DSC01366 - Version 2Here’s a quiz about what types of exposures lead to secondary trauma (assume they meet the other symptom criteria). See if you can identify which people had the type of experiences that lead to secondary trauma.

A. Homicide detective has been working murder scenes for several years. Lately, images from several cases keep popping up as he goes about his daily routine.

B.  A man who observed his father beating his mother repeatedly now struggles to connect with women he’s dating, and has poor emotional regulation.

C. Sexual assault hotline counselor has been having nightmares and is suspicious of men she encounters.

D. You felt anxious for weeks after the 9/11 attacks

E. A man supports his girlfriend after she’s been assaulted, including hearing her tell her story a few times. Now he experiences bouts of rage at small inconveniences.

The only people who have been exposed to vicarious trauma in the professional sense (DSM V criteria A.4) are the individuals in A and C. For more information about the other scenarios, read on.

Both of the individuals in A and C have been repeatedly exposed to traumatic stories in a professional capacity. First responders, therapists, volunteer counselors and advocates, even morgue technicians who collect bodies are not only exposed to trauma, but they become engaged in it—supporting survivors, solving mysteries, investigating circumstances. Research has been inadequate-both sparse and with measures don’t seem to reflect the impact– and we need to learn more about what’s happening

 

 

Why not B?

Our fellow in B is actually a primary survivor of trauma. I’ve seen therapists get confused by this, so it’s important to talk about it. When a child’s caregiver is threatened, they experience this as a threat to themselves. Also, the fact that another caregiver is inflicting the harm presumably in the child’s home can cause further attachment trauma, because now both a person and setting are unsafe at a time when the child is learning how to trust and negotiate relationships. This guy is a trauma survivor, period.

Why not D?

Next, 9/11 trauma. For now, the DSM still doesn’t count events we’ve seen on television, whether they are fact or fiction. However, if you did notice some traumatic stress symptoms after, say, the Boston marathon bombing or Newtowne, no one is saying that those symptoms aren’t real or shouldn’t be addressed. Clearly, big events can leave our nation feeling collectively anxious, and I definitely think they can trigger a latent trauma response from personal past events, it’s just that trauma experts would either consider the personal event the trigger, or would consider the trauma response something besides PTSD.

Why not E?

PTSD can occur to individuals who learn that a loved one has been exposed to death or injury. And to make it more complicated, it’s often called secondary trauma and sometimes we do call these individuals secondary survivors. It’s an important group of trauma survivors, and they need more support and research. That said, they actually have their own section in the PTSD definition, separate from professionals. Why? Because it’s a different kind of exposure, and a different kind of impact. Not less real or important, just different.