Reviewed and updated by Iris Hogan, MSW, LICSW · September 2026
When people think about PTSD, they often think about nightmares and flashbacks. Those are important symptoms, and I listen for them when I assess someone for trauma.
But they aren’t the only things I listen for.
Sometimes what catches my attention is something a woman says almost in passing:
“I don’t really trust people.”
“I never feel completely safe.”
“I’m always jumpy.”
“I can’t even consider having another child. I’m terrified of going through that again.”
“I can’t let my daughter out of my sight because I’m afraid it will happen again.”
Sometimes PTSD is missed not because the symptoms are unusual, but because we don’t recognize what PTSD sounds like in someone’s everyday life.
When a Memory Still Feels Alive
One of the things that really makes me listen for PTSD as a possibility is a memory that doesn’t feel entirely like a memory.
There is a difference between remembering that the hospital smelled like antiseptic and suddenly smelling the antiseptic as though you had just taken a breath of it.
Or remembering that there was a clock ticking in the room and actually hearing the ticking again.
Or remembering how much an injury hurt and feeling, for a moment, as though the injury is happening now.
I sometimes think of these as memories that are still “alive.” They don’t feel entirely historical. Something about the experience—the image, smell, sound, pain, fear, or physical sensation—feels present rather than remembered.
That alone doesn’t mean someone has PTSD. But when I hear it alongside avoidance, feeling constantly unsafe, being easily startled, or significant changes in trust and intimacy, I want to understand more.
The Trauma Time Warp: When Then Feels Like Now
I sometimes describe this as a trauma time warp.
We normally remember something with a sense of time attached to it: That happened then. I am here now.
Traumatic memories can sometimes have a “here-and-now” quality. A smell, sound, physical sensation, or situation that resembles something from the trauma can trigger a response that seems much bigger than the current situation warrants.
The alarm is responding to information from then, even though the person is living in now.
And this doesn’t happen only in the dramatic, movie-version flashback where someone completely loses track of the present. A woman may know perfectly well that she is standing in her kitchen in Seattle in 2026 while the smell, image, pain, or fear feels startlingly present.
The thinking part of her may know exactly what year it is. The alarm apparently did not get the memo.
When Avoidance Works—Until It Doesn’t
Here’s the inconvenient thing about avoidance: it often works. Sometimes remarkably well.
And avoidance isn’t necessarily a problem. We should avoid things that have a real potential to hurt us.
I become more curious when the danger belonged to the past, but the response in the present is still being shaped by what happened then.
Don’t drive on that road and you don’t have to feel what comes up when you pass the accident site. Don’t go back to the hospital and you don’t encounter the reminders of what happened there.
I’ve worked with women who managed this way for months or even years—until life became inconveniently uncooperative.
She needs another surgery.
She wants to have another baby.
The road she has avoided since a serious accident is suddenly the road she needs to take to get her child to school.
She has avoided sexual intimacy, but now she is in a relationship where intimacy matters to her.
This is where I think about short-term and long-term workability.
What does avoiding this give you in the short term? What does it cost you over time?
The goal isn’t to stop avoiding everything. It’s to look at whether the avoidance fits the actual risk today and whether it helps you live the life you want.
“I Never Really Feel Safe”
Another statement that makes me listen more carefully is, “I never really feel safe.”
Sometimes it’s simply:
“I’m always jumpy.”
Or a mother who cannot let her daughter out of her sight because she is terrified that what happened before will happen again.
Hypervigilance is one of those clinical words that sounds much more dramatic than it often looks in real life.
Sometimes it looks like a woman who is functioning perfectly well while always keeping part of her attention on what could go wrong.
Vigilance when there is genuine danger is protective. What catches my attention is when the level of vigilance no longer fits the danger in someone’s life today.
Living continually prepared for danger has costs. It can make it difficult to relax, sleep, concentrate, trust other people, or allow children the independence they increasingly need.
When Protection Starts Looking Like Personality
Some comments I hear frequently don’t sound like PTSD symptoms at all:
“I’ve always been independent.”
“I don’t need anybody.”
“I’d rather just do it myself.”
“I don’t like depending on people.”
“I don’t like anyone having control over me.”
And sometimes she really is just fiercely independent. Not everything is trauma.
But sometimes I become curious about what the independence is protecting.
After interpersonal trauma, depending on another person can feel risky. So can vulnerability, intimacy, or allowing someone else to have control.
What I listen for is change and connection.
Was she always this independent, or did something change after what happened?
Does doing everything herself work for her, or does she feel lonely and exhausted by it?
Does she want intimacy but find herself pulling away when someone gets close?
Sometimes something that looks like personality, preference, or even strength began—or became much stronger—as a way of staying safe.
“I Should Have…”
Another phrase I listen for is “I should have.”
“I should have known.”
“I should have left.”
“I should have fought back.”
“I should have made the doctor listen.”
“I failed my baby.”
