Bruce Dow, M.D.

What is Trauma?

    In a medical sense, a trauma is a wound or injury to the body.  A trauma center is a place where such bodily injuries are treated.  People with severe injuries (from automobile accidents, explosions, fires, etc.) may be flown long distances by helicopter to a university-affiliated trauma center for prompt, skilled, and intensive treatment.

The term “trauma” is also used for psychological injuries.  Such injuries are less obvious to observers of the traumatized person, and may go untreated for some time.  A physical trauma leaves evidence on the body.  A psychological trauma may leave no external evidence at all.

An incident that is traumatic for one person may not be traumatic for someone else.  Police officers, for example, may be exposed on a regular basis to situations they have become accustomed to, and are not traumatized by, but which would be considered traumatic to untrained individuals.  Soldiers in combat may become desensitized to events that would be psychologically traumatic to civilians.

A young child going to school for the first time may feel traumatized by the experience.  Weeks later, the same child will often have adjusted to the separation from home and family.

Divorce is often experienced as traumatic.  Loss of a job can be experienced as traumatic.  Moving to a new location in a different city, state, or region may feel traumatic.  Most people recover from such experiences over a period of weeks to months to years without requiring treatment by a doctor or other health practitioner.

When treatment is required for a psychological trauma, there are several possible psychological conditions that have been defined.  According to current terminology, there are “adjustment disorders”, “acute stress disorders”, and a more chronic condition known as “posttraumatic stress disorder” or PTSD.

Adjustment disorders may involve anxiety, depression, and disturbance of conduct in various combinations.  Adjustment disorders typically begin within three months of the stressor (trauma).  They are called acute if they last less than six months, chronic if they last more than six months, with an ongoing stressor.  With an acute stressor, an adjustment disorder cannot persist more than six months after the stressor (or its consequences) has terminated.

Bereavement is not considered to be an adjustment disorder according to current definitions, but this may change with the new diagnostic manual, DSM-V, currently under discussion, and scheduled for 2015.  Bereavement for a period of up to two months is currently considered to be normal (under DSM-IV), even if the bereaved person is significantly depressed.

“Acute stress disorder” is diagnosed following events that involve actual or threatened death or serious injury to oneself or others.  Currently there is a requirement that the person’s response to the traumatic event involved intense fear, helplessness, or horror.  In the DSM-V this requirement may be removed, since first responders such as police officers, fire fighters, and emergency medical technicians (EMTs) can experience acute stress disorder without intense fear, helplessness, or horror at the time of the event.

Acute stress disorder involves three classes of symptoms: re-experiencing (traumatic memories, flashbacks, nightmares), avoidance (of thoughts, feelings, places, people, activities), hyperarousal (insomnia, irritability, restlessness, poor concentration, startle, vigilance).  Acute stress disorder involves significant distress or impairment of functioning, and must begin and end within one month of the trauma.

If acute stress disorder symptoms begin or persist more than one month after the traumatic event, the condition is considered chronic and is called posttraumatic stress disorder (PTSD).  If left untreated, PTSD can be a life-long, extremely disabling condition.  If treated, PTSD can be substantially reduced, even cured.  The longer the delay in treatment after PTSD onset, the more difficult the treatment becomes.  As with many psychiatric conditions, the brain settles into an unhealthy pattern of activity, which can become difficult to break.

The key to recovery from PTSD involves blocking and eliminating the nightmares.  There are two current methods for blocking nightmares: dream revision therapy and prazosin (a prescription medication).  These are described in earlier blogs by the author.