Welcome back to those of you who have followed our blogs before and welcome to those of you reading for the first time! June is Post-Traumatic Stress Disorder (PTSD) Awareness Month, so I wanted to direct the attention of our blogs towards exactly that. PTSD is one major aspect of the broad category of trauma and for that reason I have decided to break things down for you over the course of this month. Starting here, I define trauma and split up some of the different aspects that follow it. In the blogs to come I will discuss the effects of trauma on the individual and the treatment of trauma and PTSD specifically. I invite you to join me and these blogs so you can learn more about PTSD and how it may be effecting you or a loved one.
Trauma. What is it? If someone tells me that I have lived through a trauma does that mean I have PTSD? What the heck is PTSD? I am not a veteran though, there is no way I have PTSD. These are just some of the thoughts or questions that come up in some of our minds when we hear trauma or PTSD. So often we use trauma to dramatically explain an experience without considering how invalidating it is to those who have actually experienced it. The misuse of the term trauma leads to a blurred line and understanding of what trauma is and whether or not someone has experienced it. Furthermore, it continues to be difficult to talk about trauma because many people do not understand what it is, they are trying to talk about. That is why I hope, in this post and in those following, to expand your understanding of trauma, challenge the way that you think about it and how you use the terms associated.
Let’s start from the top with a definition of trauma. According to the Center for Anxiety Disorders defines trauma as “a psychological, emotional response to an event or experience that is deeply disturbing or distressing.” The definition can be further expanded to define these experiences as life-threatening to self or others. What an individual deems as a traumatic event is subjective or based on personal feelings and opinions. Traumatic events can be anything from being in an accident or suffering an injury, to combat or physical abuse. Again, it can be any event someone perceives as life-threatening in some way. Trauma is observed in its residual effects and debilitation of an individual’s adaptive abilities that include emotional, cognitive, physical, spiritual, and social abilities. I will discuss this further in the next post but in short, impairments in adaptive abilities are observed as such:
- Cognitive: ability to process and make good judgements
- Physical: problems with muscles, joints, digestion and metabolism, temperature, sleep, and immune system
- Spiritual: world view, understanding of life, society, and the world at large
- Social: relationships with friends, family, community
Thought it was over? Nope. Trauma isn’t that simple. Some individuals experience trauma more than once. Whether it be over the course of their life span at different times or exclusively during a specific time frame. For those who have repeated exposure to traumatic events, this is now complex trauma. Complex trauma often but not always involves direct harm to the individual and is done within a time frame and/or relationship. This is where people may think of repeated sexual, physical, or emotional abuse or combat. Again, trauma is subjective and not limited in definition other than by the way in which the experience is interpreted by the individual. Furthermore, there is a newer term in the psychology world and that is developmental trauma disorder. Developmental Trauma Disorder is found in young children within the first three years of life. Trauma at this age range involves abuse, neglect, and/or abandonment. This exposure to trauma interferes with the child’s development in many ways and disrupts formation of attachments to caregivers. Check in to the next post to learn more about the specifics of how trauma impacts development and individuals as a whole.
Last but not least, Post Traumatic Stress Disorder. A common misconception is that when someone has experienced a trauma or what could be perceived as a traumatic event automatically has PTSD. This is not the case, just as someone who likes to be clean and orderly does not necessarily have OCD. PTSD is, “a set of alarm responses that occur when a survivor’s nervous system remains on high alert for protection of self.” They are a set of symptoms that one may experience in response to their trauma but does not highlight the experience of all trauma survivors. Although we will discuss this further next time, I do want to share with you the criterion for a PTSD diagnosis. In doing so I hope that there is clarity in what PTSD is and can clear the air on some misconceptions and assumptions.
All of the criteria are required for the diagnosis of PTSD. The following text summarizes the diagnostic criteria:
Criterion A: stressor (one required)
The person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
- Direct exposure
- Witnessing the trauma
- Learning that a relative or close friend was exposed to a trauma
- Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
Criterion B: intrusion symptoms (one required)
The traumatic event is persistently re-experienced in the following way(s):
- Unwanted upsetting memories
- Emotional distress after exposure to traumatic reminders
- Physical reactivity after exposure to traumatic reminders
Criterion C: avoidance (one required)
Avoidance of trauma-related stimuli after the trauma, in the following way(s):
- Trauma-related thoughts or feelings
- Trauma-related external reminders
Criterion D: negative alterations in cognitions and mood (two required)
Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
- Inability to recall key features of the trauma
- Overly negative thoughts and assumptions about oneself or the world
- Exaggerated blame of self or others for causing the trauma
- Negative affect
- Decreased interest in activities
- Feeling isolated
- Difficulty experiencing positive affect
Criterion E: alterations in arousal and reactivity
Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):
- Irritability or aggression
- Risky or destructive behavior
- Heightened startle reaction
- Difficulty concentrating
- Difficulty sleeping
Criterion F: duration (required)
Symptoms last for more than 1 month.
Criterion G: functional significance (required)
Symptoms create distress or functional impairment (e.g., social, occupational).
Criterion H: exclusion (required)
Symptoms are not due to medication, substance use, or other illness.
Dissociative Specification In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
- Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
- Derealization. Experience of unreality, distance, or distortion (e.g., “things are not real”).
Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.
There is a lot that goes into a diagnosis of PTSD and any other mental health disorder. That is why this is important to talk about this month and all the others. We can reduce the stigma and encourage real conversations about trauma when we know what we are talking about. We can also provide better support to those who experience trauma and can better understand where they are coming from. Stay tuned for our next blog where we discuss the impacts trauma.
-Courtney, Graduate Intern
If you or a loved one have or are currently experiencing current mental health difficulties, please do not hesitate to reach out to Olive Branch Counseling Associates to get set up with a therapist. https://www.olivebranchcounselingassociates.com/