Post-traumatic stress disorder (PTSD) can affect functioning well beyond the initial traumatic event. Symptoms commonly intersect with sleep, pain, mood, concentration, and the body’s stress response. In workers’ compensation and broader clinical settings, PTSD may also present alongside traumatic brain injury (TBI), depression, anxiety, substance use, and cumulative occupational stress—shaping recovery timelines, treatment engagement, and long-term outcomes.
This article is based on an educational Injury Insight webinar hosted by Medical and Life Care Consulting Services and presented by Dr. Tabatha Maiorano, with program context and opening remarks from Cynthia Bourbeau. The content translates webinar instruction into a structured, practical overview of PTSD presentation, co-occurring conditions, evidence-informed treatment approaches, and crisis-response supports that can improve recovery trajectories.
Why PTSD matters in clinical and claims settings
PTSD is often discussed as a diagnosis, but in day-to-day practice it shows up as a functional disruption. People may be “doing the things” (showing up to work, attending appointments, trying to push through), while still struggling with regulation, sleep, pain tolerance, and emotional control. That matters in clinical management, return-to-work planning, and case evaluation.
PTSD as a functional condition, not just a diagnosis
PTSD commonly affects:
- sleep quality and recovery capacity
- attention, memory, and processing speed
- irritability, reactivity, and interpersonal function
- pain perception and somatic symptoms
- treatment tolerance (ability to engage in rehabilitation, therapy, or structured care)
The result is that patients may appear “stuck,” even when medical workups are extensive.
Why “survival” is not the end of recovery
Trauma-related recovery often unfolds in phases. Acute stabilization may happen early, but long-term improvement depends on how well the nervous system recalibrates, how co-occurring conditions are addressed, and whether the person has workable tools to regulate symptoms in real life.
How PTSD influences medical utilization, documentation, and outcomes
People may report persistent physical complaints—such as headaches, gastrointestinal symptoms, back pain, and diffuse musculoskeletal pain—even after extensive diagnostic testing shows no acute pathology. This does not indicate that symptoms are imagined or exaggerated. In many cases, prolonged activation of the stress response amplifies bodily symptoms and narrows the body’s capacity to recover. Recognizing this pattern helps care teams plan more effective treatment, communicate clearly with patients, and set realistic expectations for recovery.
Trauma, wellness, and the body’s stress response
PTSD is not only “what happened.” It is also the ongoing effect of the body’s threat response—especially when stress exposure is repeated.
Trauma exposure vs. trauma impact
Not everyone exposed to trauma develops PTSD. Outcomes depend on:
- cumulative exposure over time
- prior experiences and underlying beliefs formed earlier in life
- available supports and coping resources
- sleep, substance use, and overall regulation capacity
Two people can face similar events and have very different symptom burdens.
Stress physiology and symptom escalation over time
As stress activation persists, people can experience escalating symptoms: sleep disruption, anxiety, irritability, exhaustion, and increased pain sensitivity. When the body stays in a high-alert state, it becomes harder to “come down,” even when the immediate threat is gone.
Why symptoms can worsen even when tests look “normal”
PTSD risk increases in populations with frequent, repeated, or unpredictable exposure to traumatic events. While first responders are commonly recognized as high-risk, trauma exposure extends across a broader network of roles and environments. Risk is shaped less by job title alone and more by the intensity, duration, and cumulative nature of exposure.
Who is at risk and why exposure patterns matter
PTSD risk increases in populations with frequent, repeated, or unpredictable exposure to traumatic events. While first responders are widely recognized as high-risk, trauma exposure extends across a broader network of roles and environments. Risk is shaped less by job title alone and more by the intensity, duration, and cumulative nature of exposure.
High-exposure occupations and cumulative stress
Repeated exposure alters what the nervous system expects. When trauma and crisis become routine, the body can remain in a persistent state of readiness even when off duty. Over time, this sustained activation increases vulnerability to anxiety, depression, irritability, sleep disturbance, and PTSD symptoms.
Dispatch and “audio-based” trauma without closure
Repeated exposure alters what the nervous system expects. When trauma and crisis become routine, the body can remain in a persistent state of readiness even when off duty. Over time, this sustained activation increases vulnerability to anxiety, depression, irritability, sleep disturbance, and PTSD symptoms.
Correctional environments and chronic threat anticipation
Correctional settings involve high vigilance, repeated exposure, long hours, limited environmental control, and ongoing anticipation of disruption or violence. This pattern can create a chronic stress response that differs from single-incident trauma and is driven by prolonged anticipation rather than discrete events.
Healthcare workers and compartmentalization over time
Healthcare professionals frequently rely on compartmentalization to function in high-stakes environments. While adaptive in the short term, prolonged compartmentalization can contribute to delayed symptom emergence as emotional material resurfaces over time, particularly when cumulative stress exceeds coping capacity
Common presentations clinicians see
PTSD is not one uniform presentation. Patterns commonly observed in clinical practice vary based on individual history, type and duration of trauma exposure, co-occurring conditions, and current stress load.
