Not Everything Is Trauma

Why psychology does not have to minimise suffering in order to take human resilience seriously

Trauma has become a word for almost everything.

A breakup is trauma. So is a difficult childhood. Avoiding conflict becomes a trauma response. People pleasing, perfectionism, fear of intimacy, exhaustion or the feeling of not having been seen as a child are quickly explained online as consequences of unresolved trauma.

There is something genuinely useful about people having language for experiences that were dismissed for a long time. Emotional neglect, chronic insecurity and violence can have profound effects. The problem starts when a clinical concept expands so far that it barely excludes anything.

Psychologist Nick Haslam calls this process “concept creep”. Together with Melanie McGrath, he has traced how the concept of trauma has broadened over time: from extraordinary events to ordinary adversity, and from direct exposure to increasingly indirect forms of harm.

Joel Paris makes the same criticism very clearly in his 2023 book Myths of Trauma: Why Adversity Does Not Necessarily Make Us Sick.

“Trauma has become a catchword for many kinds of adverse experiences.”

Joel Paris, Myths of Trauma (2022)

For Paris, this does not mean that severe experiences are unimportant. Quite the opposite. His book opens by stating explicitly that events such as rape or shootings can lead to serious psychopathology. His central question is different: why do some people develop a mental disorder after such experiences while others recover?

Adversity is not the same thing as trauma. Exposure to a potentially traumatic event is not the same thing as PTSD. And a difficult life history does not automatically explain how a person thinks, feels and behaves decades later.

Joel Paris, Myths of Trauma: Why Adversity Does Not Necessarily Make Us Sick (Oxford University Press, 2022)

An adverse event is not the same thing as PTSD

Epidemiological data show a striking gap between exposure and disorder.

In the World Mental Health Surveys, around 70 percent of respondents reported having experienced at least one potentially traumatic event during their lifetime. Lifetime prevalence of PTSD was much lower: 3.9 percent in the general population and 5.6 percent among people who had been exposed to such an event. Risk varies substantially depending on the type of event and is notably higher following interpersonal violence.

“PTSD is a real thing. Some people definitely have it, but it’s been wildly exaggerated.”

Joel Paris, interview

Most people exposed even to severe events do not develop PTSD, Paris continues. Other risk and protective factors matter.

In his book, he makes the same point: traumatic exposure is a necessary condition for PTSD, but exposure alone is not sufficient. Psychological outcomes arise through an interaction of biological, psychological and social factors.

ICD-11 therefore defines PTSD relatively narrowly. Its core features include re-experiencing the event in the present, avoiding reminders of it, and a persistent sense of current threat. Symptoms must also significantly impair everyday functioning.

Feeling sad, mistrustful or unsettled for a period after a severe experience does not in itself meet those criteria.

This distinction matters because it influences whether difficult human reactions are understood as painful but changeable, or as evidence that something inside a person has been permanently damaged.

Why do people respond so differently?

One of the most important variables is personality.

Paris has spent decades studying personality disorders and points in particular to neuroticism, one of the Big Five personality dimensions. People high in neuroticism tend to react more strongly to negative events, experience negative emotions more intensely and take longer to return to baseline.

“Personality is about individual differences and about how the same situation can produce totally different reactions in different people.”

Joel Paris, interview

For Paris, those differences are precisely why it is too simple to search for one event that explains everything that follows.

In Myths of Trauma, he describes research from his own group involving 56 women with borderline personality disorder and their sisters. Although the siblings had grown up in the same families and reported many similar adverse experiences, only three pairs were concordant for BPD. Paris points to differences in personality profiles as part of the explanation.

This does not mean that environment is unimportant. It means that the same environment does not produce the same outcome in every person.

Alongside personality, the nature and duration of the event, previous mental health difficulties, earlier adversity, social support and the circumstances following an event all matter. Rape or years of violence in a relationship are not equivalent to a breakup or an emotional slight.

The biopsychosocial model is more complicated than the equation “bad experience equals trauma”. That is exactly why it explains more.

Adaptation is not automatically pathology

This distinction becomes especially important for people who grew up in chaotic, unsafe or emotionally neglectful families.

A child may learn to monitor other people’s moods closely. To avoid conflict. To put their own needs aside. To withdraw or to depend on others as little as possible.

Those strategies can create problems later in life. That does not automatically make them symptoms of a trauma disorder.

In the interview, Paris points out that emotional neglect can make it harder for children to regulate emotion and move through negative experiences. He frequently sees such histories in people with personality disorders without assuming that classic trauma must be present.

That distinction matters.

People pleasing may have been learned because disagreement regularly triggered anger at home. Withdrawal may once have been the simplest way to avoid conflict. Heightened vigilance may have developed in an unpredictable environment.

These reactions can be taken seriously without automatically turning them into a psychiatric diagnosis.

And that also creates more room for action. A learned pattern may still be persistent, but it is different to understand it as something acquired and no longer useful than to understand it as the inevitable expression of a permanently damaged nervous system.

Complex PTSD and the question of the best explanation

The debate becomes particularly contentious around complex PTSD.

