ongoing circumstances. Its definition includes effects on mental, physical, social, emotional, or spiritual well-being, not just a visible injury.^[1]

Clinically, trauma and post-traumatic stress disorder are not interchangeable. A traumatic experience is an event or exposure. Post-traumatic stress disorder (PTSD) is a diagnosable condition involving a particular combination, duration, and impact of symptoms. Many people have temporary stress reactions after trauma and do not develop PTSD.^[4]

Events associated with PTSD can include experiencing or witnessing physical or sexual assault, abuse, serious accidents, disasters, terrorism, and other serious events. Learning that a close friend or relative experienced trauma can also lead to PTSD in some circumstances.^[4]

An experience does not have to produce PTSD to matter. Trauma-related symptoms can affect sleep, concentration, mood, relationships, or behavior, and PTSD often co-occurs with depression, substance use, or anxiety disorders. A mental health professional can determine whether symptoms meet PTSD criteria and assess related concerns.^[4]

Is My Experience Bad Enough?

For PTSD, clinicians look at the type of exposure, symptom pattern, duration, impairment, and whether substances, medication, or another illness better explain the symptoms.^[4]

A useful question is “What has changed since it happened?” Consider whether you now avoid reminders, feel persistently unsafe, blame yourself, struggle to experience positive emotions, disconnect from others, or engage in risky, reckless, or destructive behavior.^[4]

For PTSD specifically, diagnosis depends on more than whether something felt deeply painful. In adults, symptoms must include re-experiencing, avoidance, changes in arousal or reactivity, and changes in thinking or mood. They must last longer than one month, interfere with daily life, and not be better explained by substances, medication, or another illness.^[4]

Trauma-related symptoms can interfere with work, relationships, or managing emotions without meeting the full criteria for PTSD. SAMHSA calls these “subthreshold” symptoms, meaning they fall below a particular diagnostic threshold. That distinction helps explain why an assessment can be useful even when you are unsure which label fits.^[2]

What Are Adverse Childhood Experiences?

Adverse childhood experiences (ACEs) are potentially traumatic events occurring from birth through age 17. Examples include violence, abuse, neglect, witnessing violence, or having a family member attempt or die by suicide. ACE frameworks also include household conditions that can undermine safety and stability, such as substance use problems, mental illness, parental separation, or incarceration.^[5]

The Centers for Disease Control and Prevention notes that these examples are not exhaustive. Food insecurity, homelessness, unstable housing, and other experiences may also affect health and well-being. Extended or repeated stress can affect children’s stress-response systems, attention, learning, and decision-making.^[5]

ACE studies find associations between childhood adversity and later behavioral, mental, and physical health outcomes. An association means two things occur together more often than expected. It does not prove that childhood adversity alone caused a later addiction or predict what will happen to one person.^[5]

Is PTSD The Same As Complex PTSD?

No. PTSD is a defined disorder involving symptoms such as reliving a trauma, avoiding reminders, feeling persistently threatened, and experiencing changes in mood, beliefs, or reactivity. Complex post-traumatic stress disorder, or complex PTSD, is a related diagnosis whose definition depends on the diagnostic system being used.^[6]

The International Classification of Diseases, 11th Revision (ICD-11) recognizes complex PTSD as a separate diagnosis. It requires PTSD symptoms plus substantial difficulties regulating emotions, maintaining a stable sense of self, and sustaining relationships. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not list complex PTSD separately. Its broader PTSD criteria include features such as self-blame, persistent negative mood, aggression, and self-destructive behavior.^[6]

Complex PTSD was originally proposed to describe effects associated with prolonged, repeated interpersonal trauma, especially early in life. The current ICD-11 diagnosis is based on symptoms rather than requiring a specific trauma history. Prolonged trauma may raise the likelihood of complex symptoms, but it is not required for the diagnosis.^[6]

There remains debate over whether complex PTSD is distinct from PTSD in type or mainly in severity. Standardized definitions should make future treatment research easier, but it is not yet clear whether the diagnoses require fundamentally different treatment approaches.^[6]

How Can Trauma Affect Daily Life?