Hyperarousal, irritability, agitation, and vigilance
Many high-exposure individuals live in a state of hyperarousal—always alert, always scanning, always ready. It supports performance in crisis environments, but it’s taxing to the body and can impair sleep, relationships, and recovery.
Hypoarousal, fatigue, withdrawal, and depression
When the system shifts, some people experience hypoarousal—low energy, reduced motivation, depressed mood, withdrawal, and exhaustion. These individuals may appear “shut down,” and symptoms can be mistaken for lack of effort rather than dysregulation.
Sleep disruption and the “can’t shut the brain off” experience
Sleep disruption is a major driver of symptom persistence. Anxiety rises when sleep drops, and coping capacity narrows. Many patients describe an inability to shut off thoughts, worries, or physiological arousal.
The window of tolerance and why regulation is foundational
The “window of tolerance” framework helps explain why people oscillate between high activation and shutdown—and why stabilization is often step one.
Living in hyperarousal: when it helps at work but harms health
Some individuals essentially live in the upper band of their window of tolerance. They may function effectively at work but pay the price later through sleep disruption, irritability, increased pain sensitivity, and emotional volatility.
Fluctuating states and why “small” stressors can trigger major responses
A key metaphor used was cumulative stress: the “teapot” that’s already at a simmer. When someone has been carrying high stress for a long time, the final trigger may be small—yet it creates a big reaction because the system was already near the edge.
Building regulation skills before intensive trauma processing
Another key point: trauma work must be tolerable. Preparation and stabilization skills are often required before deeper trauma processing begins—especially in complex or high-exposure cases.
Co-occurring conditions and the treatment challenge
PTSD frequently overlaps with substance use, depression, anxiety, and traumatic brain injury (TBI) symptoms. When these conditions are addressed in isolation, treatment effectiveness is often limited. Integrated, whole-person approaches are essential for meaningful and sustained improvement.
Why mental health and substance use must be treated together
Older treatment models separated mental health care from substance use treatment, often requiring abstinence before addressing psychological symptoms. Current clinical understanding recognizes that symptoms and substance use commonly interact and fluctuate together. Treating both concurrently supports stabilization, improves engagement, and reduces relapse risk.
The “reward system” and the drive to reduce pain or distress
The brain is wired to seek relief, minimize pain, and restore a sense of balance. In PTSD, this drive can lead to reliance on substances or other maladaptive coping strategies that offer temporary comfort but ultimately intensify dysregulation and slow recovery.
Trauma history and earlier beliefs that shape recovery
Earlier adverse experiences and deeply held beliefs (such as “I am unsafe,” “I am not worthy,” or “I failed”) can influence how individuals interpret later events and respond to stress. Addressing these underlying belief systems is often necessary to reduce symptom persistence and help the nervous system shift out of a chronic threat state.
Substances and symptom amplification
Substance use is common in trauma-exposed populations and is often misunderstood. The clinical question is not “judgment,” but whether use is amplifying dysregulation.
Alcohol and escalation of mood, sleep, and physiology issues
Alcohol is accessible and normalized, but it can worsen sleep quality, increase blood pressure risk, and contribute to long-term health complications. It may feel regulating in the moment, yet drive symptom persistence.
Cannabis as a depressant and its clinical implications
Cannabis products are widely used. Cannabis can function as a central nervous system depressant, and in individuals already struggling with depression, low motivation, or emotional regulation, use may contribute to worsening symptoms.
Prescription patterns, access barriers, and missed rehab follow-through
A practical point raised: injuries lead to prescriptions and referrals to physical therapy, but PT hours may not match shift-work schedules. When rehab follow-through drops, reliance on prescriptions can increase—creating a cycle that complicates recovery.
Caffeine and energy drinks as a clinical risk signal
Energy drinks were highlighted as a concern in high-use patterns. Beyond caffeine content, frequent use can disrupt hydration and electrolyte balance and increase physiological strain—especially in people already living in a high-arousal state.
Trauma-informed treatments that support recovery
The goal of trauma-informed care is recovery—helping individuals build practical tools, improve function, and move forward rather than remaining in indefinite treatment.
Skills-based supports: grounding, mindfulness, guided imagery
Examples discussed included:
- guided imagery
- mindfulness and meditation
- grounding skills
- movement-based regulation strategies
A key practical distinction: doing an activity isn’t enough. The activity must be practiced in a way that strengthens attention, embodiment, and present-moment regulation.
Individual vs. group approaches and what each can offer
Individual treatment can target trauma history, beliefs, and symptom patterns. Group supports can reduce isolation and build consistency when structured properly.
Medication as a support tool when clinically indicated
Medication may support stabilization and symptom reduction in some cases, particularly when sleep disruption, anxiety, or depression significantly impair functioning.