ICD-11 recognises CPTSD as a separate diagnosis. In addition to the core symptoms of PTSD, a person must show difficulties in emotion regulation, a persistently negative self-concept and substantial problems in relationships.

Paris is strongly critical of the diagnosis. He sees major overlap with personality disorders, particularly borderline personality disorder, and warns against explaining complex difficulties almost entirely through a trauma history.

In his concluding chapter, he argues that a heavy focus on traumatic events can draw attention away from current skills, personality and functioning.

Research does not support simply equating CPTSD with borderline personality disorder. Studies find both overlap and distinguishable symptom profiles. CPTSD is more typically associated with a persistently negative self-concept, relational withdrawal and emotion-regulation difficulties. Borderline personality disorder more typically includes intense fear of abandonment, an unstable sense of self, impulsivity and highly unstable relationships.

The more useful clinical question is therefore not which label feels most personally convincing. It is which problems are actually present, what maintains them and what follows for treatment.

A diagnosis should help clarify a problem. It should not have to explain an entire biography.

When an explanation becomes an identity

This leads to another problem in popular trauma culture.

People look for explanations for things they do not understand about themselves. That is entirely understandable. If someone has struggled for years with relationships, fear, shame or self-worth and suddenly finds a description that seems to make everything fit, the relief can be enormous.

In the interview, Paris describes that moment almost casually: you read one feature and think, “That sounds like me. Bingo. Now somebody’s finally explained me.”

But recognition is not the same thing as diagnosis.

Many psychological complaints are nonspecific. Rumination, exhaustion, emotional reactivity, attachment difficulties or self-doubt appear across multiple disorders and also outside mental illness.

The internet can amplify this process. Paris notes that people find communities in which the same terms and explanatory models are repeatedly reinforced, which can strengthen attachment to a particular diagnosis.

Research on event centrality is also relevant here. The more strongly an adverse event becomes central to a person’s identity and life story, the stronger PTSD symptoms tend to be on average. Longitudinal findings also suggest that high event centrality can predict later symptoms.

That does not mean people should suppress their history. Processing an experience and organising one’s entire identity around it are two different things.

Childhood matters. Development continues.

Early experiences matter. Paris does not dispute that.

Children who lack reliable emotional support develop under different conditions from children whose caregivers are available and predictable. Severe neglect can have long-term consequences.

But even under very poor starting conditions, later development is not fully predetermined.

A well-known example comes from the long-term studies of English and Romanian adoptees. Some of these children spent their first months or years in severely deprived Romanian institutions. Longer institutional deprivation was associated with elevated risks that persisted into adulthood. At the same time, many children made substantial developmental gains after moving into stable families.

Paris discusses the same studies in the interview. For him, they show how much can change when the environment changes.

Personality itself is not immutable either. Longitudinal research shows average changes across adulthood, including increases in conscientiousness and emotional stability.

Paris observed something similar over decades of clinical work. Many of his patients were substantially more stable at 30 than they had been at 15 or 20, he says near the end of the conversation. Personality has continuity, but it is not static.

Acceptance does not mean forgiveness

What does this mean for people who have genuinely been harmed?

In the interview, Paris refers to a concept from Marsha Linehan’s dialectical behaviour therapy: radical acceptance.

It does not mean approving of wrongdoing. It does not mean forgiving a perpetrator, restoring contact or producing compassion for someone who harmed you.

It means acknowledging that something happened and that it cannot be undone now.

Paris says many patients initially struggle with the term because they confuse acceptance with forgiveness. What it means, in his view, is becoming future-oriented again rather than remaining permanently organised around past experiences.

The same principle appears in Myths of Trauma. Treatment, he argues, should give greater priority to present functioning and the future. The past cannot be changed. A person’s current life can.

Agency instead of permanent damage

This brings the conversation to a point that may matter more than the entire argument about terminology.

Agency.

“I think the idea of agency is the key to resilience for many, many people.”

Joel Paris, interview

Agency means experiencing your life as more than the result of what happened to you. It means acting on the parts of your current circumstances that can still be changed.

That may involve leaving a relationship. Changing jobs. Reducing contact with people who repeatedly harm you. Accepting support. Learning different behaviours. Building an environment in which old protective strategies are no longer required all the time.

Paris is therefore critical of therapies that spend long periods focused almost exclusively on the past. In his view, an excessive focus on trauma narratives can weaken a person’s sense of competence and agency.

That does not mean ignoring the past. Understanding why you react the way you do often requires looking back.

But understanding and changing are not the same task.

Not less compassion, but more precision

Criticism of the expanding trauma concept is quickly interpreted as an attempt to minimise suffering.

That is not the point.

Rape can lead to PTSD. Years of violence can have severe psychological effects. Emotional neglect can shape development. People may need protection and, at times, professional treatment.

But the reverse also matters: not every injury leads to mental disorder. Not every difficult behaviour is a trauma response. Not every difficult childhood determines adult life. And not every explanation we recognise ourselves in is therefore the right one.

