What Exactly is Trauma?

Written by Kally Doyle

This day in age I’d venture to say we have all heard the word ‘trauma’, and likely have used it to describe various experiences we’ve endured. You may have heard it used somewhat trivially, such as in a friend describing an embarrassing moment as “so traumatic”, or “that gave me PTSD”. On the other end, you’ve also heard it used to describe the condition an individual may have after experiencing war, a tragic car accident, a natural disaster, or an unexpected loss of a loved one. The word ‘trauma’ is often thrown around a lot on social media, as more and more individuals use the platform to openly discuss mental health issues (I don’t think this is necessarily a bad thing, btw- it does help increase awareness). This may leave you wondering what trauma actually is.

I’d like to preface this discussion by stating this is my perspective as both a human being and as a therapist, and my definition may have some variance from other mental health professionals and individuals. That’s okay- I’d argue the very definition of trauma lies within the ambiguity of the term itself.

I like to explain trauma as the following: an experience which has led to an interruption in our well-being, functioning, or emotional health. This interruption is pervasive enough to disrupt our lives. Interestingly enough, after I typed out this very condensed definition of my own, I decided to google “what is trauma” to see what the top result would be. It reads: “Trauma is an emotional response to a terrible event like an accident, rape, natural disaster. Immediately after the event, shock and denial are typical…”. This result comes from the American Psychological Association (https://www.apa.org/topics/trauma). My immediate and visceral reaction to this explanation is disappointment, and honestly a little bit of sadness.

Traumatic events do not just include those listed by the APA above. I would argue that is a very outdated view of trauma, and that it can be harmful to assume if it’s not war, physical or sexual assault, natural disaster, or tragic accident then it cannot be a trauma. Why do I say this? Well, first I will present some anecdotal evidence for my position, followed by some research indicating the definition of trauma and PTSD provided by the APA and the Diagnostic & Statistical Manual of Mental Health Disorders (the book used for diagnosing) is in desperate need of expansion.

As a therapist, the very foundation of my work relies on emotional exploration and support. People do not go to therapy to have logical debates about the status of their life and behaviors; they go to therapy ultimately because they feel helpless, sad, frustrated, depressed, suicidal, and more. I italicized emotional and feel for a reason, if you didn’t catch it- honestly, I can’t emphasize it enough- feelings are IMPORTANT! Yes, go ahead and ~cringe~ a little at the sound of me saying (typing) that phrase. Most of my clients do at first anyways…and I know I did, for a very long time. The fact of the matter is we are born with emotions. For those of you who tend to intellectualize, stop for a moment and recall the last time you had felt something…could be anything, nervousness, annoyance, love, admiration, interest…now, did you choose to feel that way, or did it appear on its own? That’s right, it appeared on its own. We do not actively think “I want to feel jealousy- ready, go!”. No, arguably no one wants to feel jealous. What happens is we feel it, and then it is usually followed by a thought: “I think she’s flirting with him!”. I may be going on a slight tangent, but my point here lies within just how important and ever-present our emotions are, even if we do not want them. This relates to understanding what trauma is because we need emotional safety in order to function properly. Even if we pride ourselves on being cool, calm, and collected, we still have emotions and they still need to be valued. If an event or relationship occurs which jeopardizes our emotional well-being and safety, well, this could potentially form a trauma.

One example that immediately comes to mind is an emotionally abusive relationship. This could be a relationship between a parent and child, sibling and sibling, or two romantic partners. Emotional abuse is something that can be very hard to not only identify, but also to admit to ourselves that it is happening in our relationship. The word ‘‘abuse’ can feel very heavy, and thus can lead to wanting to avoid labeling behaviors as such- especially if the behavior isn’t punching, pushing , smacking, etc. I will likely write a separate blog entry on emotional abuse, because it is such an important and deep topic, but to try and summarize it here, I will say it can be defined as any behavior that is meant to belittle, manipulate, insult, criticize, shame, and/or embarrass the other individual. When someone is on the receiving end of the emotional abuse, they often end up internalizing a lot of what is said and done to them over time. This often leads to intense self-doubt, repetitive cycles of anxiety and/or depression, poor understanding of boundaries, intrusive thoughts, avoidance of other people or relationships, excessive guilt, inappropriate internalization of other’s actions and issues, reduced interest in activities, hyper vigilance (potentially feeling over-guarded and watchful and believing that everyone wants to hurt or use you), difficulty feeling happiness, and more. What does this sound like to you?

Allow me to summarize the DSM-5 PTSD symptoms:

Criterion A: Exposure to actual or threatened death, serious injury, or sexual violence

Criterion B: Intrusive symptoms, including recurrent/involuntary memories of the event; recurrent distressing dreams related to event; dissociation; intense psychological distress in response to internal or external trigger of event; physiological reactions to memory of event or event itself

Criterion C: Avoidance symptoms, including avoiding physical triggers or emotions or thoughts related to event, avoidance of external reminders (people, places, conversations, objects, etc.)

Criterion D: Negative mood & thoughts, including pervasive negative beliefs about oneself, others, or the world, distorted thoughts that put blame on oneself, persistent negative emotional state (depression, sadness, fearful distrusting, etc.), diminished interest in activities, feelings of detachment from others, inability to experience positive emotions.

Criterion E: Marked alterations in arousal and reactivity, including hyper vigilance, problems with focus, etc.

F: symptoms must be present for more than 1 month;

G: disturbance causes significant impairment in life

H: Disturbance in functioning not due to drug use or other medical conditions.

Now doesn’t this description share a lot of similarities to the issues I described as often resulting from being exposed to emotional abuse?

The catch lies within the first Criteria listed, A, in that threatened or actual death, etc. must have occurred in order for it be (diagnostically) considered trauma and thus PTSD. This is where I believe the DSM needs changing. Someone who is in a relationship with a person who gaslights, uses, belittles, lies, and otherwise emotionally manipulates and neglects is likely going to suffer long-lasting effects from that relationship because their emotional safety has been compromised. We need to stop viewing trauma as just the “classic” events (war, etc.) and start valuing the place our emotional health has in our livelihood.

You don’t just have to take my word for this; more and more research is starting to emerge regarding the relationship between emotional abuse & neglect and the development of PTSD-like symptoms, among other conditions. An online article from Medical News Today, written by Jenna Fletcher (2019) reports that long-term exposure to emotional abuse/neglect can contribute to the development of insomnia, chronic pain, social withdrawal, guilt, anxiety, and poor self-esteem. Additionally, individuals subjected to emotional abuse can develop PTSD symptoms such as negative thinking and feeling patterns, anger outbursts, nightmares, hyper vigilance, and more (Fletcher, 2019).

The Gottman Institute is an organization that focuses on studying relationships and conducting research to pave the way for more effective interventions in couples/marriage counseling. In one article published to their website, written by Anna Aslanian (2019), trauma is discussed in relation to emotional betrayal. ‘Trauma' is defined as a wound, stating: “the betrayed partner has been wounded to the core of his/her being by their partner’s betrayal of trust” (Aslanian, 2019). In this post, the author discusses the implications of addiction on a relationship, including the betrayal the addiction-afflicted partner often inflicts on the other, which ultimately affects the other partner’s self-esteem, perception of reality, and emotional safety within the relationship (Aslanian, 2019).

Furthermore, there is a diagnosis that exists in the International Classification of Diseases for something called “Complex PTSD”. Many therapists are familiar with this diagnosis, and although our field’s diagnostic book (the DSM-5) does not currently list it, therapists may choose to discuss it with clients if deemed clinically relevant. Complex PTSD, or C-PTSD, is a diagnosis used to describe more extensive, and in some ways more complicated, symptoms of PTSD aside from those listed for PTSD. Complex PTSD can develop when a set of trauma(s) has been repeated over time, and that repetition results in personality changes, mood instabilities, and more layered issues due to the chronic nature of the trauma. An example of someone who may suffer from C-PTSD could be an individual whose mother was emotionally negligent and inconsistent in her parenting and support for many years, resulting in the individual carrying a deep-rooted feeling of self-doubt, being prone to angry outbursts, having long-lasting depression and anxiety, and suffering relationship difficulties even into adulthood. It is my hope and belief that the DSM will add it to an upcoming new version of the DSM, as I personally and professionally believe emotional neglect and abuse can certainly qualify as trauma.

