Trauma or just an 'unfortunate event'?

siniang

MyPTSD Pro
I keep wondering how one is to distinguish between actual trauma (that may or may not cause PTSD) or something that's merely been an "unfortunate event" in life.

I know the criteria for trauma in the DSM-5 are pretty concrete. The ICD-10 is more vague: "The patient must have been exposed to a stressful event or situation (either brief or long-lasting) of exceptionally threatening or catastrophic nature, which would be likely to cause pervasive distress in almost anyone."

During my initial assessment, T had asked me about 'trauma' in my life. When I asked what she means by 'trauma', she replied with 'things that felt traumatic to you'.

Thing is ... even my initial trauma that has clear PTSD symptoms/triggers, didn't feel 'traumatic'. Still doesn't. Just an unfortunate event. Shrug.

How am I supposed to know whether event xyz in my life was actually traumatic/bad and potentially impacted me in one way or another without me realizing it?

I know and understand that all kinds of things can have all kinds of lasting impacts on mental health, not just PTSD. And sometimes - often? - they don't. Just like most people experiencing even qualifying trauma, don't go on to develop PTSD.

So, parsimonically, if you're not experiencing concrete symptoms/distress regarding things related to event xyz, they more likely than not did not have a lasting effect.

Only. We have minimalizing of symptoms. We have things like repressed memories. We have compartmentalization and dissociation.

It matters insofar that in order to work on improving my mental health (not necessarily specific to PTSD)? I need to identify what caused it to plummed in the first place. To process traumas, to remove stressors/triggers, etc. I need to know what to process/remove.

I default to just not talking about 'stuff'. Because I default to 'they weren't a big deal'. Didn't impact me. Nothing to see here.

Only. Did they really not?

And I don't want to make a fool out of myself by bringing up random event xyz to T (or anyone, for that matter), which probably might have been distressing to almost anyone (or maybe, not?), but I don't have any particular emotions towards or reactivity whatsoever, so probably didn't leave any lasting mark. You know how when we start looking for ghosts we tend to end up seeing ghosts? Doesn't mean the ghosts suddenly become real. We can totally work oursevles into thinking something was more important/impacting/whatever than it objectively and actually really was. Overinterpretaion is very powerful and very human. Kind of like when you learn about certain symptoms for some disease, good chance you start seeing those symptoms in yourself. And most people have really bad judgment, particularly when it comes to themselves. We either minimalize or blow completely normal things compeltely out of proportion. Depending on your end goal (that you may or may not be aware of).

When I joined the forum, one of the things I read in one of the threads was that it's super common for newly diagnosed PTSD folks to look back every single event in their life, regardless how teeny tiny, to evaluate whether or not that's been traumatic and adding to the development of PTSD or other mental disorders. And in most cases, no, there's nothing to be found. But sometimes there is? As many threads here are testament to.

I'm a cause-and-effect person. I don't believe someone can 'feel like utter shit' for no particular reason - cause - at all. And when working on specific things doesn't bring progress, chances are there are still puzzle pieces missing, no?

I'm also a person that prefers cold facts. Anything that's open to interpretation and manipulation? Really uncomfortable. Broken bone? Yeah, easy. Broken mind? You sure you didn't merely work yourself in a frenzy? You sure you don't just want 'pity points'? Because, ya know, shit tons of 'bad' stuff happens to a shit tons of people every single day (with and without consequences on their mental health). And what someone considers 'bad' is such a vague thing so severely open to interpretation to begin with.

Sorry for this incoherent mess of a post. My brains been cartwheeling and, between pretty bad emotional dysregulation AND imposter syndrome, been pulling me in very different, conflicting, directions.
 
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Friday

Moderator
Yay! I’m so glad you brought this to thread 😁 There’s actually a bunch of stuff I’d really like to hit in your post... but since I already know it’s going to be a novel... this first.
The ICD-10 is more vague: "The patient must have been exposed to a stressful event or situation (either brief or long-lasting) of exceptionally threatening or catastrophic nature, which would be likely to cause pervasive distress in almost anyone."
I actually LOVE this definition the most... and here’s why.

I used to work hurricane season.

