FO: Being traumatized is necessary for having post-traumatic stress disorder. There are very many people who are stressed in general, who become nervous or depressed, or who have repetitive thoughts that are distressing; but in order to have post-traumatic stress disorder you have to have been traumatized. And we did struggle with that definition of what it means to be traumatized. It means to be exposed to something that could kill you; that could change your life; that could affect you in a deep and biological way, not just something that is very difficult to contend with like a divorce. It has to be more disruptive of you as a biological being, not just as someone who has dignity and a life ahead of you, a job ahead of you. It’s not losing a job. It’s not even losing your loved one, if the loss is through natural causes. There has to be something about the traumatic event that shocks you, that makes you feel scared or horrified or helpless at the very time it occurs. So, that basically is our definition of a traumatic event.

Having had a traumatic event, you then have post-traumatic stress disorder if you suffer in three different ways for a period of at least month. The three different ways are, first, having trauma memories. A trauma memory is different from a normal memory of a terrible event. In a trauma memory, you don’t want to remember, and yet your mind or body remembers. It can wake you up from sleep. It can be in the form of a nightmare. It can be in the form of a flashback, which means you see or smell things that aren’t there but that were there when you were traumatized. Or you hear things or you see things. It has the quality of a hallucination, but it’s not part of your imagination; it’s part of your memory.

And it can be something that you’re not entirely aware of, but you feel it in your bones. Your heart races because you’ve been exposed to something that is similar to the traumatic event, and afterward you realize—oh, that’s what it was. So, the first part of the syndrome is re-experiencing the trauma, when you don’t want to experience it, in one of several ways.





The second part of the syndrome is quite different: it is being numb or avoidant. You don’t do what you used to do; you don’t feel the way you used to feel. You don’t expect to have a long and good life. You’ve been changed; you’ve been diminished; you’ve been made less. Not necessarily depressed (which means feeling helpless, hopeless, and worthless), but in some ways it’s similar to depression. That’s the part of the syndrome that’s being numb and avoidant.

And the third part is being anxious—and anxious in several ways: not sleeping well; being irritable and angry; not being able to concentrate; being easily startled; being hyper-vigilant, which means being constantly on the look-out for danger. You can think of this as having lowered your threshold for being aroused. And this is a constant; this is not just when something triggers you into returning you to the traumatic event. It’s a generalized high level of fear and anxiety.

Veterans and Post-Traumatic Stress Disorder: A Conversation with Dr. Frank Ochberg