“If I’d gotten there sooner…”
Hindsight is enormously helpful and spectacularly unfair.
I become curious about the gap between what a woman believes she should have done and what was actually possible at the time.
What did she know then?
How much control did she actually have?
Was she frightened, injured, overwhelmed, dependent on someone else, or relying on professionals to help her?
Sometimes “I should have” creates the illusion that there was a version of the event in which she could have guaranteed a different outcome.
And sometimes blaming ourselves gives us a strange kind of control. If I caused what happened, perhaps I can make absolutely certain it never happens again.
PTSD After a Traumatic Birth
Birth trauma deserves particular attention because PTSD after childbirth isn’t always recognized.
A woman may have a healthy baby and hear repeatedly that everything turned out fine. She may tell herself the same thing.
But she may also tell me:
“I keep seeing the moment when I thought my baby was going to die.”
“I can’t go back to that hospital.”
“I can’t think about getting pregnant again.”
“I should have made them listen to me.”
A healthy baby doesn’t erase the experience of believing during the birth that you or your baby might die or be seriously harmed.
Childbirth-related PTSD can involve the same patterns we’ve been talking about throughout this article: memories that still feel very present, avoidance, changes around intimacy or another pregnancy, guilt and self-blame, and remaining unusually alert to possible danger.
If this is the part that feels familiar to you, you can read more about maternal mental health and postpartum therapy or healing birth trauma with EMDR.
A Symptom Isn’t a Diagnosis
This distinction matters.
Being jumpy doesn’t mean you have PTSD. Neither does having a vivid memory, avoiding something frightening, or finding it difficult to trust people.
PTSD is a specific diagnosis. It requires exposure to actual or threatened death, serious injury, or sexual violence, followed by symptoms across several areas: intrusive symptoms, avoidance, changes in thoughts and mood, and changes in arousal and reactivity. A diagnosis also depends on the number and combination of symptoms, how long they have been present, and whether they are causing significant distress or interfering with important areas of life.
People can also be deeply affected by experiences that don’t meet the diagnostic criteria for PTSD.
A diagnosis isn’t a measure of whether something was “bad enough.” Not meeting criteria for PTSD doesn’t mean what happened didn’t matter or that you don’t deserve help.
What I Listen for as a Trauma Therapist
When a woman comes to see me because of anxiety, panic, difficulty sleeping, relationship problems, or simply because she hasn’t felt like herself for a long time, I don’t go hunting for trauma.
But certain things make my ears perk up.
A memory that still feels strangely alive. A place she hasn’t gone near in six years. “I never feel safe.” “I don’t trust anybody.” A life that has gradually been organized around making absolutely certain that something terrible never happens again.
None of that automatically adds up to PTSD. Sometimes we explore it and PTSD isn’t the best explanation at all.
But it gives me a reason to ask more questions.
That, to me, is one of the problems with the phrase “undiagnosed PTSD.” PTSD isn’t necessarily hiding. Sometimes nobody has stopped to translate the diagnostic language into what it actually looks and sounds like in someone’s life.
PTSD Is Treatable
PTSD has effective treatments. Current clinical guidelines recommend trauma-focused psychotherapies including EMDR, Cognitive Processing Therapy (CPT), and Prolonged Exposure (PE) among the treatments with the strongest evidence for PTSD.
Treatment isn’t about convincing yourself that what happened wasn’t terrible, and it isn’t about forgetting it. Part of trauma treatment is helping what happened then become less powerful in determining what happens now.
If you’re curious about EMDR, you can read more about EMDR therapy for women or how to know if you’re ready for EMDR.
I work with adult women throughout Washington who are dealing with PTSD and other effects of trauma, including medical trauma, traumatic birth, accidents, and interpersonal trauma. All of my sessions are offered through online therapy for women in Washington.
A Reason to Hope
Sometimes the first step isn’t knowing exactly what’s wrong. It’s noticing that something from the past may still be taking up more room in the present than you realized.
If you’re wondering whether trauma or PTSD may be contributing to what you’re experiencing, a careful assessment can help you understand what is happening and what kind of treatment might actually help.
If this article resonated with you and you’re looking for support, you’re welcome to reach out.
Schedule a free 15-minute consultation.
Research & Sources
Department of Veterans Affairs & Department of Defense (2023). VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder.
Read the VA National Center for PTSD overview of recommended PTSD psychotherapies
Schnurr, P. P., et al. (2024). The management of posttraumatic stress disorder and acute stress disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Annals of Internal Medicine.
Read the guideline synopsis
Dikmen-Yildiz, P., et al. (2022). Prevalence and risk factors of birth-related posttraumatic stress among parents: A comparative systematic review and meta-analysis. Clinical Psychology Review, 94, 102157.
Read the systematic review and meta-analysis on PubMed
Until We Meet Again
Until we meet again — breathe gently, walk slowly, and treat yourself with kindness.
— Iris