While our view of trauma has expanded somewhat to include people who have lived through violent crimes, natural disasters, and other exceptionally disturbing events, there is still confusion over what “counts” as trauma, or an event that could result in PTSD. To help clear this up, we asked two trauma experts to walk us through what, exactly, qualifies as trauma, the difference between trauma and PTSD, and how rethinking our concept of trauma can help more people get the help they need. “I think everyone’s definition of ’trauma’ is different, so it can be hard for some people to think about their experience in those terms,” Fried says. “Sometimes people experience horrific things that most others would label as a trauma, but [the person who experiences it] may not feel like the term ’trauma’ is necessarily representative of their experience.” So where does PTSD come in? According to Lise LeBlanc, a registered psychotherapist specializing in trauma and author of the PTSD Guide, early works of literature show evidence of PTSD more than 3,000 years ago—long before the advent of modern psychiatry. But PTSD was only recognized in a clinical context following the Vietnam War, when massive numbers of soldiers started showing a clear and undeniable pattern of symptoms, including reliving trauma, hyper-arousal, avoidance behavior, and recurring nightmares, she notes. At that point, Fried explains, the research and literature were primarily focused on combat-related PTSD, leading up to the condition being formally introduced as a diagnosis in The Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. However, since its recognition in 1980, the DSM has never made a distinction in terms of the type of trauma that can result in PTSD—except that it has to be life-threatening, like a violent crime, car accident, natural disaster, or abuse, he says. Because of its initial connection to war, PTSD was referred to by a number of other terms, including “war neurosis,” “combat fatigue,” and “shell shock,” which only added to the confusion. “Then, it was soon discovered that people who had never been to war were also showing this same pattern of symptoms,” LeBlanc says. “At first, it was noticed in people who had lived through a horrific event, but eventually it was recognized that anyone who is directly or indirectly exposed to trauma can develop PTSD.” One distinction that has been made, Fried says, is that the effects of traumas that aren’t life-threatening don’t meet the diagnostic criteria for PTSD, and instead fall within the “Trauma and Stressor-Related Disorders” group in the DSM. “It’s also important to note that people experience trauma in many different ways,” he explains. “Just because someone isn’t experiencing what we consider ‘classic’ PTSD symptoms—such as intense fear or horror or nightmares—doesn’t mean that they didn’t experience a trauma, and that they aren’t having difficulty processing what has happened.” Though it’s entirely possible for emotional trauma to occur as a result of a physically traumatic event, like an accident, assault, or death, it can also result from an experience where there was no physical harm, like harassment, neglect, verbal abuse, manipulation, or parental separation, says LeBlanc. Additionally, emotional traumas are often more complex than other types of stressors and can often persist far after the acute situation or relationship has ended, according to Fried. “Sometimes these types of reactions are in response to situations that may seem out of the person’s control and/or dangerous, such as interactions with unpredictable people or unstable and dynamic situations,” he explains. “These situations can include intense relationships with others that include some element of psychological abuse, such with a controlling significant other or a boss who constantly belittles and is demeaning.” At the same time, LeBlanc says that it’s important to understand that a person can experience a highly stressful or traumatic event, or even repeated traumatic experiences, and not develop a trauma disorder. It’s also possible for that same person to develop a trauma disorder after exposure to an experience that is much less traumatic than something they’ve experienced before. “It’s more about the nervous system’s threshold for handling stress over time,” she says. “There are so many factors and variables involved that affect one’s ability to process stress and trauma in any given moment, including protective and risk factors, as well as whether the traumatic event was perceived as intentional or unintentional, expected or unexpected, uncontrollable or inescapable.” RELATED: 11 Red-Flag Signs of a Toxic Relationship “Some may fear that going to therapy will mean they have to focus on the very thing they’re trying to numb or avoid—which can be scary,” Fried explains. “Others may feel that simply talking about it won’t change what happened or won’t help.” The problem is that if people aren’t getting the help they need, they may turn to substances like drugs or alcohol, or distractions—like constantly being on their phone—as strategies to ignore their trauma, Fried says. Aside from the fact that these unhealthy coping mechanisms may cause someone additional harm, it can make their trauma even worse. “In my opinion, trying to avoid trauma is the biggest mistake someone can make,” LeBlanc notes. “Although avoidance is a self-protection mechanism that temporarily shields us from the full extent of the distressing thoughts and emotions associated with trauma, it is also what prevents us from processing and integrating the traumatic experience and releasing the emotions involved.” But what about people who aren’t ready for therapy, or don’t think it will be helpful? Though it can be difficult to encourage them to even consider therapy, Fried says they may be more open to it once they realize that their methods of coping with or avoiding the trauma aren’t working, or may be causing them even more harm. “When someone starts therapy for the first time, I often acknowledge that the process may seem unfamiliar and uncomfortable at first and that it can be hard to open up to a stranger, but this is normal and it gets easier as time goes,” Fried says. “A therapist certainly can’t undo a situation or event, but they can help people better cope with it while repairing their relationships with others and with themself.” RELATED: 5 Tips to Find Affordable Therapy
