Nonpathological response to ongoing traumatic stress

For individuals faced with ongoing traumatic stress, a range of adverse reactions are possible. Carrying over models from acute trauma, developed for soldiers suffering months and years after returning from combat, and for victims of rape and other community violence, most psychological literature emphasizes psychopathological syndromes, especially posttraumatic stress disorder (PTSD). The implicit assumption is that reactions that entail significant suffering must be explained by a diagnosable disorder. Ironically, this locates the mechanisms that explain ongoing suffering within the mind of the victim rather than in the stressful context in which s/he is forced to live. We present a description and venture theoretical consideration of an alternative phenomenon, which we refer to as ongoing traumatic stress response (OTSR). OTSR is not a diagnosis nor label, but an alternative framework through which to make sense of intense psychological suffering in the increasingly common situation of ongoing traumatic stress. In this article, we consider conceptual boundaries that distinguish pathologic reactions such as PTSD from nonpathologic reactions better captured by OTSR. We draw a distinction between PTSD, which is conceptualized as a disorder because it is driven primarily by internal psychological effects of a past trauma, and OTSR, which is determined by real and external environmental factors in the present. To illustrate these boundaries, we provide examples of how experiences and behaviors that may appear to reflect symptoms of PTSD or other disorders are actually adaptive and normative under extreme conditions, despite their causing clinical levels of distress.