Can you have trauma without PTSD?
Short answer: yes
Long answer: also yes, but here are the reasons. First, PTSD is a specific diagnosis that describes one possible response to trauma. In the US, we use the DSM (diagnostic and statistical manual) for diagnosis.
The official DSM diagnosis of PTSD requires 5 criteria:
Exposure to actual or threats of death, injury, or violence
Presence of intrusion symptoms like dreams, memories, or flashbacks
Presence of avoidance symptoms
Negative changes in mood or thoughts that started or intensified after the event
Significant changes in reactivity or physiological arousal
That first one is often the sticking point. Many people have intense trauma responses and search for the official definition of trauma and come away feeling invalidated because they don’t have the exposure to an intense experience. The DSM misses a huge part of what trauma is.
Trauma therapists and other professionals have long advocated for adding a new trauma diagnosis: C-PTSD, which stands for chronic post-traumatic stress disorder. C-PTSD acknowledges that we are often traumatized by our environments, especially as children when we are unable to escape abusive, neglectful, or invalidating parents.
C-PTSD gives a different side of trauma
Don’t get me wrong- PTSD is a valid and important diagnosis. But it best fits people who have experienced the things involved in that first criterion. People who are exposed to death, injury, or violence have a very different healing journey than people who grew up abused or neglected.
Chronic trauma over time changes our bodies. We release cortisol as part of our stress response, and this kicks off an inflammatory response in the body. When we don’t get any escape from that traumatic environment, our bodies let us know. People with C-PTSD often have chronic pain or chronic illnesses that respond to the highly inflammatory environment within the body.
“Small t” trauma rounds out the picture
We also know that people can have a trauma response to seemingly ordinary events. This kind of trauma is most common in Highly Sensitive People (HSPs). This kind of trauma can happen both with bad things happening and good things not happening.
This kind of trauma leads to feeling separated or disconnected from your body, your instincts, and your gut feelings. Trauma responses lock you into inflexibility and prevent you from reacting appropriately to relational or environmental problems. When you disconnect from yourself, your natural protective mechanisms put you at risk for creating a feedback loop that leaves you perpetually retraumatized.
Do I have trauma?
Below is Gabor Mate’s checklist based on his book The Myth of Normal which I’m currently reading courtesy of Libby. (Seriously, if you have a library card, get the Libby or Overdrive app so you can get access to their ebook collections!)
Trauma limits you, constricts you, and diminishes your capacity to feel, think, trust, or assert yourself. When you experience suffering, it leads to you succumbing to despair
You’re unable to hold pain, sorrow, or fear without being overwhelmed. You escape into self-soothing or self-stimulating to avoid your feelings
You feel compelled to aggrandize or efface yourself to gain acceptance or justify your existence
Your capacity to experience beauty, wonder, and gratitude is impaired
If you have all four of these traits, you have a trauma response.
But what if I don’t have all four?
He still categorizes this as a stress response which is still important to treat and manage for your own health and well being, but it doesn’t meet his criteria as trauma. Note that these are his criteria and not an official, objective list.
He also believes that two better questions to ask are “where do we each fit on the trauma spectrum” and “which marks of trauma have we carried”, so even if you don’t see yourself fully on the it’s definitely trauma side of the spectrum, you still fit on there somewhere.
Wherever you fit on the trauma spectrum, therapy can help
Trauma therapy is holistic and flexible. You don’t need an official diagnosis to benefit from working through your patterns of reactivity, avoidance, and inflexibility. As an online trauma therapist, I help people get back in touch with their bodies (healing that disconnection), minds (healing the flashbacks, intrusive thoughts, and nightmares), and spirit (restoring faith in yourself and in the world). Learn more about me here or check out my specialties which include EMDR and work with HSPs.