ALPIMS • UNDERSTANDING OVERLAP
Bodily Symptoms, Anxiety & Trauma Overlap
Compare the patterns, understand possible differences and find support that fits.
Similar symptoms can have different causes
Medical conditions, neurodevelopmental differences and PTSD/complex PTSD can coexist. These comparisons are clues for assessment—not a way to diagnose yourself or rule out trauma.
One diagnosis should not automatically explain every symptom.
Normal routine tests do not exclude every medical condition. Feeling frightened does not prove a psychological cause; not recognising a trauma reminder does not rule out PTSD.
Compare each pattern with trauma responses
Open one section at a time. Each includes overlap, differences and ideas that may help.
POTS / orthostatic intolerance
What can overlap?
Racing heart, shaking, dizziness and brain fog.
What may differ?
Symptoms repeatedly worsen upright and may ease lying down. Assessment looks for a characteristic heart-rate/blood-pressure pattern. PTSD does not require this positional pattern.
What may help?
Ask about orthostatic assessment. Sit or lie down when symptomatic. Discuss fluids, salt or compression with your clinician; suitability varies.
ME/CFS / post-exertional malaise (PEM)
What can overlap?
Exhaustion, poor sleep, concentration difficulties and reduced participation.
What may differ?
Disproportionate worsening after exertion, sometimes delayed and lasting days or longer, is characteristic of PEM. It does not require a trauma reminder.
What may help?
Use flexible pacing within current energy limits. Break tasks into smaller parts and avoid fixed activity increases where PEM is present.
MCAS / allergic-type episodes
What can overlap?
Palpitations, breathlessness, dizziness and feeling physically alarmed.
What may differ?
Hives, itching, flushing, swelling or diarrhoea alongside episodes suggest assessment for mast-cell activation.
Symptoms alone do not confirm MCAS; clinical and laboratory criteria matter.
What may help?
Follow your clinician’s treatment and emergency plan. Note suspected triggers without deliberately testing them. Avoid unnecessary food restrictions.
Migraine
What can overlap?
Sensory sensitivity, irritability, withdrawal and brain fog.
What may differ?
Episodes may include headache, nausea, light/sound sensitivity or aura. These can occur without trauma reminders.
Migraine aura and persistent visual snow are different phenomena.
What may help?
Reduce glare and noise during attacks. Seek a migraine treatment plan and support a tolerable sleep and meal routine.
Visual snow syndrome (VSS)
What can overlap?
Visual discomfort, concentration problems, distress and sometimes a sense of unreality.
What may differ?
VSS typically involves persistent tiny flickering dots across the visual field in both eyes, often with afterimages, light sensitivity or night-vision difficulty.
This is different from reliving a traumatic scene. It is also distinct from typical temporary migraine aura.
What may help?
Arrange eye/neurological assessment to exclude other causes. Try comfortable lighting, less glare and short screen breaks.
Some people benefit from individually selected tinted lenses; evidence is limited. There is no established reliably effective treatment.
Misophonia
What can overlap?
Intense distress, anger, disgust, bodily arousal and an urge to escape.
What may differ?
Reactions centre on particular sound patterns or their meaning/context, such as chewing or repetitive tapping—not necessarily loudness. A traumatic memory is not required.
With PTSD, a sound may act as a trauma reminder. Both can coexist.
What may help?
Agree a brief exit signal, quieter seating or tolerable background sound. Use hearing protection selectively when helpful.
A clinician familiar with misophonia may offer adapted CBT; evidence is developing. Do not impose exposure or deliberate trigger sounds.
Hyperacusis / sensory overload
What can overlap?
Startle, distress, escape, overwhelm or shutdown.
What may differ?
Hyperacusis concerns reduced tolerance of sound intensity; misophonia concerns specific triggers. Sensory overload can follow accumulated input or demands.
Trauma-related sound distress may involve reminders of danger; the patterns can overlap.
What may help?
Seek audiology assessment for sound intolerance. Adapt noise, light and demands.
Discuss hearing protection with an audiologist; avoid assuming constant protection or forced exposure is the right approach.
Autism / ADHD
What can overlap?
Concentration difficulties, emotional dysregulation, overwhelm and withdrawal.
What may differ?
Assessment considers developmental history and longstanding patterns across settings. Trauma can add or intensify difficulties. A late diagnosis does not mean late onset.
What may help?
