A traumatic event can, and often does, change people’s lives forever. George Carlin had a delightful and compassionate stand-up routine he did, describing the genesis of the term Post Traumatic Stress Disorder, from the early terms of battle fatigue and shell shock. Research in the 1970’s found clear parallels between the experiences of soldiers and rape victims, showing that when a person undergoes a traumatic event, it can profoundly change their cognitive and psychological functioning. Changes can reverberate through a person’s life for decades if untreated, affecting their relationships, their jobs, and every aspect of their life and well-being.
Trauma-informed treatment is a modern buzz-word, as clinicians are encouraged to better identify traumatic experiences in a client’s life, and connect their current emotional and substance abuse issues to this history. I can recall as a young clinician, working with incarcerated gang members, and identifying a staggering level of trauma in these young men’s histories, as they saw their friends die on the streets, sometime in their arms. These young men used drugs to avoid feelings and thoughts about these experiences, they had nightmares and flashbacks. They exhibited hypervigilance, and a sense of foreshortened future, feeling that their lives were doomed to be short, and there was no reason to think otherwise. The traumatic experiences that these young people suffered scarred many of them, and contributed significantly to their own violent and illegal activities. Indeed, a favorite mentor of mine opined that much of the bloodiness in the American West during the late 1800’s was directly related to undiagnosed PTSD in Civil War veterans who came West, carrying guns and caring little who they shot.
But today, the term trauma seems to be everywhere. And the idea of trauma has now been extended out to seemingly cover any unpleasant experience one might encounter. The latest example is simply mind-boggling to me, as there is now an association dedicated to certifying therapists who treat “trauma” in the partners of alleged sex addicts. Now, readers of my blogs and books know that I am a firm disbeliever in the concept of sex addiction, and blame a huge majority of sex addiction diagnosis and treatment on poor clinical practices and a staggering lack of real understanding of mental health and diagnosis.
The trauma described here is not talking about rape, or murder, or assault, violence, kidnapping or torture. The Association for Partners of Sex Addicts Trauma Specialists (APSATS) have organized themselves to certify and train the treatment of “sex addiction induced trauma, defined as the traumatic impact and symptoms caused by sex addiction on self and others.” They are talking here about infidelity. About sexual betrayal, about disappointment and lying and cheating. This is trauma?
APSATS goes on to say that partners of sex addicts often present with symptoms of PTSD. Hmm. Really? Well, I’d like to see that research and data. I’d like to see structured diagnostic interviews that demonstrate this, and compare these results to a normative population. That would be good research, good science, and good, evidence-based practice. But I’m also curious as to this language, “present with symptoms of PTSD.” Guess what, anxiety, fear, depression are all symptoms of PTSD. These betrayed spouses may show these symptoms, but they don’t have PTSD, they’re not showing signs of trauma, they’re just legitimately worried, sad and depressed over the course their life and relationship has taken.
Unfortunately, poorly-trained clinicians over-diagnose PTSD to extraordinary degrees – they hear a client describe an event of abuse or rape or tragedy in their past, and the clinician just writes down “PTSD” as a diagnosis. But that’s not the way it works. Simply having a potentially traumatic event occur doesn’t give you a PTSD diagnosis. It takes much more than that – namely, it takes a long-running cluster of symptoms that interfere in a person’s life, and includes flashbacks, hypervigilance, changes in perspectives on life, extreme physiological reactivity, avoidance of stimuli and situations, and increased physiological arousal. Do betrayed partners have these symptoms? I doubt it. In fact, when I’ve worked with these folks, they show the exact reverse, demonstrating an obsessive, ruminating fixation on the details of their partners’ betrayals and actions. They’re not avoiding these situations or details because it makes them feel awful – no, they’re diving in head-long, beating their partner about the head and shoulders with the details of their betrayal and making this betrayal a central part of their life and relationship.
Here’s a central, critical point about PTSD that APSATS missed, through ignorance or overzealousness - the experiences which create PTSD are traumatic experiences in which there was an actual risk to life and physical integrity. Traumatic experiences occur when you think your life or those around might end suddenly or violently, or when your physical safety and bodily control may be taken away from you, as in rape. Finding out that your partner has been cheating on you? Been watching pornography behind your back? Lied, deceived and betrayed your trust? These things are likely to be emotionally devastating, but I suspect no one in history has died from finding out their trust was betrayed.
Labeling as trauma the experiences of these partners of alleged sex addicts is clinically and diagnostically ludicrous. Worse, it’s offensive and diminishing to the experiences of people who have experienced true trauma, watched people die or had their bodies forcibly violated. Finding out that your partner has cheated on you is NOT the same as fighting a terrible war, losing friends to death, or being raped. Watering down the label of trauma, treating it so casually, stands the real risk of getting in the way of providing treatment to the soldiers and victims who truly need it.
PTSD is important - but is infidelity the same as real trauma?
Worse yet – this label almost certainly makes the problems even worse. Substantial research shows that when clinicians use the word trauma, and tell patients that they “must have been traumatized by that experience,” the patients believe the clinician. Patients perceive themselves then as damaged, wounded, and disordered. And the patients then began to behave that way. By treating these spouses as “traumatized,” APSATS is sadly guaranteeing that the problems these people are experiencing are going to persist, and probably worsen.
Diagnostic labels such as trauma and PTSD are important, and clarity and thoughtfulness in their use is critical for good medicine. Pop psychology concepts like “sex addiction induced trauma” have no place in a real discussion of psychological treatment. This latest offshoot of the sex addiction treatment industry simply extends the bad diagnostic approach of sex addiction, to now incorrectly and unethically diagnosing their partners as well. What’s next? Will they try to have “my partner cheated on me” added to the DSM criteria for PTSD?