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Why trauma symptoms are sometimes misdiagnosed as ‘disorders’, and what to do about it.

Updated: Sep 14, 2023

Are symptoms of my disorder actually trauma responses?

Often clients come to therapy believing that they are suffering from any number of mental health ‘disorders’, including attention deficit disorder (ADD/ADHD), obsessive compulsive disorder (OCD), Clinical Depression or a variety of anxiety or social disorders. Quite often these clients have even received official diagnoses and prescriptions to manage their symptoms and come to therapy simply because intuitively they recognize that their circumstances seem more complex than a chemical imbalance or misfiring neurons in the brain.

Often, we find that these clients experienced trauma during their childhoods that was never resolved and that their ‘disorders’ are internalized, unconscious trauma responses that can be addressed through psychotherapy. In fact, the Adverse Childhood Experiences Study that definitively linked childhood trauma to adverse adult health outcomes came because of a study of patients with eating disorders.

The authors of this study wondered why so many of their patients successfully conquered their eating disorders but relapsed after they completed the program. They proceeded to question their patients and discovered that a huge proportion of adults with eating disorders had experienced childhood trauma.

They expanded the study to investigate other ‘disorders’ and discovered that children who had experienced physical, emotional, and sexual abuse, neglect, household substance abuse, mental illness, or domestic violence, and parental separation, were at a greater risk of developing chronic diseases, mental health ‘disorders’, and substance abuse.

Trauma symptoms or mental health disorder? How to tell the difference

It is our belief that many, if not most, ‘disorders’ that are diagnosed today are not disorders at all; they are, in fact, natural psychobiological responses to trauma and can be treated with psychotherapy. There are several reasons for trauma responses to be misdiagnosed as disorders:

1. Overlapping symptoms: Many trauma responses and symptoms overlap with symptoms of mental health disorders, like anxiety and depression.

2. Lack of understanding: Mental health professionals may not have a thorough understanding of trauma and its effects on the brain and body.Neuroimaging is a new and evolving technology and only recently have researchers been able to study the impact of trauma on brain and nervous system circuitry. As a result, some traditionally trained medical and mental health professionals may not recognize trauma as the underlying cause of certain symptoms.

3. Stigma: Mental health disorders are often stigmatized, and individuals may be more likely to receive a diagnosis of a disorder than a diagnosis of trauma. Often our education, medical, and social support systems prioritize funding for diagnosed disorders, incentivizing misdiagnoses, and inappropriate treatment.

4. Incomplete Assessment: Medical and mental health professionals may not conduct a thorough assessment of an individual’s trauma history and the impact of trauma on their current systems. Very few clinics ask patients to complete Adverse Childhood Experiences questionnaires and without this information, they can easily miss the underlying trauma and diagnose a disorder instead.

5. Lack of trauma-informed care: Medical and mental health professionals may not be trained in trauma-informed care, which is an approach that recognizes and responds to the effects of trauma on individuals. Without this training they may not recognize the signs of trauma and may misdiagnose trauma responses as disorders.

Mental health disorder or trauma response? How to tell the difference

Misdiagnosis of trauma responses as disorders can result in inappropriate treatment, including medication that may not address the underlying trauma when medical and mental health professionals lack a comprehensive understanding of trauma and trauma-informed care. Accurate recognition of symptoms and appropriate psychotherapeutic treatment often results in positive outcomes for clients and helps them to resolve trauma, create healthy relationships and build meaningful lives.

Developmental trauma, also known as Complex Trauma, refers to a type of trauma that occurs during childhood, typically resulting from abuse, neglect, or other adverse experiences that disrupt a child's sense of safety, security, and attachment. This type of trauma can have long-lasting effects and can impact adult relationships in a variety of ways.

Why trauma responses are misdiagnosed as mental health disorders

1. Attachment Styles: Children who experience trauma may develop insecure attachment styles. They may struggle with feelings of abandonment or rejection, leading to anxious attachment or avoidant attachment patterns, which can carry over into their adult relationships. Individuals with anxious attachment styles may have a fear of abandonment and may become clingy or needy in relationships, while those with avoidant attachment styles may struggle with intimacy and may distance themselves emotionally, which can lead to difficulties forming and maintaining long-lasting relationships.

2. Sense of Self: Developmental trauma can also impact adult relationships by influencing how individuals view themselves and others. Individuals who have experienced trauma often struggle with trust, especially if the trauma was caused by someone close to them and may view others as untrustworthy. They may also have low self-esteem and struggle with feelings of worthlessness or shame, which can make it difficult to form healthy, supportive relationships.

3. Emotional Regulation: Finally, developmental trauma can impact adult relationships by affecting individuals' ability to regulate their emotions. Children who experience trauma may not learn healthy coping mechanisms for dealing with stress and may develop maladaptive coping mechanisms, such as substance abuse or self-harm. These coping mechanisms can carry over into adulthood and can impact relationships by making it difficult to communicate effectively, manage conflicts, or regulate emotions during times of stress.

Trauma response or mental health disorder? How to tell the difference

Developmental trauma can have a significant impact on adult relationships, and individuals who have experienced trauma may benefit from therapy or other forms of support to help them heal and develop healthy relationships. Often, however, adults who have experienced childhood trauma find traditional psychotherapy methods ineffective, and sometimes even harmful. There are several potential reasons for this:

1.Developmental trauma affects the brain and body: Trauma during childhood, when the brain and nervous system are still developing, results in changes in behaviour, emotions, and thinking patterns. Traditional cognitive psychotherapies that rely on the client’s ability to remember and process events and their reactions to them are often not able to address these complex, deep-seated issues that result from traumas that are pre-verbal or occurred before the pre-frontal cortex was fully formed.

2.Trauma is stored differently in the brain: Traumatic experiences are often stored differently in the brain than non-traumatic experiences, making it difficult for individuals to access and process them in traditional psychotherapy.

3. The impact of trauma is pervasive: Developmental trauma can impact many aspects of an individual’s life, including their sense of self, their worldview, and their ability to regulate emotions. Traditional psychotherapy may not be enough to address these pervasive effects of trauma.

4.Therapy can be retraumatizing: Traditional psychotherapy may inadvertently retraumatize individuals who have experienced developmental trauma if not approached in a careful and trauma-informed manner.

How trauma responses are misdiagnosed as mental health disorders

As a result, specialized approaches that incorporate attachment, somatic, psychodynamic, and relational models altogether may be more effective for individuals who have experienced developmental trauma than traditional Freudian modalities. These therapies, including the NeuroAffective Relational Model (NARM), are designed to address the unique challenges and needs of individuals who have experienced prolonged and repeated exposure to trauma during childhood.

The NeuroAffective Relational Model (NARM) is a therapeutic approach developed by Dr. Laurence Heller that is designed to address the impact of developmental trauma on adult individuals. NARM is based on the premise that developmental trauma can lead to chronic patterns of disconnection and dysregulation in the nervous system which can lead to difficulties with relationships, emotions, and self-regulation.

NARM is an integrative approach that draws on principles from psychodynamic, somatic, and relational therapies. It emphasizes the importance of the therapist-client relationship and focusses on helping clients develop greater awareness of their nervous system states and how they impact their behaviour and relationships.

The NARM approach is designed to help clients develop skills to regulate their nervous system, build resilience, and re-establish healthy attachment relationships. It also addresses the impact of social and cultural factors on the development of trauma and emphasizes the importance of addressing these factors in the therapeutic process.

NARM therapy typically involves a combination of talk therapy and body-based interventions to help clients access and process traumatic memories and emotions in a safe and supportive environment. It aims to help clients develop a greater sense of self-awareness, self-compassion, and connection with others.

Trauma-focused psychotherapy can help clients with diagnosed disorders to reduce their medication use and change problem behaviours. Many patients with trauma related diagnoses such as anxiety disorders are prescribed antidepressants or anti-anxiety medications to help manage their symptoms. While medications can be helpful for some patients, it is not a long-term solution and may have unwanted side effects.

Your mental health disorder may actually be a trauma response

Psychotherapy for developmental trauma, especially evidence-informed modalities like NARM, can help clients address the underlying causes of their symptoms and develop coping strategies to manage them without relying on medication, maladaptive behaviours, or substance use.

Research has shown that psychotherapy for trauma can be just as effective, if not more effective than medication in reducing symptoms of PTSD and other trauma-related disorders. In fact, some studies have found that individuals who receive psychotherapy for trauma are more likely to experience long-term improvement compared to those who received medication alone.

It is important to note that medication can be helpful for some people, especially those with severe symptoms or co-occurring disorders. However, trauma-focused psychotherapy can be a valuable adjunct to medication or an alternative for individuals who prefer to avoid medication use.

If you have been diagnosed with a disorder and the diagnosis does not sit well with you, or if you believe that you may have experienced developmental trauma, it may be helpful for you to visit a trauma-informed mental health professional to see if psychotherapy is right for you.

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