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For some individuals, what is experienced internally may not align with how symptoms are classified in care.

Clinical diagnosis is largely based on observable symptoms and reported experience. These symptoms are grouped into categories such as depression and anxiety, which guide treatment decisions. This framework, as outlined by the Diagnostic and Statistical Manual of Mental Disorders, is organized around patterns of symptoms rather than underlying biological or physiological mechanisms.

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According to trauma-focused clinicians such as Bessel van der Kolk, trauma is not only a psychological experience—it is also a physiological one, involving lasting changes in how the nervous system responds to stress and threat.

When the nervous system becomes dysregulated following prolonged or overwhelming stress, it may shift into states of hyperactivation or shutdown. These states are adaptive responses to perceived threat, but when they persist, they can shape how an individual experiences both body and mind.

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Trauma-related states of hyperactivation may resemble anxiety, including panic, agitation, and a heightened sense of threat.
States of physiological shutdown may resemble depression, including fatigue, emotional numbing, and a loss of motivation or capacity.

In these cases, the observable symptoms may align with established diagnostic categories, while the underlying process reflects a nervous system operating in a sustained state of protection.

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The Limits of Symptom-Based Diagnosis

Current diagnostic frameworks rely on clusters of symptoms rather than identifying underlying mechanisms.

As a result, different conditions may be grouped together based on how they appear, rather than what is driving them. Research in stress physiology and trauma has shown that similar symptoms can arise from different underlying processes, particularly in the context of chronic stress and trauma.

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This can make it difficult to distinguish between:

• depression as a primary mood disorder

• depression-like states associated with physiological shutdown

• anxiety as a cognitive or emotional condition

• anxiety-like states associated with chronic threat activation

These distinctions are not always visible within standard clinical assessment.

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Implications for Care

When trauma-related physiological states are understood primarily through symptom categories such as depression or anxiety, treatment often focuses on:

• symptom reduction

• cognitive restructuring

• medication management

These approaches can be effective for many individuals.

However, when the underlying issue involves persistent nervous system dysregulation, symptom-focused treatment alone may not fully address what is occurring.

In these cases, individuals may experience:

• partial or inconsistent improvement

• shifting or evolving symptoms over time

• difficulty clearly describing their internal state

• a sense that their experience is not fully captured by diagnosis                                                                                                        

A Broader Clinical Lens

This perspective does not suggest that depression and anxiety are misdiagnosed in all cases.

It suggests that, in some instances, what is being diagnosed may reflect a dysregulated nervous system shaped by stress or trauma.

Recognizing this possibility expands the clinical lens. It allows for more precise questions about:

• how symptoms are experienced in the body

• how they change over time

• what precedes or intensifies them

• how individuals respond to treatment                                                                                                                                                      

Why This Matters

If different underlying conditions can produce similar symptoms, then diagnosis alone may not fully explain what a person is experiencing.

Without this distinction, important aspects of an individual’s condition may remain unrecognized.

What may appear as depression or anxiety may, in some cases, reflect trauma-related physiological states that are not fully captured within existing diagnostic frameworks.

SEEN exists to bring visibility to these gaps—so that what is experienced, but not fully recognized within care, is no longer overlooked.

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Sources (Matched to Claims)

On diagnostic frameworks being symptom-based:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

On trauma as a physiological process affecting the nervous system:

• The Body Keeps the Score (2014). Viking.

On stress physiology and nervous system dysregulation:

• McEwen BS (2007). Physiology and neurobiology of stress and adaptation: central role of the brain. Physiological Reviews.

On variation in trauma response and underlying biological processes:

• Yehuda R, LeDoux J (2007). Response variation following trauma: a translational neuroscience approach to understanding PTSD. Neuron.

On symptom overlap and trauma-related presentations (anxiety, depression, arousal, numbing):

• National Institute of Mental Health (NIMH). Post-Traumatic Stress Disorder (PTSD).