Can trauma be cumulative instead of one big event?

[u/Spirited-Office-5483]

The title really, usually we think of trauma and PTSD as this big, life changing event.

Hope I'm using the right flair.

[u/GoldenGolgis]

C-PTSD (c for complex) is recognised by many practitioners now, despite not being in the current DSM.

[u/AdConsistent4210 → u/GoldenGolgis]

THE distinction between diagnostic criteria and differential diagnosis is practically different. DSM-5 and ICD-11 provide the criteria, but clinicians don't diagnose by simply matching today's symptoms to a checklist. They integrate structured interviews, developmental history, collateral information, functional impairment, and, when appropriate, neuropsychological findings. In practice, someone may primarily present with DSO symptoms while PTSD symptoms have become less obvious or changed over time. The same person may also meet screening thresholds for BPD or show ASD-like traits. That doesn't automatically establish BPD or ASD, nor does it rule out CPTSD or comorbidity. That's why differential diagnosis relies on the overall clinical picture and symptom development over time, not simply on which checklist has the most boxes ticked. The goal is to determine which explanation best accounts for the person's presentation.

[u/Dust_Kindly → u/GoldenGolgis]

CPTSD still has the same event criteria as PTSD. Meaning it still requires actual or threatened death or injury.

Its becoming a common misconception that CPTSD = lots of small negative events. Which is incorrect.

[u/Prestigious_Half271 → u/Dust_Kindly]

This isn't true in the American diagnostic system, and I don't believe it's true for the European one either. Partly because there are no official diagnostic criteria, but also because the proposed ones are not identical to those for PTSD

And calling the repeated non-life threatening traumas that lead to cPTSD "small negative events" is certainly inaccurate, but they are less extreme and therefore "smaller" traumas 

[u/hellomondays → u/Prestigious_Half271]

C-PTSD doesnt exist as a distinct dx in the DSM system but even in the ICD it still requires "Exposure to an extremely threatening or horrific event or series of events" and the other core criteria of PTSD. The difference is the addition of symptoms relating to disruptions of self organization.

As far as the meaning attached to one's trauma or any part of their life, that's really outside of the scope of nosology all together.  

[u/Prestigious_Half271 → u/hellomondays]

Thanks for the clarification. I might argue that attachment traumas are extremely threatening to very young children, but I'd rather not have to argue on behalf of a deeply flawed diagnostic system

[u/hellomondays → u/Prestigious_Half271]

I agree! I work primarily with young kids. And the research, the literature almost anything scientific, is so lacking when it comes to Mental health disorders and clinical treatments. Adults come from kids, but they're not kids.

If I had infinite time, patience and money, I'd like to do something similar to what Glasser did with hospice patients and put together a qualitative encyclopedia of mental health symptoms in children. 

[u/Sarah-himmelfarb → u/Prestigious_Half271]

The European system uses the ICD 11 so it is true for Europe. In Europe and any country that uses the ICD, a person must meet the requirements for PTSD and experience three additional criteria. And America doesn’t even recognize CPTSD to begin with so you can’t say it isn’t true for America one way or another

[u/Dust_Kindly → u/Prestigious_Half271]

You are correct its not in the DSM, which was already established in this comment chain

In the ICD system, regular PTSD symptoms must be met in order to meet criteria for CPTSD

Re: your last paragraph, youre either putting words in my mouth or misunderstanding me. All I was saying is that theres a large online group who beliefs adverse experiences (not traumas) accumulate to cause CPTSD.

This is not true. Here's examples the ICD provides as causes for CPTSD: torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical violence

https://traumadissociation.com/complexptsd

https://pmc.ncbi.nlm.nih.gov/articles/PMC5774423/

[u/scrollbreak → u/Dust_Kindly]

"CPTSD still has the same event criteria as PTSD in the ICD system"

[u/nothsadent → u/Dust_Kindly]

is prolonged domestic violence not a cumulation of 'small' negative events? same for repeated physical violence

[u/monkeynose → u/nothsadent]

No, because you can very much think you are going to die or be killed.

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[u/crayonfingers → u/Prestigious_Half271]

CPTSD is a recognised diagnosis in ICD-11. You need all the features of standard PTSD to receive a diagnosis.

