Definitions of Trauma and PTSD

Definitions of Trauma in Somatic Resiliency

The Somatic Resiliency definition of psychological trauma is very simple. It is not the DSM-5 definition, nor a formal one. It is a definition of trauma which is both easily understood and easily remembered by my patients. I describe two main types of trauma. The first is overwhelm trauma. I describe it as anything that overwhelms our capacity to cope, and threatens our survival, either physically or emotionally. In these events we have a high autonomic system arousal which becomes imprinted on our brains and results in the typical clinical syndrome of post-traumatic stress disorder. The other type of psychological trauma is this. Trauma is the ancient Greek word that means to wound. So, anything that deeply wounds our hearts, souls, or spirits is trauma. These are the relational wounds which drive so many of our adaptive strategies which become our difficulties over time.

I use the word adaptive strategies. I used to talk about helpful and unhelpful coping mechanisms, but have come to recognize all our responses are strategies we learn to adapt to troublesome or traumatic situations. We use them because they work at the time as protective mechanisms. Only over time do some of these strategies become maladaptive as our life circumstances change. When we discuss this with our patients it is usually a great relief to them. They tend to think of themselves as “bad” and their coping strategies as negative. They can begin to see themselves in a more positive light when they realize their adaptive strategies were actually ingenious ways they learned early on to protect themselves. When they understand this, they are better able to examine their behaviors in a more neutral way without the self-condemnation and shame that tends to come when they look at themselves. They also understand that we as clinicians do not see them in the same negative light they have seen themselves for so long.

This is one of the reasons I do not use labels of categorical personality disorders, particularly the so-called “borderline”. First, these categorical labels are very oversimplistic. Our personalities are extraordinarily complex and individual and cannot be accurately captured by a single label. Secondly, I have rarely heard the term borderline used except in a pejorative way. To use a diagnostic pathological label is exactly the opposite of what we are trying to do with the Somatic Resiliency approach. I will discuss this in more detail in the section, The Stigma of the Borderline.

Another issue for our patients is that of developmental trauma, chronic relational trauma,

PTSD and complex PTSD. It is confusing for them and also for us as clinicians. I think the main reason is that DSM-5 does not have a category or diagnosis for complex PTSD so that leaves us using the term to mean different things. One increasingly common way I have seen the term complex PTSD used is a way to denote developmental or chronic relational trauma. Another way I have seen it used is to denote trauma that is current and ongoing. Another way I have seen it used is to denote trauma which is multiple events such as combat trauma. And, many use it to describe all of the above.

The problem here is not just confusion when we talk with ourselves and with our patients. It is that much trauma does not result in the clinical syndrome pattern we are familiar with as PTSD. PTSD is often an outcome of developmental or chronic relational trauma but many times it is not. Individuals have different response to trauma depending on genetic and temperamental factors, other life events, innate resiliency, support available, and adaptation over time. If we use the term complex PTSD to describe all developmental or chronic relational trauma, we end up pathologizing a large part of the general population.

The World Health Organization (WHO) in ICD-11 has a diagnosis for complex PTSD. In fact, it is a separate diagnosis from PTSD. So let us look at their definition. They describe complex PTSD as having disorders of self-organization (DSO’s) which are affect dysregulation, negative self-concept, and disturbances in relationships in the context of the “full syndromal profile of PTSD”. They also indicate that complex PTSD can occur after any trauma, even single event trauma. I like this definition as the diagnosis of complex PTSD does not depend upon the type of trauma. I also like it because disorders of self-organization are almost universal with developmental or chronic relational trauma even in the absence of PTSD. So, it does not pathologize what are some very common human experiences. In the Somatic Resiliency approach, I use the WHO criteria as it gives a clear to describe PTSD and complex PTSD.

I use a simple way to describe this complex topic by saying, “Trauma is universal. PTSD is one of many possible outcomes of trauma”.