A Transdiagnostic Understanding of Trauma and Post-Traumatic Stress

“The body is where we live. It’s where we fear, hope, and react. It’s where we constrict and relax. And what the body most cares about are safety and survival. When something happens to the body that is too much, too fast, too soon, it overwhelms the body and can create trauma”

— Menakem (2021).

A transdiagnostic view of post-traumatic stress aligns with an understanding that trauma results from an experience, series of experiences, or enduring circumstances (such as developmental neglect or oppressive social conditions) that break or betray our inherent need for safety, belonging, and dignity (Haines, 2019), and overwhelms our natural capacity to respond. This understanding does not require fulfillment of DSM criteria.

Question

What are other symptoms or responses to traumatic stress which are not captured by the DSM criteria for PTSD?

Differences in defensive responses reflecting relational power differentials—particularly by gender—such as the “tend and befriend” and “fawning” response are often also ignored in conventional conceptualizations of PTSD.

Some other ways that trauma shows up are:

  • Inflexibility in patterns of perception and behaviour
  • Difficulty with personal boundaries (negotiation of proximity/distance, needs, autonomy/support, and power/authority), particularly in intimate relationships
  • Frequent—and often dissociative—defensiveness (aggression, withdrawal, passivity, fawning)
  • Unstable, negative, or absent self-concept and lack of a consistent core sense of self and personal identity
  • Re-enactments, or trauma repetition
  • Physical ailment comorbidities:
    • Health consequences (increased allostatic load leading to chemical imbalances, inflammation, initiation and acceleration of certain disease processes, and even alteration of brain structures) resulting in complex health problems across the life span, with frequent acute and life-limiting chronic illnesses present
  • High rates of problematic substance use
  • Self-Harm
  • Suicidality
  • Brief psychotic episodes
  • Dyssomnias, persistent sleep disturbances, poor quality of sleep
  • Amnestic episodes
  • Distorted experiences of time
  • Somatization
  • Sensory integration difficulties
  • Sexual problems
  • Impaired problem-solving ability
  • Distress intolerance, low frustration threshold
  • Panic, persistent anxiety, catastrophizing
  • Impulsivity or indecision
  • Excessive paranoia/distrust OR excessive credulity/over-trusting
  • Excessive risk seeking or risk aversion
  • Relationship problems (inability to connect and stay OR fusion and staying when being hurt)
  • Chronic shame and self-loathing; self-blaming explanations OR personal grandiosity, contempt for others, lack of empathy, and refusal of personal accountability
  • Poor health choices and/or self-neglect
  • Developmental interruption/delay

Types of Trauma

In the Fundamentals of Psychedelic-Assisted Therapy course, we focused on developing a trauma- and violence-informed lens on psychedelic-assisted therapy which is a part of the Numinus Care Model. As a reminder, there are four main types of trauma.

Shocking Adversities Trauma

These could include a single-incident trauma such as abuse, assault, injury, disaster, or massive loss. Shocking adversities may also be vicarious.
Relational-Developmental Trauma

These are also known as ACEs burden and occurs because of enduring circumstances such as emotional neglect, failures in human connection and attachment, and intergenerational trauma.
Trauma of Oppression

This type of trauma is commonly experienced by racialized and marginalized populations and those with intergenerational, multigenerational, and historical trauma.
Complex Trauma

When relational-developmental, trauma of oppression, or shocking adversities trauma occur simultaneously or in accumulating experiences.

Note

Historical or intergenerational trauma may overlap multiple categories.

References

Menakem, R. (2021). My Grandmother's Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies. Penguin Books.