Educational Series: What is PTSD? have i experienced trauma?

When I sit with clients, I frequently hear some themes of minimization, invalidation, and comparison like “What happened to me wasn’t that bad, other people have it way worse”. Trauma is inevitable if we live long enough, it is part of the human condition that connects us. Trauma is defined as any event that overwhelms our ability to cope. Traditionally, is differentiated between ‘big T’ and ‘little t’.

‘Big T’ trauma relates to the clinical definition of trauma seen in the DSM 5, and narrowly focuses on the threat of death, bodily harm, or sexual assault. Comparatively, ‘little t’ trauma is less exclusive and generally includes themes of abandonment, rejection, and being unsafe in any capacity. As a reader, if you are sitting wondering if something in your life qualifies, I would challenge you to reflect on this instead: why do you need an external definition to validate an internal experience?

Many folks experience trauma as the underlying root of chronic depression, anxiety, and obsessive-compulsive disorder. However, this does not necessarily mean that they also have a diagnosis of posttraumatic stress disorder (PTSD). Receiving a PTSD diagnosis can be difficult because there are many criteria for adults that have to be present for a month minimum after the traumatic event.

A woman lying on a blanket on the floor represents the experience of trauma and PTSD

First, the individual needs to have exposure to actual or threatened death, serious bodily injury, or sexual violence in at least one of the following ways:

• Direct experience

• As a witness

• Learning about a traumatic event that happened to a loved one

•  Repeated and/or extreme exposure to adverse details of traumatic events

Second, you need to have at least one intrusion symptom. Intrusion refers to an unwanted symptom that cannot be controlled:

• Repeated, involuntary, intrusive distressing memories of the event

• Repeated distressing dreams with the content being related to the event

• Flashbacks and dissociation

• Intense or lengthy distress when exposed to external or internal cues that

  are similar to a part of the event

• Noticeable physiological reactions to external or internal cues that are

  similar to a part of the event

Next, you need to experience at least one of the below symptoms of avoidance:

• Avoiding or attempting to avoid distressing thoughts, memories, or feelings about the event (for example, a survivor of sexual assault not wanting to discuss the attack).

• Avoiding or attempting to avoid external reminders (like people, places, noises, situations) that remind the individual of the event (like the survivor of sexual assault not going to the part of campus where she was attacked)

Additionally, at least two of the following negative changes in thoughts and mood that started OR got worse after the trauma are required:

• Inability to remember a part of the event

• Persistent and global negative beliefs about self, others, and the world

  (i.e. No one can be trusted, and the world is an unsafe place)

• Persistent distorted cognitions about the cause or consequences of the

  the event that leads the individual to blame themselves or others (i.e. the

  victim blaming)

• Feelings of fear, horror, anger, guilt, shame, etc that are persistent

• Participating less in usual activities

• Feeling disconnected from others

• Persistent inability to experience positive feelings like happiness,

  satisfaction, or love

At least two symptoms related to changes in arousal (activity) and reactivity are necessary as well:

• Irritability or angry outbursts

• Reckless or self-destructive behavior

• Hypervigilance (always being on the lookout)

• Exaggerated startle response (having a much bigger scare when you

  don’t expect someone to enter the room)

• Difficulty concentration

• Difficulty falling asleep, staying asleep, or restless sleep

As with other diagnoses, the symptoms must be causing significant difficulty in daily functioning and not be caused by another medical condition, drug, or medication. Sometimes, an additional specifier of depersonalization (feeling as though you are not real) or derealization (the world is not real) can be used to describe additional dissociative symptoms. However, these are not always necessary.

Additional Links/Resources:

https://www.samhsa.gov/mental-health/post-traumatic-stress-disorder

https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/ Posttraumatic-Stress-Disorder