How Does One Identify an Experience as a Trauma?

By Matt E. Jaremko and Beth Fehlbaum

Our title might sound somewhat nonsensical. Of course, if you have experienced a trauma, you will know it. However, admitting that you have experienced trauma may not be as straightforward as you might think.
Folks can tend to underplay the extent to which they deserve care and attention. It’s almost as if these reluctant victims think, “Oh, I’ll be all right. Let someone else use the help and support.” Additionally, some victims might underplay the extent of trauma experienced because it could keep them from having to face ugly stuff. Sadly, there are those among us who have been trained well to follow rules that delay or avoid self-care. Under defining or failing to admit traumatic experience(s) could hold one back from getting needed help.

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It was not uncommon in Matt’s years as a clinical psychologist to hear a client conclude that he/she had never really figured such and such event in the past had been traumatic. But after examining such under-defined life experiences in juxtaposition with the symptoms they had been having for years, these folks came to realize: “Yeah, that event was truly traumatic, and I wish I had started working at recovering from it much sooner.”

The criteria mental health professionals use to diagnose disorders (DSM V) states that a traumatic event is any occurrence that involves actual or threatened death, serious injury or other threat to one’s personal integrity. In our forthcoming book, Trauma Recovery: Sessions With Dr. Matt, we present fictional accounts of the lives of seven victims with the following traumatic histories: childhood sexual abuse, attempted rape, being in an explosion in combat, being in a mobile home destroyed by a tornado, driving while in a motor vehicle accident in which the passenger is killed, and being a first responder to a multi-fatality terrorist shooting in a church.


Rates of Trauma in Modern Life

Most folks would agree that the experiences depicted in our book are life-changing traumas. A recent scientific research article described a survey that asked a carefully selected representative sample of over 3000 respondents if they had experienced trauma in their lives, (Kilpatrick, et a., 2013). 87% said they had!

In order of most-to-least common, the study listed the actual traumatic event and the percent of respondents who reported it: Physical or sexual assault (53.1%), Death of family/close friend due to violence/accident/disaster (51.8%), Disaster (50.5%), Accident/Fire (48.3%), Witnessed physical/sexual assault (33.2%), Threat or injury to family or close friend due to violence/accident/disaster (32.4%), Witnessed dead bodies/parts unexpectedly (22.6%), Exposure to hazardous chemicals (16.7%), Work exposure (11.5%), Combat or warzone exposure (7.8%).

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These are startling numbers because they conclude that almost everyone is exposed to traumatic events. But if that is the case, why are we all not walking around like thunder-struck basket cases? The answer may lie in a concept known as “objective” trauma versus “subjective” trauma.


Objective Versus Subjective Trauma

If we asked a 100 people whether they thought being raped at gunpoint was traumatic, all would say, “Yes!” But if we asked the same 100 people whether experiencing the divorce of their parents at age 12 was traumatic, we might get an affirmative answer less than 100 times. Be that as it may, it could well be that at least some of the children of divorced parents consider the family disruption to be traumatic. In one case (brutal rape), the definition of trauma is based on the set of objective facts that surround the event, but in the other (divorce), the definition of trauma is subjective to the person experiencing it.

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Trauma must be defined by the experience of the survivor. Two people could undergo the same event and one person might be traumatized while the other person remained relatively unscathed. It is not wise, for example, to determine an event as not traumatic because no one was physically injured. Perceptions of an event can vary greatly from one individual to the next. It is impossible to assume that the meaning of an event that is distressing for one person will be same for another person.

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The same goes for “objectively lesser” traumatic events, such as the divorce mentioned above or psychological abuse from a spouse. Using a subjective definition, many events perhaps people consider not to be traumatic should, in fact, be considered traumatic to some people.

Divorce has been mentioned: how about financial ruin and bankruptcy? After the market crash in the 1930’s, suicides were all too common among those who lost their fortunes. Speaking of the 1930’s Great Depression, prolonged unemployment and poverty probably caused trauma to many families. In a similar vein, countless individuals and their families facing major medical issues such as cancer are being exposed to traumatic events.

In a recently published book entitled Supernormal, Meg Jay brilliantly proposes that most people experience serious adversity in their lives, both as children and as adults. One might think of these life adversities as “traumas inside the home.” They include alcohol/drug abuse by parents or siblings, neglect by parents, overbearing parental expectations, suicide of a family member, even major arguments and disagreements over political issues. These days, there is even serious mention of such a thing as President Trump Stress Disorder! I guess that would be ptsd (without caps!)

Thus, trauma takes many forms, and there are vast differences among people who experience the same trauma. So, in order to define trauma, it is best to examine the similarities and patterns of responses across the variety of stressors and victims who experience them.


Dimensions of Trauma’s Strength

There are several dimensions that have been shown to make traumatic events more or less intense. These dimensions might be considered when attempting to determine whether one’s life has been disrupted by trauma.

The effects of trauma are more likely to be worse if any of these factors are true: the trauma was caused by a human; it was experienced repeatedly; it has the quality of any of the following: unpredictable, multifaceted, sadistic, undergone in childhood, perpetrated by a caregiver, and a lack of support or negative consequences from disclosure.

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When it is another human that caused events leading to trauma, rather than a natural disaster, for example; the average reaction across victims will be worse. The recent mass shooting at a Texas church will no doubt lead to worse trauma reactions than the floods caused by the hurricane in the same state a few months before. But, once again, any one individual in either catastrophe could have a larger or smaller reaction to either of these tragedies.

The sexual assault victim who has been raped more than once will no doubt have more trauma to process than would someone who has been victimized one time. Incest victims who have been violated many times are typically more devastated than a child who had a single episode of being molested.

Repeated exposure to trauma clearly makes things worse. The effects of repeated trauma will be especially ‘hidden’ if what is repeated has been generally accepted to be ‘mild’ by the social group(s) in which it takes place. A youngster verbally abused (e.g. being called ‘stupid’) repeatedly might have an unrecognized trauma, until effects accumulate to form the symptoms of PTSD discussed below.

Being unable to predict when extreme stress is going to happen is often a predictor of whether PTSD will be severe. Consider refugees who must leave home due to war. Such folks might be in camps for unknown lengths of time with no control over even the most basic human factors. PTSD is more likely to be severe in such individuals.

In a similar vein, if events are so devastating as to consist of several distinct traumas, the stress reaction following them will be more intense. An individual in a motor vehicle accident is no doubt traumatized, but even worse so when a family member dies in the same accident. It should also be noted the age at which the trauma happens is important, with children more vulnerable to the development of post-traumatic reactions. Thus, a kidnapped child whose parent is killed trying to save him or her will be in for a long and difficult recovery process. Related to age is adversity or trauma caused by being raised by abusive or neglectful parents, and being around an abusive sibling all one’s life can cause enough cumulative stress that the effects are traumatic.

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Finally, it should be noted that the reactions of people in the victim’s support system can add to the intensity of post-trauma reactions. Let’s say someone who was supposed to be trustworthy, for example, a stepparent, sexually abused a child, but when the abuse was disclosed, the biological parent was unsupportive or even dismissive. Such events predict intense PTSD symptoms with a very difficult course of recovery.

In summary, any event that combines the actual or perceived existence of two or more of the above dimensions will most likely lead to more intense PTSD and should be recognized as such so that appropriate treatment planning can begin.


The Symptoms of PTSD

Following an analysis of the nature of the stressful events, it is important to list and examine the symptoms being displayed by the victim. For PTSD, such a symptom list will contain 5 categories: re-experiencing the event, excessive effort to avoid anything to do with the event, negative emotions (anxiety, fear, anger, guilt, shame), social and occupational self-defeating activity, missing purpose and/or enthusiasm or meaning in life.

If these symptoms are observable, then a PTSD reaction is taking place, even if an “objective” assessment indicates otherwise. Becoming stuck in PTSD is so destructive to life, it should be identified and remediated as soon as possible. “Over-diagnosing” this condition harms little, but much is gained by catching it in a timely manner.

To illustrate the idea of a “subjective” instance of PTSD, let’s consider a fictional case. Paula is a 20-year-old junior in college. While attending a college fraternity party, Paula and her dorm mate got mixed up in an unpleasant exchange with some males at the party. These males ‘cornered’ the women in an upstairs bedroom for more ‘private interplay’. The males started coming on very strongly, making suggestive overtures, and actually groping Paula’s dorm mate. Two of the males disrobed and began to expose themselves. Paula reacted by freezing up, quite unable to respond. Her roommate, however, kicked one of the boys in the exposed genitals and started screaming loudly. Another young woman came into the bedroom, and the episode was broken up before the situation got worse. (As if it wasn’t already bad enough).