Trauma responses do not all look like visible fear. Possible presentations include fear and hyperarousal, low mood or loss of pleasure, anger and outwardly directed behavior, and dissociation. These are useful ways to understand different patterns, not a complete diagnostic checklist.^[4]

A person may have symptoms from more than one pattern. PTSD symptoms can include feeling detached, becoming tense or on guard around reminders, and avoiding places, situations, thoughts, or feelings connected to what happened. PTSD can also co-occur with substance use, which should not be assumed to have been caused by trauma.^[4]

Fear And Hyperarousal

Hyperarousal means the body remains prepared for danger even when no immediate threat is present. It can feel like being tense, watchful, easily startled, irritable, unable to concentrate, or unable to sleep. PTSD can also involve physical stress reactions such as sweating or a racing heart.^[4]

Fear may be tied to clear reminders, but it can also feel generalized. A person may stop driving after a serious crash, avoid crowds after an assault, or become distressed by a sound, smell, message, or location associated with the experience. Avoidance can reduce distress temporarily while progressively narrowing daily life.^[4][7]

People whose main experience is persistent tension or worry may also need assessment for an anxiety disorder, because PTSD often co-occurs with anxiety disorders.^[4]

Numbness, Low Mood, And Loss Of Pleasure

PTSD-related changes in thinking and mood can include social isolation, ongoing fear, anger, guilt or shame, loss of interest in previous activities, and difficulty feeling happiness or satisfaction.^[4]

PTSD can include sleep disruption, social withdrawal or detachment, guilt, and loss of interest. A thorough assessment matters because PTSD often co-occurs with depression, substance use, and anxiety disorders, and symptoms can also have other explanations.^[4]

Anger And Externalizing Behavior

PTSD can include irritability, angry or aggressive outbursts, and risky, reckless, or destructive behavior. These behaviors alone do not establish PTSD because diagnosis requires the full symptom pattern and assessment by a mental health professional.^[4]

Understanding anger as a possible signal of distress does not excuse harm. Safety, accountability, and protection of other people remain important. A trauma-informed assessment can consider aggressive behavior alongside possible triggers, emotions, or PTSD symptoms.^[4][2]

Dissociation And Disconnection

Here, dissociation means feeling detached from an experience, as though observing it as an outsider rather than experiencing it directly. This can occur after a dangerous event.^[4]

Some detachment immediately after danger can be a natural stress response. PTSD may also involve difficulty recalling parts of the event, feeling cut off from others, or experiencing flashbacks that make the past feel present. The DSM framework also recognizes a dissociative subtype, meaning a PTSD presentation in which dissociation is prominent.^[4][6]

Dissociation is associated with some complex trauma presentations, but it is not an essential feature of every case of complex PTSD. Research suggests there may be groups of people with complex PTSD both with and without substantial dissociation.^[6]

Dissociation can include feeling detached from the experience, while PTSD can also involve trouble remembering key parts of a traumatic event. Alcohol or drugs can impair judgment, so assessment should include substance use and related safety concerns when these problems occur together.^[4][3]

Why Can Trauma Lead to Repeated Harmful Behavior?

A behavior may be connected to what it changes in the moment. SAMHSA describes people using avoidant, compulsive, impulsive, or self-medicating behaviors to manage the intensity of a trauma response. The connection is possible, but a clinician still needs to understand your particular experience and behavior.^[2]

Avoidance shows how short-term relief can become a longer-term problem. Staying away from a reminder may reduce distress at first. Over time, avoiding more situations can strengthen the sense that they are dangerous or unbearable and interfere with relationships or other parts of life.^[2]

Alcohol and drugs may be used to relax, feel more comfortable socially, or avoid unwanted thoughts and feelings. However, substance use can worsen sleep, increase irritability, impair judgment, and create medical, relationship, work, or school problems.^[3]

Compulsive overeating is another example in SAMHSA’s guidance on managing traumatic distress. It is one possible response described there, not an explanation for everyone who overeats.^[2]

If eating is the behavior that worries you, consider these questions: What happens just before the urge? Are you physically hungry, upset, remembering something, or unsure? What changes while you eat, and how do you feel afterward? Bring those observations to an assessment rather than deciding on a cause yourself.

