"Ok, so it happened, and I didn't know how to handle it in the moment or afterward because it was so messed up. The best option I had was to just not think or talk about it, to lock it up and move on. When I think about it, it's like it's happening all over again. So why would I ever open that box?" -P.A.
A bit of background
Both "trauma" and "Post-Traumatic Stress Disorder (PTSD)" are words that have a controversial history. Trauma is a general term that refers to injury of the body and mind. PTSD is a diagnosis of a trauma disorder with a specific set of symptoms listed in the Diagnostic and Statistical Manual for mental health disorders (DSM-5), which is what American practitioners use to diagnose. It no longer refers to just veterans and war trauma but covers anyone meeting the criteria.
PTSD was only added to the manual in 1980, and there were no other official trauma diagnoses before that. Unofficially it was termed "shell shock" during World War I and sufferers were unfortunately treated as cowards and criminals. Trauma is totally subjective, so diagnosing someone with a trauma disorder can be tricky. Which is why the DSM committee outlined what they considered to be a qualifying event for PTSD:
"Exposure to actual or threatened death, serious injury, or sexual violence..."
These events could be:
"directly experienced"
witnessed in person occurring to someone else
learned of after occurring to a "close family member or close friend"
or experienced through "repeated or extreme exposure" to the aftermath (think first-responders)
I work with PTSD up close, and it is startling how destructive it can be to the person and their family. But what about the way everyone uses the word "trauma" today? Childhood neglect, generational trauma, inappropriate sexual experiences in childhood that were not violent, etc.? These are serious issues with real effects and they don't meet criteria for PTSD as outlined by the DSM committee.
The fact is that the fields of psychology and psychiatry are still trying to figure out how to talk about this stuff. Many are beginning to talk about a spectrum of trauma rather than a binary of "traumatized" vs "you're just stressed".
Other prominent researchers have proposed new terms, like Complex PTSD (CPTSD) which is included now in the other main diagnostic manual, the ICD-11, used internationally and created by the WHO. CPTSD expands the qualifying events to other things we might generally agree could be traumatic especially when repeated over time, like chronic bullying, solitary confinement, attachment disruption with a primary caregiver, etc. Importantly, this includes things like feeling that your parent(s) didn't really care about you, neglected you, or verbally abused you.
how do i know if i have trauma?
Symptoms vary widely.
Here's how I usually describe PTSD criteria. There's a lot more to talk about regarding other reactions to trauma.
"If we take 100 people who have been through something traumatic and we interview them shortly afterward, almost all of them tend to react within a set of symptoms. It's a normal human reaction to stuff we consider deeply disturbing. These symptoms fall into three buckets:
Memory: Parts of the event can usually be recalled very, very clearly, although in a fragmented way. Sights, sensations, smells...they remain vivid years later. Because it's so vivid, it pops into mind without intention. It comes back in nightmares. A mask is created to look and feel normal, but a part you is split off and still inside of it. When something triggers the memory, intense feelings come up that are unresolved. Some have extreme physiological reactions in response to reminders. Efforts are made to forget (diving into work, alcohol, or substances).
Emotions: "It was totally my fault," "I can't trust anyone ever again," persistent shame/guilt, loss of ability to feel positive emotions, detachment from loved ones, loss of enjoyment in hobbies or work. There's a feeling of being different, apart from everyone else, disconnected. Alone. Depression is very common.
Adrenaline: Irritability and outbursts. Hypervigilance, which means being on guard duty 24/7 and especially in public. You might look okay but you are buzzing underneath the surface. This affects concentration (big overlap between trauma and ADHD) and sleep. Most people lose access to a feeling of security in the world. That feeling you get walking through a back alley at night? People with PTSD feel that at the grocery store, or anywhere with people around.
Remember, these are normal symptoms in response to trauma, the majority of people can expect to experience a few after a bad car crash. Your nervous system was shocked into a raw and sensitive state. This usually resolves within a month for most people and no diagnosis is involved. However, a minority of people find that symptoms do not resolve, and they tend to feel this way 6 months later or 1, 5, 25 years later. Now we are dealing with a trauma disorder.
In other words, you are stuck inside of a normal human process that has not resolved yet. So what keeps some people stuck? What's different about them?
There are different answers to this question. The answer that psychology has mostly settled on is: avoidance behavior. You want to avoid the memory because it brings up a lot of feeling and make you anxious. (See more about anxiety here) But your mind and body can't heal and do what they need to do if you avoid the trauma and anything associated with it.
With this in mind, many treatments were designed for trauma that go directly against this avoidance. They involve repeated exposure to the memory or to triggers so that you can process and desensitize. Basically, we agree to talk about the trauma in a focused way but with respect to your window of tolerance. These therapies can really help, or they can be re-traumatizing. I've seen both happen, although most people find benefit. To avoid making it worse, there are some proven methods:
It needs to be 100% your decision to try trauma therapy. If you feel coerced by a doctor or family, slow down.
You should be relatively safe and stabilized first. This means not being exposed to your abuser every day, having regulated biological rhythms of eating and sleeping (they don't have to be perfect, but you will need energy for this), and making sure that your basic needs shelter/clothing, etc. are being met.
You should either be working on or have a handle on your substance use. Research is conflicted on whether you can successfully treat PTSD and substance use disorders simultaneously. This is tough, as almost half of people with PTSD have issues with substances.
You will need support. Doing this alone is not always a great idea. A trusted friend or family member who knows can be huge. You probably need more support than just your therapist. Community is the best, so get hooked up with others who can relate.
Recently, other researchers argue that, since trauma affects your nervous system so strikingly, we must incorporate the body more in treatment. This is why you find recommendations for "bottom up" treatments like trauma-informed yoga, tai chi, EMDR, massage, sensorimotor psychotherapy, etc. I've seen these help where the normal methods fail and I totally support them, although the evidence for their effectiveness is not quite as solid yet.
Learn more about the trauma therapy that I offer in San Antonio, Texas
Please reach out to me with any questions or if you'd like to set up a session for trauma therapy.