DO YOU HAVE TO BE DIAGNOSED WITH PTSD TO BENEFIT FROM TRAUMA TREATMENT?
4/30/26 | By: Dr. Dana Harron
Absolutely not. PTSD is currently the only prolonged trauma response recognized by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V). However, and this is a big however, the DSM-V quite far from infallible.
In fact, it has tremendous shortcomings. Most specialists in any psychology sub-field agree that the clinical presentations they are met with in the real world are not accurately reflected in this book, which has gone through many iterations and even considered homosexuality a pathology until 1973. This is doubly true for trauma psychologists, who have been trying for years to get more inclusive diagnoses recognized.
UNDERSTANDING PTSD (POST-TRAUMATIC STRESS DISORDER) AND THE LIMITS OF THE PTSD DIAGNOSIS
H3 YOUR BODY AND BRAIN’S RESPONSE
PTSD is typically conceptualized as a trauma response that happens after one single incident, like a car accident. The language of the DSM requires that for a diagnosis a person must be exposed to “death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence” through direct exposure, witnessing, or indirectly such as learning that a close friend experienced trauma or being exposed to it through professional duties (1).
The problem here is that in reality, trauma disorders are not based upon what happened to you but about your body and brain’s response to it. You can be exposed to terrible events and not develop a trauma response, or you can be exposed to a multitude of traumas that on the face of it appears smaller in nature but that nevertheless cause a trauma response in your body.
H3 SYSTEMS IN OUR BODIES
A trauma response means that there is a disruption in our “alarm” system. You might be familiar with “fight or flight”; our bodies’ first line of defense when we experience a threat. This is a whole set of physiological reactions that make us more likely to survive any kind of attack. There’s also a system known based around the vagal nerve that immobilizes us so that a predator might miss that we’re there or assume we’re dead.
When these systems function well they activate, do their thing, and then quiet down. For someone who’s experienced trauma, though, these mechanisms become faulty. It’s as though the on and off switches are broken. The body sends alarm signals when everything is fine, and often fails to alert us to real danger. On top of this, you don’t get to pick and choose what feelings get shut off. So if you are numbing out fear, shame or another trauma-related experience, you also lose access to the full range of your emotional life.
Most of the symptoms of PTSD reflect these issues – numbing, flashbacks, constriction, nightmares. But many of the nuances of the trauma response are missed here. On top of that, the focus on what may or may not have happened means that many people who are suffering as a result of trauma miss the point and means that many people will have difficulty getting the help they need.
H2 UNDERSTANDING ACUTE STRESS DISORDER
A further problem with the PTSD diagnosis is that it requires for symptoms to have lasted for over a month. Acute stress disorder, a much less well-known diagnosis, is given when the trauma response has lasted from 3 days to one-month post-trauma. Some people do experience relief within the month, but this time stamp is completely arbitrary.
H2 UNDERSTANDING C-PTSD (COMPLEX POST-TRAUMATIC STRESS DISORDER)
Complex trauma doesn’t leave a person with a single, discrete moment to point to. Instead there is a more insidious pattern of traumatic events. They may be the types of trauma you would see in a PTSD diagnosis, or it may be that none of them, on their own, would result in a trauma reaction. Instead, the problem is the cumulative effect. These traumas can have a more subtle quality than the traumatic events people associate with PTSD. Examples include not having received warmth or attention as a child or living in an unsafe area, although you yourself are not the victim of violence. Most people who have grown up in families that were abusive or neglectful could refer to themselves as having complex trauma. Because of this, complex trauma can leave the sufferer with confusion over whether they need and deserve help.
Complex trauma is extremely common for people that live in violent or under-resourced places, and as such it has a strong social justice component. When I was completing my dissertation on trauma interventions for children, I sent out an open call in the largely poor community that I was in and found upon family interviews that only one child out of a class of thirty did not have at least one traumatic experience within their lifetime. The children were eight years old.
UNDERSTANDING DEVELOPMENTAL TRAUMA DISORDER
This is another term that is used to describe complex post-traumatic stress disorder, but it has a somewhat different emphasis in the word choice. When you describe someone as having developmental trauma disorder, you are really thinking about the effect that traumatic experience has had on development.
If discrete or complex trauma happened in the context of childhood, a person not only has to deal with the fallout from the event itself but the fact that it disrupts the other things you’re meant to be dealing with. When the brain and body feel they are fighting for survival, they can not and will not spend energy on other things. Some examples of learning that takes a back seat are emotional regulation, distress tolerance and interpersonal skills (an indicator of the helpfulness of Dialectical Behavior Therapy, which focuses on these areas).
UNDERSTANDING DISSOCIATIVE DISORDERS
Dissociative disorders are diagnosed based upon the symptoms, but they are commonly related to some traumatic experience. They include depersonalization, a feeling of not being fully real and present inside of your body, and derealization, the feeling that the world is not fully real and present. Many people with dissociation describe feeling as though they are in a movie.
At the extreme would be a diagnosis of Dissociative Identity Disorder (DID), which used to be known as multiple personality disorder. This can be thought as the end point on a continuum that has to with how coherent you feel throughout the day. Some people on the other end of this spectrum may just describe themselves as having mood swings.
GETTING TRAUMA TREATMENT
No matter what diagnosis you have received and whether or not you want to have a diagnosis, high-quality trauma-informed help is available. It’s important to work with someone who is knowledgeable about trauma. Interview several people before you commit to one, and make sure that you feel as comfortable and safe with them as you can. All of these forms of trauma responses are treatable.
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