Work-Related Trauma Online Appendix A

ONLINE APPENDIX A Work-Related Traumatic Events and Psychological Trauma Definitions of Terms in Diagnostic Classification Manuals Disorders and Syndromes Post-traumatic stress disorder (PTSD)

Definition

Source

Direct or indirect/ vicarious/ secondary; Significant impairment in life functioning (personal, family, occupational, etc.) and symptom-related distress that occurs for more than a month related to an event or situation that was extremely threatening or horrific in nature; includes the core elements intrusion (intrusive and re-experiencing memories, emotions, images, flashbacks, etc. as if the event was happening in the now), avoidance (thoughts, memories, reminders, people, places, situations associated with the event are avoided), and increased physiological arousal (e.g., feelings of heightened threat, hypervigilance, heightened startle response).

DSM-5/ ICD-11

Complex subtype - Posttraumatic stress disorder

Direct or indirect/ vicarious/ secondary (secondary includes those impacted by their work with other traumatized individuals); Significant impairment in life functioning (personal, family, occupational, etc.) and symptom-related distress that occurs for at least several weeks related to an event or series of events, including repetitive events, of extremely threatening or horrific nature and from which escape was difficult or impossible; includes the core elements intrusion (intrusive and re-experiencing memories, emotions, images, flashbacks, etc. as if the event was happening in the now that are involuntary), avoidance (thoughts, memories, reminders, people, places, situations associated with the event are avoided), and increased physiological arousal (e.g., feelings of heightened threat, hypervigilance). Severe impairments in feelings of self-worth (e.g., beliefs that one is worthless or diminished along with shame and guilt) along with severe impairments in affect regulation and sustaining relationships/ feeling close to others.

ICD-11 (not in DSM-5)

Dissociative subtype – Post-traumatic stress disorder

Meets PTSD criteria and additionally includes experiences of depersonalization or derealization not related to substance abuse or another medical condition.

DSM-5 (not in ICD-11)

Acute Stress Disorder

Direct or indirect/ vicarious/ secondary, dissociative symptoms (e.g., detachment, reduction in awareness, derealization, dissociative amnesia), and less severe than PTSD; includes the core elements intrusion, avoidance, and arousal symptoms lasting between 2 days and a month.

DSM-5 (not in ICD-11)

Secondary Traumatic Stress

Secondary traumatic stress can apply to PTSD and its subtypes as well as acute stress disorder; it includes those impacted by their work with other traumatized individuals (e.g., earthquake survivors, clinicians working in a psychotherapeutic situation).

DSM-5

Vicarious Traumatization

This can only occur in situations where individuals work with other traumatized individuals (e.g., first line responders interacting with hurricane Katrina survivors) where individuals’ inner self permanently changes and transforms as a result of extreme empathic engagement and extreme counter-transference (i.e., emotional enmeshment or entanglement) with a traumatized individual or individuals.

Pearlman and Mac Ian (1995); Saakvitne and Pearlman (1996)

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Disorders and Syndromes

Definition

Source

Acute Stress Reaction (ICD-11) Secondary Traumatic Stress (DSM-5)

The development of transient emotional, somatic, cognitive, or behavioral symptoms (e.g., confusion, feeling in a daze, social withdrawal) as a result of exposure to an event or situation of extremely threatening or horrific nature.

These transient symptoms emerge post-event but subside and reduce within a month. Generally, acute stress and secondary stress reactions differ from acute stress and secondary stress disorders based on symptom duration – symptoms under a month, rather than over a longer period of time, are considered ‘normal’ crisis-related reactions.

ICD-11; DSM-5

Traumatic Event/ Potential Trauma Event

Note there are differing views and debates on narrow versus broad approaches to defining a traumatic event and diagnosing PTSD. Note that in DSM-5, the definition of trauma was revised to equate with a potential trauma event while earlier DSMs distinguished between trauma and the event.

An event or situation that was extremely threatening or horrific in nature (ICD-11).

Exposure to a stressful event or situation of exceptionally threatening or catastrophic nature (ICD-10).

Exposure to actual or threatened death, serious injury, or a threat to physical integrity of oneself or others (DSM-4).

Exposure to actual or threatened death, serious injury, or sexual violence – equated to be the same as trauma (DSM-5).

Traumatic events include those caused by human behavior (e.g., rape, war, industrial accidents) as well as by nature (e.g., earthquakes) and often challenge an individual’s view of the world as a just, safe, and predictable place (American Psychological Association, 2023).

ICD 10/11; DSM-4/5.

Burnout

A syndrome resulting from chronic workplace stress that has not been successfully managed which includes the three core elements emotional exhaustion, mental distance or cynicism from one’s job, and feeling ineffective/ lacking accomplishment. Burnout can result from anything including things inside normal (e.g., excessive job demands), while something traumatic is the direct result of something shocking, deeply threatening, or horrific in nature. Exclusions for burnout syndrome include disorders specifically related with stress, while disorders specifically related to stress list burnout as an exclusion criterion (cf. ICD-11).

Note: this syndrome is exclusionary for diagnosing someone with a stress-related trauma disorder

ICD = International Classification of Diseases; DSM = Diagnostic and Statistical Manual.

Sources: American Psychological Association. 2023. Trauma. APA Dictionary of Psychology. Retrieved from: https://dictionary.apa.org/trauma DSM 3: American Psychiatric Association. 1980. Diagnostic and statistical manual of mental disorders (3rd ed.). American Psychiatric Association, Washington, DC. DSM 4: American Psychiatric Association. 1983. Diagnostic and statistical manual of mental disorders (4th ed.). American Psychiatric Association, Washington, DC. DSM 5: American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association, Washington, DC. ICD-10: World Health Organization. 1992. International Statistical Classification of Diseases and related Health Problems (10th Revision). Geneva, Switzerland: World Health Organization.

ICD-11: World Health Organization. 2019. International Statistical Classification of Diseases and related Health Problems (11th ed.). https://icd.who.int/ Pearlman, L. A., & Mac Ian, P. S. 1995. Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Professional Psychology: Research and Practice, 26, 558–565.

Saakvitne, K. W., & Pearlman, L. A. 1996. Transforming the pain: A workbook on vicarious traumatization. New York: Norton.

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