Trauma can take many forms. Relational trauma occurs when parents, siblings or intimate partners are unattuned, abusive, or neglectful. Sustained relational trauma from childhood affects attachment style, trust, sense of self, self-organization, coping skills, and extra-familial relationships. Sustained childhood trauma is referred to as Complex PTSD.
Trauma can also be work related for military personnel in combat situations, first responders (paramedics, firefighters, RCMP), or work related accidents. Post-traumatic stress disorder (PTSD) symptoms can take many years to surface if the body and emotions are not processed at the time of the event. In high stress occupations, personnel are expected to return to work quickly after a traumatic experience, which does not allow the time or space to resolve the traumatic experience.
The Diagnostic and Statistical Manual Fifth Edition (DSM-5) defines PTSD as "exposure to actual or threatened death, serious injury or sexual violation. The exposure must result from one or more of the following scenarios, in which the individual:
• directly experiences the traumatic event;
• witnesses the traumatic event in person;
• learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental); or
• experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related).
The disturbance, regardless of its trigger, causes clinically significant distress or impairment in the indi- vidual’s social interactions, capacity to work or other important areas of functioning. It is not the physiological result of another medical condition, medication, drugs or alcohol."
Through talking about the traumatic experiences, one releases emotions associated with the trauma, desensitizes to the experience, and eventually develops a narrative about the experience without residual somatic or psychological symptoms. This is termed "processing" the experience. One moves from a sense of helplessness to a sense of being empowered.
People with Complex PTSD require longer-term therapy to address trust and relationship issues, affect regulation, identity, empowerment, and coping skills. This may also require substance use treatment.
Dr. Marilyn Chotem, R.Psych. #773