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Key points
- In casual use, the word "trauma" is often misused.
- Trauma is not the reaction to a stressful event, but the event itself.
- As part of the PTSD diagnosis, the definition of trauma has changed over time.
Trauma has become an overused word that can be confusing. You may hear some people say, “I was so traumatized because I couldn’t find the wedding flowers I wanted.” On the other hand, some people cannot even speak about or remember parts of an event that caused them to have PTSD and depression. Sometimes, trauma is assumed to be the reaction to an event; sometimes, it is a particular type of event. The definition of trauma is not without debate. Psychologists usually refer to trauma as an event, not the reaction, and before they even apply the word to an event, they consider it a potentially traumatic event. Over the decades, the definition of trauma has changed.
When PTSD was first introduced in 1980, trauma was defined as a rare event. As soon as epidemiologists started studying trauma, it became clear how common these events were, not just across the population, but even within an individual’s life. For example, children who are abused may be assaulted regularly, as are victims of intimate partner violence. Rape or sexual assault occurs to at least one out of every four women in their lifetime. Combat is all too common and may be preceded or followed by other traumatic stressors.
When surveys were conducted that explored a larger range of potentially traumatic events, especially those that gave behavioral descriptors instead of using labels (e.g., someone forces you to have sexual contact against your will versus “rape”), the numbers jumped substantially. People may never have used that term to describe their experience, even though they still had symptoms and reactions because it didn’t fit their stereotype. The large majority of people (85-90 percent) have reported experiencing at least one traumatic event during their lifetime, and the average number of events experienced is three to four.
Like most other things, traumatic events in life probably fall on a normal distribution. Many people experience one or more traumatic events that may occur together as a series or over a long period of time and be unrelated (e.g., a car accident, an assault, an earthquake). Some lucky few (10 percent) seem to skate through life with few if any traumatic events; and at the other end of the distribution, some people seem to have experienced an extraordinary number of traumatic events.
The most recent iteration of the American Psychiatric Association's definition of trauma (Criterion A, the stressor criterion) included experiencing, witnessing in person, or learning about an event to a family member or close friend that includes exposure to actual or threatened death, serious injury or sexual violence. In other words, traumatic events are quite serious, possibly life-threatening events. To call normal but distressing life events traumas or traumatic (e.g., loss of a job, divorce, natural death of a loved one), is understandable, but tends to deflate the meaning of events that are most likely associated with PTSD. Although stressful, these types of normative events may cause other reactions (e.g., anxiety, depression) but not PTSD. The previous version of the diagnostic manual did include subjective responses of fear, helplessness, or horror. However, these responses did not best define the stressor criterion of PTSD and excluded other important emotions of sadness, anger, and shame. These emotional responses were dropped in the recent version.
For the mental health field, the definition of trauma is not a settled issue. Some researchers believe that the current definition is too narrow, some too broad. Some researchers are satisfied with the criteria, but some think that there shouldn’t be a stressor criterion at all—that if someone is experiencing the symptoms of PTSD then it doesn’t matter what the traumatic event was. Until more research is conducted, I fall on the side of keeping it as it is.
Why does this matter? Some of it is pragmatic. Scientific study of PTSD needs to have clear definitions of what they are studying, otherwise from study to study, it is not clear if the findings can be replicated and what we actually know. To understand the nature of trauma and how to prevent or treat PTSD requires some agreement on how to measure the phenomenon of trauma. When the word is watered down to include any stressful event, it becomes meaningless and we fail to appreciate the severity of some of life’s worst events and their impact on those who have suffered from them or have not recovered.
