Addressing PTSD and Trauma from a Functional Medicine and Integrative Psychiatry Perspective

Something people often don't realize is that psychological trauma and PTSD have both emotional and physiological effects and therefore, symptoms. In the psychiatric diagnostic book, the DSM, criteria includes both aspects but unfortunately doesn't give much more than a surface level checklist of symptoms.

An Integrative Psychiatry Approach to PTSD

Integrative psychiatry offers a different lens than the conventional psychiatric approach to PTSD, which focuses on thoughts, emotions, and behavior In integrative psychiatry, we ask a different question: What happened in the brain and body when the trauma occurred and what is happening physiologically now as a result?

Trauma changes so much physiologically including the autonomic nervous system, the HPA axis (think stress hormones), inflammation and immune signaling, sleep architecture, the gut–brain axis, and sensory processing. These symptoms can look "psychiatric" but I think it is helpful to reframe them as someone's wise physiological survival adaptations.

A holistic approach to trauma goes beyond cognitive reframing, medication, and exposure therapy. It adds in nervous system regulation, somatic therapies, breathwork, HRV training, limbic retraining, and grounding the body’s survival signals through practicing skills. As I was discussing with a friend who is a family medicine physician on a run this week, we can't think our way out of a dysregulated/triggered nervous system.

The Role of Inflammation & the Immune System

PTSD is increasingly understood as a neuroinflammatory condition, which means as it sounds - inflammation of the nervous system. Studies show this to be true - people with PTSD tend to have: elevated cytokines (IL-6, TNF-α, CRP), microglial activation, disrupted serotonin/glutamate balance (which can affect mood, anxiety, sleep, sensory processing, GI function, pain, cognition, emotional regulation, autonomic dysfunction), and changes in the stress hormone pathways.

Integrative psychiatry works with the whole neuroimmune system. That is why PTSD treatment may include addressing MCAS (Mast Cell Activation Syndrome), anti-inflammatory nutrition, sleep repair, addressing cortisol dysfunction, improving mitochondrial function, and if relevant - addressing underlying infections, mold, or environmental triggers.

Cortisol and PTSD

Our body's main stress hormone, cortisol, is disrupted in trauma as well. Some functional medicine clinicians order cortisol tests such as as salivary cortisol levels but the reality is, these tests aren't really that helpful since we already know that cortisol rhythm is negatively impacted. Cortisol dysfunction can help explain why some people with PTSD have difficulties with fatigue, sleep (think: anxiety in the middle of the night or upon waking in the morning), inability to tolerate "normal life load".

We don't focus on treating cortisol but instead - sleep architecture, autonomic dysfunction, trauma and limbic loops, MCAS, inflammation, mitochondria, metabolic instability (think: Threat → inflammation → sympathetic activation → metabolic crash). By focusing on these aspects, cortisol normalizes.

Emphasizing Safety and Relationship

Trauma is a wound to connection, trust, and the ability for someone to feel safe in their own body. Therefore, relationship and safety has to be at the forefront of any trauma healing plan. Through relationship, we help you co-regulate, attune, and create space and time where your body can learn to live outside of survival mode. Coregulation also helps stabilize cortisol as well as lessens sympathetic overactivation, vagal activity, and calms the fear center of the brain - the amygdala.

There is No Single Path

If only it were so easy. The healing path is customized, depending on a person's history, nervous system, medical background (ie if someone has POTS or an autoimmune condition), trauma timeline, environment, and degree of sensitivity to treatment. Here are some treatment options part of an integrative psychiatry PTSD toolkit.

HPA Axis Calming Treatment Options

There are a variety of options here, both pill and non-pill forms but we can break this up into two categories: Root Cause and Symptomatic Stabilizers. In my approach, I don't put these categories on a morality scale - both have their merits!

• Root Cause:

  • MCAS Stabilization: Not a one-size-fits-all approach

  • Mold/mycotoxin exposure

  • Somatic therapies

  • Limbic retraining (Primal Trust, Gupta Program are examples)

  • Frequency Specific Microcurrent (FSM)

  • Ketamine assisted psychotherapy

  • Internal Family Systems/EMDR/Brain Spotting

  • Polyvagal regulation

  • Relational safety building

  • Attachment repair

    
    

• Symptomatic Stabilizers

  • Alpha-agonists at bedtime: low dose clonidine

  • Gabapentin at bedtime

  • Low dose naltrexone for dissociation

  • Blood sugar stabilization: getting recommended daily amount of protein daily, protein/fat with each meal, limiting sugar

  • Sympathetic nervous system overwhelm: hydroxyzine, ashwagandha, rhodiola, passionflower, lemonbalm, prazosin/doxazosin

  • POTS treatment: volume + circulation support, metabolic stability, autonomic stabilizers

PTSD and trauma affects both the body and the mind. It alters cortisol rhythms, autonomic tone, immune system signaling, and what keeps from people feeling grounded in the world. And it also shapes beliefs, identity as well as how safe or unsafe the world feels.

A kind reminder: This blog post is designed as a general guide. This is not a substitute for personalized medical advice, nor is a patient-physician relationship established in this blog post.

PS - Starting in January 2026, I am joining Dr. Kat Hopkins at Olos Integrative Medicine. If you are interested in a whole person, integrative psychiatry approach to PTSD, reach out here.