When a Shadow Brings Peace: A Trauma-Related Visual Phenomenon in an Adolescent With Posttraumatic Stress Disorder
Ron Gabriel A Peji, Diane D Lipat, Alyssia M de Rojas
Cureus January 21, 2026 DOI: 10.7759/cureus.101987 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | Filipino preadolescent female with PTSD and major depressive disorder following prolonged intrafamilial sexual abuse |
| Intervention | Trauma-focused psychotherapy incorporating expressive techniques |
| Topics | PTSD |
| Key findings | The patient experienced a transient, non-vivid, dark, cloud-like visual phenomenon exclusively during calm, safe, or happy states, with intact insight, preserved reality testing, no distress, and no functional impairment. The authors argue this is a non-psychotic, trauma-related perceptual phenomenon rather than psychosis, and that contextual, emotional, and insight-based assessment can prevent misdiagnosis and inappropriate treatment in traumatized adolescents. |
Abstract
Trauma-related perceptual experiences may resemble psychotic symptoms, creating diagnostic challenges in adolescent populations. We report the case of a Filipino preadolescent female diagnosed with posttraumatic stress disorder (PTSD) and major depressive disorder following prolonged intrafamilial sexual abuse. During trauma-focused psychotherapy incorporating expressive techniques, the patient consistently depicted and occasionally perceived a non-vivid, dark, cloud-like visual phenomenon that appeared exclusively during states of emotional calm, safety, or happiness. The experience was transient, purely visual, and associated with a subjective sense of peace. Importantly, the patient demonstrated intact insight, preserved reality testing, absence of distress, and no functional impairment related to the phenomenon. Comprehensive phenomenological assessment and differential diagnosis ruled out psychotic disorder, neurological causes, and mood-congruent psychosis. The visual experience was conceptualized as a non-psychotic, trauma-related perceptual phenomenon. This case highlights the importance of contextual, emotional, and insight-based assessment of perceptual experiences in traumatized adolescents to prevent misdiagnosis and inappropriate treatment.
Comparable studies
Other case reports and case series on PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Combining Cognitive-Behavioral Conjoint Therapy for PTSD with 3,4-Methylenedioxymethamphetamine (MDMA): A Case Example. One couple with PTSD and a severe trauma history, participating in a pilot trial... | 2019 | Case study | n = 2 |
| Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series Veterans with co-morbid depression and PTSD | 2022 | Retrospective case series | n = 35 |
| Repeated oral esketamine in patients with treatment resistant depression and comorbid posttraumatic stress disorder Patients with treatment-resistant depression and comorbid PTSD | 2023 | Case series | n = 5 |
| Treatment of nightmares in the context of posttraumatic stress disorder A client with chronic, severe posttraumatic stress disorder (PTSD) | 2010 | Case study | n = 1 |
| 5-MeO-DMT for post-traumatic stress disorder: a real-world longitudinal case study 23-year-old female with chronic refractory PTSD | 2023 | Case study | n = 1 |
Citations in the library
Cites 4
- Hallucinations: A Systematic Review of Points of Similarity and Difference Across Diagnostic Classes. Schizophrenia Bulletin November 21, 2016
- Auditory verbal hallucinations in schizophrenia and post-traumatic stress disorder: common phenomenology, common cause, common interventions? Frontiers in Psychology 2015
- A new phenomenological survey of auditory hallucinations: evidence for subtypes and implications for theory and practice. Schizophrenia Bulletin January 2014
- Dissociation, trauma, and the role of lived experience: toward a new conceptualization of voice hearing. Psychological Bulletin January 2012