I have several friends in the trauma-field, a few of whom are psychiatrists. Some of them were adamantly opposed to what they felt were limited descriptions of diagnoses related to trauma in the DSM IV published in 2000 and the DSM V published in 2013. With regard to trauma diagnoses, it seems like so much of the neuroscientific world focuses on issues around Post Traumatic Stress Disorder, or PTSD, which, as this article reveals, limits the description by missing many key ways trauma can impact a person.
A few years ago a colleague shared an article with me authored by Toni Luxenberg, PhD, Joseph Spinazzola, PhD, and Bessel van der Kolk, MD entitled: Complex Trauma and Disorders of Extreme Stress (DESNOS) Diagnosis.
The authors of this article, who are highly respected in the trauma world, all provide an expanded understanding of the possible impact serious traumas can have on the human psyche. “The relevance of trauma has begun to permeate our culture’s popular awareness, but a large body of research investigating the effects of trauma on psychological functioning has shown that PTSD captures only a limited aspect of post-traumatic psychopathology. One critical element in determining psychopathology outcomes is the developmental level at which the trauma occurs and whether it occurs in the context of a relationship with a caregiver or intimate partner. For example, victims of car accidents and natural disasters often have quite different clinical presentations than those who experienced abuse, deprivation, and/or neglect at the hands of their caregivers. In addition, the age at which the trauma occurred also shapes subsequent adaptation patterns.While the symptomatology of victims of single-incident traumas are well captured in the DSM-IV diagnosis of PTSD, victims of interpersonal trauma present with a more complex picture.”
They go on to say: “In 1992, the World Health Organization described the ‘lasting personality changes following catastrophic stress,’ which went well beyond the classic PTSD criteria and research has supported these theoretical conceptualizations. In the DSM-IV Field Trial, van der Kolk and his colleagues reported that PTSD, dissociation, somatization, and affect dysregulation were all highly interrelated.They further found that many individuals with PTSD also consistently displayed several other symptoms not captured in the PTSD diagnostic criteria. Subsequent research has provided strong empirical support for these initial observations.”
Here are some examples this article provides that shows what is not included in PTSD descriptions: “Chronically traumatized patients typically have histories marked by numerous and varied dysfunctional relationships. Childhood maltreatment has consistently been linked with difficulty trusting others, re-victimization, and the victimization of others. Such individuals often ‘shut down’ and do not pick up danger signs, such as their own feelings of unease, hurt, or anger, or inappropriate behavior on another’s part. For example, overly friendly behavior in a virtual stranger or new acquaintance typically will lead to a sense of confusion and wariness in most non-traumatized individuals, but it may not in those who have been chronically traumatized and have no healthy template for interpersonal interactions. In addition, chronically traumatized individuals are often unable to use bodily signals (such as accelerated heart rate, discomfort, changes in breathing, physical urges to flee, or gastrointestinal distress) as guides for action, only feel alive when agitated or in conflict, and often accept re-victimization as a matter of course in relationships.”
As students of trauma, I think it is important to broaden our understanding of the many ways unresolved trauma can impact a person. Adding some of these features of “Disorders of Extreme Stress Not Otherwise Specified” can both broaden and deepen our appreciation for the power of trauma to deeply wound and cause devastation to human life and to the lives of those with whom that person is in relationship. It is not just PTSD that is an outcome of trauma, it can be so much more.
Invitation for Reflections:
- What are some of your reactions to this information? Does it come more as a surprise or perhaps as a relief because a diagnosis of PTSD alone comes short of providing an adequate explanation of the impact of trauma?
- How might this information change some of the ways you view the behaviors of those with unresolved trauma, behaviors that seem outside of the descriptions of PTSD?
- Who might you share this information with to enhance their knowledge of the nature of trauma and how it impacts so many human lives?
Diane Wagenhals, Director, Lakeside Global Institute