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.
Another fabulous post! Informative and right on the mark! Thank you for posting this.
Thanks 💕
Supposedly their are a small percentage of people that are highly resistant to PTSD.
In battle, war there is a certain time I think like 60 days where after that point ptsd spikes
We have the same ptsd rates as the British since we mirrored their structure.
That does not hold up for deployments. British remain close to same numbers America’s spikes heavily
So same war different rates
British deploy units together and do not split them up also they give more time as unit out of combat or r and r
Oh that’s very interesting. It’s too bad the Americans aren’t paying attention to what works better.
22 vets commit suicide everyday for the last two years.
Wow, that’s horrible.
Yes, a few have committed suicide in the parking lot of the Veterans Administration after asking for help and telling them they were suicidal.
There is a stigma of weakness or cowardice in our military if you ask for help or admit you have PTSD
I hope someone at the VA gets a clue sooner rather than later that this is totally unacceptable, although that seems unlikely.
This post is helpful and really informative.💓
I’m constantly making myself believe I’m a liar that didn’t happen that I’m a bad person. But I remember. But because it’s blurry or there’s gaps I have these thoughts that it’s all not true because I’ve remembered by seeing clips triggers making me feel sick and weird emotions seeing things and feeling all zoned out and checked out im there I can hear sometimes but sometimes I carnt I think it’s dissociation it just feels so confusing.💓 I did write a post 💓 Three other girls maybe more have said what he did and my mom knows thinking back to all the things I said but I tell myself no it’s what I saw on the tele I saw it on the soaps constantly making myself believe in a twisted person💓🌸
And because of the things I’ve done so desperate for people to notice to know “attentsion seeking” when I was younger in high school and sometimes now but nothing as bad as I used to be 💓💓
Those kinds of trauma-related beliefs are so hard and sadly all too common
It’s just a constant thing that it’s not PTSD it didn’t happen 💓
I’m glad I’m not alone and it’s normal💓
Im not sure! I agree with the points that sidran makes here. I think PTSD is on a continum, just as trauma is, and peoples responses are also on a continum. xox
I agree
Personally, I feel like I had repressed trauma up until my sister committed suicide around 6 years ago. That event brought those repressed memories and feelings rushing to the surface and since then, I have had the symptoms of c-ptsd. Funny how those type of things can manifest.
Yes the mind is such a strange thing.
What are your thoughts? Is there a difference between trauma and PTSD, and how do we separate the two?
I’m no expert and am hesitant to say much, BUT IMHO (humblest of opinions) . trauma is immediate, something that happens that may be life or world changing, but there’s a definite beginning and end. PTSD on the other hand, although possibly/probably triggered by the trauma event, is something that lingers. It affects the person’s life for (perhaps) EVER. It’s subtle and it shows up a long time after the actual trauma event occurred. But in the interim the night terrors, hypervigilance, inability to trust or form healthy, meaningful relationships occurs..and are symptoms of PTSD. I’m speaking from personal experience. I watched my husband (who served in Viet Nam) begin to deteriorate and part of the reason? PTSD. I’ve found that as time goes on I’m less and less able to cope with stressful situations, even minor ones. I don’t know if that’s another symptom or what, but there you are. And Trauma and PTSD are inextricably bound on some levels…because one of them happened and the other feeds off the reaction to the event.
PTSD really is a horrible illness
Yes it is. I was pretty shocked to learn I suffer from it, although the signs were there and have been for a long time.
When it comes to most things mind-related we really know very little
One of the things that really sticks with me is the extent to which a person’s ability to deal with trauma is impacted by earlier life experiences. So often resilience is characterised as a a purely individual trait, a kind of inner strength that comes from their own actions (which means that people who have less resilience are looked down on as being either defective or psychologically “lazy”) and issues such as whether or not they had secure relationships as a child, whether help-seeking behaviour was encouraged or not, and whether there was outright trauma or abuse, are completely overlooked. It’s something that tends to annoy me a bit in the writings of people like Victor Frankl. I also think it’s highly relevant to PTSD in the military population, given that many people join either to get away from an overtly bad family/social situations or at least to try and find a closeness and sense of belonging that did not exist in their family of origin. I think there is probably a subgroup who would be at higher risk of PTSD or CPTSD from subsequent military trauma because of having less inner resources to cope, especially once they are discharged and no longer “belong”.