Offer clear choices, predictable plans, manageable tasks and sensory adaptations. Support trauma-related difficulties separately where present.
Fibromyalgia / chronic pain
What can overlap?
Pain, tension, poor sleep, fatigue and reduced activity.
What may differ?
Persistent pain patterns need assessment in their own right. Pain alone does not establish PTSD; trauma may contribute in some people.
What may help?
Seek a personalised pain plan and adapt activity to capacity. Check for PEM before recommending activity increases. Treat sleep and coexisting conditions.
IBS / bladder or pelvic pain
What can overlap?
Gut discomfort, urgency, tension and distress.
What may differ?
Symptoms may track bowel movements, bladder filling or other bodily patterns. Stress sensitivity does not establish a trauma cause.
What may help?
Seek condition-specific assessment. Keep changes manageable and avoid broad dietary restriction without guidance. Pelvic-floor care may help when clinically indicated.
Sleep apnoea
What can overlap?
Waking alarmed, poor sleep, fatigue and brain fog.
What may differ?
Snoring, witnessed breathing pauses and gasping suggest a breathing-related sleep problem. A sleep study may be appropriate; nightmares alone do not distinguish causes.
What may help?
Ask about sleep assessment. Use prescribed treatment and review fit or comfort problems rather than abandoning treatment unsupported.
Vocal cord dysfunction / inducible laryngeal obstruction
What can overlap?
Throat tightness, breathlessness and panic.
What may differ?
Episodes involve altered laryngeal function, often difficulty breathing in. Assessment may include viewing the larynx. Fear during an episode does not establish its cause.
What may help?
Seek respiratory/ENT assessment and specialist speech-therapy breathing techniques. Use your agreed plan; new or severe breathing symptoms need urgent care.
Functional neurological disorder (FND)
What can overlap?
Weakness, shaking, altered sensation, seizure-like episodes and sometimes dissociation.
What may differ?
FND is diagnosed using positive clinical features, not simply normal tests or a trauma history. Trauma is not required and other neurological conditions may coexist.
What may help?
Ask for a clear explanation of the diagnosis and tailored rehabilitation. Address pain, fatigue or trauma where relevant without assuming one cause.
PTSD / complex PTSD
What can overlap?
Can include many of the symptoms above.
What may differ?
Trauma-related re-experiencing and avoidance are distinguishing features. Complex PTSD also includes persistent difficulties with emotion regulation, self-concept and relationships.
Symptoms need not have an obvious reminder every time.
What may help?
Seek trauma-informed assessment and appropriately adapted treatment. Offer choice, consent and predictable sessions, while respecting physical and sensory limits.
Choose one manageable next step
Notice one episode: What happened beforehand? Were you upright, exerting yourself, exposed to a particular sound, having visual symptoms or reminded of a frightening experience?
Bring a brief example: Describe timing, other symptoms, duration and what helped. Do not deliberately provoke symptoms.
Adapt the plan: Pacing and sensory protection should not automatically be labelled fear-based avoidance. Therapy and activity plans need to consider PEM, pain, autonomic and sensory limits.
Improvement with therapy, rest or medication alone does not establish the original cause.
When symptoms need urgent assessment
New or severe chest pain, severe breathing difficulty, collapse or sudden stroke-like symptoms require urgent help. Call 000 in Australia. Follow an anaphylaxis emergency plan where applicable.
Sudden vision loss, a new curtain or shadow, new flashes with many floaters, or a sudden major visual change needs urgent assessment. Do not assume it is visual snow or migraine.
Reference list & further reading
- POTS — Johns Hopkins Medicine
- ME/CFS symptoms — CDC
- ME/CFS management — NICE NG206
- MCAS — AAAAI
- Migraine — MedlinePlus Genetics
- Fraser (2024): How do I recognise and manage visual snow syndrome?
- Swedo et al. (2022): Consensus definition of misophonia
- Jager et al. (2021): CBT for misophonia— randomised trial
- Hyperacusis — NHS
- Autism — NIMH
- ADHD — NIMH
- Fibromyalgia — NIAMS
- IBS — NIDDK
- Bladder pain syndrome — NIDDK
- Sleep apnoea — NHLBI
- Laryngeal obstruction assessment — North Bristol NHS
- FND: Australian treatment recommendations (2025)
- PTSD — NIMH
- Complex PTSD — NHS
Practical adaptations are options to discuss or try gently, not guaranteed treatments. Evidence and individual responses vary.