What is trauma?
The term trauma comes from the Greek word trauma which means ‘injury or wound.’ It was first used within general physical healthcare when referring to injuries to parts of the body including brain injuries. Subsequently, the term has been used within contemporary mental healthcare to refer to stressful events that could lead to mental health problems although physical injuries may or may not be present.
Traumatic events are not just unpleasant or undesirable events. They are considered traumatic due to the significant impact that they have on the individual. Such events tend to be life threatening or are so severe as to trigger the body’s alarm system and set off body and mind responses. Latest neuroscience research findings show that physical changes to the brain may also result from the experience of traumatic events. Simply put, trauma is an emotional shock that triggers one’s ‘alarm system’ to respond. Examples of traumatic events include road traffic accidents, witnessing or experiencing serious physical injury or violence, war, earthquake, rape, kidnapping, domestic violence etc. You can experience a single traumatic event which causes problems (Type 1 trauma), or multiple traumatic events likely to cause greater problems (Type 2 trauma).
Health professionals may use the term trauma to refer to the effects of the event in regards to physical injury, and/or impact on mental health wellbeing. However, they may also refer to the event itself as the trauma. Therefore, a doctor in an Accident and Emergency Department may say, ‘..this patient has a head trauma’ in reference to a head injury. Meanwhile a psychiatrist may say ‘this patient experienced trauma following a car accident’ in reference to the mental health problems following the accident. Or they may say ‘the patient had several traumas in their childhood’ in reference to the traumatic events themselves.
What is PTSD?
Although people may use PTSD and trauma synonymously, because they are related, they are not exactly the same; trauma does not equal PTSD. When a person is considered to have PTSD, this refers to enduring symptoms that are experienced following a traumatic event and have resulted in significant effects on a person’s life. It is the significance of the effects that is important in determining the difference, and it means that certain criteria must be fulfilled to determine if someone is experiencing trauma symptoms to the level of PTSD. Similar to trauma, a person may have PTSD due a single traumatic event, or multiple traumatic events.
There are 2 main classification systems which are used in diagnosis of mental health problems. The International Classification of Diseases (ICD -11 is the current edition) covers physical illnesses/diseases as well as mental health problems. It is published by the World Health Organisation and is more internationally used. The Diagnostic and Statistical Manual (DSM V is the current edition) covers only mental health problems. It is published by the American Psychiatric Association and is popular in America. The manuals have similarities and differences in how they classify PTSD.
According to the ICD-11 (WHO, 2019):
Post-traumatic stress disorder (PTSD) is a disorder that may develop following exposure to an extremely threatening or horrific event or series of events.
It is characterized by all of the following:
1) Re-experiencing the traumatic event or events in the present in the form of vivid intrusive memories, flashbacks, or nightmares. These are typically accompanied by strong or overwhelming emotions, particularly fear or horror, and strong physical sensations;
2) Avoidance of thoughts and memories of the event or events, or avoidance of activities, situations, or people reminiscent of the event or events;
3) persistent perceptions of heightened current threat, for example as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises. The symptoms persist for at least several weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
Meanwhile, according to the DSM V (APA, 2013), for PTSD to be considered, the following criteria have to be met:
Criterion A. Being exposed to an actual or threatened death, serious injury, or sexual violence. This can be either it actually happened to you, or observing it happening to others, or finding that it happened to a close family member or friend directly, finding out about traumatic events above either repeatedly or it was very extreme as part of your occupation for example emergency services workers who may come across dead bodies.
Criterion B. Intrusion symptoms. These can be unwanted thoughts, or memories, upsetting dreams that you may experience.
Criterion C. Avoidance symptoms. These are ways of avoiding reminders of what happened, including related situations, or trying to block and suppress the thoughts, feelings, bodily sensations and memories related to what happened.
Criterion D. Cognitions (thoughts) and mood symptoms. This refers to having unhelpful thoughts about what happened at the time- such as it was all my fault (when there were other factors), I am a bad person (when other factors may indicate otherwise). This will also affect how you feel in your mood, perhaps feeling low, and finding it difficult to feel excited or happy, or other ‘good feelings.’ There may also be a sense of being unable to clearly remember important parts of the memory l happy, having little interest or pleasure in doing previously enjoyed activities, and perhaps avoiding or keeping away from others.
Criterion E. Arousal and reactivity symptoms. These refer to being jumpy and easily startled, quite alert. Some people may also find themselves being angry, snappy and irritable towards others, not sleeping well, and finding it difficult to stay focused or concentrate on an activity.
Additionally, some people may experience dissociative symptoms. In this case, people may feel that they are removed from and are not an integral part of their immediate surroundings, or some may feel unreal or as if they are having an out of body experience, or part of them is detached from the rest of their body.
The ICD-11 recognises that some people may have Complex PTSD. This is a severe form of PTSD with a greater impact of how they manage their emotions, relationships with other as well as unhelpful beliefs about one as a failure or worthless including feelings of shame and guilt. The DSM V does not include Complex PTSD in its classification.
I hope the above information is helpful towards a better understanding of trauma and PTSD from a psychological perspective. In later blogs, current approaches to treatments Trauma Focused Cognitive Behavioural Therapy (TF-CBT) will be discussed. Bessel van der Kolk is one of the leading experts in the field of trauma. Here is a quote from his bestseller, The Body Keeps the Score: Brain, Mind and Body in the Transformation of Trauma which gives some advice on seeking treatment for trauma/PTSD: