Thanks to growing mental health awareness, the use of the term “trauma” and a public appreciation of its psychological and social impact has surged in recent years. But what is trauma and what does it really mean for something to be “traumatic”? In its most basic form, trauma is a type of event (or events) that often causes stress for people who experience it. The Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5)—the book that mental health professionals use to diagnose mental disorders—tells us that trauma involves experiencing death, serious injury, or sexual violence, or experiencing a threat that one of these things might happen. According to the DSM-5, these experiences are considered traumas when people either directly experience them themselves (e.g., being attacked or in a natural disaster or accident), watch them happen in person to someone else, learn about violent or accidental harm happening to a loved one, or are exposed to intense or repeated upsetting details about how one of these events happened to someone else (e.g., repeatedly handling human remains as a first responder). Some people experience trauma as a singular event like a car accident or a natural disaster. For others, trauma is chronic and repeated throughout their lives (e.g., living in an abusive situation). Trauma can be devastating, but it is also common. In fact, studies show us that about 82% of people will experience something that would meet the DSM-5 criteria for a trauma at some point in their lifetime. It is important to know that experiencing a trauma does not necessarily mean that someone suffers negative effects from that trauma. Instead, most people recover naturally from trauma with no long-lasting effects.
Research suggests that about 12% of people who have experienced a trauma have posttraumatic stress disorder (PTSD).
PTSD involves four groups of symptoms. The first group — re-experiencing symptoms — involve reliving the trauma in some way such as through nightmares, flashbacks, and upsetting and unwanted memories. The second group — avoidance symptoms — involve avoiding thinking about the trauma or the people, places, and things that remind someone of their trauma. The third group involves changes in mood and thinking. People with these symptoms can have a hard time feeling positive emotions like happiness or feeling connected to other people. They may also think about the trauma in ways that may not be accurate or helpful like blaming themselves for its occurrence. Finally, the fourth group — hyperarousal symptoms — involve feeling hyperactive in a variety of ways including having sleeping problems, being irritable or cranky, and constantly feeling on guard or jumpy.
It is typical to experience these symptoms in the immediate days, weeks, and months following a trauma. However, for most people, these symptoms decrease on their own. Having these symptoms right after a trauma does not mean someone has PTSD, but instead means they are recovering naturally from a difficult event. When these symptoms do not decrease on their own after trauma, and they occur at a sufficient frequency and intensity for at least a month, they are called PTSD. In this way, PTSD is often thought of as a problem of “stalled recovery,” because something has gotten in the way of the natural recovery process. Put another way, it’s not the PTSD symptoms themselves that indicate a problem, it’s the fact that they haven’t gone away on their own.
Although PTSD is a common response to trauma, it is not the only way that trauma can affect people. In fact, research shows that trauma can be associated with many difficulties, including depression, anxiety, alcohol and drug use, relationship problems, self-harm, and suicide. It has also been linked to more physical problems, such as chronic pain, more frequent visits to medical doctors, and more nights spent in hospitals. The research on trauma tells us that there are many ways that trauma is experienced and felt in the days, weeks, months, and years that follow it, that do not necessarily “look like” PTSD. Although many of these effects of trauma are undesirable, there can be silver linings for some people. One such silver lining, “posttraumatic growth,” is something that occurs when people feel that their battle with trauma has resulted in some kind of positive mental shift for them. Although posttraumatic growth doesn’t mean that trauma happening to someone is a good thing, individuals who show posttraumatic growth often describe having an increased sense of meaning, purpose, or their own strength and ability to handle hardship. They may also feel closer to other people or to their spirituality, or that their priorities in life have changed for the better.
Ultimately, our job as psychologists, researchers, and clinicians is to figure out what “gets people stuck” in the wake of trauma and how we can best remove it so that people can recover and move towards the posttraumatic growth they are capable of.
It is also important to note trauma is one kind of difficult experience, but it is not the only one. There are many experiences that people have that do not meet the DSM-5 definition of trauma, and yet they can still impact someone profoundly. These include marital affairs, experiencing one’s parents as cold or uncaring, coping with the death of a loved one following a prolonged illness, as well as broad social challenges like poverty or sexism. These experiences can impact someone’s life, psychological, and physical well-being profoundly. For example, experiencing discrimination has been consistently linked to many negative mental health outcomes, including depression, stress, and anxiety, as well as many physical health problems, such as increased risk for cardiovascular disease. The difference between these conditions and PTSD is that these conditions can develop following a difficult experience, but do not require a difficult experience to develop as with PTSD. Trauma is not necessarily more or less harmful than other forms of stressors, it simply reflects a unique kind of stressor that typically leads to “flight or flight” responses in the body and PTSD symptoms. Ultimately, all kinds of stressors can be extremely challenging, and there is not a legitimate metric that indicates which kinds are “objectively worse” than others, nor is comparing them necessarily helpful. Fortunately, mental healthcare can help tremendously with recovering and promoting resilience to all kinds of stressors, traumatic or otherwise. Many scientific studies suggest that cognitive behavioural therapies in particular can be effective in treating common outcomes of trauma and stress such as PTSD, anxiety, depression, as well as managing distress associated with chronic pain and physical health conditions. Research and clinical work show us again and again that people who survive trauma and other stressors can find their resilience and recovery with support.