Defining trauma is completely subjective. It is how you define a disturbing or distressing experience. Trauma affects the way you see yourself and how you see yourself in the world around you. Do not compare your experience to anyone one else’s experience.
Trauma can usually be divided into two categories - Big “T” and little “t.” Big “T” traumas are the events most commonly associated with post-traumatic stress disorder (PTSD). These can include death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. A person can be directly or indirectly exposed to these events (see more under What is PTSD?). include link Witnesses to big “T” events or people living and working in close proximity to trauma survivors are also vulnerable to PTSD, especially those who encounter emotional shock on a regular basis like paramedics, therapists, and police officers.
Little “t” traumas are highly distressing events that affect individuals on a personal level, but don’t fall into the big “T” category. Examples of little “t” trauma include non-life-threatening injuries, emotional abuse, death of a pet, bullying or harassment, and loss of significant relationships. People have unique capacities to handle stress, referred to as resilience, which impacts their ability to cope with trauma. What is highly distressing to one person may not cause the same emotional response in someone else, so the key to understanding little “t” trauma is to examine how it affects the individual rather than focusing on the event itself.
Although little “t” traumas may not meet full criteria for a PTSD diagnosis, these events can be extremely upsetting and cause significant emotional damage. Also influencing the emotional response is the number of little “t” traumatic events that someone experiences and at what age these events occurred. Evidence now concludes that repeated exposure to little “t” traumas can cause more emotional harm than exposure to a single big “T” traumatic event. Minimizing the impact of these little “t” incidents can create adverse coping behaviors. Failing to address the emotional suffering of any traumatic event may lead to cumulative damage over time.
To cope with the distressing symptoms of trauma, people may self-medicate, numbing their emotional pain through addictive substances or behaviors. Individuals with trauma histories are more likely to require professional help and long-term support to overcome their addictions. The goal of therapy is to address both the trauma and addiction providing clients with the best opportunity for long-term success.
All of the criteria are required for the diagnosis of PTSD (for those 6 years of age or older). The following summarizes the diagnostic criteria:
Criterion A: stressor (one required)
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
Criterion B: intrusion symptoms (one required)
The traumatic event is persistently re-experienced in the following way(s):
Criterion C: avoidance (one required)
Avoidance of trauma-related stimuli after the trauma, in the following way(s):
Criterion D: negative alterations in cognitions and mood (two required)
Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
Criterion E: alterations in arousal and reactivity
Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):
Criterion F: duration (required)
Symptoms last for more than 1 month.
Criterion G: functional significance (required)
Symptoms create distress or functional impairment (e.g., social, occupational).
Criterion H: exclusion (required)
Symptoms are not due to medication, substance use, or other illness.
Law enforcement officers are exposed to a number of serious direct threats and stressful conditions. In addition, they experience and witness the devastating effects of assaults, robberies, kidnappings, and other events. Individuals in this profession have surprisingly lower-than-expected overall rates of PTSD, estimated to be about 10 percent overall (although some estimates are lower than this). This lower-than-expected rate is most likely due to the number of opportunities for individuals in this profession to engage in counseling and directly expressing their feelings to others once they are involved in these situations, as well as rigorous pre-employment screenings.
This profession also includes paramedic work and being first responders to natural disasters in many countries. It is considered to be an extremely hazardous profession. Firefighters are exposed to a number of stressful conditions and traumatic events, ranging from threats to their own safety to experiencing the devastating effects of these catastrophes. The prevalence of PTSD has been described as high as 20 percent in this group of individuals. Volunteer firefighters may have even higher rates of PTSD.
People in these professions are routinely exposed to critical incidents and have a higher number of health problems than individuals in other professions. Prevalence rates of PTSD in this group have been reported as high as 20 percent; however, these figures can be variable depending on the samples used. When staff members undergo pre-employment screening and are informed about how to access support and counseling services, these rates are much lower. Best estimates of the prevalence of PTSD in this profession indicate that these prevalences are comparable with the prevalence of PTSD that occurs in police officers.
Healthcare workers are as a group at a higher risk to develop PTSD than individuals in the general population, especially healthcare workers in emergency rooms or in intensive care units. However, there are a number of qualifying variables associated with this group of workers. For instance, nurses working in critical care units are more likely to develop PTSD than nurses on other units; senior-level nurses report fewer PTSD symptoms than junior-level nurses (but also report higher rates of burnout); and healthcare workers directly exposed to violence, such as an assault, are more likely to develop PTSD than surgeons who treat assault victims.
Rescue workers, medical workers, and volunteers who are first responders to disasters witness the aftermath and can even become involved in severe traumatic events. The prevalence of PTSD in these individuals has been estimated to be between 15 and 30 percent depending on the sample.
Some journalists, such as journalists who work as war correspondents, are exposed to increased risks of being injured, killed, or kidnapped. This particular group has a high lifetime prevalence of PTSD that is close to 30 percent. This figure may be in part explained by a lack of support and available treatment options for these individuals.
While the above occupations are associated with a higher risk for the development of PTSD than many other occupations, this association should not be interpreted as causal. Being a firefighter, police officer, or combat veteran does not cause one to develop PTSD any more than being involved in a natural disaster causes one to develop PTSD. Risk factors simply increase the probability that some illness or disorder may occur; they cannot be interpreted as causes. In addition, there are a number of other very salient risk factors associated with the development of PTSD. One of these is substance abuse.
For some, PTSD symptoms can be unbearable at times which makes the individual feel like they will never be rid of their symptoms. Regardless of pre-existing conditions, the risk of suicide is higher among those who have PTSD compared to individuals without PTSD. For combat veterans, possibly 5,000-8,000 suicides occur annually. There is evidence that more police officer deaths occur as a result of suicide than in the line of duty.
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US Department of Veterans Affairs: