This is post #2 in my blog on stress and trauma, so let’s start at the start. What counts as trauma?
The patient sat down and told me the condensed version of her life. An uncle attempted to rape her when she was 13 years old. She had been in a serious car accident, lived through a hurricane, suffered two miscarriages, had a gun pointed at her in a road rage incident, had more than one college professor try to exchange grades for sex, knew a close girlfriend raped by a stranger two blocks from her home, and watched her father die on the spot from a stroke. She referred to herself more than once by saying, “I think I was traumatized by that.” Was she traumatized?
There are three definitions of trauma. The narrowest definition from the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) defines traumatic events as only those events that involve threats to a person’s life or witnessing such threats to loved ones. These events are typically sudden and unexpected. They are capable of creating a moment of extreme, sheer panic in which one fears for one’s life. These are the types of events that are most likely to lead to the development of posttraumatic stress disorder (PTSD).
In the largest study ever conducted on this topic, over 68,000 respondents were surveyed in 24 countries. Researchers found that 70.4% of the respondents had experienced at least one life-threatening trauma (Benjet et al., 2016). While life-threat traumas are certainly not everyday types of events for individuals, they are common events when considering a total lifetime.
The second definition of trauma is broader than the first and includes stressful events that are beyond the everyday experiences of most persons, but they do not rise to the level of life-threatening. These can include neglect, emotional abuse, bullying, divorce, moving to a new city or new school, and watching terrorist attacks on television. These types of events may lead to emotional problems but rarely, if ever, lead to PTSD.
The third definition of trauma is much, much broader and can include nearly any type of everyday stress. These can include a traffic jam, a tough exam, being late for an appointment, or a loss by a favorite football team. Whether folks truly mean it or not, they refer to these events as traumas all the time. For example, “I was stuck in traffic for an hour. It was traumatic!”
Clinicians and researchers have tried to provide some clarity by referring to life-threat trauma as Big T trauma and non-life-threat stress as Little T trauma, but these terms do not have a lot of traction. We are stuck with the word trauma that functions much like the word torture. Folks can use the word torture for any life experience from the mundane to the extraordinary. Torture can mean systematic physical harm in captivity, or torture can mean the stressful experience of physical rehabilitation, or torture can mean being a brokenhearted fan of a chronically lousy football team.
Which definition of trauma we use is important for communication. We need to be able to talk with each other and have words mean the same thing. We also need a clear definition for research. Research rests on the foundation that the things we measure have to be clear and replicable (i.e., operationalized) or else it is impossible to compare the results of one study to the next. In regards to PTSD, the relevant definition of trauma is the first definition-the narrowest definition of events that are sudden, unexpected, and involve threats to individuals’ lives.
Lastly, there is one more aspect as to whether individuals have been traumatized. It is not enough to have experienced traumatic events. To be traumatized usually means that individuals have been affected by the events. That is, they have symptoms of PTSD and some impairments in their abilities to function. To be traumatized means that individuals have some emotional or behavioral problems as a result of the traumas.
The patient at the beginning of my story believed in her mind that she was traumatized, but actually she was resilient. She did not have, and never did have, any true symptoms of PTSD. By the psychiatric definition of PTSD, she was not traumatized. She was not content with that interpretation, though—but that's for another story.
C. Benjet and 34 additional authors (2016). The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium, Psychological Medicine 46, 327-343