Biopsychosocial Impact of Trauma

Trauma Definitions and Their Limitations

Warfare has been a human activity throughout all of recorded history. Anecdotal references to what would later become understood as trauma, particularly post-traumatic stress disorder (PTSD), go back at least three thousand years to the writings of the Greek poet Homer. In Homer’s The Iliad, even its most powerful figure—the Greek supermortal Achilles—possesses characteristics that modern professionals would clearly recognize as trauma. Nonetheless, historical societal reactions to traumas such as PTSD have been to view the traumas as human failings. Not uncommonly, the perceptions of sufferers are associated with the person being weak or in some way at fault for their afflictions.  

Pierre Janet first described trauma in the late 1800s, stating human beings react to horrific events through negative cognitive and emotional interpretations. In the early 1900s, understanding of trauma developed with the classification of post-traumatic stress disorder (PTSD), described as “neurosis” or “shell shock” after World War I and World War II. Subsequently, there have been a variety of definitions for trauma in the field of psychology.

Herman, van der Kolk, and others researched the impact of trauma across the lifespan and explored the historical foundations of trauma research. Socially, they describe periods of academic “amnesia” when the field of psychology has ignored advances in research and thereby created gaps in our global understanding and acceptance of trauma.

In general, trauma has the potential to cause physical, psychological, and cognitive changes that can impact a person's ability to function throughout their lifetime. Trauma has been classified and defined according to severity, duration, and symptoms. A trauma experience suggests a deficit in one’s ability to adapt to a variety of experiences. More recent definitions attempt to define trauma beyond a single traumatic event and expand the focus to include an individual’s resilience.

The American Psychological Association (APA) and Diagnostic and Statistical Manual (DSM-5) define trauma within the parameters of an individual’s direct exposure to a traumatic event. According to the DSM-5, in order to be diagnosed with PTSD, the individual would need to have been exposed to a traumatic event and/or have family member(s) or close friend(s) exposed to a traumatic event (including death, threatened death, sexual violence, or serious injury).

Expanding on this, the APA provides a broader definition to include physical, emotional, and psychological threats. Adding these APA elements broadens the definition to include a traumatic response from any event that has a negative impact on an individual’s psychological well-being. Some argue that even these expanded definitions are still too rigid and thus limit opportunities for empirically validated treatments and interventions. In addition to these issues, the current APA definitions of trauma are specific to adult experiences and do not address children’s unique experiences.

The experience of multiple and repeated instances of exposure to traumatic events throughout one’s life is often defined as complex trauma or re-victimization. Such exposure to a multitude of traumatic events can pervasively impact and completely overwhelm a person’s ability to manage or function.

Mental Health Consequences of Trauma

Any experience of trauma can have a staggering impact. Even one traumatic event can significantly alter day-to-day functioning. Vibhakar et al. argue that PTSD and depression are common in individuals who survive traumatic events. Death by suicide has also been shown to correlate with previous traumatic exposure.

Culture, gender, trauma severity, history of disease, adverse childhood experiences, and previous psychiatric disorders have been shown to influence the impact of trauma. These factors can lead to increased risk of meeting the criteria for a diagnosis of PTSD, making a more inclusive biopsychosocial understanding of trauma even more important. Exposure to trauma can negatively impact an individual’s ability to function and create negative mental health consequences.

Expanded Biopsychosocial Definition of Trauma

As previously noted, many researchers argue current definitions of trauma fall short and thereby limit the effectiveness and potential benefits of trauma-informed interventions. As a result, treatment for survivors may be less effective and lead to the development of secondary problems including: substance abuse, anxiety, depression, and death by suicide. Norcross and Wampold also suggest a more integrative understanding of trauma and propose updating psychology’s current view.

