What is “High Functioning PTSD”?
High functioning PTSD is a non-clinical phrase for people who meet post-traumatic stress disorder (PTSD) criteria yet keep up with work or family duties by masking symptoms. The risks are delayed care and burnout; screening and evidence-based treatment can help.[1]
“High functioning PTSD” isn’t an official diagnosis, but many people keep life moving while carrying classic PTSD symptoms—until stress peaks. Below, learn the real criteria, the “17 symptoms” debate, how it can look from the outside, and safe, evidence-based care options in Utah.
Is “High Functioning PTSD” Real?
Yes, the experience is real, even if the label isn’t in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). DSM-5 defines PTSD by exposure to trauma plus symptoms across intrusion, avoidance, negative mood/cognition, and arousal/reactivity—these can be present even when someone appears “high performing.” The danger is that masking delays help and can worsen comorbid anxiety, depression, or substance use.[1][2]
Signs You Might Be “High Functioning” With PTSD
Masking at Work or in Relationships
You deliver at work and show up for family, yet feel numb, on edge, or detached; you avoid reminders but call it “being busy.” Loved ones may see irritability, withdrawal, or over-control.
Hyper-Productivity, Perfectionism, and Burnout
Overworking can function like avoidance—if you never slow down, intrusive memories have less room to surface. The trade-off is exhaustion and brittleness under stress.[2]
Somatic Signs: Sleep, Startle, Headaches, Tremors
PTSD commonly shows up in the body: poor sleep, exaggerated startle, tension headaches or migraines, and sometimes tremor-like shaking during distress release. Rule-outs (neurologic, endocrine, medication effects) matter—get evaluated.
What Does a PTSD Flashback Look Like to an Outsider?
Flashbacks range from brief, vivid intrusions to full re-experiencing. You might notice the person go distant, freeze, curl in, scan the room, or respond to “invisible” cues.
What helps: stay calm, reduce stimuli (light/noise), announce your presence softly, offer grounding (“feel feet on the floor; look for five blue objects”), and avoid sudden touch unless asked.[2]
Trauma Looping, the Trauma Response Wheel, and the Trauma Cycle
Trauma Looping: Why the Mind Replays Threat Cues
The brain’s threat system overlearns danger. Neutral cues trigger old alarms; rumination and avoidance keep the loop alive. Treatment targets new learning (safety) and skills for arousal regulation.
Trauma Response Wheel: Common Patterns Under Stress
Fight, flight, freeze, and fawn can all be adaptive—until they’re rigid. Psychoeducation helps people identify their default patterns and build flexible responses.[3]
Cycle of Trauma vs. Healing Cycles
Trauma cycles: trigger → hyperarousal → avoidance → short-term relief → more sensitivity.
Healing cycles: trigger → skillful regulation → corrective experience → confidence.
Expect gradual progress, not linear perfection.
Comorbid PTSD: Depression, Anxiety, Substance Use, and Pain
PTSD rarely travels alone. Screening for mood/anxiety disorders, alcohol/substance use, and chronic pain is standard; integrated treatment prevents “whack-a-mole” care and improves outcomes.[2]
Screening & When to Seek Care
Self-Screen: PCL-5 (PTSD Checklist)
The PTSD Checklist for DSM-5 (PCL-5) is a validated self-report measure aligned to DSM-5. It’s not a diagnosis, but it can guide whether to book a full evaluation. Elevated scores or functional impairment warrant professional assessment.
Documentation & Disability: Practical Considerations
If symptoms limit work or daily life, keep records of diagnoses, treatment notes, and functional impacts. Federal and workplace disability processes have specific documentation requirements; clinicians familiar with PTSD can help you navigate.
Evidence-Based Treatments (Utah Options)
Expert Eye Movement Desensitization and Reprocessing (EMDR) Treatment
Eye Movement Desensitization and Reprocessing (EMDR) supports adaptive memory reconsolidation using bilateral stimulation in a structured protocol. It’s well-supported for PTSD when delivered by trained clinicians with proper preparation.
Accelerated Resolution Therapy (ART)
Accelerated Resolution Therapy (ART) combines imagery rescripting and eye movements in a brief, protocol-driven format. Some clients prefer ART’s focused approach; discuss fit with your therapist.[3]
Trauma-Focused Cognitive Behavioral Therapy (CBT), Exposure-Based Care, Skills Training
Trauma-focused cognitive behavioral therapy (CBT) and exposure therapies (including written or imaginal exposure) build corrective learning; dialectical behavior therapy (DBT)-style skills help with emotion regulation and distress tolerance before or alongside processing.
Integrated Trauma Care at Harper Clinic Utah
Harper Clinic is a state-of-the-art functional medicine clinic in Utah, providing trauma-informed care. We understand the sensitive nature of treating trauma and PTSD, and provide a blend of holistic, therapeutic interventions to help survivors heal.
Our evidence-based trauma therapies, like EMDR and ART can help patients rapidly process distressing memories, while our holistic healing activities, such as yoga, massage, and Reiki, can help those who have experienced abuse, harm, or violence reclaim control over their bodies and heal their spirit. For compassionate support and trauma-informed care, contact our team today.
High Functioning PTSD FAQs
Is “High Functioning PTSD” an Official Diagnosis?
No, it’s a popular phrase describing people who meet PTSD criteria while functioning outwardly. Assessment still relies on DSM-5.
What Does a PTSD Flashback Look Like to an Outsider?
Distant gaze, fear reactions, startle, or “checking out.” Lower stimulation, offer grounding, and avoid sudden touch.
Can Ketamine Make PTSD Worse?
Transient spikes can occur; careful screening, monitoring, and integration therapy reduce risk. Not first-line.
Sources
- U.S. Department of Veterans Affairs. PTSD—DSM-5 criteria (professional resource). https://www.ptsd.va.gov/professional/treat/essentials/dsm5_ptsd.asp
- Mayo Clinic. Post-traumatic stress disorder (PTSD): Symptoms & causes. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
- NCBI Bookshelf. Trauma-focused treatments and mechanisms (overview). https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/
- Cloitre, M., et al. ICD-11 Complex PTSD: Overview and rationale. European Journal of Psychotraumatology. https://pmc.ncbi.nlm.nih.gov/articles/PMC6457782/
- Abdallah, C. G., et al. Ketamine and PTSD: Mechanisms and evidence. Chronic Stress. https://pmc.ncbi.nlm.nih.gov/articles/PMC7917421/