What is Trauma?

We have all heard the word, but what actually is trauma? What classifies as a traumatic event? And what about the difference between disorders like Post Traumatic Stress Disorder (PTSD), or Complex Post Traumatic Stress Disorder (C-PTSD)? The goal of this post is to give you broader insight into trauma and some of it’s related disorders.

Quick author’s note: This post will be discussing trauma and mentioning different types of traumatic events (obviously!). If you are not in a place to be reading about this right now, that’s okay! Listen to your gut. There’s no prizes for making yourself uncomfortable, and you can always come back later 😊

Let’s start with definitions.

The word itself stems from the Greek language and literally translates to wound. While it may have originally only referred to physical wounds, it now captures both physical and emotional. Trauma can also be used to describe an extremely stressful event (or events).

What counts as a traumatic event?

We are getting a little more clinical now (bear with me here!). You may have heard of a book called the DSM-V. This is a manual that Psychologists refer to, and its full name is the Diagnostic and Statistical Manual of Mental Disorders (Volume 5), published by the America Psychological Association. Within the DSM-V a traumatic event is given the following criteria:

• Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
  • Directly experiencing the traumatic event(s).
  • Witnessing, in person, the event(s) as it occurred to others.
  • Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
  • Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).

An important part of this definition is that the risk of death, injury, or sexual violence, can be threatened rather than actual. This means that even if no one was harmed the event can still be traumatic.

Alongside the DSM-V is the International Classification of Diseases, 11 (ICD-11) created by the World Health Organisation. This is used as a global standard for recording health information (this is used for physical conditions, not just psychological). The ICD-11 refers to traumatic events as:

• An extremely threatening or horrific event or series of events.

These are two internationally recognized definitions of trauma, but as with everything in life – they aren’t perfect. Sometimes people experience trauma symptoms because of an event (or events) that, at first glance, may not appear to meet the above criterias. Who determines what is “extrememely threatening” or “horrific”?

It might seem obvious when we talk about a soldier who has been deployed overseas, or someone who has been in a car accident – but what about a child who grew up with emotionally detached caregivers? Who was always fed, clothed, and taken to school, but didn’t receive love, understanding, or warmth?

Another way to view trauma

Let’s turn our attention away from trying to describe every possible kind of traumatic event and instead look towards the impact it has on the individual. Using this view, an event(s) can be considered traumatic when it is so distressing that it shatters your sense of security/safety, and leaves you feeling overwhelmed, helpless, and/or isolated.

I find this view to be much more useful in my day-to-day work because it focuses on an individual’s experience of an event, and captures the experience of those who may not have gone through something that meets the formal criteria. For example, a child who grew up in a physically safe home but with extremely unreliable caregivers (e.g., not being able to rely on the adults around them for comfort, understanding, or help) may have regularly felt unsafe and alone. This experience can negatively impact their view of themselves, others, and the world, and lead to them expressing trauma symptoms.

PTSD and CPTSD

Firstly, I want to note that CPTSD is not currently listed within the DSM-V as it is a relatively new diagnosis. It is, however, included in the ICD-11.

PTSD and CPTSD are both disorders which refer to symptoms that occur following a traumatic event. PTSD symptoms include:

• Re-experiencing the traumatic event through intrusive symptoms (nightmares; flashbacks; recurring unwanted memories; and emotional/physical responses to reminders of the event)
• Avoidance of things relating to the event (e.g., avoiding thinking about the event; avoiding emotions relating to the event; avoiding external reminders of the event, such as sounds, places, and people)
• Changes to the ways you think and feel (e.g., difficulty remembering key parts of the event; overly negative assumptions about yourself/the world; negative emotions and/or difficulty experiencing positive emotions; less interest in activities; feeling isolated, or; exaggerated blame towards yourself/others for causing the trauma)

CPTSD symptoms (as the name suggests) are more complex than those of PTSD. CPTSD typically occurs following prolonged/repetitive traumatic events that were impossible to escape from (e.g., childhood abuse, prolonged domestic violence, torture, slavery, etc.). It covers all symptoms of PTSD and additionally includes difficulties with regulating emotions; strong negative views of yourself, and; difficulties sustaining healthy relationships/feeling close with others.

However, it is normal to have a strong emotional response to traumatic events. It is the events that are abnormal, not your emotions. This is why conditions such as PTSD cannot be diagnosed until the event has ended and some time has passed. In fact, we have a separate diagnosis for someone experiencing the symptoms of PTSD in the first few months following the event (Acute Stress Disorder), and we only change this diagnosis to PTSD once more time has elapsed.

I hope this information has helped you understand a little more about trauma and trauma related disorders. There are a lot of things that weren’t covered in this post (like the factors that can increase/decrease the likelihood of someone developing a trauma related disorder), so if you believe you may be experiencing symptoms or have additional questions I highly recommend you reach out to your doctor or mental health professional to discuss further.