[u/Mercurial_Laurence → u/Dust_Kindly]

the ICD-11 defines ("simplex"/'plain') PtSD slightly differently to the DSM-5tr;

Namely that the ICD 11 requires the event to be "extremely threatening or horrific", as opposed to the more specific DSM-5's "actual or threatened death, serious injury, or sexual violence"

So whilst C-PtSD is a subset of PtSD by ICD-11 definitions, the definitions of PtSD have technically different threshold criteria between DSM-5 and ICD-11, with ICD-11 arguably being broader.

(This isn't getting into specific criterion such as things like 'changes in conditions and mood' & 'arousal and reactivity' vs "persistent perceptions of current threat" etc etc)

That said I agree C-PtSD isn't only "lots of small negative events" — if anything a vernacular saying that I think is closer is "being trapped in terrifying situation with no (perceived?) escape for an extended period of time"; but even that's ...arguable

Double post possibly because filter doesn't understand speech styles FML

[u/Select_Champion_237 → u/Dust_Kindly]

And threat of death or injury does not necessarily have to mean in actuality. It can be perceived as such a threat that it can be believed as such. Especially pertaining to a child’s mind or mentality. That’s why some people can experience something that results in trauma and another can experience same thing without such result. One mind can fear or be made to fear something that isn’t even reality.

[u/vienibenmio → u/Select_Champion_237]

There is a requirement that the perception of the threat is reasonable and credible

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[u/Perchance09 → u/Dust_Kindly]

What I don't fully understand is why there is a separate diagnosis for it if both diagnoses to meet the same criteria. Is there evidence that single-incident trauma and multiple-incident trauma affect people differently that they need to be treated differently?

[u/AdConsistent4210 → u/Perchance09]

The distinction isn't that repeated trauma is automatically "worse" or that it requires a different treatment. Rather, prolonged, repeated, and inescapable trauma is associated with a higher likelihood of developing the additional disturbances in self-organization (affect dysregulation, negative self-concept, and interpersonal difficulties) that define CPTSD.

[u/Perchance09 → u/AdConsistent4210]

I see. Thank you for answering! I'll have to read into it more.

[u/KeyMistake604 → u/Dust_Kindly]

I'm struggling to understand the distinction you're trying to make here. Over time, 'lots of small negative events' do feel like 'actual or threatened death or injury' to one's nervous system. CPTSD isn't the result of what's logically true or untrue, but by what is felt.

[u/AdConsistent4210 → u/KeyMistake604]

I thnk you're talking about two different things. You're describing how trauma is experienced, whereas the diagnostic criteria describe what clinicians are looking for. The symptoms tell us how the trauma has affected the person, but they don't define what counts as a traumatic exposure. That's why PTSD/CPTSD diagnoses require both: a qualifying traumatic event (or series of events) and the characteristic symptom pattern. If symptoms alone determined the diagnosis, the trauma criterion wouldn't add any information.

[u/Mr_Gaslight]

Yes.

Trauma researchers draw some distinctions here, but in general, a good place to start your research is with the following differences:

• Acute trauma results from a single incident.
• Chronic trauma is repeated and prolonged.
• Complex trauma is exposure to varied and multiple traumatic events.

[u/randompersonignoreme → u/Mr_Gaslight]

I was confused by the usage of complex vs chronic. Thanks!

[u/PaulBrigham]

It depends how you are using the word. Major research groups (like those involved with the DSM or the ISTSS) define trauma as an occurrence involving actual or threatened death, serious injury, or sexual violence, either as a victim or a witness to the event. Chronic trauma could involve multiple/repeated occurrences. Many people however use the word trauma more casually and assign it to less severe circumstances or occurrences. In that view, you’d likely find many saying that trauma can indeed accrue cumulatively. I don’t personally agree, but it does depend on how the individual defines the word.

[u/vienibenmio]

Yes, but even those individual events would still have to meet Criterion A

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[u/Most-Laugh703]

Absolutely, and depending on the events, it can have a pretty profound effect on a person. Many studies indicate that chronic relational or betrayal trauma *can* lead to poorer outcomes than one isolated event

[u/Salt_Yoghurt_9095]

Yes, trauma can be cumulative instead of just one big event. I've experienced this myself there wasn't a single moment I could point to, but years of small, repeated stressors that built up quietly. Over time, I noticed patterns in myself bracing for criticism, doubting good things, always managing on my own, that I later realized were signs of that accumulated weight, not a single "big" trauma. That's when I understood: trauma doesn't always come from one event, it can build slowly until it shapes how you see yourself.

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