Yes it seems like for some people with a biopsychosocial vulnerability to PTSD there is a relatively finite inner reserve to process traumatic events, and subsequent events later in life are more likely to result in PTSD.
I had a single traumatic incident in which I genuinely believed I would die (car wreck), which seems to have collected other trauma with it, and my PTSD symptoms include trauma in addition to the car wreck. Car wreck has been addressed through EMDR and might be doing that again for others that are persistent five years later. I also have a very low tolerance for chaos.
Yeah it seems like PTSD is seldom focused on the traumatic events itself – it’s like a magnet that draws in all kinds of other things.
Thank you for this post xx
interesting post! i think the only difference between the 2 is the DSM. for those that experience it, it smells and feels exactly the same.
Good point
😉
As a PTSD sufferer I am only still in the whole reason why and if I can do something or not to be able to get some kind of idea that I can see it through my life as I am 43 and I have quite a few more in me. I was in Hospital a few weeks ago and I was in complete control of the whole thing, but I’m not going to get it that easy. As I stepped out of the waiting area I had barely finished placing my foot down on the 1st step and I was in panic and trying to get my breathing back . If you have the ability to close your eyes and try to make it stop and I opened my eyes and I was done. I was not even aware that they were finished.
The last time I was in my car I don’t know how but I have been a little stressed for years but I am not sure how to fix it, because I have no idea how it works. I was a depression master and I wanted to see that there in its place. At least knowing the triggers are the only thing I wish for.
2014 was the issue of my own life as well as 2 of my kids have a bigger problem with life because of the carelessness of others on the road. #share
It’s such a complex illness that there’s still so much we need to learn about.
The other side effects of the same thing as the people who have been able to find a way to cover it is a little more worn by each passing day in the world of treatable disease this is where I have been able to get a little peace with knowing that they are not going to find the answer. Its really a little more devious than its sister, depression. That’s for bringing it to the world
You’ve given a great explanation. I thought of something to expand on.
It seems like the word “Trauma” has been thrown into the PTSD bucket and a lot of people are afraid to say they’ve been traumatized, for fear of being labeled or diagnosed with PTSD.
I think it’s fairly obvious to most people that everyone who has PTSD has experienced trauma, but maybe not so clear that some people experience trauma without developing PTSD. Like you mentioned – two people at the same event can have two different experiences/results.
Great point. I agree.
I work with data, much of it health data. I’ve noticed this really bizarre trend at the last two trade conferences of someone with very high ACES – 8 or higher – speak as a “poster child for resilience” in more detail than I think is healthy to a group of consultants, policymakers, epidemiologists and health practitioners about what they went through and why they they think they were “so resilient” as to not develop PTSD from “so much” childhood trauma (eye roll). While I hate the practice in general – do they not get that they have people like me with sitting on the other side of that stage who have equivalent scores and are triggered by the whole thing? Trauma/PTSD aren’t *just* the domain of the ‘othered’ patient – the point seems generally to be to raise awareness of social support in resilience to trauma. If the person experiencing trauma had at least one supportive relationship during the period of trauma, they are less likely to develop PTSD from it, even if their ability to take any concrete action to thwart the threat was nil. I suppose that’s fine. I have equivalently high an ACE score, did not have any true supportive relationship growing up to buffer its effects, and do have complex PTSD. I do have social support in my current crisis (aka my Partner), and that has certainly helped compared to facing the same events alone last time. So I’ll add social support/social response as another variable, though I hate how the health community is pointing that out lately. Have the trauma responded to supportively by your community, you’ll likely have lower risk of PTSD from it. Have it met with shame, secrets, lies or silence and your risk goes up for PTSD.
Very good points. Just because someone isn’t directly an abuser doesn’t mean they don’t have an effect on how someone responds to traumatic events.