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What is Trauma

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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.

Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviors is not sufficient to meet this requirement.

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.

To learn more about EMDR and how to treat trauma, click here.

What is PTSD

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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):

  • Direct exposure
  • Witnessing the trauma
  • Learning that a relative or close friend was exposed to a trauma
  • Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B: intrusion symptoms (one required)

The traumatic event is persistently re-experienced in the following way(s):

  • Unwanted upsetting memories
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

Criterion C: avoidance (one required)

Avoidance of trauma-related stimuli after the trauma, in the following way(s):

  • Trauma-related thoughts or feelings
  • Trauma-related external reminders


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):

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect

Criterion E: alterations in arousal and reactivity

Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

  • Irritability or aggression
  • Risky or destructive behavior
  • Hypervigilance
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping


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.

Two Specifications:

Negative

  • Dissociative Specification: In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
  • 1. Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).
  • 2. Derealization. Experience of unreality, distance, or distortion (e.g., "things are not real").
  • Delayed Specification: Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.


For more information on PTSD, you can download the VA's booklet by clicking here: https://www.ptsd.va.gov/public/understanding_ptsd/booklet.pdf



Statistics

Here are some facts (based on the U.S. population):
Source: https://www.ptsd.va.gov/public/ptsd-overview/basics/how-common-is-ptsd.asp
  • Approximately 7 or 8 out of every 100 people (or 7-8% of the population) will have PTSD at some point in their lives.
  • Approximately 8 million adults have PTSD during a given year. This is only a small portion of those who have gone through a trauma.
  • Approximately 10 of every 100 women (or 10%) develop PTSD sometime in their lives compared with about 4 of every 100 men (or 4%).

Several professions are associated with a higher risk for the development of PTSD. These include:
Source: https://deserthopetreatment.com/ptsd-substance-abuse/high-risk-professions/

1.Military occupations: The experience of combat is a high risk factor for the development of PTSD. Combat veterans appear to develop PTSD at different rates depending on the conflict. For instance:
  • Veterans involved in operations Iraqi freedom and enduring freedom are reported to have rates of PTSD of 11-20 percent.
  • Gulf War veterans have rates of PTSD around 12 percent.
  • The rates of PTSD in Vietnam veterans are reported to be between 15 and 20 percent; however, the lifetime prevalence of PTSD in Vietnam veterans may be as high as 30 percent.
  • A large number of individuals in the military also report experiencing sexual harassment and sexual abuse. The rates of PTSD as a result of these experiences are not well defined but would be expected to be relatively high compared to the overall rate of PTSD in the general population.

2. Police officers:

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.


3. Firefighters:

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.


4. Emergency medical and ambulance personal:

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.


5. Other healthcare workers:

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.


6. First responders to disasters:

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.


7. Journalists:

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.


Resources

The Code Green Campaign: www.codegreencampaign.org/

US Department of Veterans Affairs: www.va.gov

 

Safe Call Now – 1-206-459-3020

A 24/7 help line staffed by first responders for first responders and their family members. They can assist with treatment options for responders who are suffering from mental health, substance abuse and other personal issues.

 

Fire/EMS Helpline – 1-888-731-3473

Also known as Share The Load. A program run by the National Volunteer Fire Council. They have a help line, text based help service, and have also collected a list of many good resources for people looking for help and support.

 

National Suicide Prevention Lifeline – 1-800-273-8255

The national (USA) suicide hotline. Not first responder specific, but they can and will talk to anyone who needs help. We’ve been told by one of their founders they have a large number of first responders and veterans who volunteer.

 

Crisis Text Line

A service that allows people in crisis to speak with a trained crisis counselor by texting “Start” or “Help” to 741-741.

 

Copline (Law Enforcement Only) – 1-800-267-5463

A confidential helpline for members of US law enforcement. Their website also has additional information on help and resources.

 

Frontline Helpline – 1-866-676-7500

Run by Frontline Responder Services. Offer 24/7 coverage with first responder call-takers.

 

Veterans Crisis Line (Veterans only)- 1-800-273-8255 & press 1, or text 838255

A crisis line specifically for veterans of the US armed forces.

 

 

Books

·       The Rite of Return: Coming Back from Duty-Induced PTSD by Karen M. Lansing

·       Bulletproof Spirit: The First Responder's Essential Resource for Protecting and Healing Mind and Heart by Captain Dan Willis

·       The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk M.D.

 

 

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