After the event, some of the girls in Paula’s dorm had occasion to talk about the event and similar events. Much to Paula’s surprise, a number of the other women in her dorm had had experiences like hers, a number of times. They seemed almost “immune” to it. Paula’s roommate appeared to have no visible reactions after the event.

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For Paula, however, things were different. She stopped going out with her friends on weekends. Occasionally, she would wake from bad dreams in the middle of the night about being locked in a frat house with a half dozen naked drunk college males. She was anxious all the time but ashamed that she could not ‘shake it off’ like her roommate did. She even considered quitting school, since she found little meaning in a place where such evil things took place, but everyone acted like they were no big deal.

As we observe this situation, we see two young women at the same event with two highly different reactions. Paula needs help, and she needs it quickly. Unless she gets it, she runs a great risk of becoming stuck in a pattern of internal dialogue in which she thinks it’s not okay, or that it’s even silly or weak for her to react in the way her mind and body have done. The subjective aspects of her life before this trauma and her reactions after it have created a PTSD reaction just as real as any more ‘objectively’ horrible trauma. The victim, not anyone else, best defines trauma.

Paula’s story is a common example of how and why folks who have been traumatized do not seek treatment or avoid seeking more information about trauma recovery. In our forthcoming book, Trauma Recovery: Sessions With Dr. Matt, one of the characters, Felicia, has experienced a sexual assault much like described here with Paula. Felicia goes for years suffering PTSD symptoms, in part due to an ongoing internal dialogue with herself in which she told herself that she was weak and unworthy of having a normal life.

Let’s examine another example of “childhood adversity” that might not be considered as an objective trauma but results in all the PTSD symptoms. Growing up with a parent who is an active alcoholic is highly stressful. Adult Children of Alcoholics is a self-help recovery movement for such folks. People with this history have life experiences that include all of the dimensions of trauma’s strength discussed above, and many individuals who are adult children of alcoholics have all five of the symptoms of PTSD. However, many such folks would never equate themselves to a rape victim or an incest victim. Nonetheless, their subjective reactions amount to a life full of trauma.

Dr. Patricia Resick, a noted expert in treatment for assault-related trauma, has pointed out the role of becoming “stuck” in unhealthy emotions and beliefs that nothing came be done after victimization. Dr. Resick contends that much can be done to reclaim/rebuild life, and that such work can be basically quite effective once begun, but—to accomplish recovery, one must overcome the stuck points such as those illustrated in this article. Perhaps the first step in that process is being more ‘liberal’ in defining life events as traumatic.


Life Events Sometimes Not Considered as Traumatic

So, here are some examples of life events that tend to not be defined as trauma because folks have, for the reasons cited above, under-defined them or avoided examining these life events with the criteria of trauma in mind. If you have any of the five symptoms discussed above, maybe you should look more closely at this list to see if these events happened to you and might be the cause of your hard-to-account-for symptoms:

1. Repeated verbal abuse by a parent/caregiver

2. Date rape or otherwise unwanted sexual physical contact

3. Experiencing or witnessing domestic violence

4. Victimized by a crime, even a ‘white-collar’ crime where much was lost

5. Living with chemically dependent family members

6. Severe and sustained economic downturn

7. Divorce and separation from your children

You should especially consider the above as traumas if any of the dimensions that add to the strength of a trauma are involved: repeated, happened in childhood, caused by a human—especially a caregiver or trusted person, were intentional, and the reporting of them was discouraged or punished.

Therapy is not necessarily a lengthy, expensive venture. Once you commit to one of several efficient and time-limited cognitive-behavioral treatments, you have a good chance of turning your life around. More information about types of treatment—including names of therapists—may be found at Dr. Resick’s website for understanding and treating trauma: cptforptsd.com

Our book, Trauma Recovery: Sessions with Dr. Matt, points out that 40% or more of people who have experienced trauma end up being stronger and better adjusted after the trauma is ‘processed.” This is called “post-traumatic growth.” In easy to understand language, we present the “the how and why” trauma victims get better, even stronger.


The First Step

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If you’re ready to move toward post-trauma growth, we propose that you can begin by taking the initial step toward recognizing your under defined trauma.

 

 

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