Trauma & PTSD Treatment in New Hampshire

What Trauma and PTSD Actually Look Like

Post-traumatic stress disorder (PTSD) is a psychiatric condition that can develop after a traumatic event, marked by intrusive memories, avoidance, hypervigilance, and negative changes in mood or thinking. Not everyone affected by trauma meets full criteria for PTSD, and that doesn’t mean the symptoms aren’t real or worth treating — hypervigilance, difficulty trusting others, emotional numbness, and a persistent sense that something isn’t safe can significantly affect daily life on their own. What trauma-related presentations share is that they respond best to a careful, specific evaluation — one that takes the time to understand what happened, how it’s showing up now, and what’s actually needed, rather than a generic response to a single checklist question about “trauma history.”

Conditions Evaluated and Treated

Dr. Narlesky evaluates and treats a range of trauma-related presentations, including:

• Post-Traumatic Stress Disorder (PTSD) — intrusive memories, flashbacks, hypervigilance, avoidance behavior, and negative changes in mood or thinking following a traumatic event
• Complex trauma — the effects of prolonged or repeated traumatic experiences, often beginning in childhood, which can shape emotional regulation, relationships, and self-perception in ways that don’t always fit neatly into a single diagnostic category
• Acute stress reactions — significant distress in the immediate aftermath of a traumatic event, before symptoms have had time to become chronic
• Trauma-related anxiety and depression — mood and anxiety symptoms that are directly tied to a traumatic history, where treating the trauma itself is central to treating the symptoms
• Dissociative symptoms — feeling disconnected from oneself, one’s surroundings, or one’s memories, which can accompany trauma but are often under-recognized or misattributed to other causes

These presentations frequently overlap with anxiety and depression, and prior providers may have treated the more visible symptoms without addressing the underlying trauma driving them. The distinction from bipolar disorder also matters. Hyperarousal, poor sleep, irritability, and reactive mood shifts after trauma can be misread as hypomania, and the difference usually lies in the pattern: bipolar mood episodes have a sustained course of their own, while trauma-related shifts tend to be tied to triggers and reminders.

Obsessive-compulsive disorder (OCD) and PTSD can share features such as intrusive thoughts, avoidance, and repetitive behaviors, and the two conditions can occur together. These similarities can make symptoms difficult to interpret without considering how they developed and how they affect daily life — intrusive memories in PTSD tend to be of something that happened, while obsessions center on a feared outcome. Dr. Narlesky evaluates the full symptom pattern, relevant history, and when symptoms tend to occur to clarify whether PTSD, OCD, or both may be contributing and guide an individualized treatment plan.

How Dr. Narlesky Approaches Trauma and PTSD

Trauma-related conditions require an evaluation that moves carefully and doesn’t ask someone to relive difficult material before trust has been established. Dr. Narlesky’s evaluation includes:

• A history of relevant experiences, at whatever level of detail feels appropriate to share — patients are never required to recount specifics they’re not ready to discuss
• Assessment of current symptoms: intrusive memories, avoidance patterns, hypervigilance, sleep disruption, emotional numbness, and changes in mood or outlook
• Review of prior treatment, including what’s helped and what hasn’t
• Assessment for co-occurring depression and anxiety, which frequently accompany trauma and change how the full clinical picture should be understood
• Medical history review to identify factors that may be compounding symptoms, including sleep disorders and other conditions that can mimic or worsen trauma-related symptoms
• Functional impact — how symptoms are affecting relationships, work, and day-to-day life

The goal is an accurate clinical picture built at the patient’s own pace, not a rushed intake designed to check a box.

Treatment

Treatment for trauma and PTSD is individualized based on what the evaluation reveals. Options may include:

Medication, when appropriate, targeted at specific symptoms — sleep disruption, hyperarousal, mood symptoms, or anxiety — based on the patient’s presentation and history. Dr. Narlesky explains the reasoning behind any medication recommendation, including what it targets and what to expect.

Therapy coordination. Certain therapy modalities have strong evidence specifically for trauma and PTSD. Dr. Narlesky does not provide therapy directly but frequently coordinates care with a patient’s existing therapist when one is involved. Patients unsure which kind of clinician they need can start with the difference between a psychiatrist and a therapist.

Ongoing monitoring through follow-up visits that track symptom changes over time, adjust treatment as needed, and provide space for genuine clinical conversation — not just a medication check.

Pacing that respects where the patient is. Trauma treatment isn’t a race, and pushing too quickly can do more harm than good. Dr. Narlesky’s approach is to move at a pace that reflects clinical judgment and the patient’s own readiness.

When to Consider a Psychiatric Evaluation

A psychiatric evaluation for trauma or PTSD is worth considering if:

• A specific event or period of your life continues to affect how you feel, sleep, or relate to others
• You experience intrusive memories, flashbacks, or a persistent sense of being unsafe
• You avoid certain places, people, or situations because they trigger distress
• You’ve been treated for anxiety or depression but feel like an underlying trauma has never been directly addressed
• You feel emotionally numb, disconnected, or unable to trust in ways that seem tied to past experiences
• You’re not sure whether what you experienced “counts” as trauma, but it continues to affect you

You don’t need a specific diagnosis in mind, and you don’t need to have a clear narrative of what happened before reaching out.

What to Expect

Your first appointment is typically 60 minutes, conducted via secure video from anywhere in New Hampshire. Dr. Narlesky will take a history at a pace that respects what you’re comfortable sharing, assess current symptoms, and begin developing a treatment plan specific to your situation.

Follow-up visits include ongoing clinical assessment and medication management when applicable, with the pace of treatment guided by how you’re responding.

Who This Practice Serves

This practice provides ongoing outpatient psychiatric care for adults 18 and older located in New Hampshire. It is not equipped for acute psychiatric crises, frequent or recurring safety-related needs, inpatient or intensive outpatient-level care, benzodiazepine management, forensic or disability evaluations, standalone psychotherapy, or addiction treatment as a primary concern. Full details are available on the Disclaimer and FAQ pages.

If you’re in crisis, call or text 988, or call 911 or go to your nearest emergency room.

Accepting New Patients Across New Hampshire

If you’re looking for a psychiatrist in New Hampshire who takes trauma and its effects seriously, new patient appointments are available on a rolling basis.

In-network with Anthem BCBS, Aetna, Cigna, Carelon Behavioral Health, Point32 Healthcare, and Providence Health Plan.