How Trauma Can Be Impacted By Misdiagnosis

My Experience With Trauma

I remember it like it was yesterday. I knew I had bad dreams and had trouble sleeping. But it was my “normal,” and as I grew into adulthood, I thought nothing of it. It was the fall of 1991, just days after I was married. We spent part of our honeymoon visiting her family in Nebraska.

We were staying in a guest room at her parents’ house on an air mattress. We drifted off to sleep until about 2 AM, when I awoke with a start, as I often did. My wife was staring at me, looking perplexed and concerned.

“Do you always do that in your sleep?” she asked.

“Do what?”

“You shake and startle, yelling things, like you are fighting in your sleep, and you thrash around until you wake up breathing heavy and looking scared.”

“Well, I don’t know what I do in my sleep. No biggie.”

And so we went back to sleep, and I continued going back to sleep for the next six years, until I had to resign from my job due to what seemed like symptoms of a depressive disorder. I found a counselor and began therapy, only to find out months later that I wasn’t depressed.

I had been through some traumatic events in my childhood that left me with PTSD. This realization shifted the focus of my treatment in counseling and dramatically reduced the distressing symptoms and impairment.

I am not one to shy away from sharing personal experience, and I support self-disclosure in therapy (at the right time and the right amount, of course). One of the main reasons I am unafraid to share is due to years of therapy I went through in my personal life that changed me for the better. This is especially the case because we were able to uncover the true source of my suffering and impairment, which was not a depressive disorder but childhood trauma.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder takes up the better part of the whole chapter on trauma and stress-related disorders in the DSM-5, which states that there is a projected lifetime risk at age seventy-five years in the USA of 8.7% (that’s almost 1 in 10 people), and a 3.7% twelve-month prevalence in US adults (about 4 in 100 people).

Having worked as a military family life counselor and supervisor for twelve years, I saw the diagnostic criteria and prevalence of impairment from trauma often. But one observation I made in those twelve years was interesting.

I observed in my practice just as many children suffering from the diagnostic criteria and symptoms of trauma as I did adults. And the adults seemed to have experienced trauma more from childhood experiences than from combat or battle.

These observations aligned with a statement made by one of my professors, Dr. Jared Pingleton, who stated that, based on statistics and studies done in the United States, the number one cause of PTSD in the USA was not combat, not natural disasters, but child abuse, by a wide margin.

The DSM-5 is clear on he difference in diagnostic criteria of PTSD for children under the age of six and those older than six. The reason is that a young child’s mind is still developing, so it does not yet have the capacity to know what it is feeling or why. As well as not being able to cope with the level of stress and trauma from the experience. This is what is commonly referred to in layman’s terms as the “fight or flight” response.

How Trauma Works in Children

I prefer to describe it this way: a child’s mind is like a house that is being built. Once the framing is complete and the walls and insulation are in place, the contractor will contact the electrician to wire the house for electricity. The first thing that goes in is a breaker box (fuse box, as some call it).

Why the breaker box? If a circuit becomes overloaded with too much electricity, the breaker will flip to the off position. It does this to keep the circuit from becoming overloaded and burning down the house. Young children’s minds are similar. As they develop in early childhood, they can have powerful and traumatic experiences; so much so that they do not have the cognitive capability to understand or work through the stress and anxiety.

This creates a fight or flight response similar to the breaker flipping to the off position. The child will then defer to this autonomic response to the situations or stimuli that remind them of the traumatic experience. This deferral can carry on all the way into and through adulthood, with adults often not being able to remember or understand what traumatized them.

This avoidance or deferral from experiences or situations that remind people of their trauma can be paralyzing and debilitating. It can interfere with functioning and leave the individual with considerable impairment, all due to our built-in safety mechanisms wired into our psyche to protect us from perceived threats.

The symptoms can often resemble or be similar to symptoms of other disorders or diagnoses. Not only in my therapy, but in many of my clients’ therapy, I have seen diagnoses of bipolar disorder, borderline personality disorder, anxiety disorders, depressive disorders, ADHD, and even autistic spectrum disorders that ended up having a traumatic event as their source.

It’s no mystery that psychology as a study is ambiguous and not absolute. Correlation does not necessarily mean causation. You can find symptoms and criteria that may fit several different diagnoses. This makes diagnosing a suffering individual somewhat of a crapshoot.

But in a day and age where certain diagnoses can be the difference between insurance covering treatment or denying coverage, where certain diagnoses can be the difference between getting approved or denied for disability, for benefits, or for qualification for treatment or education, it’s safe to say there is a considerable amount of misdiagnosis in the USA.

Treatment for PTSD

Due to the unique nature of the manifestation of trauma symptoms and the unique ability of the human psyche to block out the memory of certain traumatic experiences, treatments for PTSD have a specific directive. First and foremost, equipping the individual with the capability to manage the physical symptoms of trauma. Then and only then can the source of the trauma be explored.

If your client doesn’t know how to swim, the last thing you want to do with them is throw them into the water and flood them with memories they do not have the physical and mental capability to manage. Second, when the traumatic experience is being explored, the goal is to take power away from that experience by helping the client change their perceptions about what happened to them.

It’s common for victims of abuse and trauma to go through self-blame, guilt, and shame when they had nothing to do with why they experienced what they did. These false perceptions can be deeply rooted and hard to rewire. But when done successfully, the client can then do something they have not known how to do until now: reframe their experience. This will change the way they feel about what they have been through, and ultimately, how they cope with it.

The added element of psychiatry and psychotropic medications can complicate and exacerbate the symptoms of trauma even more. My case is a perfect example. I was someone who was suffering from traumatic symptoms and being medicated with antidepressants due to a diagnosis of depression instead.

There are several treatments for trauma and PTSD. You have eye movement desensitizing and reprocessing (EMDR), trauma-focused cognitive behavior therapy (TFCBT), and prolonged exposure (PE), which are three of the most effective modalities with the fewest side effects.

But the point is clear: if someone is in distress and it looks like they may be suffering from trauma, the diagnosis must be first considered and confirmed. Then there needs to be a shift made in the client’s treatment. From a psychotherapeutic explorative approach, or a medicated approach, to a trauma-focused approach.

A Word to Practitioners

As practitioners, we must first educate ourselves as mental health professionals with a better understanding of trauma and PTSD. Second, we must be more aware of the symptoms clients may be suffering from or experiencing. Instead of immediately pigeonholing the client with a diagnosis, consider the individual and the distress they are feeling and experiencing. Be open to the possibility of trauma.

Third, be willing to shift the client in their treatment to a trauma-focused approach that will be more effective. If you are unable to administer the trauma-focused approach, be prepared to refer the client to someone who does.

A Word to Individuals

As a non-practitioner or an individual, ask yourself (or the person you know who is suffering): Have you (or the person you know) been having trouble sleeping? Have you been experiencing nightmares or jolts in your sleep? Have you found yourself suddenly overwhelmed by stress or anxiety quickly in certain situations?

Have you had difficulty with certain memories from the past (especially childhood memories)? Have you found yourself unusually or suddenly hypervigilant or hyperaware of your surroundings and situation? Have you been avoiding certain people, situations, or activities that you used to engage with?

Have you been experiencing considerable impairment or avoidance in your romantic relationships? Have you seen pervasive maladaptive behaviors develop as a way of coping with stress and anxiety that you are not managing well? There may be a possibility that trauma or PTSD may have something to do with the suffering you are experiencing.

And finally, as an individual or practitioner who has experienced trauma of some kind or PTSD, consider contacting a therapist trained in a trauma modality that can help lead you through the process of therapy to health, healing, and freedom from the effects of trauma and traumatic experiences.