EMDR and why it’s widely used in trauma treatment
EMDR was highlighted as a leading trauma therapy approach, with a strong caution against overpromising quick fixes.
What EMDR is designed to do (and what it isn’t)
EMDR is intended to help the brain process traumatic material that remains “stuck.” It is not simply talk therapy, and it is not a guaranteed short protocol for every person.
Why preparation phases matter before reprocessing
A critical clinical point: EMDR uses an eight-phase model, and early phases focus on stabilization and regulation skills. Some individuals may need only a short stabilization period; others may need months before reprocessing is appropriate
“Illogical beliefs” and how reframing can reduce symptoms
A common feature of PTSD is a disconnect between what an individual logically knows and what they emotionally experience—such as recognizing they performed well in an event while still feeling they failed. Trauma-focused treatment often targets these stuck, illogical beliefs to help restore a more accurate and integrated internal narrative.
Telehealth delivery and how bilateral stimulation can be done remotely
EMDR can be delivered through telehealth using structured methods, including on-screen visual tracking and software-based tools that guide bilateral stimulation. When appropriate safeguards and preparation are in place, remote delivery can support effective trauma processing.
Crisis response and supportive systems
Recovery is strengthened when support extends beyond a single weekly appointment. Structured response systems following critical incidents can reduce isolation, normalize early reactions, and promote timely connection to ongoing care.
Critical incident stress management: defusing vs. debriefing
CISM approaches may include rapid post-incident supports, defusing, and debriefing. These interventions can help normalize reactions, reduce isolation, and connect individuals to follow-up support.
Peer support programs: value, training, consistency
Peer support programs are increasingly common and can be highly effective—but quality depends on training, program design, and follow-through. Consistency matters
Confidentiality, fit, and sustainability of support teams
Confidentiality and program credibility are essential. Support teams should not be built solely on volunteers; readiness and fit matter, and programs require clear structure, training, and follow-through to remain sustainable.
Recovery outcomes and what “getting well” can look like
A practical goal of trauma-informed care is to build skill, regulation, and functional capacity—rather than creating dependency on indefinite treatment.
Progress vs. perfection—realistic treatment goals
Recovery is often measurable in steps: improved sleep, fewer triggers, more regulation, better tolerance of stress, improved function at home and at work.
When triggers can’t be avoided: adapting treatment plans
Avoidance isn’t always possible. Treatment can still be effective by helping individuals build capacity, regulate responses, and function better—even in environments where the trigger remains present.
Building resilience with consistent tools and follow-through
Resilience grows when people practice tools consistently, have support systems that match real-life schedules, and receive care that’s clinically aligned with both symptoms and function
Q&A: Common Clinical Questions in PTSD Treatment
What does a PTSD treatment course look like, and how many sessions are needed?
There isn’t one standard timeline. The course depends on the individual’s stability, history, and available resources. Promises of “fixed” session counts are unreliable. Stabilization and preparation are often needed before intensive trauma processing begins, particularly in complex cases.
What exercises can help between sessions?
Guided imagery, mindfulness, meditation, grounding, and movement-based tools can be effective. The key is finding what works for the individual and practicing it intentionally and mindfully rather than automatically.
If a trigger can’t be avoided, can PTSD still improve?
Yes. When avoidance isn’t possible, the focus shifts to increasing regulation, tolerance, and functional control. The aim is progress, not perfection.
What treatments can help grief-related trauma?
Trauma-focused approaches can help when grief is complicated by guilt, self-blame, or stuck beliefs. Treatment targets what keeps distress locked in place.
If a trigger can’t be avoided, can PTSD still improve?
Yes. When avoidance isn’t possible, the focus shifts to increasing regulation, tolerance, and functional control. The aim is progress, not perfection.
What treatments can help grief-related trauma?
Trauma-focused approaches can help when grief is complicated by guilt, self-blame, or stuck beliefs. Treatment targets what keeps distress locked in place.
Can trauma-focused therapy be delivered through telehealth?
Yes. Telehealth can be effective with structured methods, including guided visual tracking and software-supported bilateral stimulation.
Conclusion
Post-traumatic stress disorder requires comprehensive, coordinated care that extends well beyond initial stabilization. The medical, functional, and psychological effects of trauma evolve over time, making accurate assessment of ongoing treatment needs essential in both clinical and medico-legal settings.
Medical and Life Care Consulting Services supports PTSD-related cases through comprehensive nurse case management, life care planning, medical cost projections, and expert clinical analysis. Our team brings deep experience in evaluating complex trauma presentations, co-occurring conditions, and the long-term implications of PTSD on function and recovery.
By combining evidence-based methodology with real-world clinical insight, MLCC helps attorneys, claims professionals, and healthcare stakeholders gain clarity, support defensible decision-making, and ensure appropriate care planning for individuals affected by post-traumatic stress disorder.
