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What Is Traumatic Enough For Ptsd?

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anthony

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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)?
 
Hi Anthony,

As I read this list I can answer positively to many of the situations. I've had 3 therapists diagnose me with PTSD and yet when I took the test on this site it says I don't.

I grew up with domestic violence, my father beat my mother regularly, landing her in the hospital several times. I have some memory of him attacking me as a child and teen but can only remember him throwing me on the ground and being over me. I remember seeing our neighbor in his side yard and wondering why he wasn't helping me, but I don't remember being hit. I remember locking myself in the bathroom and the door frame splintering as my father broke the door in, but I have no memory of what happened afterwards. In fact I believe I remember thinking that "Wow, I thought he was going to kill me, I'm lucky he didn't."

I also have memory of a neighbor across the street from my grandparents house holding a knife to my thoat and ordering me to unbutton my blouse. I remember what my blouse looked like, I remember looking out the second story window at my grandparents house across the street..so close but I couldn't get there. I begged him to let me go and I remember a tear sliding down my cheek. I remember the terror. That's it nothing more, in fact I can't even remember how I got home.

I remember my mother having taken me out to dinneras a teen and leaving me in a bar. I was driven home by two men I didn't know. My father wanted to know where my mom was. When I told him what happened he was furious and jumped in his car to find her. I went with him. We found her in our family store on the floor getting screwed by a highschool friend of mine's father. My father started to
beat him so I called the police yelling that he was going to kill him. I was terrified. Then I got angry and ended up holding the door closed screaming at my father to kill him. The guy threw me out of the way and escaped.

There were other molestations, fondlings, sexual exposures, being beaten by my brother.

I am writing all this because the test says I don't have PTSD. I don't know why it matters to me, but it does. I don't care one way or another what my "labled" diagnosis is except that I want to know what I am dealing with so I can do what I need to to get better. Any ideas?
 
Hi, please review the opening statement for the test: "This form is a Post Traumatic Stress Disorder (PTSD) Diagnosis tool, however; this tool by no means constitutes a diagnosis of PostTraumatic Stress Disorder. This form acts as a guide only in which you may use to discuss with your psychiatrist or mental health professional." What you fill in for yourself and what a trained professional eye can see, two very different things. Even review another statement at the beginning of the test, "To achieve optimal results, have a spouse or family member assist you in filling out this form, as they often know more about your reactions and symptom analysis than you the sufferer do." For the same reasons, what you tell yourself and what others see... two very different things.

If you have been diagnosed under 3 independent occasions, then it screams to me that you're in denial at the moment and nothing you do is really going to help you just yet. You cannot help yourself or receive help if you don't believe you are as bad as what others obviously believe you are / you are displaying too others.
 
Thanks Anthony. I guess I needed to hear that. I just feel so weak for not being strong enough to be a normal person. I see what other people have gone thru and mine seems nominal in comparison. And I am not in any danger now so shouldn't feel so anxious all the time. My T says that I am resistant and in denial about many things. He also says I am intelligent, motivated and open to changing (seems like an oximoron to me) so will get thru this. So how do I get past denial?
 
I am and thanks for creating the site. Sorry to have been a pest. I guess that it just feels so overwhelming and terrifying that I want to keep suppressing and denying it. I wish there was an easy and magic answer. I wish that I and my family/friends didn't have to live with me.
 
Hi Lauren, I am not by any means that well read on PTSD; that's why I started to come into this site...to learn about it. But I have observed in myself that the dissociative memory lapses that you describe serve to create a mental cushion and actually feed denial. The problem is that denial keeps one stuck right in square one in the healing process. The same memory lapses that sheild the self from utter suffering ironically keep one suffering by denial of the severity of the damage. Just as the body swells near an injury site to try to splint the injury, the mind does these kind of compartmentalizing to seal off the trauma from the whole. But your memory lapses are key...they are your first clue that actually, what you went through was traumatic enough to not be able to access the memory and that in itself indicates it was very bad for you. Thus, there is no comparing it to others' trauma b/c it's yours.

Keep up with the therapy and work on regaining the self even if it is a wounded one.
Muse
 
Thank you for clarifying that mutiple death losses does mean trauma as this is what lead to my official diagnosis, my best friend died of leukemia, very suddenly, found out he had it on Friday and died on Saturday, my first child's father died three years later (investigated as a homicide, nothing proven) a year later my husband and also my second child's father was electrocuted at work and died on the scene, this happened due to poor work practices as he was apprenticing as a Union Electrician. I also think it is interesting to point out that there are factors in a person's overall make up due to an insecure childhood, or even maybe genetics that seem to precursor the likelihood that someone will develop PTSD from trauma. I have to say wow, until reading this list I never realized how many trauma's I had endured in my life until just this moment...my therapist has explained this to me but I am speechless, glad I got some more EMDR under my belt today. I choked two weeks ago in front of my youngest child, absolutely choking, no air supply, could have died and it really has me shaken up again, my fiancee saved me using the heimlich maneuver. Today I found I have many friends who would be willing to parent my children if anything ever happens to me. Now I need to draw up a will just in case, goodness forbid!
 
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