Can high functioning people have CPTSD?

Hi, I’m Sarah and I’m a psychotherapist. I’ve been working with childhood trauma for the past 15 years helping people who feel bad about themselves to start feeling better.

Many people I work with arrive thinking:
If I could just figure out what’s wrong with me, maybe I could fix it.

They often describe themselves as feeling confused. Or stuck. Or that something isn’t right, even though on paper things look fine.

They assume the problem must be them.

Because nothing was “bad enough” to explain this feeling.

They didn’t grow up hungry. Their mum made dinner. They weren’t beaten. They went on holidays. They didn’t have holes in their clothes. Not like their friend James whose dad went to the pub every night and came home in a terrible mood. Not like the stories you hear when people talk about trauma or child abuse.

So why does everything feel so hard?

And why, no matter how much they think about it, research it, or try to sort themselves out, does the same feeling keep coming back?

Why CPTSD gets missed in high-functioning people

When people picture CPTSD, they often imagine chaos: lives falling apart, not being able to work, obvious crises, visible suffering.

The people I work with can’t relate to this.

They function impressively, which is part of what makes the whole thing so confusing. They hold down jobs. They’re reliable. They’re thoughtful. Other people come to them with problems.

They don’t relate to the idea of not coping. If anything, they’ve coped too well.

Most have never seen a psychiatrist and never will. In the UK, only a psychiatrist can formally diagnose CPTSD, and people who are managing, earning, parenting, and showing up are very unlikely to end up in that system. That doesn’t mean the framework of CPTSD and trauma isn’t useful for them to understand what happened and how to move forward.

For many people, CPTSD functions as an informal diagnosis: a way of understanding themselves that finally makes sense of experiences they’ve never been able to explain.

“It wasn’t bad enough”

I’ve heard this so many times.

People tell me:

• “We always had enough.”

• “My parents weren’t monsters.”

• “Other people had it much worse.”

• “I don’t know why it’s still affecting me.”

In better off families, money or status often adds another layer of shame. You should have been fine. You should have used what you were given. You should have been grateful.

And if you’re not okay despite all of that, it starts to feel embarrassing to complain.

So the conclusion becomes:
There must just be something wrong with me.

What CPTSD looks like when you’re doing “fine”

People I work with don’t usually describe themselves as traumatised. They’re more likely to say they feel disconnected from their own lives as if they’re present, but not really in them.

They prioritise others over themselves. They’re responsible, kind, considerate. And because they seem capable, they often get forgotten, overlooked, or treated like they don’t mind.

They might not recognise dissociation for what it is. They’ll say they need ‘downtime’, or they were on autopilot, or that they just kept going because that’s what you do.

From the outside, things look stable. Inside, there’s often a persistent sense of wtf is wrong with me and why can’t I fix it.

They’re stuck in the middle:
If I’m okay, why do I feel bad? But if I were really not okay, I wouldn’t be able to function. So I must be exaggerating.

Emotional flashbacks (without knowing that’s what they are)

It’s often a relief when people hear about the concept of an emotional flashback. Because it means maybe they’re not crazy and something can change.

They’ve lived for years with: one minute I was fine and the next I wasn’t. No obvious reason. No clear trigger. Just a sudden drop into shame, rage, numbness, or despair.

Because they’ve minimised their childhood, they tend to see trauma as violence, war, obvious abuse and don’t find them in their own stories. They don’t understand the cumulative impact of growing up without emotional safety, repair, or attunement, a gradual ‘drip, drip, drip’ of not feeling important or cared for.

When they read Pete Walker or Jonice Webb, they say things like: It felt like it was written about me.

Not because there was one catastrophic event, but because of the slow erosion of trust and love over time.

Why success can make this worse, not better

Many high functioning people used achievement as a way out.

They did well at school. They focused on thinking rather than feeling. They told themselves that if they could just get far enough away, geographically, socially, financially, everything would be okay.

Success becomes a coping strategy for managing shame: If I’m doing well, then I’m okay.

The problem is that it’s a fragile solution. It only works while things are aligned. Miss a promotion, go through a breakup, and the whole system comes into question. Why can’t I make this work? Why do I feel so bad?

Often it’s in midlife that things catch up. People tell themselves they grew out of their problems, only to find they can’t feel happy despite everything they’ve built. Relationships feel flat or confusing. They start wondering if this is really it.

Why therapy hasn’t helped

Many of the people I work with have tried therapy before.

They’re well informed; they’ve read the books. They know about attachment. They don’t need things explained to them in a soothing voice with pastel metaphors.

They often end up taking responsibility for the therapist, smoothing things over, or feeling patronised by approaches that don’t match their internal experience. Sometimes the dynamic quietly mirrors their family: they become the caretaker again.

They’re also avoidant. They don’t resonate with needing reassurance or being visibly distressed. They look aloof rather than needy, which means they’re overlooked. in real life (and often the caretaker or peacemaker).

Soft validation, “healing journeys”, and endless exploration without traction can make them want to run a mile.

What actually helps

What tends to help isn’t being told how to feel, or being treated as fragile.

It’s understanding patterns. Seeing dynamics clearly. Having someone who can keep up, challenge them, and explain what’s happening without gatekeeping or mystique.

It’s not about pushing or forcing emotional breakthroughs. Often the change happens quietly: a joke that lands, a moment of being understood, the realisation that someone actually cares and isn’t going to use that against them.

Over time, people notice they’re less brutal with themselves. They start to see how mean their families were and how mean they’ve been to themselves in response.

They don’t lose their edge. They don’t turn into someone who cries at kittens on TV or starts talking about their inner light. They don’t become victims.

If anything, they become freer.

Do you need a CPTSD diagnosis?

Probably not.

Many people find the CPTSD framework useful without ever seeing a psychiatrist. It gives language to something that’s been unnamed for years and helps shift the blame off themselves.

That doesn’t invalidate people whose suffering looks louder or more visible. Different adaptations to different environments produce different outcomes.

What matters is whether a framework helps you understand yourself, relate differently, and feel better.

And yes, you can ask your doctor for medication if you need it. And no, I won’t think you’re not trying hard enough.

You’re fine, but since when did you ever settle for fine?

The people I work with aren’t falling apart.

They’re fine. But they’d hoped for something more than just coping. More than functioning. More than endlessly managing themselves.

If any of this resonates, it doesn’t mean you’re broken. It means you adapted. And those adaptations once kept you safe.

The work is about understanding them — and deciding what you want to keep, and what you’re finally allowed to let go of.

What actually helps

At some point, you realise you don’t need more insight. You already understand yourself better than most people.

What you need is somewhere you’re not the most emotionally mature person in the room.

Somewhere you don’t have to perform being capable in order to be accepted. Where you don’t have to stay one step ahead, manage the atmosphere, and hold it all together.

Most of the people I work with have spent their lives coping by being competent, reasonable and self sufficient. That worked until it didn’t. And when it stops working, trying harder just makes everything feel it’s your fault.

Therapy isn’t about turning you into someone softer, quieter, or less sharp. You don’t need to become an advocate for cold water plunges, Reiki or start a gratitude journal. It’s about not having to live the rest of your life on hard mode.

Because it doesn’t need to be this hard.

For an overview on CPTSD you might like What is CPTSD and do I have it?

If you’re still telling yourself that nothing that bad really happened you might like What is Emotional Neglect?