Liz Long Rottman
Complex trauma doesn’t heal linearly. You won’t wake up one day fixed. Instead, healing announces itself through small, strange shifts—some you’ll notice and some your therapist will notice first. Today, I’m breaking down the actual signs that CPTSD is beginning to resolve, backed by what we know about trauma neurobiology and what I’ve observed in 15 years of working with people, first as a bodyworker and now as a therapist.
Sign 1: Environmental Awareness Expands
Something I notice frequently because it’s more obvious: a client might see me for one to three years and then suddenly notice something in my office. It’s not something small they didn’t see—sometimes it’s “I didn’t realize how much I like that interesting design on the wood of your coffee table.” Sometimes, and this has happened more than once, they missed the entire 4-foot branch on the wall. That branch has been there the whole time.
This isn’t about being unobservant. Trauma causes chronic threat detection. Perceptual tunneling has been documented since the 1990s—our brain is scanning for danger, not for decorative branches. When clients start seeing the branch, the art, the books, the room details, their dorsolateral prefrontal cortex is coming back online. There’s a surplus of attentional capacity available, whereas when they were more symptomatic, it was less available. This is very nervous system determined: Is my environment safe enough to notice things beyond threat cues?
This is one of the most reliable indicators I track clinically. Environmental awareness expands when the internal threat response contracts.
Sign 2: Mental Clarity and Cognitive Organization Return
People with CPTSD complain about brain fog and executive dysfunction. Executive functioning helps us inhibit our emotions when it’s not appropriate or safe to express them. It helps us be flexible, use working memory to learn, and organize our lives. This has nothing to do with intelligence—you can have a very high IQ and very low executive functioning.
With CPTSD, the prefrontal cortex is chronically suppressed by an overactive amygdala. The person may not necessarily have ADHD, but they’ll behave as though they do. We may treat the CPTSD and find out they have ADHD, but often as the nervous system regulates, clients report that their thoughts become more linear—coming one at a time instead of all at once, not at all, or in a random fragmented way that’s overwhelming and hard to track.
They notice they can complete multi-step tasks without losing the thread, remember conversations more accurately—whereas with CPTSD you can have a conversation and two minutes later it’s gone. It’s not dementia. It’s the amygdala not allowing the cortex to do what it does. They can now make decisions without paralyzing rumination.
If you haven’t experienced rumination, it’s when either constantly or especially after an emotionally charged event, you can’t stop thinking about it. You can’t stop trying to solve it. Even when you try to stop, those thoughts pop up again with anxiety feelings in the body.
The sensation of regaining your ability to think is like clearing—like when TD static or radio static clears and you can get a clear signal again. People are able to think through problems instead of just reacting. When you have CPTSD, everything is overwhelming. When something happens, even something minor, it’s the worst. You feel crushed, overwhelmed—a big wash of sensation comes over you. As you heal, a problem happens and instead of that big sensation, you can see it’s something you need to address. You can triage: Is this something I need to do right now or can I wait? How might I prioritize my actions?
We have evidence from neuroimaging that trauma treatment increases prefrontal activation and decreases amygdala reactivity. We know this phenomenologically—from my own personal experience and from seeing my clients gain more executive functioning and decrease their fear response. But we also know from empirical science through instruments that this is true. Cognitive functioning returns because the structure of our brain is no longer hijacked by survival responses like fight, flight, or freeze.
Sign 3: Curiosity About Others Returns
I’m going to be clear this usually takes a few years. The reason I mention that is because the idea of being curious about others can actually be scary to people with CPTSD. I hope that for those who don’t have CPTSD, it lands for you how intense the fear of people can get with this diagnosis. Even me suggesting that we could be curious about others can be frightening.
Healthy humans are naturally interested in other people. Even people who are introverted or on the autism spectrum—healthy people with autism—all people like to be with people, maybe to different degrees in different ways, but it’s an important part of our overall holistic health. We’re wired for social connection. It’s one reason humans are so powerful on earth, for better or worse. Trauma disrupts that circuitry, especially CPTSD since it’s an attachment and relational-based type of trauma.
When we’re in chronic survival mode, other people are threats to manage, sources of potential rejection, and triggers for hypervigilance. Imagine someone walks into a room where you’re alone. For the person with CPTSD, that person symbolizes a threat. As soon as someone walks in, they get a little tight. This person who just walked in is suddenly a source of potential rejection and inspiration for hypervigilance. Involuntarily, you become more intensely scanning for threat in the environment.
How does the person with CPTSD look when another person walks into the room? Not that different. A lot of this tension and threat might be happening on very subtle levels, but the body is tensing, heart rate is increasing, changes in the brain are occurring. When we’re in this state of threat, there’s no bandwidth for genuine curiosity.
It’s a sign you’re healing when you meet someone and your brain starts populating with questions you actually want to ask. You actually want to know the answers. You’re not asking questions just to seem normal or mask your symptoms. You can notice the details of what the person is saying, remember them, feel present. You can think about the person after the experience. You don’t experience the interaction as anxious or numb—you feel a sense of openness, maybe some uprightness, perhaps some joy and warmth eventually.