The Visible Behavior Is Only One Layer

PTSD symptoms and substance use problems can occur together. Substance use can affect relationships, work, school, and the ability to meet responsibilities.^[3]

Care can address both the reasons substance use feels useful in the short term and the problems it creates. Concurrent treatment can help people work on PTSD symptoms and substance use while developing other coping methods.^[3]

Trauma History Does Not Prove Causation

A trauma history by itself does not prove that later substance misuse or another harmful behavior was caused by trauma. Observational studies can identify associations, and PTSD may co-occur with depression, anxiety disorders, or substance use, so assessment should consider more than trauma alone.^[8][4]

Research on childhood sexual abuse illustrates both the importance and limits of population evidence. An umbrella review, which evaluates findings from multiple research reviews, included 19 meta-analyses. A meta-analysis combines results from several studies. Together, these reviews covered 559 primary studies—meaning the original studies analyzed—and 4,089,547 participants. Childhood sexual abuse was associated with 26 of 28 examined adult psychiatric, psychosocial, and physical health outcomes.^[8]

Those findings came from observational research, which can identify associations but cannot by itself prove causation. The review also found that evidence quality differed across outcomes. Reviews concerning PTSD, schizophrenia, and substance misuse met its high-quality standards, while evidence for some other outcomes was rated moderate or low.^[8]

The practical conclusion is not that abuse determines a person’s future. Childhood sexual abuse has been associated with later outcomes, but the umbrella review does not prove that abuse causes a specific person’s current behavior.^[8]

Trauma In Children

Children and adolescents may show distress through physical symptoms and behavior after traumatic events. A parent may notice stomachaches, headaches, nightmares, concentration problems, loss of interest, guilt, revenge thoughts, withdrawal, or changes in school performance.^[9]

Age affects how distress appears. Young children may become clingy, fearful, irritable, disruptive, or tearful. They may return to bed-wetting or thumb-sucking and may repeat parts of an event in play. Older children and adolescents may avoid reminders, isolate themselves, use substances, become angry, or act in disruptive, disrespectful, or destructive ways.^[9]

These reactions do not automatically mean a child has PTSD. Many reactions after trauma lessen with time, but sudden changes or symptoms lasting more than a few weeks should prompt attention or contact with a health care provider.^[9][4]

Why Might A Child Look Angry Instead Of Afraid?

After traumatic events, older children and teenagers may show disruptive or destructive behavior, anger, resentment, guilt, or thoughts of revenge. Younger children may have tantrums or become irritable and disruptive.^[9][4]

Try to stay calm and supportive. Pay attention to sudden behavioral changes, and avoid getting angry if the child acts out or shows strong emotions.^[9]

What Can Parents Do After A Traumatic Event?

Begin with physical and emotional safety. Address basic needs, reduce avoidable stress, and maintain familiar routines such as bedtime stories, eating dinner together, and playing games. Allow the child to talk, write, draw, or remain quiet rather than forcing a detailed conversation before they are ready.^[9]

Try to remain calm, even if the child’s behavior is upsetting. Avoid demanding that they be brave or tough. Do not become angry about regression, intense feelings, or acting out, and do not make promises about what will happen next if you cannot guarantee them.^[9]

Help children feel some control by offering choices, such as picking their clothes or meals. Caregivers can also seek support for their own reactions.^[9]

Many reactions lessen over time. The National Institute of Mental Health advises contacting a health care provider when symptoms last more than a month. It also advises seeking help when new concerns such as flashbacks, strong physical stress reactions, emotional numbness, or marked depression continue for more than a few weeks.^[9]

After Online Abuse Or Exploitation

If online contact involved suspected or disclosed child sexual abuse, the same principles for responding to a disclosure apply. A calm, supportive response and appropriate medical, mental health, and protective help are important.^[10]

A child may disclose only part of what happened. Disclosure means telling someone about sexual abuse. It can unfold over weeks, months, or years, and younger children may lack the vocabulary to describe the experience. Fear of blame, punishment, family disruption, retaliation, or not being believed may delay disclosure.^[10]

If your child tells you about abuse, stay as calm as possible. Believe the child, state clearly that the abuse was not their fault, praise them for telling you, and take steps to separate them from the person who harmed them. Do not promise secrecy because protecting the child may require involving other adults or authorities.^[10]

Seek appropriate medical care and a mental health professional experienced in child sexual abuse. The National Child Traumatic Stress Network also recommends reporting abuse to local authorities. For immediate danger, call 911. The Childhelp National Child Abuse Hotline is available at 1-800-422-4453⁠.^[10]

A child may later retract a disclosure. This is called recantation. The National Child Traumatic Stress Network explains that recantation can follow secrecy, denial or difficulty accepting the abuse, family pressure, mixed feelings about the offender, or distress about what happened after disclosure. It should not automatically be treated as proof that the original disclosure was false.^[10]

A pediatrician or mental health professional knowledgeable about child sexual abuse can help if you are concerned about how to speak with your child or what support the child needs.^[10]

Can Trauma And Addiction Be Treated Together?

Yes. PTSD and substance use problems can be treated concurrently, meaning at the same time. Concurrent treatment may involve two therapies delivered by different clinicians or one integrated treatment addressing both conditions with the same therapist.^[3]

Research summarized by the National Center for PTSD indicates that trauma-focused psychotherapies remain effective options for people with PTSD whether or not they also have a substance use disorder. Supported PTSD treatments include Cognitive Processing Therapy, Prolonged Exposure, and Eye Movement Desensitization and Reprocessing.^[3]

Substance use treatment may include motivational enhancement, cognitive behavioral therapy, contingency management, and relapse prevention. Motivational enhancement builds readiness for change. Cognitive behavioral therapy helps people recognize, avoid, and cope with situations in which they are likely to use substances. Contingency management uses structured rewards for treatment goals, while relapse prevention prepares a person to recognize and respond to situations associated with renewed use.^[3]

Medication may also be part of substance use treatment. Certain medications can reduce the pleasure associated with alcohol or drugs, reduce cravings, and help with withdrawal symptoms.^[3]

What Usually Happens First?

Treatment planning should be individualized around the person’s symptoms and needs. When relevant, care may need to account for immediate danger, ongoing trauma, PTSD symptoms, substance use, medication issues, and co-occurring concerns such as depression, anxiety, or suicidal thoughts.^[4][3]

Practical priorities can include:

1. Address immediate safety. In a life-threatening situation, call 911. If there are suicidal thoughts, call or text 988. Ongoing abuse or danger may need attention alongside symptom treatment.^[4]
2. Assess the whole picture. Evaluation can include PTSD symptoms, substance use, depression, anxiety, suicidal thoughts, sleep, relationships, work, school, responsibilities, and daily functioning.^[4][3]
3. Build skills and support. Treatment may include learning to identify triggers, manage symptoms, use coping strategies, and involve trusted support when appropriate.^[4]
4. Treat PTSD and substance use together when both are present. This may involve separate therapies at the same time or an integrated treatment.^[3]
5. Review progress with the provider. If symptoms are not improving, the treatment plan can be revisited.^[4]

When trauma is ongoing, such as in an abusive relationship, treatment is usually most effective when it addresses both the traumatic situation and the symptoms of PTSD.^[4]

Trauma-informed care also emphasizes physical and psychological safety, trust, transparency, collaboration, peer support, empowerment, voice, and choice. It seeks to recognize trauma responses while avoiding practices that unnecessarily recreate helplessness or loss of control.^[11]

Having substance use problems does not automatically mean PTSD treatment must wait until a person is symptom-free. National Center for PTSD guidance says PTSD and substance use problems can be treated at the same time through concurrent treatment, including separate therapies or an integrated approach.^[3]

When Substance Use Is Part Of The Pattern

When drug or alcohol use reaches the level of addiction, Veterans Affairs guidance calls it substance use disorder (SUD). Substance use, especially at that level, can involve medical problems, trouble in relationships, difficulty keeping a job or staying in school, and problems meeting responsibilities.^[3]

Substance use may begin as an attempt to sleep, relax, socialize, or deal with thoughts and feelings the person would rather avoid. It can then worsen sleep, irritation, avoidance, judgment, and functioning. People with both PTSD and substance use disorders also have an increased risk of depression, anxiety, and suicide.^[3]

Concurrent treatment does not mean ignoring substance use while discussing trauma. It means both problems have active treatment plans. One plan might target cravings, high-risk situations, and relapse risk, while another addresses traumatic memories, avoidance, guilt or shame, or arousal symptoms such as feeling tense or easily startled.^[3][4]

COPE, short for Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure, combines trauma-focused PTSD treatment with substance use treatment. Studies involving veterans and civilians have shown improvement in PTSD symptoms, although that finding does not guarantee an individual result.^[3]

Mutual support and self-help programs may be helpful for some people with both PTSD and drug or alcohol problems, but they do not focus on treating PTSD. Combining mutual support with concurrent treatment is an option.^[3]

What Does Trauma Treatment Involve?

PTSD treatment is not simply retelling everything that happened. Different therapies work through memories, beliefs, emotions, and avoidance in different ways. A provider can explain an approach and discuss its likely benefits, risks, discomforts, alternatives, and how it fits the person’s preferences.^[12][13][7]

For PTSD, the National Center for PTSD identifies trauma-focused psychotherapy as the talk therapy with the strongest research support. “Trauma-focused” means treatment directly addresses the traumatic event and what it means to the person. Leading options include Cognitive Processing Therapy, Prolonged Exposure, and Eye Movement Desensitization and Reprocessing.^[12]

No one option is right for everyone. Choice can reflect benefits, risks, side effects, treatment goals, personal preferences, questions for the provider, and practical differences such as talking or writing, between-session practice, and individual or group formats.^[12][13][7]

Cognitive Processing Therapy

Cognitive Processing Therapy (CPT) helps a person examine distressing conclusions formed around trauma. These might include “It was my fault,” “No one can be trusted,” or “I am permanently damaged.” Treatment teaches the person to evaluate whether the evidence supports these beliefs and consider a more accurate perspective.^[13]

CPT does not necessarily begin with a detailed account of the event. Early sessions include education about PTSD and discussion of how the trauma has affected the person. Later work may address beliefs involving safety, trust, control, self-esteem, and intimacy. Detailed trauma writing can be included if the person and therapist decide it would help.^[13]

CPT is available in individual or group formats and typically involves worksheets and practice between sessions. The Veterans Affairs description says it usually consists of 12 weekly sessions over about three months, although actual care can vary.^[13]

Prolonged Exposure

Prolonged Exposure (PE) helps people gradually approach trauma-related memories and emotions, along with safe people, places, or activities they have avoided. The process is planned and progressive rather than forcing someone into an overwhelming situation.^[7]

A person and therapist may create a list of avoided but safe situations, then work through it in manageable steps. Treatment also involves talking about the trauma in detail. Between sessions, the person practices approaching safe situations and may listen to a recording of trauma-focused work completed in therapy.^[7]

PE generally involves 8 to 15 weekly sessions lasting 60 to 90 minutes, or about three months in the Veterans Affairs description. Discussing memories and changing avoidance can cause temporary mild-to-moderate discomfort.^[7]

Eye Movement Desensitization And Reprocessing

Eye Movement Desensitization and Reprocessing (EMDR) is an individual PTSD therapy in which a person brings a traumatic memory to mind while attending to alternating movement or sound, such as a finger moving from side to side or tones alternating between ears.^[14]

Treatment begins with education, readiness assessment, and coping preparation. The person then identifies a memory and its associated thoughts, feelings, and bodily sensations. They focus on these while attending to brief periods of back-and-forth stimulation, pausing to discuss what they noticed.^[14]

EMDR does not usually require describing every detail aloud, although the person does think about the trauma during sessions. It generally does not require homework. The Veterans Affairs description estimates about three months of weekly 50-to-90-minute sessions, but individual courses vary.^[14]

A 2017 meta-analysis included eight randomized controlled trials involving 295 children and adolescents.^[15] These trials assign participants by chance to treatment or comparison groups.

EMDR reduced post-traumatic and anxiety symptoms more than waitlist or placebo conditions, meaning delayed-treatment or inactive comparison groups. Results were described as comparable with cognitive behavioral therapy, but larger studies are needed to clarify differences. The depressive-symptom difference did not meet the analysis’s threshold for ruling out chance.^[15]

Because only eight studies were included and the combined sample was small, the authors described the findings as preliminary and called for larger studies. The analysis did not establish that EMDR is superior to cognitive behavioral therapy for young people.^[15]

Medication

Medication can be used alone or with psychotherapy for PTSD. The U.S. Food and Drug Administration has approved two selective serotonin reuptake inhibitors, a class of antidepressants, for PTSD. Other medicines may be prescribed for PTSD or particular symptoms depending on individual circumstances.^[4]

The National Center for PTSD identifies sertraline, paroxetine, and venlafaxine as medication options with substantial evidence. Benefits take time to develop and generally end after the medicine is stopped. A prescriber should monitor response and side effects and discuss changes when needed.^[12]

Medication may help manage PTSD symptoms such as sadness, worry, anger, emotional numbness, sleep problems, or nightmares. A health care provider can help decide whether medication is appropriate for a particular person.^[4]

What Does Recovery From Trauma Involve?

The National Institute of Mental Health advises expecting symptoms to improve gradually rather than immediately. A treatment plan can address the symptoms and daily difficulties that matter to you.^[4]

PTSD psychotherapy often follows a structured course. The National Institute of Mental Health says psychotherapy commonly lasts 6 to 12 weeks but can continue longer. Specific trauma-focused programs commonly run for about 8 to 16 sessions, while CPT, PE, and EMDR are often described as lasting roughly three months.^[4][12]

These are treatment formats, not recovery deadlines. PTSD’s course varies. Some people recover within six months, while others have symptoms for one year or longer. Ongoing trauma, co-occurring depression, anxiety or substance use, stressors such as losing a job or home, social support, and treatment fit can affect care planning and recovery.^[4][12]

If symptoms are not improving after six to eight weeks, the National Institute of Mental Health recommends talking with the health care provider. That conversation can cover whether symptoms fit PTSD, whether ongoing trauma or co-occurring conditions are interfering, and whether another evidence-based option might fit better.^[4][12]

What Progress Can Look Like

You and your provider can discuss progress in the areas affected by symptoms and treatment, such as the following.^{[4][13][7][12]}

• Recognizing a trigger sooner
• Reducing risky, reckless, or destructive behavior
• Using alcohol or drugs less or avoiding them
• Sleeping more consistently
• Returning to safe activities that had been avoided
• Feeling less inappropriate blame for what happened
• Seeking support when it is needed

A temporary increase in emotion can occur when someone begins approaching memories or situations they have avoided. Cognitive Processing Therapy, Prolonged Exposure, and Eye Movement Desensitization and Reprocessing can involve discomfort during trauma-focused work. These sources describe that discomfort as usually brief. If it is not brief or feels unmanageable, discuss pacing and concerns with the treating professional.^[13][7][14]

How Can Loved Ones Support Trauma Recovery?

