How Adults From the General Population Define Trauma

Panisch, L. S., Sperlich, M. I., & Fava, N. M. (2024). How adults from the general population define trauma: Highlighting a need for a broader and more inclusive understanding. Traumatology, 30(2), 178–186. https://doi.org/10.1037/trm0000422

Rationale

While there is extensive research on trauma narratives and expressions, little is known about how adults in the general population explicitly define and conceptualize the term “trauma.”

Previous studies have indicated incongruence between how many adults conceptualize trauma and how it is defined by the DSM-5 for PTSD diagnosis (American Psychiatric Association, 2013; Civilotti et al., 2021; Gilmoor et al., 2020; Henderson, 2019; Ingram et al., 2019; Livingston et al., 2019; Pressley & Smith, 2017; Rechsteiner et al., 2020; Reed et al., 2017).

This study addresses a gap in the literature by providing a thematic analysis of how adults from the general population define trauma when asked directly, without guiding their responses toward specific domains like events or reactions.

Understanding these definitions is crucial for developing shared understandings between clinicians and clients, which can impact assessment, diagnosis, and treatment of trauma-related conditions.

Method

The study utilized thematic analysis (Braun & Clarke, 2006) to identify patterns and themes within qualitative data. Data were collected as part of a larger online mixed-method study conducted between November 2016 and March 2017.

Participants were recruited through Amazon Mechanical Turk (MTurk) and completed a screening survey followed by the main survey package.

The specific question analyzed for this study was: “What does the word ‘trauma’ mean to you?”

Responses were coded independently by two authors, with all three authors meeting regularly to discuss codes, develop themes, and reach consensus through triangulation.

Sample

The analytic sample consisted of 261 adults from the United States with a mean age of 41 years (SD = 11.9). The majority identified as White (84.7%), with smaller percentages identifying as Black (8.4%), Asian (6.5%), and Latinx (6.1%).

The majority of participants (87.7%) reported experiencing some form of trauma or childhood adversity.

Results

Six main themes emerged from the analysis:

1. Event (30.7% of responses): This theme focused on defining trauma solely in terms of a specific occurrence or situation. Respondents described trauma as something that happens, often with negative connotations, but without mentioning reactions or consequences. Most of these definitions did not align with the DSM-5’s Criterion A for PTSD. An example quote is: “Something tragic.”
2. Reaction (7.7% of responses): In this theme, respondents defined trauma primarily in terms of how a person responds to or is affected by an experience. These definitions often included descriptions of emotional, psychological, or physical responses without explicitly mentioning the precipitating event. Reactions were typically described as negative or distressing. A representative quote is: “Experiencing emotional and/or physical distress.”
3. Reaction and event with event emphasized (38.7% of responses): This theme included definitions that mentioned both an event and a reaction, but placed greater emphasis on the event itself. These responses acknowledged that trauma involves both an occurrence and its impact, but tended to frame the reaction as a consequence of the event. An illustrative quote is: “A negative experience that has long-lasting physical or psychological ramifications in the short and/or long term.”
4. Reaction and event with reaction emphasized (11.9% of responses): Similar to the previous theme, these definitions included both events and reactions, but placed greater emphasis on the reaction. These responses framed trauma primarily in terms of its impact, while still acknowledging that it stems from a specific event or experience. A typical quote for this theme is: “The aftermath of a terrible, incredibly stressful event whether physical, mental or emotional.”
5. Long-lasting impact (30.2% of responses): This theme captured definitions that highlighted the enduring effects of trauma. Respondents in this category viewed trauma not just as an event or immediate reaction, but as something that continues to affect a person over time. This theme often overlapped with others, leading to subthemes based on whether the long-lasting impact was associated with events, reactions, or both. An example quote is: “An event that has caused lasting emotional implications.”
6. Injury (11.1% of responses): In this theme, respondents defined trauma using terms related to harm or damage, often without specifying whether they were referring to physical or psychological injury. These definitions tended to be brief and did not provide context about whether the injury was a result of an event or a form of reaction. A representative quote is: “Trauma means an injury to your body, your psyche or your mental health.”

Insight and Depth

This study provides valuable insights into how the general public conceptualizes trauma, revealing a tendency to focus on events rather than reactions.

It also highlights a significant discrepancy between lay definitions and clinical criteria for trauma, with 92.8% of event-focused definitions not aligning with PTSD Criterion A in the DSM-5.

The emergence of the “long-lasting impact” theme suggests that many people understand trauma as having enduring effects, which aligns with clinical perspectives but may also indicate fatalistic views about the permanence of trauma’s impact.

These findings underscore the importance of developing more inclusive, relatable definitions of trauma that can bridge the gap between clinical and public understanding, potentially improving access to and engagement with trauma-informed care.

