When a Shadow Brings Peace: A Trauma-Related Visual Phenomenon in an Adolescent With Posttraumatic Stress Disorder

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.