Trauma is experienced in many ways that do not fit the clinical diagnosis of Post Traumatic Stress Disorder. Consequently, trauma is often misdiagnosed. Effective treatment requires that clinicians and clients recognize how emotions relate to trauma and how they signify that the core problem is trauma.
Post Traumatic Stress Disorder (PTSD) is conventionally diagnosed when a person has been in some way exposed to an event that involved actual or threatened death or serious injury to self or others. The person must also have experienced intense fear, helplessness, or horror and currently is re-experiencing these states in some form or other. In children these feelings may be expressed instead by disorganized or agitated behavior.
However, the experience of trauma does not always fit the clinical category of Post Traumatic Stress Disorder. A person can experience trauma in ways other than involvement with an actual injury or threat to self or others. It is inadequate understanding of this expanded awareness of trauma that stimulates further confusion, depression, anxiety, and stress in an already traumatized individual and has many therapists misidentifying the problem and thus effective treatment.
A diagnosis that more accurately describes trauma is Complex Post Traumatic Stress Disorder or Experiences of Extreme Stress. Included in these diagnoses is the understanding that trauma may not have involved actual or threatened death or serious injury to self or others. Instead it may involve a perception of threat in some way, a belief that one's self is in jeopardy and that the threat bars any outlet to a feeling of safety. In this respect trauma compromises other than an individual's physical well being. Rather it not only stimulates a pervasive feeling of anxiety and depression, but it chronically provokes an ongoing fear of the abuser in thought or in person, disrupts memory and consciousness, diminishes a positive perception of self and a felt sensation that all is right in the world, and destroys the ability to consistently manage distressful physical and emotional sensations.
From this perspective depression and anxiety and the symptoms of a host of other diagnoses can denote an underlying experience of trauma. By noting these areas of difficulty in individuals a therapist can determine whether or not the core problem is trauma. As importantly is the individual's understanding how emotions relate to trauma and how they are the self's wake up call that trauma has occurred.
The Affective System is key to determining this. The Affective System refers to a three-part system with which we are hard wired upon conception. It includes the drives, pain, and the emotions. Eating, drinking, and breathing are examples of three primary drives. Our emotions comprise the second part of our Affective System. Emotions regulate our drives so that we can experience a sense of healthy control. Pain is the third part of the Affective System. It is both a drive and an emotion and is the innate part of our affective system that signals danger.
It is the emotional part of our Affective System that uniformly debilitates trauma survivors. Our emotions are necessary to experience a felt sense of safety and fulfillment. They are triggered by thoughts, sensations, images, people, places, and things. And structures in our brain organize them to work properly.
Trauma disrupts this process of organization in the brains of trauma survivors and accounts for the chronic fear, depression, and/or anxiety survivors routinely report. Any effective treatment must adequately address this deregulation or clients will not heal.
This is not to discount cognitive-behavioral therapies. They are important and effective therapies at different stages of healing. However, for sustained change, ultimately treatment will need to provide survivors a broader spectrum for healing that helps effectively change negative beliefs and conjointly provides methods for managing painful emotions, for extinguishing painful reactions to debilitating memories, and for helping survivors make accurate meaning out of their experiences.
This holistic perspective recognizes that we are mind, body, spirit beings and offers methodologies that can gently, safely, and effectively support survivors to shift fearful thoughts, feelings of depression and anxiety, flawed sensing, and defensive behavior to a state of confidence and joy.
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