Defining traumatic stress is a complex task because it incorporates so many different presentations, triggering events, brain developments, resources, and can be individual or collective (van der Kolk, et al., 1996). Non-traumatic stress differs primarily in that it is an almost unavoidable aspect of daily human life, and while it can range from small stressors to significant stressors, and can occur from both positive and negative situations, this stress can range from annoyances to exacerbating or experiencing mental health issues – or propel us forward and give us motivation and positive outcomes (Yeager & Roberts, 2003). Stress also releases certain biological responses and hormones, such as a temporary increase in cortisol production (Richter-Levin & Sandi, 2021). However, in the case of traumatic stress, cortisol takes longer and longer to revert to normal – in some cases that are chronic and severe, this may lead to constantly high levels of cortisol, which can further progress to the point that cortisol is completely depleted and unable to be created, leading to adrenal fatigue.
When one has been exposed to significant non-traumatic stress repeatedly, and does not have adequate coping skills, this can develop into acute stress disorder or post-traumatic stress disorder. However, Richter-Levin and Sandi (2021) write that the most “common reaction to stress is resilience, indicating that resilience is the rule and stress-related pathology the exception” (p.1).
While non-traumatic stress can develop into traumatic stress, traumatic stress itself is usually defined by exposure to a traumatic event with which one is unable to process or cope with (Foa, et al., 2009). Commonly considered forms of traumatic events include such things as war, violence, rape, childhood abuse, natural disasters, and other experiences which dramatically shake one’s sense of safety (van der Kolk, et al., 1996). But what constitutes a sense of safety can vary dramatically, and previous exposure to traumatic stress can make one more susceptible to further traumatic stressors. PTSD is most often viewed as a response to a specific, singular event – however, new research and understandings are evolving on complex trauma, such as in cases of ongoing childhood abuse which dramatically impact the lifelong behaviors, thought patterns, and emotional states within the brain development of those children.
The DSM, used to diagnose psychological disorders, has fairly strict, black and white, guidelines on what symptoms need to be expressed for a diagnosis. However, van der Kolk et al. (1996) point out that these symptoms are manifested in vastly different ways for different people. And culture also frames how we experience these symptoms and behaviors. Western societies, namely the USA, tend to shift towards individualism and place blame often on victims in order to maintain a sense of safety within society, and tends to follow the medical model (such as the use of the DSM) of checklists of symptoms to determine a diagnosis, with emphasis placed on the psychopathologies and mental illnesses in terms of the mind. A century or so ago, individuals used more somatic descriptions in their symptoms of PTSD, which, aside from a few authors pushing research on this topic today such as van der Kolk and the recently developed somatic therapies, is not the mainstream. In many other cultures, mental distress of any sort is often described somatically.
Syrian refugees, like many war-exposed refugees, have been exposed to major levels of traumatic stress – within Syria, during migration, and post-migration all carry their own different circumstances which constitute extreme levels of stress, much of which is traumatic (Mahmood et al., 2019). Syria is a collectivistic society, so cultural trauma is felt very deeply within the interconnected web of individuals, damaging the sense of self dramatically (Matos et al., 2021) and is worsened by the separation of family members and communities as refugees find asylum in different countries or from internal displacements (Kakaje et al, 2021). Furthermore, mental illness has been stigmatized within Syria even prior to the onset of the war, with very limited clinicians and resources available, relying mainly on medical staff without mental health training for supports (Kakaje et al., 2021). This worsened even further as medical facilities have been explicitly targeted to be bombed in the war. Syrians tend to express mental illness, including PTSD, in terms of somatic complaints such as insomnia, headaches, and stomach or chest pain (Borho et al., 2021). Because Syrians express trauma in ways that are different from the Western model, some authors have questioned the efficacy of other studies, even when they use “adapted” Western-made diagnosis instruments (Barkil-Oteo et al., 2018).
References
Barkil-Oteo, A., Abdallah, W., Mourra, S., & Jefee-Bahloul, H. (2018). Trauma and resiliency: A tale of a Syrian refugee. American Journal of Psychiatry, 175(1).
Borho, A., Morawa, E., Schmitt, G.M. et al. (2021). Somatic distress among Syrian refugees with residence permission in Germany: analysis of a cross-sectional register-based study. BMC Public Health 21, 896. https://doi.org/10.1186/s12889-021-10731-x
Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (2009). Effective Treatments for PTSD. Practice Guidelines from the International Society for Traumatic Stress Studies (2nd ed.). New York, NY: The Guilford Press.
Kakaje, A., Al Zohbi, R., Hosam Aldeen, O., Makki, L., Alyousbashi, A., & Alhaffar, M. (2021). Mental disorder and PTSD in Syria during wartime: A nationwide crisis. BMC psychiatry, 21(1), 2. https://doi.org/10.1186/s12888-020-03002-3
Mahmood, H.N., Ibrahim, H., Goessmann, K. et al. (2019). Post-traumatic stress disorder and depression among Syrian refugees residing in the Kurdistan region of Iraq. Confl Health 13(51). https://doi.org/10.1186/s13031-019-0238-5
Matos, L., Costa, P.A., Park, C.L., Indart, M.J., & Leal, I. (2021). ‘The war made me a better person’: Syrian refugees’ meaning-making – Trajectories in the aftermath of collective trauma. Int. J. Environ. Res. Public Health, 18. https://doi.org/10.3390/ijerph18168481
Richter-Levin, G. & Sandi, C. (2021). Labels Matter: Is it stress or is it Trauma?. Transl Psychiatry 11, 385. https://doi.org/10.1038/s41398-021-01514-4
Van der Kolk, B.A. & McFarlane, A.C. (1996). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. New York, NY: The Guilford Press.
Yeager, K. & Roberts, A. (2003). Differentiating Among Stress, Acute Stress Disorder, Crisis Episodes, Trauma, and PTSD: Paradigm and Treatment Goals. Brief Treatment and Crisis Intervention, 3. 10.1093/brief-treatment/mhg002.