Strengths

• Use of free-form definitions allowed for unbiased responses
• Large sample size (n=261) from the general population
• Rigorous thematic analysis process with multiple coders and consensus-building
• Identification of novel themes and subthemes not previously reported in the literature
• Analysis of how long-lasting impacts relate to events and reactions

Limitations

• Sample primarily identified as White, limiting generalizability to more diverse populations
• Lack of data on employment and limited data on income restricts analysis of socioeconomic factors
• Use of MTurk for recruitment may introduce selection bias
• Single-question format limits depth of individual responses

Implications

The results have significant implications for clinical practice and public health:

1. Clinicians may need to educate clients about the impact of distress related to both traumatic events and reactions.
2. There is a need for more inclusive definitions of trauma in diagnostic criteria and clinical practice.
3. Public health initiatives could benefit from using language that aligns with how the general population conceptualizes trauma.
4. Treatment approaches may need to address fatalistic views about the long-lasting nature of trauma’s impact.
5. The focus on events over reactions in public definitions may influence how and when individuals seek help for trauma-related issues.

Conclusion:

Understanding how the general public defines trauma is crucial for improving trauma-informed care and developing more inclusive diagnostic criteria.

This study reveals a tendency for people to focus on traumatic events rather than reactions, and to conceptualize trauma in ways that often diverge from clinical definitions.

Further research is needed to explore these definitions among more diverse populations and to investigate how different conceptualizations of trauma influence help-seeking behaviors and treatment outcomes.

The complexity of trauma as a concept underscores the need for ongoing dialogue between clinicians, researchers, and the public to ensure that trauma-related care is accessible, relatable, and effective for all who need it.

References

Primary reference

Panisch, L. S., Sperlich, M. I., & Fava, N. M. (2024). How adults from the general population define trauma: Highlighting a need for a broader and more inclusive understanding. Traumatology, 30(2), 178–186. https://doi.org/10.1037/trm0000422

Other references

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.

Civilotti, C., Di Fini, G., & Maran, D. A. (2021). Trauma and coping strategies in police officers: A quantitative-qualitative pilot study. International Journal of Environmental Research and Public Health, 18(3), 982.

Gilmoor, A., Vallath, S., Regeer, B., & Bunders, J. (2020). “If somebody could just understand what I am going through, it would make all the difference”: Conceptualizations of trauma in homeless populations experiencing severe mental illness. Transcultural Psychiatry, 57(3), 455-467.

Henderson, Z. (2019). In their own words: How Black teens define trauma. Journal of Child and Adolescent Trauma, 12(1), 141-151.

Ingram, L., Qaio, S., Li, X., & Deal, M. (2019). The inner working of trauma: A qualitative assessment of experiences of trauma, intergenerational family dynamics, and psychological well-being in women with HIV in South Carolina. Journal of Psychosocial Nursing and Mental Health Services, 57(4), 23-31.

Livingston, N. A., Berke, D. S., Ruben, M. A., Matza, A. R., & Shipherd, J. C. (2019). Experiences of trauma, discrimination, microaggressions, and minority stress among trauma-exposed LGBT veterans: Unexpected findings and unresolved service gaps. Psychological Trauma: Theory, Research, Practice, and Policy, 11(7), 695-703.

Pressley, J., & Smith, R. (2017). No ordinary life: Complex narratives of trauma and resilience in under-resourced communities. Journal of Aggression, Maltreatment & Trauma, 26(2), 137-154.

Rechsteiner, K., Maercker, A., Heim, E., & Meili, I. (2020). Metaphors for trauma: A cross-cultural qualitative comparison in Brazil, India, Poland, and Switzerland. Journal of Traumatic Stress, 33(5), 643-653.

Reed, R., Sharman, R., & Inglis, C. (2017). Women’s descriptions of childbirth trauma relating to care provider actions and interactions. BMC Pregnancy and Childbirth, 17(1), 21.

Keep Learning

Suggested Socratic questions for a college class to discuss this paper:

1. How might cultural differences influence the way people define trauma? What implications could this have for cross-cultural trauma research and treatment?
2. Why do you think there is such a strong focus on events rather than reactions in lay definitions of trauma? How might this impact individuals’ recognition of their own traumatic experiences?
3. How could the discrepancy between lay and clinical definitions of trauma affect diagnosis and treatment? What steps could be taken to bridge this gap?
4. What are the potential consequences of viewing trauma as having inevitable long-lasting impacts? How might this perception influence recovery and treatment-seeking behaviors?
5. How might socioeconomic factors influence how people define and experience trauma? Why is it important to consider these factors in trauma research?
6. In what ways could the findings of this study inform public health messaging about trauma and mental health?
7. How might the tendency to define trauma in terms of events rather than reactions influence policies related to trauma-informed care in various settings (e.g., schools, healthcare, criminal justice system)?
8. What ethical considerations should researchers and clinicians keep in mind when attempting to develop more inclusive definitions of trauma?
9. How might the findings of this study impact the way trauma is discussed in non-clinical settings, such as in the media or in educational contexts?
10. What further research questions does this study raise about how trauma is conceptualized and experienced across different populations or contexts?