The vast majority of people in a hurricane’s path? Know it’s coming, take steps to insure the (relative) safety of their property (boarding up, sandbagging, taking things indoors that usually live outdoors, etc.) and evacuate themselves and their loved ones to safety or prepare to ride it out in comfort (food, water, entertainment, etc.) at home until such a time as they need to evacuate. <<< ALMOST ANYONE is NOT going to feel pervasive etc so forth and so on in this situation. Nor is evacuation/preparing to ride out a storm particularly catastrophic. The vast majority of people? Are absolutely fine before/during/after. It’s not that the power of big storms doesn’t touch them, it will in fact effect most people a little, for a very short period of time. The energy leading up whilst preparing, the vigilance and awe and spikes of various kinds of “oomph” during, various emotions & adrenaline dissipating after. >>> BUT? SOME people are going to freak. the. f*ck. out. At any/every stage of the storm. For a huuuuuuuuuge number of reasons. That they’re freaking out, whilst nearly everyone is calmly going about their business? Is both telling and extremely useful (from a clinical perspective). It means ...something... is going on with them. Nearly always some sort of pre-existing condition.

Where do we get into “almost anyone” territory? During the same storm most people are riding out safely and securely at home or in evacuation?

- The parent whose child is swept down a storm drain.
- The wife whose husband is impaled by a tree crashing through their roof.
- The person watching others screaming for help as the storm sweeps them away.
- The bloating bodies swept into your living room being ripped apart by alligators.
- The heart attack, asthma attack, diabetic shock, bee sting, that kills your spouse, lover, child, parent, friend, neighbor, stranger, convulsing to death in your arms as emergency services can’t reach you and you either don’t know what to do, or know exactly what to do but don’t have what you need to save them.
- The looters more interested in raping you (or your loved ones) than stealing your stuff
- Being shot/stabbed by a looter
- Being mistaken for a looter, as you’re seeking help for your dying (person) and being shot stabbed.
- The person, half drowned a dozen times over, cut, bleeding, terrified or resolute, who has gone to “find help”, or food, or or medicine, or at the behest of people who reeeeally don’t “need” anything, they just want it, and you were sent to retrieve it. Risking life and limb, suffering severe injury or near death, or witnessing the terrible consequences of others.
- The EMS/FirstResponder/DisasterResponse person who has attended ALL of those event since lunch yesterday (the last time they ate, and sleep was 3 days ago).
- The person sitting on the roof, watching all of these things happen to their neighbors around them, unable -or too scared- to do anything to help... or who dove in, time after time after time, trying to help. Sometimes succeeding, sometimes not.

See the difference in those 2 types of situations? And why it might be diagnostically significant? Same storm... but situationally? Almost anyone = 2 totally opposite things.

It also doesn’t require the person who has experienced the “almost anyone” to experience -anything- at the time of the event. As many -if not most- people who experience trauma are NOT distressed the way most people would be expected to be. Some are. Lots aren’t. Which the ICD nearly accounts for. As pervasive distress? Is a very different thing than immediate distress. LOVE LOVE LOVE the ICD Definition. It’s just freaking useful by way of perspective.
 
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siniang

MyPTSD Pro
While I patiently wait for more brilliant Friday insights 😎 ... vvv

There’s actually a bunch of stuff I’d really like to hit in your post

I already wanted to get back re this first feedback.

I personally prefer the ICD definition over the DSM-5 because I think it's more real-life, while the DSM is very restrictive in what they consider 'qualifying trauma', that seem to some degree cherry-picked, particularly with regard to previous versions (qualifying trauma in DSM-4, but not in DSM-5, for example).

On the other hand, in the ICD, the trauma must have been of "exceptionally threatening or catastrophic nature". But what even does "exceptionally" mean? Where is the line between "meh, just trauma" and "catastrophic trauma"?

And does "exposed" mean "experienced self" or ...well... exposed... which could include "learning about"?

All the examples listed above? Clear-cut. Obvious. No one would doubt these.

But what about the more subtle traumas? Like long-term emotional childhood abuse?

A friend of mine is diagnosed cPTSD in another country (I think they use ICD over DSM) and they told me that in an actual trauma clinic they were told that all kinds of things can be traumatic enough to cause PTSD, even merely as much as being ignored when crying as a baby.

