Understanding the Core of Psychological Trauma: Trauma in Contemporary French Theory

Introduction

Scientific research in recent decades has provided a clear, evidence-based description of the serious consequences of trauma-related experiences (Breslau & Davis, 1992; Carlson, Furby, Armstrong, & Shlaes, 1997; Foa & Rothbaum, 1998; Horowitz, 1986). Various concepts have been developed to explicate the consequences of these experiences (Gersons & Carlier, 1992; Kinzie & Goetz, 1996; Wilson, 1989, 1994). Post-Traumatic Stress Disorder (PTSD) and other mental disorders (including anxiety, depression, substance abuse, dissociative disorders and psychosomatic disorders) can result from psychological trauma (Brewin, 2000). Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) are described in DSM-IV-TR (APA, 2000) as mental disorders which may occur after traumatic experiences such as severe accidents, rape, torture, violence and war. The risk for PTSD increases with the degree of exposure to trauma and both the frequency and the severity of the traumatic events (e.g. Bramsen, 1995).

Over the years, a scientific consensus has appeared in the Anglo-American scientific literature about the symptoms of both acute and posttraumatic stress – i.e. intrusive recollections of the traumatic event, a profound sense of numbness, avoidance, increased arousal and hyperactivity and/or exaggerated startle response and dissociative reactions (Foa, Riggs & Gershuny, 1995). If these reactions – intrusive re-experience, avoidance and hyperarousal – persist (at least for one month) causing significant distress or loss of function, PTSD can be diagnosed according to the DSM-IV-TR (APA, 2000).

In DSM-5 (APA, 2013), PTSD was included in a new section on trauma- and stress-or-related disorders. This move from DSM-IV-TR, which addressed PTSD as an anxiety disorder, is among several changes approved for this condition that is increasingly at the center of public as well as professional attention (APA, 2013). In PTSD, the trigger is exposure to an actual or threatened death, serious injury or sexual violation. The exposure must result from one or more of the following scenarios, in which the individual: directly experiences the traumatic event, witnesses the traumatic event in person, learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental); or experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures or movies unless work-related). The disturbance, regardless of its trigger, is supposed to cause clinically significant distress or impairment in the individual’s social interactions, capacity to work or other important areas of functioning and was not the result of another medical condition, medication, drugs or alcohol.

In DSM-IV (APA, 2000), the controversy as to the definition of PTSD’s traumatic stressor criterion, since PTSD first appeared in the DSM-III (APA, 1980), may have implications for pointing at trauma in organizational context. This criterion (A1, in DSM-IV) represented an attempt to provide an objective definition of the traumatic event – such as a terror attack on an airport - that was necessary for the validity of the PTSD diagnosis. Despite a long controversy, there was little empirical research exploring whether events meeting DSM-IV-TR’s Criterion A1 were better associated with the diagnosis or severity of PTSD than non-Criterion A1 stressful events. In fact, the trauma literature of recent years is not well linked to the research that has been conducted on the psychological and physiological impact of “mere” stressful life events over the past century (e.g. Holmes & Rahe, 1967; Vinokur & Selzer, 1975).