What is Trauma?

Trauma

TraumaOklahoma has done a very good job educating its behavioral health providers about the impact and importance of trauma in the population we serve. A recent out-of-state trainer commented that we were ahead of many other states in our handling of the topic.

 

That’s nice to hear since Oklahoma is more commonly known for leading other states in things like chronic health problems and incarceration rates. As I listened to the trainer speak, I kept asking myself, what is trauma? Is an event considered traumatic because of its nature, its effect or simply because of one’s perception?

The American Psychological Association (APA) defines trauma as “an emotional response to a terrible event”. The Merriam-Webster Online dictionary gives multiple definitions for trauma. The first describes physical trauma and defines it as “an injury (as a wound) to living tissue caused by an extrinsic agent”. The second listing refers to “a disordered psychic or behavioral state” and more closely aligns with the APA definition. 

While the APA and second dictionary definition certainly describe the psychological state of those who have experienced a trauma, I think the “injury” definition provides a pretty accurate description as well. As we continue to learn what happens to one’s brain as a result of a traumatic event, I think we need to expand our working definition of trauma.

An amazing video from the California Attorney General’s office details the lasting impact on brain development of children exposed to the stress of domestic violence. Of course the brain is not the only part of the body affected by traumatic stress. The harmful effects of steroid hormones released in response to stress have been well documented. I think the lesson is that trauma is not just a psychological event; there are actual physical (brain and body) changes as a result.

I’ve known any number of people who have experienced traumatic events and yet don’t come close to meeting the criteria for Post Traumatic Stress Disorder (PTSD). Just because the criteria for PTSD aren’t present doesn’t mean the trauma didn’t have a lasting impact or “injury” to the affected party.

What if we defined a traumatic event as anything that significantly and negatively impacts the way one sees themselves and/or the rest of the world? While the resulting behavior pattern may sometimes meet criteria for PTSD, I would argue it more often takes other forms such as depression, substance use, relationship problems or any other number of common concerns.

 

If the events occur early enough during personality development, it seems likely that what we often call personality disorders are actually the result of personality formation in response to a traumatic event or series of events. That doesn’t mean the various diagnoses made following a trauma are completely inaccurate; just that they likely disregard the origin. I’ve heard it said before that once we become trauma informed, we stop asking “what’s wrong with you” and start asking “what happened to you”?

What have been your experiences in working with trauma? Is the increasing focus on trauma informed care simply the latest fad in behavioral health or are we on to something meaningful in helping those who suffer? As always, I’d love to hear your thoughts, ideas and experiences.

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