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.