Which not only I'd be very doubtful about, but also doesn't meet the definition of exceptional/catastrophic. But those are trauma health professionals ...

Or in my case. My trauma ...

Likely to cause pervasive distress in almost anyone? Check.
Of exceptionally threatening or catastrophic nature? Nah.

And - coming back to my initial question - what about those traumas we don't realize where threatening or catastrophic? And maybe they just really weren't? Or that are by all objective accounts catastrophic, but for one reason or another wouldn't cause distress in almost anyone?
What about traumas that happen before we become self-aware (at what... age 3? 4?) Do we even have a sense of "catastrophic" already?

We've had quite a few threads in this forum where people have actually, officially been diagnosed with PTSD over trauma that wouldn't meet ICD definition and barely DSM.

I'm not concerned over clear horrific ('catastrophic') trauma that not a single person would question. But I am wondering about 'life events' that may or may not have been traumatic without us realizing, and may or may not have caused distress in almost anyone (because, how is someone even to know? Because also ... whether or not something does cause distress in someone? Is dependent on so many external factors)
 

enough

MyPTSD Pro
It isn't lost on me that even a slmple everyday task done in the right (wrong) frame of view can become the fulcrum point of a lever big enough to move an entire life to a new resting place.
The homeowner that has lost everything in a fire, doesn't know where her pets are, barely got out with singed hair, is calm and seems accepting of the situation and is giving off a vibe of "yeah this sucks but I am going to be OK" until asked if we can move her car to a safe place so parked in fire trucks can get out and somewhere between explaining that there is a key under the fender and getting it, getting in and driving it 100 feet or so loses her shit and ends up leaving in an ambulance with a chaplain. I always wondered, was it the realization that the car was all that was left? was it the juxtaposition of parking it and losing everything by the next time she touched the wheel? Was she going to have the response to some event no matter what or when? I have to remind myself that asking her about the car move was just a guy asking a woman if the car could be moved, not even on the map of any definitions of traumatic event. Still wish I hadn't been a part of the meltdown in any way. It was very traumatic for all involved, but just a part of a much bigger shit storm. The fulcrum point by which the whole life was set off balance.
Personally, everytime I look for things in the dark with a flashlight is an event that I will remember for a long time because one time it was a very traumatic event. Send me out looking tonight? You can ask me a month later and I will be able to retrace every step, describe all I saw. It is a mundane, nothing thing to do that we have all done lots of times, but it is a doorway to my traumatic memory center and stuff gets in every time the door is open. To a lesser degree driving and kayaking are mundane events that don't meet the criteria either, except that they did once and now they are a near miss everytime.
In my brain, enough near misses is a direct hit. DSM be damned.
 

Sideways

Moderator
impacted me in one way or another without me realizing it?
This is where a skilled therapist is key.

A crap T will go looking for anything and everything and bingo, they find something to blame, and sometimes the patient is sitting there blinking at them thinking, "That really wasn't a big deal".

A skilled T, on the other hand, will help you unpack stuff and be able to help you differentiate between what you're minimising or avoiding (symptom), and what may have been a bad experience, but which you've had the resilience or dumb luck to be able to move forward from in a healthy way.

That's why we use skilled therapists. Because they can help us identify the difference when we can't.

I need to identify what caused it to plummed in the first place. To process traumas, to remove stressors/triggers, etc. I need to know what to process/remove.
You know how when we start looking for ghosts we tend to end up seeing ghosts?
Yup. And there's almost an entire industry of under-qualified people masquerading as therapists who have a vested interest in finding ghosts, and then making a really big deal out of them so that people keep coming back to therapy.

Stepping back from it, you and your therapist aren't actually treating your ghosts, or trying to make those ghosts disappear. That's not why we go to therapy.

We go to therapy to reduce distress that we're currently feeling, and dysfunction that is currently impacting our life. A skilled T will be able to get to know you and your history and
a) identify any issues in your history that are contributing to your current symptoms;
b) identify appropriate therapy processes (which may include medication) to help you reduce, manage, or recover from those symptoms. That may or may not have anything to do with ghosts from the past - it's the training and experience of a therapist which makes the difference.

Treatment for your current symptoms? May not have anything to do with digging up your past.

