This may help explain what I am trying to say.....
This article outlines the difference between life traumas, and outlines what is traumatic enough to warrant PTSD, by the definitions of "trauma" and the DSM legalities of "traumatic." By the end of this post, you will understand where many physicians go wrong in their diagnosis of PTSD, interpreting for themselves the variation of what is "traumatic enough" to warrant PTSD.
A Traumatic Event
In life we all face crises, large and small, ranging from the loss of a wallet to the death of a loved one. Yet these events, although stressful and often called traumatic, are not considered true trauma. Trauma, in the technical sense of the word, refers to situations in which you are rendered powerless and great danger is involved. Trauma in this sense refers to events involving death and injury or the possibility of death and injury. These events must be unusual and out of the ordinary, not events that are part of the normal course of life. They are events that evoke a state of extreme horror, helplessness and fear; an event of such intensity and magnitude that they would overtax any human being’s ability to cope.
Examples range from the loss of jobs, or death of a parent, and even though these losses may change your life forever, these events are not considered traumas because they are expected life losses. However, instead of losing one family member, you lost several family members or friends in the one accident or natural disaster, you would then be considered a trauma survivor. Such simultaneous multiple losses are considered out of the ordinary and overwhelming.
How Do You Know if You’re Within a Traumatic Situation?
You are in a traumatic situation when you either know or believe that you may be injured or killed, or that others about you may be. For example, if a mugger says he will shoot you, you have every reason to believe you are in danger; thus you would be considered a trauma survivor. Now if the mugger says nothing but you sense from the look on their face or certain gestures that they are capable of murder, or for any other reason you believe your may die or be seriously injured during the mugging, you are also being traumatized, thus a trauma survivor.
PTSD can also develop in persons who witness trauma on a daily basis or are subject to near constant and unabated stress as part of their job. This statement holds true even for individuals who are carefully screened for mental health problems prior to admissions, such as emergency services, police, rescue workers, health care professionals, nurses and doctors. Nobody is immune when daily constant trauma is witnessed.
Trauma Means Wounding
Perhaps you have heard a doctor talk about head trauma, bone trauma or trauma to some other part of the body. On a physical level, trauma has two meanings. Firstly is that some part or particular organ has been suddenly damaged by a force so great that the body's natural protections (skull, skin, etc.) were unable to prevent injury. Secondly, trauma refers to injuries in which the body's natural healing abilities are inadequate to mend the wound without medical assistance.
Just as the body can be traumatized, so can the psyche, as outlined in guilt from trauma. Trauma refers to the wounding of your emotions, your spirit, your will to live, your beliefs about yourself and the world, your dignity and your sense of security. Assault on your psyche can be so great that your normal ways of thinking and feeling and the usual ways in which you once handled stress in the past are now inadequate.
Being traumatized is not like being offended or rejected in a work or love relationship. Such events can injure your emotions, your pride, and perhaps your sense of fairness, though they are not within the magnitude of trauma. During trauma you touch your own death, or the deaths of others. At the same time, you are helpless to prevent death or injury.
Depersonalization and Trauma
During trauma you are subject to a process called depersonalization. This refers to the stripping away of your personhood, your individuality and your humanity. At the moment of attack, whether the assailant is a mugger, rapist, enemy soldier or hurricane, you do not feel like a valuable person with the right to safety, happiness and health. At that moment, you feel more like a thing, a vulnerable object subject to the will of a power, or force greater than yourself.
When the assailant is a natural catastrophe, it can be explained away as an accident of fate, providing human error was not at fault; however, then the assailant is another person, and your trust in humanity, society and human beings in general is shaken or shattered entirely.
What is Traumatic Enough for PTSD Criterion A?
If you have suffered any of the below with helplessness, fear or horror, you have suffered a traumatic event. Remember, we are talking the worst of these events (example, escaped your burning house at near death, not just your house burned down).
Have you been within a natural catastrophe such as an earthquake, fire, flood, hurricane, tornado, volcano, landslide or a dangerous dust storm / windstorm?
Have you experienced a community or work related disaster such as an explosion or chemical spill?
Have you ever lived in a refugee or concentration camp and / or been tortured?
Were you ever sexually or physically assaulted by a stranger, group of strangers, family member or anyone else? Sexual assault includes fondling, molestation, oral, anal, vaginal sex or any other forced sexual activity. Physical assault includes any form of physical contact intended to intimidate or cause pain; being hit, slapped, thrown down stairs, beaten with fists or a weapon, stick, belt, club, gun or being threatened or attacked with a weapon.
Were you physically maltreated as a child with excessive beatings or spankings?
Were parents' or caretakers' disciplinary measures sadistic? For example, were you ever made to eat worms or insects, to stand nude in the cold or in front of others, to inure a pet, sibling or other person? Were you ever confined in a cage, closet or tied up? Were you deprived of adequate nutrition and medical care you needed?
Have you ever witnessed the death, torture, rape or beating of another person in war or crime?
Have you ever seen someone die or be badly injured in a car, airplane or other such accident?
Has anyone within your family, or close friend, been murdered or committed suicide?
As a child, did you ever witness the beating, rape, murder, torture or suicide of a parent, caretaker or friend?
Have you ever been within a war and exposed to combat, enemy, friendly fire or atrocities?
Have you ever been kidnapped, abducted, raped, burglarized, robbed or mugged?
Were you ever injured in a burglary, robbery, mugging or other criminal episode; a car, boat, bicycle, airplane or other vehicle accident?
Have you ever been involved within a situation in which you felt that you or a member of your family would be harmed or killed? (The criminal issue is whether at the time of the trauma you perceived the situation as life threatening to yourself or others.)
Were you ever a member of a medical team, fire fighting team, police force, rescue squad or rescue operation that involved one of: danger to your safety and life; witnessing death and injury; making life and death decisions; or high stress working conditions with long hours and unsafe conditions (i.e., cleaning outside windows of high-rise buildings)?
