Trauma & Stress

Trauma has increasingly been recognized as an important factor in psychological distress and impairment. The Diagnostic and Statistical Manual (DSM) describes the consequences of trauma in the diagnosis of PTSD. PTSD, as defined in the DSM, is a response pattern to a traumatic event where the individual experiences terror and helplessness. In healthcare, this type of trauma certainly occurs, but there is often a much broader context that needs to be understood. COVID-19 provides a good example; many healthcare workers experienced instances of terror, but these were often within a broader context of fears about the global situation, challenging work conditions, and isolation.

“Trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body.”

– Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

Taking a more holistic view of trauma than the DSM allows can be beneficial. For example, the Canadian Military has moved away from using strict diagnostic categories that narrowly define the psychological consequences of operational stress in soldiers. Operational Stress Injuries (OSIs) are a range of problems that can arise as a result. OSIs are grouped into four categories:

Trauma – Impact Injury: Includes PTSD and acute stress disorder, characterized by intrusive recurrent memories of the event, nightmares, or feelings as though the event is reoccurring. This often triggers a fear response, leading to physiological arousal, muscle tension, edginess, and an increased startle reflex. Such activation typically results in avoidance patterns, which can be either conscious—deliberately avoiding stressors—or automatic, involving emotional numbing or detachment from one’s environment.

Fatigue – Accumulated Stress Injury: Manifests as conditions like depression or adjustment disorder. This type of injury leads to physiological deactivation, akin to hibernation, with lowered energy and changes in sleep and appetite patterns. This is often a protective response, preparing the individual to “weather a storm” and is associated with psychological changes like rumination, which can perpetuate a cycle of withdrawal and self-blame.

Grief – Loss Injury: A natural response to significant loss, such as the death of a patient or colleague, or loss of meaningful work. Grieving is a process where one remembers and feels emotions related to the loss, gradually processing these emotions over time.

Moral Injury – Spiritual Injury: Often referred to as moral distress among healthcare professionals, this occurs when an individual’s values conflict with the realities of their situation. This may involve having to act in ways that contradict their self-perception, often constrained by factors like patient autonomy and systemic issues.

“The curious paradox is that when I accept myself just as I am, then I can change.”

― Carl R. Rogers, On Becoming a Person: A Therapist’s View of Psychotherapy

Addressing the different injuries resulting from trauma and stress can be complex, and individuals often cannot manage alone. Seeking short-term fixes—such as substance use, distractions, or overworking—can further complicate issues. Recovery is more likely a process where the individual avoids extremes and finds a balanced path forward. Three strategies that healthcare professionals can consider are seeking connection, practicing self-compassion, and finding professional help.


Trauma and Anxiety: 

Depression and Fatigue: 

Coping Strategies: