When trauma looks like anxiety, depression, or burnout

Clinicians frequently see clients presenting with anxiety, low mood, emotional exhaustion, or burnout. For some of these patients, standard treatments appear ineffective, and symptoms persist or recur despite appropriate care. In these cases, the underlying driver may be the long-term effects of chronic stress or trauma rather than a primary mood or anxiety disorder.

Complex trauma does not always involve clear or recognisable traumatic events. Many patients describe their history as “not that bad” or struggle to identify anything that feels traumatic at all. As a result, their difficulties are often misunderstood by professionals, and they are left with negative beliefs about themselves that “something is wrong with me”.

In chronic stress and trauma presentations, the nervous system has adapted to prolonged threat or emotional unsafety. This can lead to ongoing hypervigilance, emotional shutdown, shame, difficulty resting, and problems with concentration or motivation - symptoms that closely resemble anxiety, depression, or burnout.

A key feature in the development of complex PTSD is insecure attachment. When early relationships are unpredictable, emotionally unavailable, or frightening, the nervous system learns to stay on guard or develop action systems geared toward survival. These adaptations can shape how a person relates to themselves and others well into adulthood. When there is a foundation of insecure attachment, any later traumatic or stressful life events are more likely to lead to the syndrome of Complex PTSD.

Complex PTSD is characterised by both classic PTSD symptoms, as well as enduring changes in perception, cognition and mood. Importantly, it is not the presence or severity of adversity that is most clinically relevant, but how experiences have affected the person.

Diagnostic clarity often emerges less from what happened and more from how the person relates to what happened. Helpful clinical indicators may include: self-blame or shame when discussing relationships; minimising or intellectualising distress; repeated patterns of unsafe relationships; difficulty identifiying needs, boundaries or emotions; or a history of using unhealthy coping mechanisms without being able to control habits.

Many of these clients present as capable, insightful, and high functioning, yet feel chronically depleted or stuck. When trauma-related adaptations are misunderstood as “simple” depression or anxiety, treatment may focus on symptom reduction alone. While this can be helpful to some extent, it may not address the underlying nervous system and relational drivers of distress.

A trauma-informed formulation supports work on safety, regulation, relational patterns, and meaning. This often leads to improved engagement, a sense of being understood, and more sustainable change.

GPs play an essential role in recognising when clients with chronic stress presentations may benefit from a trauma-informed psychological assessment. Gentle curiosity about patterns, impact, and long-term functioning can help guide referral decisions and improve outcomes.

Cloitre, M. et al. (2013). Evidence for ICD-11 PTSD and complex PTSD. European Journal of Psychotraumatology, 4.

Herman, J. L. (1992). Trauma and Recovery. Basic Books.

Liotti, G. (2004). Trauma, dissociation, and disorganised attachment. Psychotherapy, 41(4), 472–486.

World Health Organization. (2018). ICD-11: Disorders specifically associated with stress.