Is it Complex Trauma or Neurodivergence or Both?

A comparison of how C-PTSD, ADHD, and Autism can show up in adults.

When seeking therapy support, it’s important to use interventions that work for your brain. There is a large amount of crossover in how complex trauma (C-PTSD), ADHD, and Autism (ASD) show up in adults. Unfortunately, most counselors get limited education on the nuances of neurodivergence within their educational programs, unless they decide afterward to pursue it as a specialty. This means that what might look like complex trauma to many counselors, may have its roots in neurodiversity.

That’s not to say that neurodiverse people don’t experience trauma. They likely will experience an immense amount of trauma, operating in a world that isn’t built to support diverse ways of thinking.

If you do not know you are neuro-diverse and find yourself in therapy, your counselor might end up using interventions that aren’t helpful.

For example, if you have both ASD and ADHD, you may feel like there are parts of you that are constantly warring back and forth, one trying to maintain routine and the other hating all aspects of it. An IFS therapist may isolate those pieces of you as parts of your internal family system and assign causality to trauma when in reality your “parts” are ADHD and Autism coming up against one another.

To dive deeper into this let’s look at some of the symptoms displayed in C-PTSD, ADHD, and ASD in adults. (I apologize in advance for the long lists!)

C-PTSD Symptoms:

• flashbacks

• recurrent and intrusive thoughts or dreams

• mental and physical reactions to reminders of the traumatic event

• avoidance of people, places, things, or events that remind you of the trauma (sometimes subconsciously)

• memory loss

• negative thoughts toward yourself or the world

• self-blame

• bad moods that stick around

• detachment and disinterest

• difficulty showing positive emotion

• irritability

• recklessness

• hypervigilance, or being on “high alert”

• trouble concentrating

• startling easily

• trouble sleeping

• a negative view of yourself

• dissociation, or disconnecting from yourself and your emotions

• emotions that feel “out of control”

• relationship difficulties

• loss of your belief system

• difficulty recognizing reality

The above may result in a feeling of not being safe and lead to coping mechanisms to increase the feeling of safety (self-soothing). Examples of this might include substance use, hyper-fixing on things or people, or fantasy-making/daydreaming.

ADHD Symptoms:

There are a few categories of ADHD, which are broken up into Inattentive, Hyperactive/Impulsive, and Combined.

Symptoms would need to be present for more than 6 months, and in adults typically we’d be looking for 5 or more symptoms. For combined type, multiple symptoms in both categories would be present. The symptoms don’t need to be present all the time, but it’s highlighted that they would be happening often.

Inattentive Type:

• Does not seem to listen when spoken to directly.

• Has trouble holding attention on tasks or play activities.

• Does not follow through on instructions and fails to finish chores, or duties in the workplace (e.g., loses focus, side-tracked).

• Has trouble organizing tasks and activities.

• Avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period.

• Loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

• Easily distracted

• Forgetful in daily activities.

• Rejection sensitivity dysphoria-experience severe emotional pain because of a failure or feeling rejected.

• Doesn’t give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.

Individuals are typically inattentive toward things they do not enjoy/like. Hyperfocus is common when the individual enjoys the activity/task. ADHD is not an attention deficit. The name in inherently a poor representation of the nuances.

Hyperactivity/Impulsiveness

• Leaves seat in situations when remaining seated is expected.

• Fidgets with or taps hands or feet, or squirms in seat.

• Unable to play or take part in leisure activities quietly.

• Often “on the go” acting as if “driven by a motor”.

• Talks excessively.

• Blurts out an answer before a question has been completed.

• Have trouble waiting their turn.

• Interrupts or intrudes on others (e.g., butts into conversations or games)

• Rejection sensitivity dysphoria-experience severe emotional pain because of a failure or feeling rejected.

Because of social conditioning, these symptoms can also be translated to a constant feeling of inner restlessness specifically in adults.

Other Criteria for ADHD:

• Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).

• Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.

• There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.

Some important pieces to note here:

We can’t measure how someone is functioning internally.

Measurable metrics may be “all good” on the surface when internally your quality of life is terrible.

Because of social conditioning, minority groups may often be misdiagnosed or fly under the radar due to masking-more on this later.

Autism Spectrum Disorder Symptoms in Adults:

• Somewhat flat affect, or unique nonverbal emotional display

• May be prone to unintentional social blunders, misspeaking

• Experiences challenge maintaining conversations and staying on topic – responding with long monologues or extremely short answers

• Language for social interaction is occasionally stilted

• Difficulty articulating personal thoughts

• Intense memory of details – such as facts or names

• Needs support to understand figurative language – may be more comfortable taking things literally.

• Self-stimulatory behavior like hand rubbing on thigh/finger rubbing in pockets or foot-tapping

• Preference for sameness and routine – may experience stress or outbursts when these are interrupted;

• Dressing in comfortable clothes that may contradict social expectations

• Susceptible to distraction by sounds or visual effects.

• Needs support to set long-term goals and schedules

• May be unintentionally late or forget appointments

• Experiences challenge understanding broad theories while mastering minute details

• Needs encouragement and support to understand other people’s expectations and perspectives.

• Pathological Demand avoidance- an anxiety-driven need to be in control and avoid other people’s demands and expectations.

Masking

Now there was a piece I mentioned above about “masking”, and this is a very important piece to know about neurodivergence and trauma. Safety is a top priority of the brain, and we are also socially conditioned to fit in from a very young age. This is where masking comes in. Masking is essentially camouflaging the self into a societal norm to be accepted and appear “normal”. This might look like:

• Planning responses to stimuli, questions or other social cues

• Rehearsing conversations or scripting them before engagements

• Faking smiles or other facial expressions

• Not disclosing personal interests, opting for ‘socially acceptable’ ones

• Mirroring hand movements or other gestures

• Make yourself maintain eye contact during conversations

• Acting as if overpowering sensory stimulations don’t affect you

This can result in significant energy expenditure and contribute to cycles of burnout or exhaustion. It is also a reason why many neurodiverse people don’t get diagnosed until they reach a level of burnout that requires support.

So what does this long list of non-exhaustive symptoms mean? There is a lot of similarity!

Similarities:

• Emotional dysregulation

• Difficulty concentrating

• Memory challenges

• Social difficulties

• Rejection sensitivity

• Utilizing coping mechanisms to self-soothe and reduce distress

• Sensory sensitivities

• Executive functioning challenges

• Masking symptoms

If you see yourself in these traits ask your current or next counselor if they‘re informed on how neurodivergence shows up. The lens through which we view the world can make all the difference. It is important to look at both trauma and neurodiversity as potential factors, for how to feel so you can have therapy that supports what you need as an individual.