Trauma & Posttraumatic Stress Disorder (PTSD)

Many people experience trauma in their life of varying type and intensity. We all respond differently to a traumatic event. Trauma can have a negative impact on our psychological and emotional well-being. A traumatic event is one that shatters our sense of feeling safe and ability to assume predictability in life. There are many different types of trauma. Often people are not aware that they may have experienced a trauma, as it is often assumed to be associated with an event that involves physical harm to self or others. Traumatic events that people are most familiar with include being involved in war, sexual or physical assault, or a  car accident. But trauma can also include things such as changing countries, losing a friend, or learning your partner had an affair.

Traumatic events can either be directly experienced by the person or they can be witnessed, such as learning about the trauma your parents went through during immigration. Trauma and stress are slightly different. Trauma is an event that shatters our sense of confidence in consistency within our worldview, and can cause stress. Stress refers to events and experiences that are providing a consistent psychological and emotional burden such as too much work, too many responsibilities at home or ongoing conflict with a family member. 

Trauma and stress can cause issues when they overwhelm our capacity to cope. Individually, we vary in terms of our ability to cope with trauma and stress. Often therapy helps by helping people make meaning of the events or learn tools to cope in healthy ways with things they may not be able to change or control.

Some trauma and stressors can lead to a psychological disorder. While not all trauma and stressors cause a diagnosable disorder, they may still require help because they negatively impact one’s work, family relationships, social life, daily routine, and mood.

A trauma or stress-related disorder can present in varying symptoms. Previously, it was thought that trauma was expressed as an anxiety- or fear–based response (e.g., flashbacks, startle response). It is now recognized that trauma can be experienced as anger, aggressive symptoms (externalizing), sadness, withdrawal and apathy (internalizing). 

Post-Traumatic Stress Disorder (PTSD)

For Post-Traumatic Stress Disorder (PTSD) we look at whether a person has had an exposure to actual or threatened serious harm (death, injury, sexual violence) directly or witnessed it or learning about it happening to a close other. This includes repeated exposure to aversive details of traumatic events for first responders (e.g., firefighters, police officers, court judge, jury). Following such traumatic event(s) a person may experience : 

  • Intrusive symptoms that are recurring, involuntary and distressing such as recalling memories and dreams, flashbacks, psychological and/or physiological distress to internal or external cues that resemble the trauma
  • Avoidance of anything that reminds a person of the event and which can arouse distressing thoughts, feelings or memories that triggers reminders such as people, places, conversations, activities, or situations 
  • A pattern of negative thinking and mood or when pre-existing mood and thoughts worsen, such as difficulty remembering certain aspects of an event (dissociative amnesia); negative beliefs about oneself, negative feelings such as fear, anger, shame; a reduction in interest in things one typically enjoyed; detachment from others; difficulty experiencing positive emotions.
  • Arousal and reactivity such feeling irritable, anger outbursts with little or no provocation, reckless/self-destructive behaviour, hypervigilance, startle response (serious fright in response to a sound more than typical), difficulty with concentration and  sleep.
  • Some people may experience de-personalisation or feeling detached from one’s body as if one were in a dream, a sense of unreality related to self or body or of time moving slowly.
  • Some may experience de-realization where the world around you feels unreal, dreamlike, distance, distorted. 

Acute Stress Disorder

Acute Stress Disorder has a similar presentation to PTSD, except that the symptoms last for no longer than one month. Acute Stress Disorder is diagnosed when a person is exposed to actual or threatened death, injury or sexual violation directly or indirectly, or is repeatedly exposed to aversive details of traumatic events, and experience symptoms such as:

  • Involuntary and recurrent distressing memories, dreams or flashbacks; distressing reactions to internal or external reminders or internal and external cues that resemble the traumatic event
  • Difficulty experiencing positive emotions
  • Altered sense of reality of one’s surroundings (being in a daze) and/or inability to remember important aspects of the trauma
  • Efforts to avoid distressing internal or external reminders of the trauma
  • Irritability, anger outbursts, hypervigilance, difficulty with concentration, exaggerated startle response

Complex Trauma

Complex Trauma refers to repeated and cumulative experiences of trauma that occur in context of relationship contexts such as child abuse and domestic abuse. The trauma usually involves direct harm, exploitation, maltreatment, neglect, antipathy by primary caregivers or other responsible adults and occurs at vulnerable times in someone’s life, particularly in childhood or adolescence, but also includes conditions of vulnerability that can occur any time in life such as disability/disempowerment.

Symptoms of complex trauma include:

  • Difficulty regulating affective impulses such as anger, self-destructive, dissociative episodes
  • Chronic sense of guilt, responsibility, difficulty with stress or intimacy
  • Hopelessness and despair
  • Physical symptoms

Adjustment Disorder

Adjustment Disorder is diagnosed when there are emotional or behavioural symptoms in response to an identifiable stressor. The stressor may be one event (e.g. a romantic break up) or multiple stressors (e.g. problems at work or in your marriage). They can be events that recur or continue (e.g. a painful illness with increasing disability, living in an area that has high crime-rate). Stressors can effect one person or the whole family and community (e.g. natural disaster). Stressors can accompany developmental milestones (e.g. marriage, leaving parent’s home, not attaining certain occupational goals, retirement). Adjustment disorder may also be diagnosed following death of a loved one if the intensity and persistence of the grief reaction exceeds normal grieving and:

  • The emotional and behavioural symptoms occur within 3 months of the stress
  • There is a significant level of distress out of proportion to severity or intensity of the stress
  • The distress impacts one’s social and professional life and other important areas of functioning