The Difference Between PTSD and Trauma
Knowing the difference between adverse life experiences and PTSD is crucial in how we cope, heal, and live life after trauma.
TRIGGER WARNING:
This article includes themes of suicide, depression, trauma, and other related topics. Reader discretion is advised.
I handled the day-to-day of my life post-trauma with denial, the good-ol’ grin-bear-it method. I became adept at avoiding memories and feelings at all costs. I acclimated to the repetitive, violent nightmares about my family, in which I saw my sister die over and over again. The nightmares where I called 911 but couldn’t get through. The obsessive replaying of events, of words exchanged and things done to me. Stay busy enough, be normal enough, excel at every achievement, survive, survive, survive. That was life for me, from the time I was 15 or so until that June, just a few days after my twenty second birthday. I started calling out of work almost every day. I slept until one in the afternoon and when I got up, the first thing I would do is cry. And cry. And cry and cry and cry. Pain was alive inside of me, viscerally, so much so that I felt that I could reach into my chest cavity and remove some kind of pulsating viscous of black tarr and cartilage and solve the problem that way. But medication and hospitalization and treatment were for people way more incapacitated than I was. I had 2–3 jobs at a time and was attending college and living on my own. High functioning as they call it. Until I wasn’t.
My partner was leaving for work when I stopped him.
“If I’m alone here, I don’t know what will happen. I think I need to go to the hospital. I can’t take this anymore.”
The Emergency Room
“So, what’s the problem?”
A doctor leans into me with her stethoscope. My legs are hanging over the side of an uncomfortable bed. A hospital gown replaces the clothes I wore in, which are now locked in a cabinet outside of the room, along with my cell phone and purse.
“Um, I’m depressed, I guess. I haven’t been able to go to work. I have nightmares almost every night, and they’re violent and gory. I feel like I can’t breathe or think. I don’t know,” I say. I wonder what she’s looking for. I wonder where I’m supposed to be directing her. I feel like I’ve disappointed a parent or teacher when I can’t. How do you lead someone to a problem that is mostly still unknown to you? I’m terribly aware of what could happen to me if I say the wrong thing. My belongings won’t be the only thing locked up. I tuck my wrists under my thighs.
She furrows her eyebrows in confusion at me, pressing the stethoscope to my chest. It’s cold and sterile. I wonder again what she’s looking for that wasn’t revealed in my answer. I hadn’t yet learned how separate the medical and behavioral worlds were.
“Alright,” she says, “the social worker will be in soon.”
“Soon” is an hour. I was presented with two options, based on my begrudging disclosure that I had been self-harming: Inpatient or outpatient. The options were similar to prison or probation. I chose probation.
Outpatient care is where I was diagnosed with C-PTSD, which stands for Complex Post Traumatic Stress Disorder. It’s characterized by chronic experience with PTSD symptoms and repetitive trauma rather than one event. Other than that, most people are at least vaguely aware of what PTSD is. What many don’t understand is how specific the diagnosis is, and how it is often maligned with adverse life experiences. Adverse life experiences range from surviving illness, enduring emotional or physical abuse, instability in home life, and so on. In the venn diagram of ALE’s and PTSD, trauma is the overlapping center point. And that can cause a bit of confusion.
Defining Trauma
Trauma is defined as a deeply distressing or disturbing incident, but without subsequent triggers or symptoms, it’s usually not diagnosed as PTSD. According to Dr. Daniela Montalto, PhD, about 75 percent of people report experiencing trauma. Of those, about 8 to 12 percent go on to develop PTSD. As Dr. Montalto explains, Adverse Life Experiences (ALE’s) and PTSD share trauma as an experience, it is the kind and quality of the reaction to trauma that defines the difference. With an ALE, like homelessness in childhood, a person can recover from the event and live a life uninterrupted by things like: Chronic nightmares related to the event(s), hypervigilance, avoiding internal and external reminders of the event(s), persistent loss of positive emotions, problems with concentration, physiological distress, and so on. When a person has at least one of each of these, as described in the DSM-5, that person is categorized as experiencing PTSD.
To use an analogy: You’re learning to ride a bike as a child and you crash into something, falling off and scraping your knee badly. This event is highly distressing, and for a few days afterwards, you are sore from the accident. The pain and soreness from your accident are present in the aftermath, and your mood becomes more negative for a time. In a month, your wounds are healed and you are back to riding your bicycle despite your accident.
Your experience in the accident could be considered traumatic, but you didn’t suffer from a stress disorder for months to years on end afterwards. You didn’t experience repeat nightmares about crashing, nor did you avoid riding a bike ever again. Or, you may have avoided riding a bike, but your life was otherwise uninterrupted by the event. Remember: PTSD requires the presence of one of each of the following: Exposure, intrusion, avoidance, negative cognition and mood, hyper-arousal, and all for more than 1 month, independent of other medical impairments.
Why is the distinction important? As Dr. Laura McNally, an Australian registered psychologist puts it: “To confuse symptoms of emotional dysregulation with trauma means an increased risk of misdiagnosis, overdiagnosis or inappropriate treatment methodology for an already vulnerable population. If a person suffering from dysregulation is dealt with the additional blow of misattribution bias, this means a more lengthy, costly, and difficult treatment journey.”
In my adolescence, it was normal for me to stay up all night making sure my sister was alive. It was normal for me to try to figure out where she was when she disappeared. Her partners would warn me that tonight was the night, and I would listen hard in the early morning hours for any sign of movement. I would peek out from my bedroom to see if her light was on underneath her door. I would imagine opening it and finding her splayed on her bedroom floor. Since then, my nightmares became a place for those imaginations to come to fruition, no detail in the imagery being spared. Doctors put me on prazosin, a drug that supposedly prevents nightmares, but has since failed in clinical trials. When a friend of mine who I considered family died by suicide this past February, my nightmares resurged. Instead of seeing her in the casket, it was my own sister.
To this day, I actively work to scrub the images of my youth, both real and dreamt, from my mind. PTSD is that oozing viscera logged in my chest cavity. It’s infused with my being. C-PTSD survivors live with it as an appendage to be managed, and if you’re lucky, therapy is the scalpel that makes the first incision. It’s not to say that other traumas are less valid, or that other pains felt are less real. I don’t believe in the pain olympics. The distinction is, however, extremely important as clinical language is made more accessible. We must be wary not to manifest memories, we must be conscious of our emotional experiences and address them directly. No one really suffers any more than the other — only differently.
