In this series, I dig a little deeper into the meaning of psychological terms. This week’s terms are trauma vs. PTSD.
I wanted to take a look at the difference between experiencing trauma and having PTSD (post-traumatic stress disorder). Personally, I believe that I have experienced trauma, but I don’t meet the criteria for PTSD. So is there a firm dividing line between the two, or is it more of a continuum?
Psychological trauma
Psychological trauma occurs when an individual is faced with highly distressing events that overwhelm their ability to integrate their emotional experience or threaten 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.
Response to trauma
It’s the subjective individual response rather than the event itself that determines trauma. That’s why 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, their background (including childhood trauma), personality, coping resources, and level of available support.
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. They represent part of the process of making sense of what happened and gaining perspective. They may last anywhere from a few days to a few weeks or even months, although there may be recurring responses to triggers.
PTSD
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). However, they become problematic when they instinctively continue after the stressor is removed.
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 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
Someone must have symptoms from each of the four areas in order to be diagnosed, although symptoms may be more concentrated in one area rather than others. The symptoms must have been present for at least one month and must impair functioning in social, occupational, or other domains.
Variability in individual responses
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 believe that 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? Do you see a difference between trauma and PTSD, and how do we separate the two?
You may also be interested in the post Big-T Trauma, Little-t trauma, and Mental Health Cutlery and my review of Bessel van der Kolk’s book The Body Keeps the Score.
References
- Australian Psychological Society: Trauma
- DSM-5 criteria for PTSD
- Robinson, L., Smith, M., & Segal, J. (2021). Emotional and psychological trauma. Helpguide.org.
- Giller, E. (1999). What is psychological trauma? Sidran Institute.
- Wikipedia: Psychological trauma
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
I experienced trauma and have PTSD. It is somewhat clear to me what the distinction is between the two because my family members experienced the same events (although in their own ways), yet in the only one still suffering four years later. I notice little things every now and then that make me think the accident is still impacting them, too, but for the most part I deal with it much more than they do.
*yet I’m the only one
I’m glad you’ve been able to find a better way to deal with it.
A single trauma event may be shocking and have a huge impact at the time, eg a car crash, which may cause abnormal worry over driving, especially driving the same route. If you were to have a second crash in the same place, this may intensify the initial trauma.
Being exposed to a trauma situation repeatedly or for a long time causes the brain to operate in survival mode where processing of events is suspended, so the brain stores the threat in the current area rather than the past, the brain doesn’t know that you are now safe and reacts as though the threat is still there. EMDR helps the brain process the memory and reduce the fear.
I didn’t consider I could have ptsd, but when the psychologist told me his diagnosis it made so much sense.
That’s a very good way of putting it.
It’s how my psychologist explained it to me.
Thank you. This was very informative.
I believe I have ptsd although I’ve not been diagnosed. Someone did something when I was nine and ever since the event I can’t stand to be startled Especially from behind. The same person continued to be inappropriate up until I was 19 years old and I think it’s truly done some damage. The night of my wedding reception I had a nightmare about them bc I’d seen them at the reception. Nightmares happen regularly and 5 years ago when I was on Lexapro I hallucinated this person in my bedroom.
At this point I avoid the person the best I can but under the circumstances it isn’t always possible.
I don’t like self diagnosing but all I know is it’s miserable and I get uncomfortable talking about it so I haven’t explored it in depth in counseling.
That sounds like a perfect storm of conditions to cause PTSD. Another thing to look into is complex PTSD (c-PTSD), a type of PTSD that can happen when there is repeated exposure over an extended period of time.
Its so odd because I made the connection of events as an adult. I had a sibling relationship with this person but we weren’t related. I realized the entire basis for that makeshift relationship was because someone suggested he saw me as a sister. This was not the case, and it let to more inappropriate interactions. Because so much time had passed, even my husband was uncomfortable with cutting him off because my view of him changed overnight.
That’s tough. It sounds like that person was probably grooming you all along.
It was never recognized bc they are on the autism spectrum and are in my life at all because they are housed because of their disabilities. However they can keep a management position in their job for the past 10 years and they are high functioning.
Oh that’s really hard.
Not to mention the only time I tried to tell I was shut down for “wanting attention” so I didn’t bother much after. It’s definitely been interesting
I bet.