Psychotraumatology is the discipline that deals with prevention, treatment, and research in:
- Situations that traumatize people
- Reactions that occur when exposed to a traumatic event; Posttraumatic stress disorder (PTSD) and Acute Stress Disorder (ACD), in particular.
Though the term “psychotraumatology” is relatively new, the phenomenon itself is not; severe life-threatening events have always occurred. Classic descriptions of the psychological repercussions of life-threatening events date back to 1666 when Samuel Pepy described his psychological symptoms after having witnessed the great fire of London. Many post-traumatic disorders have been named after life-threatening events that have occurred this century; shell shock (from WW1), KZ-Syndrome (Holocaust survivors), war neurosis (from the battlefield), war sailor syndrome (WW2), accident neurosis, Vietnam syndrome, rape trauma syndrome, and many more.
In the 1960s, a new area of psychology began to evolve in the USA - counselling psychology. In the beginning, the original idea was, that giving support in short periods, at critical times, could prevent the crisis-reactions from developing into lasting conditions. These ideas, which were summarized by Gerald Caplan, were widely spread and brought to Scandinavia by the Swedish psychiatrist, Johan Cullberg (1934) who wrote the book, Crisis and Development. Counselling psychology has been an eye-opener for several different professional groups to the value of early and goal-directed intervention.
Until the 1980s, it was widely assumed that a crisis had a similar phase-course and similar effects on everyone, no matter the different nature of the events. After thorough research, a diagnosis called “post-traumatic stress disorder” (PTSD) was proposed. The diagnosis is based on a person having experienced a violent event that could cause significant symptoms of strain in nearly everyone.
This normative stressor criterium was changed in 1994 to a subjective stress criteria that stress that a person has reacted with great fear or helplessness in face of a life-threatening event, or experienced a threat against their own physical integrity or that of others. In WHO’s diagnosis system (ICD-10), which is used in Denmark, PTSD is referred to as a “posttraumatic stress disorder”. This system has chosen to maintain the normative stressor criteria.
The diagnostic criteria in the DSM-V
Diagnostic Criteria ICD-10
Lifetime prevalence of PTSD has been evaluated in two national studies, one American and one Danish. The US National Comorbidity Survey (1995 and 2005) found a lifetime prevalence of 7-8%.
What is stress counselling?
The term “stress counselling” is often used in the media about acute psychological help, and there has come an expectation that the authorities contact crisis psychologists within a few hours of a traumatizing event. In reality, psychological stress counselling is often offered as a prolonged course of treatment following a referral from your own doctor.
A course of treatment begins with a thorough evaluation of the person’s symptoms, and every course of treatment is therefore individually tailored to fit the symptoms of each person. Treatment is emotionally demanding work, but most of the symptoms can eventually be relieved and the event will become an integrated part of the person’s life story.
If the triggering event has affected a larger group of people at a workplace (e.g. a robbery), psychological debriefing can be applied. It is a form of intervention where the event is processed collectively. Overseen by a professional, the group sits in a circle and goes through the actions, thoughts, sensory impressions, and feelings of each person, one segment at a time.
When major disasters occur, many different interventions are implemented at the same time in order to catch and meet the many needs for information, counselling and treatment, of survivors and others affected by the event. Following the explosion accident on Lindoe in 1994, there were thus ten different interventions in place. Such situations demand crisis management i.e. planning, coordinating and management of the combined effort.