Friday, September 15, 2017

Why trauma is much more than a PTSD diagnosis

Posttraumatic stress disorder (PTSD) is synonymous with trauma, however, many people who are traumatised might not receive a PTSD diagnosis.

There are two main reasons as to why:
1. Criterion A in the PTSD diagnostic criteria
2. There are many other signs of trauma besides the stipulated criteria in a PTSD diagnosis

Let’s discuss the importance of criterion A first. There used to be two parts to this criterion, A1 and A2, but A2 was deleted from the DSM-5, the most recent edition of the DSM, because it had no “utility”. A2 stated that: The person's response (to criterion A) involved intense fear, helplessness, or horror. Why A2 was deleted is beyond me, because without having a response to an event, it is impossible to be traumatised.

If the the American Psychiatric Association's (APA), “scientific” model of PTSD/trauma were replicable, an A1 event would always result in trauma. It doesn’t. Some people experience these events and don’t develop PTSD, or other signs of trauma. Why? In addition, many other experiences not listed in criterion A do result in trauma. Why? Because of the person’s response and experience of the event. This needs to be taken seriously as too many people who are suffering and desperate as a result, are not getting the help they need.

By deleting and not expanding on A2, the APA has undermined the importance of the subjective experience, deeming it non-scientific, which is just ridiculous. The implication is that criterion A is an objective measurement of trauma, which it is not. A huge contradiction in deleting A2 and calling it useless, is that the rest of the PTSD criteria, namely; B, C, D, E and G* only measure the person’s response. Crucially however, if criterion A is not nominated, the other criteria won’t even be considered. 

Conventional methods either ignore or overly focus on symptoms, instead of seeing them as a bread crumb trail to the causes. For example, if your blood test results fall within normal parameters (forget optimal), albeit at the cusp of the lower or upper end, your symptoms will be ignored and the dots won't be connected, you might even be passed off as a hypochondriac and if you're a woman you'll often be given a prescription for either anti-depressants or anti-anxiety medication. Whereas,  if you can tick criterion A, the symptoms become all important in the sense of either squashing them with medication, which doesn't work long term, or using methods such as cognitive behavioural therapy which only 'talks' to the prefrontal cortex, which is often offline when traumatised. Things are changing, but too slowly for those who are suffering, this is why the importance of trauma-informed care cannot be overemphasised.

Trauma should be listed as an etiological factor for nearly every diagnosis in the DSM, along with any other root causes. Just imagine how the treatment of certain conditions would change if unresolved traumatic stress, giving rise to many symptoms, if not all symptoms in some cases, was addressed? Why not treat the cause(s) instead of the symptoms which very often puts us on an expensive, helpless and hopeless merry-go-round with seemingly no way of getting off? We need to ask who benefits from the system as it is currently set up, it certainly isn’t the tens of thousands, if not millions, suffering needlessly from unresolved traumatic stress in all its many manifestations.

*View the other criteria here:

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