Does this sound like a psychiatrist who isn’t trauma-informed?

[erik5]

I'm asking here because I'm worried my care may not be trauma-informed. I've been diagnosed with CPTSD, depression, dissociation, and I experience constant fatigue. I used to work part-time, but over time my fatigue worsened to the point where I couldn't continue, and I'm now on full disability.

I've tried multiple antidepressants and anti-anxiety medications, but they've had little effect. Trauma has barely come up in my sessions, even though CPTSD is a formal diagnosis.

During the day I mostly use the internet for distraction, both because I feel too depressed and exhausted to be active and because it helps me cope with mental pain. If I'm not distracted, I easily get panic and emotional flashbacks.

My psychiatrist has suggested that I might have mild, undiagnosed autism and that I'm stuck in rigid behavior, which he believes explains why I don't do much besides using the computer. This doesn't seem correct to me, I feel more exhausted, unmotivated, and driven to distract myself. He prescribed a medication for "rigid behavior" and said he was sure it would change my life a lot, but it had no effect.

He also thought my exhaustion might be a medication side effect, but changing medications didn't help. I've wondered whether my fatigue could be trauma-related, especially given physical symptoms like a very low heart rate and muscle shaking, but he has never brought up this as a possibility or medications for CPTSD.

He now wants me to return to work and think it will help, even though I've said that I feel just as exhausted.

Does this sound like a lack of trauma-informed care and would it be reasonable to push back or seek a different psychiatrist?

Thank you for reading, I really appreciate any perspectives.

[TheBigBlue]

Erik, I can't give medical advice, but I do want to share how this lands for me, based on my own experience.

What you're describing does raise questions about whether your care is truly trauma-informed. Especially when CPTSD is a formal diagnosis, it's concerning if trauma rarely comes up at all, and if exhaustion, dissociation, and reliance on distraction are framed primarily as "rigidity" or motivation issues rather than possible nervous-system overwhelm.

In my experience (this may differ by country), psychiatrists often focus mainly on medication management. The most meaningful work for me has happened in trauma-informed psychotherapy - where safety and stabilization come first, long before pushing return-to-work or trauma processing. For me, fatigue, shutdown, and heavy use of distraction weren't avoidance or laziness; they were ways my nervous system coped when it felt overwhelmed or unsafe. When that wasn't recognized, I felt misunderstood.

A core principle I've learned is that safety and stability come before pressure. If returning to work doesn't feel possible right now and your body is clearly saying "too much," that deserves to be heard and taken seriously. Trauma can absolutely show up as exhaustion, autonomic symptoms, and collapse - even if it doesn't look dramatic on the surface.

I think it's reasonable to trust your own sense here. Pushing back with questions, asking directly how CPTSD is being considered in your care, or seeking a second opinion doesn't mean you're being difficult - it means you're advocating for yourself. You deserve care that understands trauma, not care that explains it away.

You're not alone in this, and your doubts make sense to me.

(If that's ok)

[erik5]

Erik, I can't give medical advice, but I do want to share how this lands for me, based on my own experience.

What you're describing does raise questions about whether your care is truly trauma-informed. Especially when CPTSD is a formal diagnosis, it's concerning if trauma rarely comes up at all, and if exhaustion, dissociation, and reliance on distraction are framed primarily as "rigidity" or motivation issues rather than possible nervous-system overwhelm.

In my experience (this may differ by country), psychiatrists often focus mainly on medication management. The most meaningful work for me has happened in trauma-informed psychotherapy - where safety and stabilization come first, long before pushing return-to-work or trauma processing. For me, fatigue, shutdown, and heavy use of distraction weren't avoidance or laziness; they were ways my nervous system coped when it felt overwhelmed or unsafe. When that wasn't recognized, I felt misunderstood.

A core principle I've learned is that safety and stability come before pressure. If returning to work doesn't feel possible right now and your body is clearly saying "too much," that deserves to be heard and taken seriously. Trauma can absolutely show up as exhaustion, autonomic symptoms, and collapse - even if it doesn't look dramatic on the surface.

I think it's reasonable to trust your own sense here. Pushing back with questions, asking directly how CPTSD is being considered in your care, or seeking a second opinion doesn't mean you're being difficult - it means you're advocating for yourself. You deserve care that understands trauma, not care that explains it away.

You're not alone in this, and your doubts make sense to me.

(If that's ok)

Thank you for the feedback.

I brought up the possibility if I could be in the dorsal vagal shutdown state (not sure I used the right terms) and that that's why I'm so exhausted, but he said that that's impossible since you can only be that state for a few days, which seems to be incorrect according to what I've read, though I'm not sure. He changed the topic after that, so it seems like he doesn't consider that this can could have anything to do with my exhaustion.

I have other symptoms of freeze shutdown, like an abnormally low heart rate, shaking, rigid and floppy muscles, brain fog, and I was diagnosed with dissociation. I also recognize myself as a typical freeze-type in Pete Walker's book about CPTSD.

Low energy has always been a problem, but it got worse when I was working, so if I have freeze shutdown I think work may have overwhelmed me.

Someone said that SNRI meds that calms down fight/flight treated their trauma-induced chronic fatigue, but as far as I know he hasn't mentioned prescribing such meds for me.