Start by listening and offering emotional support, understanding, patience, and encouragement. You do not need every detail to take distress seriously. You might say, “I believe that this is affecting you,” “You did not deserve what happened,” and “I can help you look for care.”^[4][13][14]

Avoid assuming a single cause. Many factors influence trauma responses, and reminders can trigger symptoms. Ask whether the person has noticed links among reminders, emotions, urges, and behavior.^[4]

Practical help can include helping someone make an appointment or accompanying them to health care visits. The National Institute of Mental Health also recommends learning about PTSD and encouraging the person to talk with their provider if symptoms do not improve after six to eight weeks.^[4]

What Are the Limits of Trauma Research?

Evidence about adverse childhood experiences describes population-level associations, not a simple formula for predicting one person’s future. The examples of adverse experiences are also not a complete list.^[5]

Childhood sexual abuse has been associated with many later outcomes, but the strength and quality of evidence differ by outcome. More research is needed into the developmental pathways connecting childhood abuse with adult health and psychosocial outcomes.^[8]

PTSD and complex PTSD are also defined differently across major diagnostic systems. Researchers continue to examine whether complex PTSD is categorically distinct, reflects greater severity, or needs meaningfully different treatment.^[6]

Evidence about PTSD and co-occurring substance use does not establish that the same explanation applies to gaming, sexual behavior, spending, eating, or technology use. A mental health professional can assess PTSD symptoms and co-occurring concerns without assuming a single cause.^[4]

When to Seek Help for Trauma

Consider professional help when symptoms are severe enough to interfere with daily life, such as relationships or work. Reasons can include persistent avoidance, nightmares, flashbacks, sleep problems, feeling detached or numb, intense guilt or shame, anger or aggressive outbursts, risky or destructive behavior, substance use concerns, or suicidal thoughts.^[4]

You do not need to decide whether you have trauma, PTSD, addiction, or another diagnosis before making an appointment. A mental health professional can assess the experience, symptoms, behavior, and co-occurring concerns rather than treating one piece in isolation.

Seek a professional with relevant training in trauma and the behavior causing concern. Ask how they assess PTSD, which evidence-based treatments they offer, how they address substance use or compulsive behavior, how progress is measured, and what happens if the initial plan does not help.

Trauma-informed approaches recognize trauma’s effects and organize care around principles such as safety, peer support, trustworthiness and transparency, collaboration, and empowerment, voice, and choice.^[11]

If you or someone you know is struggling with suicidal thoughts, call or text the 988 Suicide & Crisis Lifeline at 988. If there is immediate life-threatening danger, call 911⁠.^[4]

Taking the Next Step Toward Trauma Recovery

When you speak with a mental health professional, be ready to discuss the experience, symptoms, behavior, substance use if present, and other concerns.

If alcohol or drugs are involved, look for care that can address both trauma-related symptoms and substance use. Ask specifically whether the program offers concurrent PTSD and substance use treatment rather than assuming one condition must wait.^[3]

A traumatic experience does not mean harmful behavior is inevitable or permanent. When PTSD symptoms and substance use are both present, they can be treated at the same time, and an experienced professional can help plan care around your symptoms and needs.^[4][3]

Get Treatment Help

If you or someone you love is struggling with addiction, getting help is just a phone call away, or consider trying therapy online with BetterHelp.

Exclusive offer: 20% Off BetterHelp*

Try Therapy Online With BetterHelp

or Call now (866) 850-9549

Following links to the BetterHelp website may earn us a commission that helps us manage and maintain AddictionHelp.com. *Get 20% off your first month of BetterHelp. Offer valid for new BetterHelp users only. Offer cannot be combined with insurance.