Since the lovely @river-neurodivergent-willow asked about the definition of trauma in the DSM-5, here I am with a big ol' block of text for you all
So the question I'm responding to is:
That's very kind of you to explain thank you. I am confused wouldn't things like when a person witnesses death, or is involved in death, witnesses like a very bad car crash or things like witnessing something be something PTSD can be diagnosed? I thought witnessing does count for DSM does it not? And also things like someone just their like partner dying or their loved one dying is that not traumatic count in DSM? Sorry if this is too many questions I don't know much about this but you know a lot! You don't have to answer!
River and Willow you're really sweet. It is absolutely no trouble to answer.
Disclaimer: I am not a clinical psychologist. My main qualifications are a) I'm halfway through a psychology degree, and b) I own a copy of the DSM-5-TR and have it open right in front of me.
So – the trauma in PTSD criterion A doesn’t have to be something you’ve experienced firsthand! Trauma is, in DSM terms, something you can be exposed to in one of four different ways. First, direct experience. Second, witnessing the event in person (e.g. seeing someone else in a car crash). Third, leaning that a close family member or close friend was involved in a traumatic event. If this traumatic event was actual/threatened death, this has to be due to violence or an accident… so, apparently, having your parent be stabbed is traumatic, but having them unexpectedly die of cancer isn’t. And finally, being repeatedly or intensely exposed to trauma details (the DSM provides the example of ‘first responders collecting human remains’).
(Warning: trauma dump ahead, with mentions of parental death, neurodegenerative disease, surgical complications, and brain injuries. Skip this paragraph if this is triggering.)
Whether ‘loved one or partner dying’ counts as traumatic in DSM terms apparently hinges on ‘was it violence or an accident’. I think this is a pretty weird distinction, especially since ‘accidental’ is a weird term. For example, when my grandfather had his oesophagus removed, the surgery went wrong, causing a hypoxic brain injury that led to his death three weeks later. I’ve seen my mother’s reaction to this – it was clearly a VERY traumatic event – and I’m fairly sure it counts as ‘accidental’. On the other hand, my father’s youngest brother also died unexpectedly – he had a heart attack, and was gone very quickly. And I don’t know if this is accidental in the DSM sense. But the thing is, even if my father doesn’t seem traumatised by this, I don’t see how a sudden death in a hospital is necessarily ‘more traumatic’ than a sudden death at home. Both are still devastating in different ways. Moreover, I do not like the fact that the DSM-5 definition, by nature, excludes certain deaths by disease. While it is true that death is a natural part of life, it could be pretty damn traumatic to watch a relative die an excruciating death by cancer. Likewise, I have a friend whose father died of Huntington’s Disease… yeah, I can’t imagine how that could have not been traumatic.
In DSM-5-TR, if you’re having an intense and prolonged reaction to a loved one’s death, and this bereavement results in a psychological wellbeing decline that gets in the way of life, school, work, and/or family, it might be classified as Prolonged Grief Disorder. Technically, Prolonged Grief Disorder is in the ‘trauma and stressor-related disorders’ chapter. I think that some of the overlap between PTSD symptoms and Prolong Grief Disorder symptoms is… interesting. For example:
Prolonged Grief Disorder Criterion C3: ‘Avoidance of reminders that the person is dead (in children and adolescents, may be characterised by efforts to avoid reminders’… vs PTSD Criterion C2: ‘Avoidance of or efforts to avoid external reminders[…] that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)’.
Prolonged Grief Disorder Criterion C6: ‘Emotional numbness (absence or marked reduction of emotional experience) as a result of the death’… vs PTSD Criterion C7: ‘Persistent inability to experience positive emotions’ (i’m aware there’s a difference with the persistent negative feeling of PTSD as opposed to the persistent numbness of prolonged grief, buttttt)
I don’t wanna say they’re the same disorder, as there are some significant differences, but I also think that the DSM-5’s arbitrary definition of what constitutes a traumatic death seems limited. If someone is showing PTSD symptoms in response to a relative’s nonviolent, nonaccidental death, then Prolonged Grief ain’t gonna fit, but it also still isn’t officially PTSD. Officially, the DSM-5 says that if PTSD symptoms occur in response to something that isn’t ‘traumatic’ (e.g. a parent dying nonviolently and non-suddenly), then that’s Adjustment Disorder. However, Adjustment Disorder is basically a catch-all term for ‘you are doing badly because of a stressor, but let’s not call it trauma’. I would argue that this is a really stupid diagnostic distinction, since if you have PTSD symptoms, surely it’s better to diagnose PTSD instead of ‘not sick enough, so less specific diagnosis that functionally is almost never used outside of crisis scenarios anyway’?
So: in conclusion, a loved one dying is always considered a massive stressor by DSM-5 standards… but not necessarily traumatic unless it meets some (slightly arbitrary) criteria.
Hope this is useful! Please lemme know if you have more questions – I seriously love looking into these things and sharing this kind of information.
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"Trauma does not reside in the external event that induces physical or emotional pain—nor even in the pain itself—but in our becoming stuck in our primitive responses to painful events. Trauma is caused when we are unable to release blocked energies, to fully move through the physical/emotional reactions to hurtful experience. Trauma is not what happens to us, but what we hold inside in the absence of an empathetic witness."
my amazing boyfriend: hey honey, i dont think i can see you tonight. i dont feel very well. :(
me half the time: thank you for telling me! i hope you feel better. i love you! get some rest!
me the other half: mY GOD! IVE BEEN ABANDONED AGAIN! I bet he's just saying this because he doesnt want to see me. why would he? im so annoying and all i do is burden him with my existence. i hate myse-
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thinking of you and your family jaycee 🩶 i’m here if you ever feel like you need to talk about it with someone that isn’t directly involved. all my love.