But what even does "exceptionally" mean? Where is the line between "meh, just trauma" and "catastrophic trauma"?
I worked car crash personal injury claims while I was a student. There was 3 floors of us claims staff in our company, and one team only (of about 8 staff) who dealt with "catastrophic injuries".

"Catastrophic injuries" had 3 different interpretations:
1) what Joe Average interprets it to mean;
2) what medical professionals interpret it to mean; and
3) what lawyers interpret it to mean.

We were looking for those claims that fell into the third bracket. And the people that confirmed which cases fell into that bracket had 2 things: formal training and qualifications, and a shitload of experience.

I was offered a position in that team only once (a) I'd been working claims for about 3 years, had assessed a few thousand claims, and so had a bucketload of experience; and (b) graduated from law, and so also had the professional training and qualifications.

There is a difference. There are cases that are borderline and could go either way (and may flip flop between catastrophic and not-catastrophic throughout the life of the claim depending on circumstances of the file as it changes over the course of events.

People in the catastrophic claims team got paid more. Because they had the training, qualifications and experience to know the technical difference.

The same is true of mental health professionals. The good ones? Are trained, qualified, and experienced enough to know what distinguishes cases where untrained people like you and I (and crappy Ts) can't tell the difference.

Joe Average can come along with a rock solid understanding of what 'catastrophic' means to him. Doesn't mean he knows what it means technically to a doctor, or technically to a lawyer. Sometimes he'll be on the money with his guess. Sometimes crappy Ts are on the money with their interpretations. But other times? Differentiating really does require that training, qualifications, and experience.

Joe Average isn't expected to know the difference. Joe Average can read the DSM and the ICD. Doesn't mean he knows what it means in the technical medical sense. He is, however, free to go and spend 10 years getting qualified to understand the meaning in the medical sense if he wants to.
I am wondering about 'life events' that may or may not have been traumatic without us realizing, and may or may not have caused distress in almost anyone

I'd think that with ptsd specifically, there would be some degree of realisation of the event at the time it occurred (even if we freeze), because of the special role of the amygdala in ptsd.

If a person later comes to realise that, unbeknownst to them at the time, they have survived something traumatic? It could very well give rise to a number of mental health conditions. Ptsd seems unlikely to be the proper diagnosis there. But again, that's what we seek out good professionals for.

I don't believe someone can 'feel like utter shit' for no particular reason - cause - at all.
This? Is a problem. Because loads of mental illnesses occur because of nothing more than dumb luck in many many people. Generalised Anxiety Disorder being one of them. There are millions of people all over the world suffering crippling mental illnesses because of nothing more than dumb luck.

The lack of identifiable cause (beyond mere speculation: did the person with schizophrenia smoke a joint in their late teens? Does the person with Depression have bad genes? Are those the causal factors, or is it just dumb luck? We don't know) doesn't in any way impact the severity of their disorder.
 
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Freida

Sponsor
I called my stuff " a series of unfortunate events" for years. (ok,decades 😁)

I truly didn't think it was traumatic. I mean, ya, it all sucked but..no biggie. Suck it up buttercup and move forward

My T diagnosed me with ptsd on our third meeting - and I don't even remember talking to her about it.. I kind of freaked out on her because it was such a loser diagnosis -- telling me that my blah blah was breaking my brain and turned me into a pathic winer and blah blah ( oh ya, I win the judgement award in a big way! )

It took her a year get me to see that one of the events I thought of as "just a really bad day, people almost died but didn't, so no big deal" was more than a bad day -- it was trauma. And still....nawww...

I've been doing this for years now and I still sometimes wonder -- how can anyone think what I've gone thru is all that bad? I mean shit happens, you get over it, you either pull the trigger or you don't. Plus many times I truly think they are sucky at their jobs and can't figure out I'm just bat shit crazy and making stuff up.

In the beginning I researched and researched and talked with people and did deep info dives trying to educate myself out of this mess - but all that did was waste time.

Because good T's know what they are doing, and they will eventually get you to see it. The stuff you don't remember, don't think of as bad, don't think of as trauma.

