In 1992, Judith Herman wrote about the effects of the women’s movement and described women’s consciousness- raising groups as providing many of the same benefits that rap groups provided for veterans: Intimacy, confidentiality,
the acceptance of and bearing witness to the horrors of the traumatic events, and the experience of being believed by peers when society at large did not want to hear, acknowledge, or believe in the veracity of the reports. person, learning about the traumatic event of a close family member or friend, and experiencing firsthand the repeated or extreme exposure to details of the traumatic event (APA, 2013). The historical emergence of this diagnostic categorization has led to the major advantage of depathologizing the victims’ and survivors’ responses to their experiences. It reflects an understanding that any person who experiences similar life events will be likely to have similar distressing and disorganizing reactions and responses. The classification of PTSD as a disorder has supported efforts aimed at removing the stigma given to the psychological and physiological effects of trauma by describing the constellation of PTSD responses as normative responses to the life experiences that generated them, as opposed to being generated by some internal pathology within the individual. This stigma had guided previous societal responses toward the victims of these traumas and such statements as “Just get over it” or “What’s wrong with you?” or “Get a handle on yourself, already.” Today in many situations and institutions there is a more compassionate understanding. experienced empowerment and self-efficacy in thwarting danger. These body-based responses have important implications for treatment and will be discussed in more detail in later chapters. In recent years, researchers have begun to identify additional response strategies beyond fight–flight–freeze. Taylor and colleagues (2000) noted a propensity for females to respond to stress with a “tend or befriend” response focused on promoting safety and stress reduction for offspring as well as maintenance of social networks. Particularly when considering abuse that is ongoing and occurs early in life, it has been suggested that the fight–flight–freeze model may insufficiently capture the full array of responses that may occur to survive ongoing abuse (Katz et al., 2021). It is normal for individuals to respond to danger with feelings of distress. Acute symptoms may follow a traumatic event, and these symptoms may cause enough short- term impairment to be classified as acute stress disorder (APA, 2013) but not necessarily as long-term or chronic PTSD unless there are other mitigating factors. It is not the traumatic event that causes ongoing difficulties, but the individual’s response to the event. PTSD does not occur in the immediate aftermath of a traumatic event. It is important to understand that the development of PTSD is a process that is triggered by multiple factors, including the way in which the person responded during the event, the presence or absence of supports following the event, pre-existing traumas, other life events, family history, and personality style (Briere & Scott, 2014). These factors will be explored more fully in the next section on complex traumatic stress disorder (formerly known as complex PTSD) . World War I work; to the more modern conceptualizations of Herman, van der Kolk, and Levine and Frederick in the later twentieth and early twenty-first centuries. This chapter discussed the development of the PTSD diagnosis, from the introduction of PTSD as a diagnostic category in DSM-III in 1980 to the 2013 categorization of PTSD in DSM-5. A brief description of Levine and Frederick’s seminal research on the psychophysiologic response to trauma, based on animal
Posttraumatic Stress Disorder as a Diagnostic Category In 1980, the American Psychiatric Association (APA) added PTSD to the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; APA, 1980). The fifth edition of the DSM (DSM-5) placed the diagnosis in a new category—trauma- and stressor-related disorders (APA, 2013), and the newest text revision (DSM-5-TR; APA 2022) made only a slight adjustment to reduce redundancy in the qualifying event criteria for children. Because of this limited change, this course will continue to reference the DSM-5 throughout, as it is the foundational reference for its current categorization. The creation of this diagnostic category in the manual’s most recent edition further distinguished
trauma reactions from other disorders associated with disturbances in mood and anxiety. For a condition in this category to be diagnosed, exposure to a traumatic or stressful event is required. According to the DSM-5, PTSD is a constellation of symptoms accompanied by clinically significant impairment or distress that occurs after exposure to a traumatic event. The DSM-5 identifies four types of exposure to a traumatic event: Directly experiencing the traumatic event, witnessing the traumatic event in Symptom Clusters: Reactions to Trauma The diagnosis and observations of PTSD result in four main symptom clusters: Re-experiencing symptoms, avoidance symptoms, negative cognitions and mood symptoms, and arousal symptoms. Re-experiencing symptoms include spontaneous or intrusive memories and recurrent dreams or flashbacks; avoidance symptoms are efforts to avoid trauma-related stimuli (e.g., thoughts, feelings, or external reminders) after the trauma; negative cognitions and mood symptoms represent a plethora of thoughts and feelings ranging from self-blame to disinterest in activities, irritability, and a change in worldview; and arousal symptoms include hyperarousal, startle responses, hypervigilance, and sleep disturbances. Under stress and in the face of danger, the body tends to respond with a biological imperative: Flight, fight, or freeze. In the wild, the dance between predator and prey is a constant of life. When the hawk is stalking the rabbit, the rabbit has several choices available if it is to survive. It can attempt to outrun the hawk and reach the safety of the concealing brush (flight), it can turn and fight the hawk off (not a very good choice for a rabbit, but potentially a good choice for a wild boar being stalked by a lion), or it can freeze in its tracks. As put forth in the seminal work of Levine and Frederick (1997), because the hawk is tracking movement, a freeze strategy can sometimes be successful. Humans also tend to respond with one of these three strategies in the face of danger. If they are successful in their strategy and the anticipated attack does not occur or they manage to avoid it, they may have a posttraumatic response following the event (such as an adrenaline rush, shaking, or fear) but will probably not develop PTSD because they have Conclusion This introductory chapter has served to orient the reader to the field of trauma study and its history. The differences between public and private traumatic events and the similarities and differences in response to them were examined. The concepts of learned helplessness and resilience were introduced. The history of the field of trauma studies was traced from its early roots in the work of Janet, Freud, and Breuer during the 1800s; through Kardiner’s
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