In the final chapter of Myths of Trauma, Paris emphasises one of the most consistent findings in the research: resilience after adversity is common rather than exceptional.

That may be one of the facts most easily lost in the public discussion.

People can be deeply hurt and continue to develop. They can carry consequences and still build functioning lives. Personality changes. Environments change. People learn.

We are shaped by what happened to us. We are not defined by it.

Sources and further reading

Berntsen, D., & Rubin, D. C. (2006). The centrality of event scale: A measure of integrating a trauma into one’s identity and its relation to post-traumatic stress disorder symptoms. Behaviour Research and Therapy, 44(2), 219–231. https://doi.org/10.1016/j.brat.2005.01.009

Boals, A., & Ruggero, C. (2016). Event centrality prospectively predicts PTSD symptoms. Anxiety, Stress, & Coping, 29(5), 533–541. https://doi.org/10.1080/10615806.2015.1080822

Bonanno, G. A., Chen, S., & Galatzer-Levy, I. R. (2023). Resilience to potential trauma and adversity through regulatory flexibility. Nature Reviews Psychology, 2(11), 663–675. https://doi.org/10.1038/s44159-023-00233-5

Galatzer-Levy, I. R., Huang, S. H., & Bonanno, G. A. (2018). Trajectories of resilience and dysfunction following potential trauma: A review and statistical evaluation. Clinical Psychology Review, 63, 41–55. https://doi.org/10.1016/j.cpr.2018.05.008

Haslam, N. (2016). Concept creep: Psychology’s expanding concepts of harm and pathology. Psychological Inquiry, 27(1), 1–17. https://doi.org/10.1080/1047840X.2016.1082418

Haslam, N., & McGrath, M. J. (2020). The creeping concept of trauma. Social Research: An International Quarterly, 87(3), 509–531. https://doi.org/10.1353/sor.2020.0052

Karatzias, T., Bohus, M., Shevlin, M., Hyland, P., Bisson, J. I., Roberts, N. P., & Cloitre, M. (2023). Distinguishing between ICD-11 complex post-traumatic stress disorder and borderline personality disorder: Clinical guide and recommendations for future research. The British Journal of Psychiatry, 223(3), 403–406. https://doi.org/10.1192/bjp.2023.80

Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., Degenhardt, L., de Girolamo, G., Dinolova, R. V., Ferry, F., Florescu, S., Gureje, O., Haro, J. M., Huang, Y., Karam, E. G., Kawakami, N., Lee, S., Lépine, J.-P., Levinson, D., … Koenen, K. C. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8(sup5), Article 1353383. https://doi.org/10.1080/20008198.2017.1353383

Koenen, K. C., Ratanatharathorn, A., Ng, L., McLaughlin, K. A., Bromet, E. J., Stein, D. J., Karam, E. G., Ruscio, A. M., Benjet, C., Scott, K., Atwoli, L., Petukhova, M., Lim, C. C. W., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Bunting, B., Ciutan, M., de Girolamo, G., … Kessler, R. C. (2017). Posttraumatic stress disorder in the World Mental Health Surveys. Psychological Medicine, 47(13), 2260–2274. https://doi.org/10.1017/S0033291717000708

Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.

McElroy, E., Shevlin, M., Murphy, S., Roberts, B., Makhashvili, N., Javakhishvili, J., Bisson, J. I., Ben-Ezra, M., & Hyland, P. (2019). ICD-11 PTSD and complex PTSD: Structural validation using network analysis. World Psychiatry, 18(2), 236–237. https://doi.org/10.1002/wps.20638

Ogle, C. M., Siegler, I. C., Beckham, J. C., & Rubin, D. C. (2017). Neuroticism increases PTSD symptom severity by amplifying the emotionality, rehearsal, and centrality of trauma memories. Journal of Personality, 85(5), 702–715. https://doi.org/10.1111/jopy.12278

Paris, J. (2022). Myths of trauma: Why adversity does not necessarily make us sick. Oxford University Press. https://doi.org/10.1093/med/9780197615768.001.0001

Roberts, B. W., Walton, K. E., & Viechtbauer, W. (2006). Patterns of mean-level change in personality traits across the life course: A meta-analysis of longitudinal studies. Psychological Bulletin, 132(1), 1–25. https://doi.org/10.1037/0033-2909.132.1.1

Sonuga-Barke, E. J. S., Kennedy, M., Kumsta, R., Knights, N., Golm, D., Rutter, M., Maughan, B., Schlotz, W., & Kreppner, J. (2017). Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: The young adult follow-up of the longitudinal English and Romanian Adoptees study. The Lancet, 389(10078), 1539–1548. https://doi.org/10.1016/S0140-6736(17)30045-4

World Health Organization. (2024, May 27). Post-traumatic stress disorder. https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder

About the interview

In this episode of Reclaim Your Reality, I speak with Prof. Dr. Joel Paris about the expanding concept of trauma, PTSD and CPTSD, personality and individual vulnerability, emotional neglect, resilience, radical acceptance and personal agency.

https://youtu.be/yNUI475qJCg