One additional type of trauma I’d like to touch on is the one dubbed ‘vicarious trauma’. Vicarious trauma can occur with individuals who work in a role of helping other people who have experienced or are experiencing a traumatic event. Individuals who work as therapists, social workers, case managers, Child Protective Services investigators, lawyers, doctors, police officers, EMTs, and firefighters are examples of professions who are at risk for vicarious traumatization. It can happen because these professionals are continuously exposed to individuals in the midst of trauma, and sometimes the professional can then find themselves feeling burnt out, uninterested in their usual pleasurable activities, experiencing intrusive thoughts about the client/individual’s trauma, having relationship issues, feeling apathetic, feeling anxious/depressed, detached, and more. Sometimes individuals in these professions can also develop substance use issues to cope, much like individuals suffering from “classic” PTSD can. The symptoms of vicarious traumatization often mirror those of PTSD. It is worth noting that just because one is employed in one of these aforementioned positions does not mean they will ever experience vicarious trauma. Personal therapy, relevant support groups, building and maintaining connections with others, healthy emotional and physical boundaries (knowing when to take time off, recognizing when a client’s story is affecting you and taking the initiative to seek counsel about your feelings), and proper, routine self-care are instrumental in working through vicarious trauma and also in preventing it altogether. A phrase I learned in grad school stays with me today regarding this topic: “Care, don’t carry”. When we carry someone’s experience as our own, it increases the likelihood we will experience the symptoms mentioned above and it also increases the likelihood we are not being as effective of a helper as we could be because we are over-identifying with the person. I have also shared this phrase with clients who tend to become easily overwhelmed with the emotions and tragedies of those around them. It is absolutely okay, and healthy, to care for someone and their experiences- but that person’s experiences and feelings belong to them, not you. It is not our job as therapists (or even as friends or family members, for that matter) to take on everyone’s problems.

It is worth noting that trauma is also not a one-fits-all term. Something that is considered traumatic for one individual may not be regarded as such by another individual, despite the experience being similar. For example, trauma for one individual may have occurred when their mother left them for a period of time at age 2, causing a deep-rooted fear of abandonment and subsequent behavioral and mental health issues in that person as they grew up. For another individual, whose mother also left for a period of time around the same age, this individual may not have internalized it as abandonment and therefore may not have experienced it as a trauma in their lives. Many factors, such as each individual’s innate personality traits and relationship with their mother, determine whether this period of absence would be viewed as traumatic and scarring.

I believe you, as the expert in your own life, should be the one to designate or not designate terms such as ‘trauma’ to your experiences. I put an emphasis on helping my clients identify whether words such as “trauma” feel appropriate in describing their experiences and emotions, while also educating on what trauma can look like and how it can feel. I also believe in the importance of developing a vocabulary for yourself to provide a narrative on what you have been through; during trauma, the region of our brain responsible for language goes “offline”, which is why we often struggle to label those events or tell them to others after they have occurred. Often times, we may struggle to say that was “abuse” or that was “sexual assault” or that was “traumatic”, and instead we feel a variety of emotions and have fragmented memories or stories stuffed inside ourselves. A therapist who specializes in trauma can help you find the right words to articulate your experiences and help bring those emotions into the room safely in order to help you gain a new understanding and healing.

In conclusion, I hope you have gained some understanding of what trauma can look like and what kind of events may be considered traumatic. Trauma is not limited to near-death physical encounters, or rape; it also can include emotional neglect and abuse inflicted by parents, siblings, relationship partners, and others. It can be helpful to think of trauma as some event or experience that has caused a lasting interruption in your life. I personally believe we as a society often minimize trauma, which contributes to why it can be so difficult to know when it has occurred and why something has affected us so deeply. There is much more to be said about trauma, and this is very much a rudimentary explanation; however, it is my goal to help increase awareness that emotional abuse and neglect is something we very much need to pay attention to in our healing and in the treatment of trauma.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Anna Aslanian, LMFT. 2021, February 9. “Betrayal Trauma in Addiction.” [blog post]. Retrieved from www.gottman.com/blog/betrayal-trauma-in-addiction/

Fletcher, Jenna. 2019, November 21. “Emotional Abuse: The Short- and Long-Term Effects.” Medical News Today. Retrieved from www.medicalnewstoday.com/articles/327080