In this series, I dig a little deeper into the meaning of psychological terms. This week’s term: trauma vs. PTSD
I wanted to take a look at the difference between experiencing trauma and having PTSD (post-traumatic stress disorder). Part of this is that I believe that I have experienced trauma, but while it still impacts me to some extent, I do not meet the criteria for PTSD. So is there a firm dividing line between the two, or is it more of a continuum?
According to the Sidran Institute, psychological trauma occurs when an individual is faced with highly distressing events that overwhelm their ability to integrate their emotional experience, or threatens life, limb, or sanity. The traumatic event often involves “abuse of power, betrayal of trust, entrapment, helplessness, pain, confusion, and/or loss.” Wikipedia adds that these events often involve “a violation of the person’s familiar ideas about the world and their human rights, putting the person in a state of extreme confusion and insecurity. This is seen when institutions depended upon for survival violate, humiliate, betray, or cause major losses or separations instead of evoking aspects like deserve, special, safe, new and freedom.” The traumatized individual is left feeling helpless in a dangerous world.
It is not the event itself that determines trauma but rather the individual’s subjective response to it, so not everyone who experiences the same potentially traumatizing event will have the same response. Responses to stressors may be proactive, reactive, or passive. Proactive responses are taken before the stressor can have a large impact, reactive responses occur after the stressor, and passive responses include emotional numbness or avoidance. An individual’s response can vary depending on the nature of the event, the person’s background (including childhood trauma), personality, coping resources, and level of available support. The Sidran Institute states that severe psychological trauma is most likely to occur with human-caused stressors that are repeated, unpredictable, sadistic, occurring in childhood, and carried out by a caregiver. Protective temperamental and environmental factors can improve coping in response to stressors. Such factors included limited early life stress, resiliency, and active help-seeking behaviour.
Having some trauma-related symptoms is a normal reaction to major stressors, and represent part of the process of making sense of what happened and gaining perspective. These responses may last anywhere from a few days to a few weeks or even months, although there may be recurring responses to triggers. PTSD develops when the mind is left in a state of psychological shock and unable to process the trauma, and the person’s overall functioning is impacted. Trauma symptoms may be forms of adaptation that were helpful while the trauma was occurring (such as dissociation) that become problematic when they instinctively continue after the stressor is removed.
The DSM-5 (Diagnostic and Statistical Manual 5th ed.) diagnostic criteria for PTSD are clustered around 4 different areas:
- Intrusion symptoms: recurrent memories, traumatic nightmares, flashbacks, psychological distress and physiological reactivity to trauma reminders
- Persistent avoidance: avoidance of both thoughts/feelings and external reminders
- Negative alterations in cognition and mood: dissociative amnesia, persistent negative beliefs, distorted blame of self/others, negative trauma-related emotions, diminished interest in activities, detachment from others, inability to experience positive emotions
- Alterations in arousal and reactivity: irritable/aggressive behaviour, self-destructive/reckless behaviour, hypervigilance, exaggerated startle response, problems concentrating, sleep disturbance
To be diagnosed, a person must have symptoms from each of the four areas, although people’s symptoms may be more concentrated in one area rather than others. These symptoms must have been present for at least one month, and must impair functioning in social, occupational, or other domains.
What does this all mean? If there are a group of people who are subjected to a particular stressor, a certain subset of those exposed will have a trauma reaction. Among that group, some will be able to process the trauma and move forward, while others will remain stuck and develop PTSD. Those who access therapy for PTSD will work on finally processing and integrating the trauma memories. For myself, I’ve experienced trauma, but I think my processing was slowed rather than stuck, so it didn’t develop into PTSD.
What are your thoughts? Is there a difference between trauma and PTSD, and how do we separate the two?
- Australian Psychological Society: Trauma
- DSM-5 criteria for PTSD
- Helpguide.org: Emotional and psychological trauma
- Sidran Institute: What is psychological Trauma?
- Wikipedia: Psychological trauma
You can find the rest of the What Is series here.
The Mental Health @ Home Store has a mini e-book on PTSD Treatment Options: An Overview that covers a number of evidence-based therapies for PTSD. It’s also available as part of the Therapy Mini-Ebook Collection.