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Introduction to trauma
Trauma is an experience that is emotionally painful, distressful or shocking, which often results in lasting mental and physical effects. (Note: We address only psychological trauma, not physical injury, although physical injury can lead to emotional or psychological trauma responses.) Trauma involves an event (or repetitive events) and a reaction or response that includes an overwhelming experience of helplessness or powerlessness.
Types of trauma and their effects
Three main categories of traumatic events can each lead to a different trauma response and respond to a different form of treatment:
- recent acute traumatic events (e.g., car crash, violent assault)
- past single traumatic events (e.g., rape, death of spouse, accident) and events that last a period of time (e.g., a natural disaster or outbreak of political violence or war)
- long-term chronic abuse (e.g., ongoing childhood sexual or other abuse, including neglect; growing up in violent environment).
Simple versus complex post-traumatic stress disorder
Experiencing traumatic events can lead to a person developing simple or complex post-traumatic stress disorder (PTSD).
- Recent acute traumatic events or past single traumatic events are most likely to lead to simple PTSD.
- Long-term chronic trauma including sexual abuse can lead to problems that are difficult to treat and can involve more complex, psychosocial factors that affect a person's ability to form healthy, trusting relationships. In 1992 Judith Herman proposed a new diagnosis to describe the symptoms related to chronic trauma; complex PTSD (Herman, 1992).
- Overview of complex PTSD (National Center for PTSD)
- A developmental approach to understanding complex PTSD (International Society for Traumatic Stress Studies)
A diagnosis of complex post-traumatic stress disorder, has been proposed for the International Classification of Diseases, 11th edition (ICD-11) which is due to be published in 2017.
Although the Diagnostic and Statistical Manual 5 (DSM 5) does not include a complex post-traumatic stress disorder diagnosis, a new diagnostic category, "Trauma and Stressor Related Disorders" was added. Highlights of Changes from DSM-IV-TR to DSM 5 summarizes these changes.
Literature on DSM-5 and ICD-11 summarizes the research, reviews and position papers that informed the development of the DSM 5 and ICD-11 criteria.
Effects of trauma
Trauma can affect people emotionally, cognitively, physically and socially. For an overview of the effects of trauma (also called trauma responses), see the following online public information brochures:
- Effects of Traumatic Experiences, found on the U.S. website Athealth.com, provides an overview of trauma and its effects and symptoms.
- Common Questions about Trauma (CAMH) outlines what abuse-related trauma is, how the effects of trauma develop, and why healing and getting help are important.
- Women: What Do These Signs Have in Common? (CAMH) helps women recognize that current challenges such as depression, sleep disturbances, relationship challenges, anxiety and/or substance use can be signs of untreated trauma responses.
Identifying the need for trauma treatment
Criteria for identifying or diagnosing simple or complex post-traumatic stress disorder (PTSD) are different, as are the treatments. It is also important to determine whether clients need more help stabilizing and controlling their responses.
- Lori Haskell (2003) provides a description of these diagnostic criteria and formal assessment techniques in First Stage Trauma Treatment: A Guide for Mental Health Professionals Working with Women
- ISTSS offers a number of assessment resources, including assessment measures and testing manuals.
- The National Child Traumatic Stress Network has an overview of the importance of a comprehensive assessment of complex trauma and includes a case illustration.
Herman, JL (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5 (3), 377-391.