Sleep Disruption, People-Pleasing, and Dissociation Top the Symptom List in CPTSD

Amend Treatment has released findings from a new national study examining how Complex PTSD (CPTSD) manifests in high-functioning women ages 30–55. Despite appearing outwardly successful, many respondents reported severe, untreated trauma symptoms including insomnia, emotional exhaustion, dissociation, and chronic people-pleasing behaviors.

The study, Women & CPTSD: The Invisible Load, combined nationwide survey data with social media discourse analysis to explore how trauma shows up in women who are parenting, caregiving, or leading professionally while remaining largely undiagnosed. Findings reveal a stark mismatch between public functioning and private suffering.

Key findings include:

• Sleep as a primary trauma indicator: Nearly 80% of participants reported severe sleep disruption, including nightmares, dread of going to bed, and early-morning panic. Sleep disturbance was consistently described as the most unmanageable symptom, significantly impairing daily functioning.
• Fawn response and emotional suppression: More than half of respondents reported chronic people-pleasing, conflict avoidance, and boundary collapse. This trauma-adapted “fawn response” often delayed care and contributed to burnout.
• Dissociation and safety risks: Many women described episodes of emotional numbness, derealization, and time loss during routine activities such as driving, raising safety concerns.
• Hormonal factors overlooked: Among menstruating participants, symptoms intensified in the premenstrual phase, including heightened nightmares, flashbacks, and irritability—an interaction rarely addressed in standard trauma treatment.
• Delayed care and misdiagnosis: Respondents cited years-long delays in receiving trauma-specific care due to misdiagnosis, role obligations, stigma, and lack of awareness of intensive treatment options.

"Women with CPTSD are often dismissed because they 'look fine,'" said Shira Rebibo, LMFT, Clinical Director at Amend Treatment. "This study validates what we've long seen in clinical settings: these women are collapsing in private. Their symptoms show up in the body, in sleep, in the nervous system, not in ways that most systems are trained to recognize."

The study also identified three recurring archetypes across social narratives, each facing distinct barriers to care.

- The Quiet Professional: Highly Competent, exhausted, and emotionally numb

- The Sleepless Striver: Restless, perfectionistic, and struggling with chronic insomnia

- The Invisible Caregiver: Emotionally depleted, constantly overextending for others

Each archetype faces barriers to care, including family obligations, shame, financial limitations, and fear of judgment.

A Call to Change How Women’s Trauma Is Recognized

Amend Treatment hopes the findings will encourage earlier diagnosis, more nuanced screening, and greater public understanding of how CPTSD presents in women who do not “look” symptomatic.

The full report is available at www.amendtreatment.com/cptsd-in-women-study.

About Amend Treatment

Amend Treatment is a trauma-specialized mental health program based in Malibu, California, offering residential treatment, virtual IOP, and ongoing clinical care for CPTSD, severe depression, and co-occurring disorders.

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