A biopsychosocial understanding of trauma encompasses biological, psychological, and social factors that intersect to impact an individual who experiences a traumatic event (or several traumatic events throughout their lives). Further, Feder et al. and others argue that understanding these factors is essential in developing successful interventions that can increase resiliency and healing across the lifespan. Many individuals who experience trauma are able to remain highly functional and it remains unclear what specifically may serve as protective/risk factors for each individual.

Trauma Treatment and Interventions

Specifying definitions and classifications of trauma has led to the development of trauma-informed practices in the field of psychology. Trauma-informed interventions provide clinicians with a blueprint to holistically empathize with and support trauma survivors. The therapist/survivor therapeutic relationship can be the most important factor in healing from trauma and not a specific theorycognitive behavioral for example.

Coyle et al. argue that many mental health clinicians lack adequate training to conduct trauma-informed interventions with their clients. These researchers specifically identify deficits in trauma-related training that would prepare mental health professionals to assess possible trauma histories. For example, Coyle et al. note the variability across training programs and discrepancies between inquiry based on gender, age, sex, diagnosis, personal attitudes, and beliefs. Further, Brand et al. report deficits in trauma textbooks that present inadequate and inaccurate information including inconsistent definitions of trauma and deficits in the exploration of mental health consequences—like dissociation. In addition, the field’s understanding of trauma appears to focus predominantly on adults and majority populations and needs to be expanded to include underrepresented populations and children.

There is also need for more trauma-informed interventions and treatment strategies as these have been shown to significantly reduce the negative impact of trauma. Jenzer et al. argue that there is evidence that connects trauma exposure and one’s ability to cope. Feder et al. specifically argue for a developmental approach that acknowledges differences and changes throughout the lifespan. Without adequate definitions, clinicians are unable to learn and then practice trauma-informed interventions to effectively and therapeutically work with survivors.

The near-universal impact of the COVID-19 Pandemic, which began in late 2019, can provide insight into the multiple layers of a potential traumatic response. The global onslaught of the pandemic impacted individuals, worldwide, resulting in a collective traumatic experience. Those at the most risk for developing negative mental health outcomes, as a result of social isolation and physical distancing (and other established measures to prevent the spread of the virus), were also those who may have previously experienced traumatic events.

As the above review and analysis of the literature indicates, those who have experienced a traumatic response may continue to re-experience these events, and certain triggers may continue to provoke mental health issues. Thus, the pandemic experience had the potential to create traumatic psychological pathways that increase future risk. The pandemic event itself was a traumatic experience that affected every individual differently and has the potential to significantly impact mental health outcomes. The widespread impact of the pandemic highlighted a need to develop consistent definitions and evidence-based treatment strategies to ensure a mentally healthy recovery for all those affected.

Conclusion

The topic of trauma is expansive, and this article has provided a brief overview of some of the current definitions of trauma through the lens of psychology. Despite the advancements made in trauma research, more in-depth studies are needed to determine the intricate relationships between trauma, environment, biology, gender, age, mental health, and physical health. Although not all who experience traumatic events become psychologically or physically unwell, negative psychological outcomes are a common consequence of trauma.

Many researchers continue to disagree on definitions, treatments, and interventions. Trauma research should be expanded to include cultural, social, historical, and political factors that impact the biopsychosocial aspects of our current understanding. Focused research should also highlight positive resiliency factors that may promote healing and thriving. Furthermore, continued exploration into differences between interpersonal trauma sexual assault and intimate partner violence—and non-interpersonal trauma, like motor vehicle accidents, natural disasters, pandemics, and war may be impactful in shaping research, treatment, and outcomes.

About the Author

Dr. Kristin Clifford is a licensed clinical psychologist who has been working in the mental health field since 2008. Dr. Clifford is currently an assistant professor in the master of clinical psychology program at Benedictine University in Lisle, Illinois, and focuses her research and clinical work on trauma, attachment, and neuropsychological interventions. Her training and clinical experiences are varied and include neuropsychological assessment, biofeedback, individual-group-couple’s therapy, and psychological assessment in community mental health centers, hospitals, university counseling centers, and private practice.

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