When we describe every disturbing event as "traumatic" the definition gets watered down. We need to clarify what trauma is and how we can address it effectively. In this post, Arbour therapist and registered Psychologist, Fred Chou helps define and describe what trauma is all about.
The term trauma often gets used in the counselling world and has found its way into media and everyday conversations. The recognition of trauma in mainstream settings has good and potentially problematic implications. On one hand, recognizing trauma is a good thing as it legitimizes the experiences of individuals who have experienced traumatic event(s) in their lives. For those individuals, the experience of trauma can have lasting impact that is psychological and/or physical.
Trauma offers a framework for understanding their experience. Yet, on the other hand, the overuse of the term trauma runs the risk of psychologism and concept creep—the idea that all human concerns can be explained through psychology (i.e., psychologism) and a concept losing its original meaning because it is being applied to everything (i.e., concept creep). Concept creep happens when all stressful experiences are labelled as trauma or traumatic, when it does not fit the criteria in the first place.
The risk of labelling all stressful experiences as traumatic can de-legitimize the experience of folks who have experienced trauma according to diagnostic definitions of trauma. Therefore, it is helpful to differentiate what trauma is and what it is not as it leads to different self-help and counselling strategies to address these concerns.
Because there is a lot of misunderstanding about trauma, I want to start a blog series that provides information about trauma in an accessible manner. This initial post will cover some of the basics for understanding what trauma is.
...it is helpful to differentiate what trauma is and what it is not as it leads to different self-help and counselling strategies to address these concerns.
For starters, it is helpful to frame trauma as a stress response that can be situated on a continuum, from normative to traumatic. Below are some common terminologies associated with trauma that can help with understanding what trauma is.
Stress-Related Definitions
Stress: One’s physiological or psychological response to internal or external stressors.
Normative (Healthy) Stress Response: Refers to being able to return back to an initial physiological/psychological baseline (homeostasis) after experiencing a stressful event.
Pathogenic Stress Response: A stress response that changes an individual’s physiological/psychological baseline state to potentially become less adaptive, but does not interfere with the ability to self-regulate.
Traumatic Stress Response: The experience of adversity or traumatic event(s) that results in changing an individual’s physiological/psychological baseline AND interferes with one’s ability to self-regulate. One of the core characteristic of traumatic stress is that it impacts one’s capacity to regulate.
Trauma Definitions
Trauma: A non-specific term that can refer to highly distressing event or series of events itself; the experience following a highly distressing event or series of events; and a proxy for intense emotional experiences. From that standpoint, it can be used as a umbrella term to generally refer to highly stressful events and not as a diagnostic term.
Traumatic event(s): Based on the DSM-5-TR Criterion A, this refers to traumatic events as exposure to actual or threatened death, serious injury, or sexual violence. These experiences can be direct, witnessed indirectly, learning that traumatic event(s) occurred to a close family member or friend, or experiencing repeated exposure to details of traumatic event(s).
Traumatized: The constellation of physical/psychological/relational states of being that an individual, who has experienced a traumatic event, may experience following the traumatic event itself.
Post-traumatic Stress Disorder (PTSD): A disorder brought on by exposure to traumatic event(s) that results in dysregulatory symptoms. These symptoms can include re-experiencing thoughts and feelings associated with the traumatic event, avoidance of circumstances associated with the traumatic event, experiences of reactivity and arousal that interferes with daily life, and negative mood and cognition.
Not every stressful event is a traumatic event, but all traumatic events are stressful. Furthermore, not everyone who has experienced a traumatic event becomes traumatized or has a traumatic stress response to it. It is a mixture of biopsychosocial factors along with resilience and protective factors that may influence whether someone becomes traumatized or not. For instance, one may have received support from a caring community and its members immediately after a traumatic event that can help mitigate its impact, thus reducing the risk of becoming traumatized.
Not every stressful event is a traumatic event, but all traumatic events are stressful.
Now to complicate matters, there are also developmental as well as cultural considerations when it comes to trauma. For instance, adversity experienced during childhood is that much more impactful because one does not have as much coping and self-regulatory resources available early in life. One may also argue that trauma as a concept is culturally encapsulated and does not apply universally to every cultural understanding of suffering.
There is also legitimate critique that definitions of trauma and traumatic events may be too narrow. Terms such as intergenerational trauma, historical trauma, racial trauma, developmental trauma, and complex trauma have added more nuance to the trauma literature. In fact, there is a whole discipline for studying psychological trauma called traumatology. Defining these terms is beyond the scope of this current blog post, but I hope to begin to shed some light on the concept of trauma. That said, for those who are interested in beginning to explore this topic further, two good and fairly accessible books are the “Body Keeps Score” by Dr. Bessel van Der kolk and “The Boy Who was Raised as a Dog” by Dr. Bruce Perry, which focuses on childhood trauma.
It is a mixture of biopsychosocial factors along with resilience and protective factors that may influence whether someone becomes traumatized or not.
So to summarize:
The term trauma has gained traction in everyday conversations and at times has become ubiquitous with stress, adversity, hardship and/or suffering.
Though all trauma is considered stressful, not all stressful events are traumatic.
A way of understanding trauma is to situate it from a stress response framework and a key characteristic of traumatic stress response is that it affects one’s capacity to self-regulate.
There are many terms associated with trauma and ongoing debates in the scientific literature. Nonetheless, the study of trauma and its treatment offers the opportunity to legitimize experiences of suffering individuals and communities have gone through.
Till next time,
Dr. Fred Chou, R.Psych.
Dr. Fred Chou is an Arbour therapist who works with individuals for a variety of concerns including depression, anxiety, life transitions, and grief and loss. He also specializes in working with psychological trauma and issues related to race and racism.
You can find out more about Fred here: Meet Fred
Notes:
These definitions and explanations have been adapted from the psychologist, Dr. Tim Black, the APA Dictionary of Psychology, and from Krupnik’s (2019) article Trauma or Adversity?
DSM-5-TR refers to the latest edition of the Diagnostic Statistical Manual (DSM). The DSM serves as the main diagnostic framework for mental health professionals in North America.
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