When you hear the word trauma what do you think about?

This is something that is hard for some to grasp. Trauma by definition is an emotional response to an event like an accident, a crime, natural disaster, or unexpected violent event. The problem is, we often define trauma by the index of how ‘terrible’ the event was. If we do this then we completely miss the premise of trauma. Trauma is defined by the persons emotional response, not the actual event itself. Two people sitting side by side on the same bus that is involved in a major accident could both walk away with similar minor injuries and one could have lasting traumatic effects and one could not. It’s the things that happened after for each person mentally, and how they processed it, and their prior experiences with the the world that often determine if their experience will lead to the commonly heard term for the disorder Post Traumatic Stress Disorder.

Post Traumatic Stress Disorder according to the DSM-5 is extensive, found here and this is good because it helps clinicians determine the nature, impact and scope of the trauma as they seek to understand and help. First it defines the exposure being: exposure to actual or threatened death, serious injury or sexual violence in one of the following ways: directly experiencing the event, witnessing in person event occurring to someone else, learning the event happened to a close friend or family member in cases of actual or threatened death it must have been violent or accidental, repeated exposure to averse details of traumatic events because of work ( note first responders and officers). It’s important to understand this set of criteria because PTSD is a serious diagnosis and we want to only use it when appropriate.

The second set of criteria is the intrusive symptoms that are present : recurrent distressing memories, recurrent distressing dreams, dissociative reactions (zoning out while replaying events), intense or prolonged psychological distress at exposure to internal or external triggers related to the event, and obvious psychological reactions to the internal or external triggers. Third is the persistent avoidance of any physical or mental triggers to the trauma since the event occurred.

The fourth set of criteria surrounds the cognitive changes, negative thoughts that stem from the trauma about self or others and mood changes. In this category at least least 2 to have to be present : dissociative amnesia, persistent negative beliefs about one’s self, others or the world, distorted cognitions about the event, negative feelings like guilt horror and or shame, diminished participation in previously fun activities, feeling detached from self or others, and inability to express positive emotion. The fifth set of criteria have to do with the emotional distress that is now associated with the event since it occurred. In this set 2 symptoms must be present as well: angry or irritable behavior or outbursts, reckless behavior, hyper vigilance, increased startle response, difficulty concentrating, and sleep disturbances.

It is important to note that symptoms must be present for more than a month, and that is causes an impairment in day to day functioning from your normal activities. Finally that the disturbance is not related to any psychological effects of substance abuse. If symptoms have not been present for a month and it is soon after the incident then the individual may have Acute Stress Disorder, often the response to trauma is sudden in ASD and it does not persist longer than a month or so. When ASD symptoms persist for more than a month then we change the diagnosis to PTSD because the brain is going to need more time to recover.

One way to explore potential PTSD diagnosis is through using the PCL-5. This is a diagnostic tool and I find as a clinician it is helpful to talk through each question with my client and understand the impact of the symptoms and what their current Basel is so they understand the assessment process. It is also helpful to use it ongoing during treatment to see if the treat is working and the score is decreasing.

There are three main types of trauma: acute trauma that results from a single stand alone event, chronic trauma that results from repeated ongoing abuse or violence, and complex trauma that results from prolonged exposure to traumatic events often from interpersonal relationships that begins typically in childhood. Not everyone develops PTSD and not everyone sees symptoms within that 30-60 day window. It can take time to develop or it can be present for a while and go dormant and resurface. There are risk factors that make some people more susceptible to developing PTSD than others and those include having other psychological disorders, having little social support after the event, having childhood trauma and dealing with extra stress after the event. It’s important to keep in mind that PTSD is a serious diagnosis and someone should not self diagnose or just use the term lightly.

We covered a lot in the clinical aspects of PTSD I hope it helps you understand more what PTSD is and what it is not. Looking at PTSD from a Christian perspective is something I do on a daily basis in my work as a therapist. I find it comforting to know that one of the main themes in the Bible is that we should love one another. “A new commandment I give to you, that you love one another: just as I have loved you, you also are to love one another. By this all people will know that you are my disciples, if you have love for one another.” John 13:34–35. There was no greater example of someone who cared for the broken and hurting than Jesus himself. He encounters many people who have been traumatized and he offers healing, and hope one that can be found in a connection with a heavenly Father who offers unconditional love and tender care.

One of the biggest concerns I often hear is that people who do suffer from PTSD feel like they cannot relate to their church community, or even to God. I think one of the more helpful books in the Bible when we think about trauma feelings and thoughts is found in the book of Psalms. When I consider David, I think about the impact of his trauma and how it challenged him. He is running and fleeing for his life many times. He is engulfed in wars, and he still continues to trust and follow the Lord because he knows it is the best way. But he did struggle, and we know this when we read a Psalm. In this Psalm David is admitting he is plagued with troublesome thoughts and influenced by his pain. In fact he even goes so far as to say he wants to run far away and escape. David is clearly experiencing one of the common trauma responses of flight. We know when we encounter a trauma or a trigger often our nervous system wants to go into fight, flight, freeze or fawn mode. This is such powerful reminder for us, that yes trauma is understood in the context of scripture and we can and should turn to it for understanding.

When we are walking on a path to healing, it is important to remember that God did not cause our circumstances, he did not desire it for us. We know that the world is full of darkness and sin, despite what God desired for us, that the fall of man changed everything. However, we also know that God desires more for us. “What then shall we say to these things? If God is for us, who can be against us? He who did not spare his own Son but gave him up for us all, how will he not also with him graciously give us all things?” Romans 8:31-32. God made a path for us to be united with Him through His son, and that is a beautiful reminder of his mercy and grace!

God is sovereign despite our struggles. He is ever present and has a desire for us to be with him. “Know therefore today and lay it to your heart, that the Lord is God in heaven above and on the earth beneath; there is no other.” Deuteronomy 4:39. We will encounter hardships, even trauma, because sin is ever present, but we do have a hope and a place to turn to. When we rewrite the narrative of our trauma, and seek to not understand the why but the who can help us, it can be powerful. I encourage you, if you are struggling with PTSD to find some good support in a counselor who will help you understand the impacts of the trauma but also how to walk forward to heal.

A great resource for finding Christian counselors is at Focus on the Family’s Counseling Network.