The influence of trauma in mental and chemical health treatment is getting more and more attention. Trauma has many faces. How can we, as therapists, broaden our understanding of trauma and its many symptoms to better serve the people seeking out help?
When we hear the word “trauma,” we tend to think of events that lead to death or injury. These events might include sexual violence, accidents, war crimes, and/or natural disasters. This is an accurate description of the trauma. It also fulfills the criteria for a diagnosis of post-traumatic stress (PTSD).
But the transmission of the effects of trauma may be far broader and more complicated. Thus, it is important that the intricacies of trauma-related symptoms within interpersonal or systemic contexts continue to gain recognition. When we, as therapists and other helping professionals, increase our awareness of trauma and its varied symptoms, we can better serve people seeking our help.
How is trauma defined in the DSM?
The fifth and newest edition of the Diagnostic and Statistical Manual of Mental Disorders broadened the definition of trauma to include direct or indirect recurring exposure to traumatic events. The broadened definition refers to two types of trauma.
- Complex trauma, which is the result of repetitive, prolonged trauma that occurs in interpersonal relationships with an uneven power dynamic. This type of trauma might include neglect or abuse from a caregiver, for example.
- Vicarious or secondary trauma may be defined as indirect exposure to trauma firsthand or through narratives of the event. In other words, this type of trauma is often experienced by helping professionals such as therapists.
Symptom criteria in the DSM-5 for a PTSD diagnosis includes four categories beyond trauma exposure.
- Intrusive symptoms, such as flashbacks or distressing memories
- Avoidance symptoms, including avoidance of internal or external reminders
- Negative alterations in mood or cognition. In other words, a person might have a persistent negative emotional state or negative beliefs about the self or the world.
- Hyperarousal symptoms, such as anger, reckless behaviour, or difficulty concentrating
If some symptoms are present and interfere with typical function, but not all symptom criteria is met, a diagnosis of Other or Unspecified Trauma- and Stressor-Related Disorder may be given.
How can a broader diagnostic definition help in understanding trauma?
Exploration of trauma helps broaden the diagnostic definition. Recent findings in neuroscience may also be relevant to the understanding of the contextual factors in interpersonal traumas. Research has found that social exclusion and rejection are mediated by the same aspects as our physical pain system.
Human physiology does not differentiate between social and physical pain. Trauma-related symptoms may result when someone feels threatened or experiences physical harm or injury, either directly or indirectly. But experiences of social exclusion or rejection are likely to result in the same symptoms.
Transgenerational or Intergenerational Trauma
First identified in the 1960s, this type of trauma describes the symptoms experienced by descendants of Holocaust survivors. It occurs when trauma symptoms are present within generations of the same family, beyond the generation of the person who experienced the trauma. This particular trauma may also be present in the context of immigration-related traumas.
Research suggests symptoms may be transmitted to later generations when a parent’s unresolved grief, depression, anxiety, and/or other symptoms interfere with the ability to establish a healthy or secure attachment with their children and consistently meet the emotional needs of their children.
This type of trauma also involves a subjective reexperiencing and recollection of traumatic events by an individual or a community over multiple generations. The term has origins in the 1980s and is based on the studied traumas of the colonization, relocation, and assimilation of the Native Americans.
The experience of historical trauma is absorbed into the cultural memory of the group, flowing from generation to generation. This is similar to the way non-traumatic aspects of the culture regenerate.