What we’re talking about is the social engagement system, which requires ventral vagal activation from polyvagal theory. It is a theory, but it’s very helpful. Even if it gets disproven, I’m still probably going to think about people along these lines because I’ve seen so many people helped by it. When that ventral vagal activation occurs, we’re in the rest-and-digest part of the autonomic nervous system. This is where digestion starts working better, which means hormones start working better, which means the immune system starts working better, and overall health increases.
When the ventral vagal comes back online, we’re more curious, more connected, more genuinely interested because we are physiologically free to do that. The body is now free to do that, whereas before it wasn’t.
Sign 4: Medical Symptoms Resolve (Sometimes)
I see a lot of folks in my practice who have CPTSD and also have what we call medically unexplained symptoms. Just because somebody has a symptom the medical field hasn’t diagnosed doesn’t mean they’re not suffering with a physical problem. We have to be really careful about dismissing people’s reports of symptoms.
Sometimes the CPTSD is causing the symptom itself, and resolving the CPTSD decreases the symptom. Sometimes the CPTSD is exacerbating a different medical condition, and the medical condition symptoms can decrease as well. Symptoms like chronic pain, digestive issues, migraines, and autoimmune symptoms can quiet.
Let’s be clear: if you have an autoimmune disorder, that is not the same thing as your CPTSD. But if you resolve the CPTSD, which absolutely impacts the immune system, you’re going to experience a decrease in those autoimmune symptoms.
The research is clear: chronic stress and trauma dysregulates the HPA axis, which can wildly impact hormones, the immune system, and the inflammatory system. We often say colloquially that trauma lives in the tissues—that’s a shortcut. What that means is that when we’re chronically traumatized, we’re chronically bracing. Even if you’re somebody who’s experienced a collapse pattern—can’t get off the couch, can’t stop binging YouTube—you’re still bracing. One reason the collapse pattern happens is because there’s so much tension in the body that the person is exhausted.
Somatic therapy studies have shown that when the nervous system shifts out of chronic activation, inflammatory markers decrease, pain thresholds normalize—not where we don’t feel pain, but we feel the appropriate amount of pain so we know not to keep hurting ourselves. We’re not completely blasted by pain, and stress-related physical symptoms resolve, sometimes dramatically.
I have to say, as a therapist who has seen these things resolve so many times, it’s pretty amazing. That may be because I grew up at a time when the medical philosophy was: you have a symptom, you take a medication, the medication fixes it. To see things get resolved by means of physical and psychological interventions and have that affect what’s supposed to be in the medical category feels miraculous because it goes strongly against what I was taught.
An example: somebody with decades of unexplained stomach problems—they disappear after a few years of trauma processing. I know it sounds like a long time. I have looked far and wide for anything that speeds this up. Sometimes people do have unusually fast healing processes and that’s wonderful, but for the majority of people that’s not the case. To insist that people need to heal quickly can be disheartening for people going through the actual normal long process. The long process isn’t wrong—the quick processes are actually the outliers.
This person with stomach problems—their pain wasn’t fake, their digestion issues weren’t made up. They were actually being caused by physiological means, but those physiological processes were kicked off by the fear in the amygdala that started a whole cascade through the body. Trauma is not just psychological, it’s systemic. When we heal the symptoms of CPTSD, we often take a few medical issues with us, which is very nice—though not without supportive interventions from appropriate medical providers.
Sign 5: Symptoms Change, Not Just Disappear
Sometimes when people start to heal, their symptoms don’t disappear, but they change. Maybe some things are getting better, but there’s a few things where it was this, now it’s that. This can be confusing.
For example, someone might have been dissociating for years, but then they start having panic attacks. Sounds worse, but in the developmental process of healing CPTSD, panic is actually more sophisticated than dissociation. Some aliveness is starting to come back. I have sat with many clients frustrated with that part of healing because the dissociation, while uncomfortable, wasn’t nearly as uncomfortable as the panic attacks—even though the panic attacks are an improvement.
When we’re in panic, the nervous system recognizes there’s something we need to fight or flee—we have “do something about it” energy. When we’re dissociating, the system has given up entirely. It’s not even trying to survive at that point—it’s trying to soothe and get through it, which is a different type of survival. There’s a resignation that this isn’t going to get better.
Another example: nightmares stop and waves of grief emerge. It wasn’t that the person didn’t have grief—it was always there, but it was held at bay by the nightmare pattern.
All of this to say: trauma resolution is not simply symptom elimination. It can look like symptoms going from a worse symptom to a better symptom. In terms of the nervous system hierarchy, in the event of an attack, the system will want to fight or run before it’s going to want to collapse. If the system decides to collapse, that’s because it’s assessed that the threat is too big to fight or run—that’s not good.
What we’re looking for with trauma resolution is not never feeling uncomfortable feelings again, never feeling activated again, never feeling triggered again. It’s really more about restoring nervous system flexibility. Someone cuts me off in traffic—that used to activate me for so long. Now someone cuts me off in traffic, I feel my heart racing, I feel anger, and then 30 seconds to 90 seconds later, I’m back to more of a baseline. I might feel a little shake still, but I’m on my way out of it.