I buried my stuff deep. Really deep.
Once we started digging it up? I finally figured out what they were talking about. And even now I sometimes wonder.....
 

grit

Not Active
actual trauma (that may or may not cause PTSD) or something that's merely been an "unfortunate event"
IMHO and experience these two things are the same. What makes them difference is the person, the situation and the culture/language etc.
I see a lot of people jumped into the culture and language (DSM/ICD) but in practical senses there are millions of people experiencing horrific experiences and still somewhat functioning and may never even be diagnosed (diagnosis itself is partial culture and language based than real thing). How we digest experiences is variable!

As about the person, is the person a child (the mere lack of appropriate coping mechanism) may expose the child to extreme repercussions of any strange event (even mom going back to work after maternity) so hard to determine until after the facts or some memory or symptoms or behaviours being observed and interpreted by a professional or others in one's life. There are many children who are sexually abused at such young age (like months old) who may display traumatic symptoms as an adult but no one can really say the cause and affect directly since no one actually remembers the sexual assault but can only see backwards maybe something like that happened. Humans are complex. We are not mouses. Also children as their nature are innocent and easy to absorb really bad environment and not know it until adult and certain beliefs or behviours start to pop up?

I had horrific traumatic childhood experience so violent but it was common and part of the culture. Only until I came North America did I realize what??? the scars do no lie either but cause I did not record it as traumatic - though for sure my body and mind did, even though I can see its limitation in my life now, I am still much more grounded about it rather than identify with it and completely lose myself in the experiences I have had. Even an animal without language knows when hurting by anther animal - so knowing something is wrong or being harmed is universal at least in the mammals but remembering it as such for a human is special case.

I think and this is my humble opinion of what you are looking for. You had basically the typical childhood and parents but unfortunately maybe your intelligence was higher or you were highly sensitive (more emphatic than your parents etc), the environment you were born (the parents) was not optimal. So what has happened is as a child, you were confused, unsatisfied with some results, and maybe be invalidated intentionally or unintentionally and you have developed certain confusion that your child brain could not explore or understand. It is also possible your parents have mental health issues when you were young and their minds (the minds that supposed to make us - to give or activate a child's mind one must have a healthy mind) were not fully open, healthy or willing to gratify your burgeoning mind. No matter what, a child experiencing confusion, inattentive parents, and misattunement for a long time will experience something that will show up as limitation in later life - and hopefully most adults learn to grow out of it or seek help. But those experiences do not go away. they stay and become rigid character, addiction, ptsd or some behaviour.

From your discussion, I do not think (from my lay-down on the couch here...(-; that you have mental health issues organically but more like psychological ...like you are rebel in the environment you grew up and of course growing up slowly in invalidating environment sort of creates certain character. So this concludes the situation side of trauma.

I think if you ask yourself what does healthy side of you looks like? and when was the last time you had it may give you a clear subjective evidence of what is it you are battling? If you never had a healthy side of you or cannt recall now, then ask can you imagine and then ask can you obtain? A lot of people cannot do this and will get stuck as they feel now and also identify with the feelings/state of mind and when one gets into that vicious cycle, it is hard to know is it organic/chemical or situational?

I know I am throwing a lot of nonsense probably but to me what I am learning about myself is I change when I learn about a behaviour consciously so it sort of giving me this idea that if I could not change it or even the idea of changing it was giving me more anxiety or more depression, then perhaps that would be structural/genetic rather an psychological/learned/nurture.
 

Mach123

MyPTSD Pro
Hi I can’t say anything about this except I understand the conundrum and I sympathize and in my case these questions went away entirely. It took a long time in therapy though, pretty much the last 10 years.
 

ruborcoraxxx

MyPTSD Pro
I also have the impression that people tend less to develop ptsd if the event is considered unfortunate and not something that is the fault of the victim. It still can happen, but it’s less likely. By example in the case of rape, either it’s not considered a rape and there is a pain that is at the same time ignored and validated by others, in the sense the situation is deemed "normal". If you tell yourself your sexual assault is normal… it’s easier to let it go. Or is that a traumatic stress, opposite to post traumatic stress? And when the support group rejects you because of what happened, the subsequent abandon, which is life-threatening in small human settings, can cause ptsd in itself, more than the former incident. So yeah, anything that might threaten the sense of belonging for a certain time I think can cause ptsd or at the very least stress-related disorders and personality disorders. It’s just my two cents and I’m not a doctor. Perhaps I’m off-topic but reading all the thread made me think of this.
 
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