Trauma and PTSD

Trauma can be defined as a psychological, emotional response to an event or an experience that is deeply distressing or disturbing. It is important to note that trauma is subjective to the person, meaning what may be traumatic for one person, may not necessarily be traumatic for another. This can include many things, but some examples could include being involved in an accident, having an illness or injury, losing a loved one, or going through a divorce. However, it can also include experiences that are severely detrimental to a person, such as rape, physical and/or emotional abuse, neglect, or one's life being threatened.

As stated before, everyone processes a traumatic event differently because we all face them through the lens of prior experiences in our lives. For example, one person might have witnessed a car accident and find themselves very anxious to the point of having a panic attack, while another person can witness the same exact car accident and be able to go about their day without any issue. This is because everyone has different emotional thresholds. However, anytime an individual's emotional threshold is overwhelmed, it may bring up traumatic flashbacks or nightmares of their experience.

Because trauma reactions fall across a wide spectrum, psychologists have developed categories as a way to differentiate between types of trauma. Among them are complex trauma, acute stress disorder, and post-traumatic stress disorder (PTSD).

Complex Trauma:

According to an article written by Dr. Courtois who is a psychologist and trauma expert, complex trauma can be defined as:

"(1) repetitive, prolonged, or cumulative (2 ) most often interpersonal, involving direct harm, exploitation, and maltreatment including neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults, and (3) often occur at developmentally vulnerable times in the victim's life, especially in early childhood or adolescence, but can also occur later in life and in conditions of vulnerability associated with disability/ disempowerment/dependency/age /infirmity, and so on."

Acute Stress Disorder:

The DSM-5 describes acute stress disorder as the development of specific fear behaviors that last from 3 days to 1 month after a traumatic event. These symptoms always occur after the patient has experienced or witnessed death or threat of death, serious injury or sexual assault. Examples of traumatic events from the DSM-5 include physical attack, physical abuse, mugging, active combat, sexual violence, natural disaster and serious accidents. Individuals with acute stress disorder experience intrusive thoughts or memories of the traumatic event. Distressing dreams about the trauma and general sleep disturbances are also common. The patient may also experience flashbacks or distress when exposed to triggers of the traumatic event. Conversely, the patient may “block out” or be unable to remember parts or the entire traumatic event. Many patients avoid external reminders, such as places or people related to the traumatic event. In addition to these intrusive symptoms, patients experience a negative mood. They may feel depressed, anxious, angry or guilty and unable to feel happy. Additionally, the patient may have unrealistic feelings or beliefs about the event. For example, believing that a plane crash could have been prevented had the patient done something differently. Hyper vigilance, problems with concentration and exaggerated startle response are also common. Additionally, the DSM-5 explains that physical symptoms, such as headaches, dizziness and sensitivity to light or sound may occur, even without injury.

Post-Traumatic Stress Disorder (PTSD):

The DSM-5 describes PTSD as being exposed to one or more event(s) that involved death or threatened death, actual or threatened serious injury, or threatened sexual violation. In addition, these events were experienced in one or more of the following ways:

  1. You experienced the event.
  2. You witnessed the event as it occurred to someone else.
  3. You learned about an event where a close relative or friend experienced an actual or threatened violent or accidental death.
  4. You experienced repeated exposure to distressing details of an event, such as a police officer repeatedly hearing details about child sexual abuse.

In addition to the above, the individual experiences at least one of the following intrusive symptoms associated with the traumatic event:

  1. Unexpected or expected reoccurring, involuntary, and intrusive upsetting memories of the traumatic event
  2. Repeated upsetting dreams where the content of the dreams is related to the traumatic event
  3. The experience of some type of dissociation (for example, flashbacks) where you feel as though the traumatic event is happening again
  4. Strong and persistent distress upon exposure to cues that are either inside or outside of your body that are connected to your traumatic event
  5. Strong bodily reactions (for example, increased heart rate) upon exposure to a reminder of the traumatic event

The individual also engages in frequent avoidance of reminders associated with the traumatic event, as demonstrated by one of the following:

  1. Avoidance of thoughts, feelings, or physical sensations that bring up memories of the traumatic event
  2. Avoidance of people, places, conversations, activities, objects, or situations that bring up memories of the traumatic event

The individual also experiences at least two of the following negative changes in thoughts and mood that occurred or worsened following the experience of the traumatic event:

  1. The inability to remember an important aspect of the traumatic event
  2. Persistent and elevated negative evaluations about yourself, others, or the world (for example, "I am unlovable," or "The world is an evil place")
  3. Elevated self-blame or blame of others about the cause or consequence of a traumatic event
  4. A negative emotional state (for example, shame, anger, or fear) that is pervasive
  5. Loss of interest in activities that you used to enjoy
  6. Feeling detached from others
  7. The inability to experience positive emotions (for example, happiness, love, joy)

The individual also exhibits at least two of the following changes in arousal that started or worsened following the experience of a traumatic event:

  1. Irritability or aggressive behavior
  2. Impulsive or self-destructive behavior
  3. Feeling constantly "on guard" or like danger is lurking around every corner (or hypervigilance)
  4. Heightened startle response
  5. Difficulty concentrating
  6. Problems sleeping

Finally, the above symptoms last for more than one month, and bring about considerable distress and/or interfere greatly with a number of different areas of your life and are not due to a medical condition or some form of substance use.

As one of my specialties, I have a passion for helping clients work through trauma, no matter if it meets criteria for an actual diagnosis of acute stress disorder or PTSD or if it is just a single event that is keeping an individual stuck. I treat trauma in a variety of ways and it is very dependent on the individual. Some of the main modalities that I utilize to treat trauma is EMDR, narrative therapy, experiential therapy, and cognitive behavioral therapy. 

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