Nervous system rigidity is more like being stuck in a state of terror all the time. If you’ve never experienced that, it’s hard to believe people are living that way. Stuck in terror all the time—that’s rigidity. If I’m stuck in flat dissociation, monotone all the time, that’s rigidity. There’s no variation. Panic in and of itself isn’t bad. Dissociation in and of itself isn’t bad. But those are states we’re meant to visit and then leave.
We’re moving through layers: freeze, fight-flight, and then genuine regulation. That’s the hierarchy. In therapeutic terms, we arrive there through titration—slowly introducing both positive experiences in therapy and revisiting some of the trauma experiences. Doesn’t have to be the actual memory—it can just be the way it’s feeling in the body. Slowly over time, as we do both of those things, we don’t jump from traumatized to healed, but we gradually make our way there.
We’re moving through the stages and each stage has its own appearance. As a therapist, that’s what I’m looking for. When the person walks into my office, what stage are we in? Are we very early? Are we halfway through? Each of those stages has a different way of looking and working with them.
Additional Research-Backed Signs
Sleep architecture normalizes. People are sleeping through the night or sleep becomes restorative—some folks will sleep through the night but don’t feel rested when they wake up. Sleep is often suppressed in CPTSD and that returns as well.
Emotional range expands. It’s not just numb to overwhelmed. You get access to nuanced emotions: contentment, a little frustrated, wistful sadness, joy about this thing. It’s not just all good or all bad. It’s not that you heal from CPTSD and then everything feels good forever—it’s that things become more nuanced.
You start thinking about the future. I’m not huge on New Year’s resolutions, but it’s a cultural thing. I’ve seen many clients go through many New Years and they don’t even acknowledge it. Then you start to see them wanting to, around this time of year (early January), actually plan the year or think about their values or accomplish something. The reason future orientation is hard is because trauma locks you into an eternal present moment scanning for threat. I teach at a Buddhist college, so we’re all about presence and being in the moment—but you can be too in the moment. With CPTSD, you’re kind of too in the moment in some ways. When you start to heal, you can actually make plans, imagine possibilities, and think past the next week.
Boundaries become clear. People with CPTSD often feel boundaryless. They don’t know where they end and others begin. They might feel like people know what they feel and think—not in a schizophrenia kind of way, but in a subtler version of that. They’ll feel this persistent shame that everybody knows how “screwed up” they are (heavily in quotes). Or they can feel aggression when they have to say no to someone—they get mad that they’re being put in a position where they have to say no. They really just want other people to already know what they need without them having to say it.
As we heal from CPTSD, we can also identify more what we want in relationships instead of constantly reacting to other people’s wants. We can actually say, “I’m noticing that I want this in this relationship.”
Interoception improves. Interoception is feeling within—I can feel hunger, thirst, fatigue, whereas before I might have just felt a constant blanket of terror or dissociation. They can respond appropriately instead of ignoring bodily signals until a crisis emerges. If we want to stay in a good mood, some of the easiest ways to do that—amygdala activation aside—are to stay regulated through food, movement, and relationship. If I can’t feel the signals that I’m hungry or sleepy or need a friend, I can’t keep myself in homeostasis—I can’t keep my body running in a comfortable way. That can add to the amygdala activation and make the crisis happen.
Conclusion
None of these shifts are small—they’re all a really big deal. They can feel kind of small to the person because they’re the one living it. When I see these things, I get really excited and I’ll tell my clients I’m geeking out because I saw this thing, and they think that’s funny. These represent real fundamental neurobiological changes happening in the brain, the nerves, the immune system, and the endocrine system. They’re extremely important for the people experiencing them and their loved ones.
Trauma healing does not mean returning to who you were before. Especially for CPTSD, there often was no before. That’s one of the biggest ways we distinguish CPTSD from PTSD. With PTSD, there was a before the trauma, the trauma, and now me with symptoms. With CPTSD, it usually starts really early, so we haven’t formed our personalities yet. The trauma is part of the personality. As we heal from it, we’re actually developing something we never had.
That’s actually kind of cool. I think sometimes folks with CPTSD get a very hard view on life, but also a cool one. They actually have this chance to become very different than a lot of people get. Most people kind of crystallize their personality in their early twenties, but people who heal from CPTSD, especially a little bit later in life, get to find a whole new person in there. You have to develop a nervous system that can respond with flexibility to life instead of just rigid survival.
If you notice any of these signs, even small ones, that’s really important data and it should be taken seriously. I always encourage my clients when they notice that: get yourself the piece of chocolate, go to your special place in nature, celebrate it, go have dinner with a friend, get a little rock and paint it. It means your system is reorganizing. Trust the process even when it doesn’t look like what you’re expecting—when you go from dissociation to panic, not fun but positive.
This is maybe my third YouTube video, so I’m going to do the awkward YouTube thing and say subscribe for more on the actual mechanisms of trauma recovery. I’m also talking a lot about counselor effectiveness on this channel. I’m going to bring in phenomenology—I have a philosophy background. So I’m going to talk about philosophy. At some point, I’ll talk about phenomenology versus empiricism. I invite people who are nerdy and wanting an authentic experience.
