How Trauma is Disguised by Other Disorders

By Julia Catlin

One thing that has been difficult for me during my time as a mental health professional is seeing clients who come to me with a laundry list of mental health diagnoses, and often a laundry list of medications to accompany them.  The frustrating part is not seeing many diagnoses. What is frustrating to me is learning how depression, anxiety, Oppositional Defiant Disorder, and Attention Deficit Hyperactivity Disorder (ADHD), may be covering up a larger, clearer problem.  I think that problem is trauma.

If the problem is trauma, then why do people get labeled with these other diagnoses?  Why not just call it trauma in the first place?

The unfortunate truth is that it is easier for people to see depression, anxiety, bad behavior, and drug addiction, as part of who a person is, rather than something a person has experienced.  The physiological and emotional reactions that ride along with depression and anxiety, for example, are pretty similar to trauma. The emotional reactions could include anger and irritability, not wanting to leave the house or limiting social interactions, feeling sad or having suicidal thoughts, running away, feeling like there is no escape from emotional pain or “feeling this way.” Physiological reactions are harder to pin down, and include headaches, stomach pain, back and neck pain, trouble breathing, chest pain, a racing heart, feeling like one is going to die or experiencing panic attacks, or even overall fatigue and pain throughout the body.  For a problem as pervasive as this, one would think that it would be easy to identify and treat, but that is simply not the case. Not yet.

Doctors, psychiatrists, and other medical professionals do not often attribute these problems to trauma, even with the increased usage of mental health screenings for depression and anxiety. Dr. Bessel van der Kolk, author of the 2014 New York Times best-selling book, The Body Keeps the Score, proposed to the American Psychiatric Association a new diagnosis called Developmental Trauma Disorder to be implemented into the DSM 5, the manual used to diagnose mental health disorders. This proposed diagnosis was rejected and claims were made by professionals in the field that there was not enough research and evidence to back what could be claimed as a “clinician’s intuition” rather than a real epidemic.  

To many clinicians, trauma is becoming a buzzword and a central focus after the Kaiser Permanente study by Dr. Vince Felitti on Adverse Childhood Experiences.  A great TED talk explains this well: Nadine Burke Harris explains the ACEs study and some of the reasons we may not want to look at trauma for what it is: a national healthcare epidemic.  Risks of diseases such as Chronic Obstructive Pulmonary Disease (COPD), lung cancer, and cardiovascular disease increase exponentially for every additional ACE a person has. Just four or more ACES indicate a much higher risk, though it is estimated that about a quarter of the population has at least one or two ACEs.

Though it may be an uncomfortable task, addressing trauma is important for care coordination and enhancing recovery of other mental health diagnoses like depression, anxiety, bipolar disorder, and borderline personality disorder.  Perhaps it will improve communication in the mental health field, as well. Instead of referring to people as “unstable,” we will recognize the relationship patterns they developed in early childhood as a result of domestic violence in the household.  Perhaps “behavioral outbursts” will then be classified as children struggling to get needs met in the only way they know how to communicate or have attention paid to them. And maybe, “overly anxious” will indicate a person trying to find solid ground where there was none before.  “Problems,” “disorders,” and “illnesses” are matters of perspective.

How we choose to view and respond to others’ life experiences can not only indicate our own levels of empathy but can change the way others experience empathy and relationships.  Let’s choose to look at what is underneath the surface. Complexity of the human condition is difficult and beautiful. We can choose to embrace this duality, and even celebrate it.  

Like icebergs, there are always more to people than what meets the eye. To understand what may be hidden from our vantage point, we must dive underneath and explore the depths and the darkness. In exploring the darkness, we have a new appreciation for what is in the spotlight.