Trauma or Drama: A Predictive Processing Perspective on the Continuum of Stress

Abstract

The notion of psychological trauma has been liberally used both in clinical literature and general discourse. However, no consensus exists on its exact meaning and definition. Whereas traditionally trauma has been mostly associated with criterion A of acute and posttraumatic stress disorders (PTSDs) as defined in the Diagnostic and Statistical Manual of Mental Disorders , many researchers find this definition too constraining and not accounting for the complexity and many aspects of trauma. This touched off a quest for a broader more accommodating trauma concept, and a dimensional view of trauma with PTSD as its extreme manifestation has been suggested. The dimensional view also has its detractors arguing that “conceptual bracket creep” may undermine the category’s utility. Both categorical and dimensional views mostly rely on trauma’s clinical phenomenology and lack a unified theoretical basis. In an attempt to reconcile this contradiction, a hybrid categorical–dimensional model of trauma based on the general theory of stress has been recently proposed ( Krupnik, 2019 ). Herein, I explore the categorical boundary of the trauma concept, as posited by the model, within the predictive processing framework (PPF). I integrate the PPF view with the theory of stress. In conclusion, I briefly discuss how the proposed model of trauma may guide clinical practice.

Depression as a Failed Anxiety: The Continuum of Precision-Weighting Dysregulation in Affective Disorders

“…In this view, any stress response starts with rising anxiety. As mentioned above, ASR is believed to be associated with hyper-precise exteroceptive and interoceptive priors (Figure 1B), and so is TSR only to a higher degree (Figure 1A) due to an abrupt recalibration of threat priors in response to trauma (Krupnik, 2020b). Thus, on the precision-weighting dysregulation continuum, ASR takes place between DSR and TSR (Figure 1).…”

“…Type 2 refers to the situation of chronic stress that creates a drift away from the initial homeostatic state without triggering gradual drigt an emergency response. In a recent model of the stress continuum, stress response is subdivided into normative, pathogenic, and traumatic stress responses (Krupnik, 2019b(Krupnik, , 2020b 1 . Normative stress response (NSR) is defined as a response to an environmental disturbance where the organism returns to the initial homeostatic state.…”

“…In pathogenic stress response (PSR), the organism experiences allostatic overload type 2 and undergoes allostasis to a new sub-optimal homeostatic state, whereas in traumatic stress response (TSR), the organism experiences allostatic overload type 1 with the ensuing breakdown of self-regulatory functions and a transition to a PTSD-like state. The distinction between PSR and TSR was suggested to reflect the difference between adversity and trauma (Krupnik, 2019b(Krupnik, , 2020b. In this model, a stress reaction with prolonged high anxiety or depression falls within PSR.…”

“…A contrast has recently been drawn between precisionweighting dysregulation in the depressive (DSR) vs. traumatic (TSR) stress response (Krupnik, 2020b). It was proposed that unlike the depressive generative model where iPEs are underweighted in the context of overweighted ePEs, the traumatic generative model underweights both iPEs and ePEs.…”

“…The range of allostasis and allostatic load were proposed as the axes determining the continuum of stress response(Krupnik, 2020b).…”