Preamble and Acknowledgements

Preamble

Posttraumatic stress disorder (PTSD) is a potentially disabling condition that is now a widely recognized public health issue, particularly among public safety personnel (PSP). A recent study conducted by Carleton et al. (2018) investigated the proportion of Canadian PSP reporting symptom clusters consistent with various mental disorders. The results indicated that 23.2% of the total sample screened positive for PTSD (in contrast, estimates of the prevalence of PTSD among the general population range from 1.1 to 3.5%). PTSD and other mental disorders are concerning for all Canadians; nevertheless, the Federal Framework on Post-traumatic Stress Disorder Act was introduced to address the “clear need for persons who have served as first responders, firefighters, military personnel, corrections officers and members of the RCMP to receive direct and timely access to PTSD support.” The Act called for the creation of a federal framework on PTSD. The Public Health Agency of Canada (PHAC) was mandated to lead the implementation of the Act. Early on, the need for a glossary of terminology around psychological trauma became clear and, in collaboration with PHAC and other partners, the Canadian Institute for Public Safety Research and Treatment (CIPSRT) led the development of the glossary.

Assembling a glossary of terms that describes mental health and mental health conditions is a significant challenge. No universally accepted list works for every person and every situation. Words used to describe mental health and mental health conditions have different meanings for different people in different contexts. Therefore, there is a need for a glossary that makes the evolving language of PTSD and related terms accessible to everyone. Such a resource provides a common language that various stakeholders (e.g., researchers, health professionals, PSP) can use to communicate more effectively.

Health professionals use words very carefully to describe the signs, symptoms, and diagnoses of mental disorders. Careful use of language helps professionals to summarize complex sets of signs and symptoms, connecting patients with treatments most likely to help them. Careful use of language also helps researchers working to develop better tools for assessment, treatment, diagnosis, and prevention. The Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2013) and the International Classification of Diseases (ICD; World Health Organization, 2018) each provide widely used criteria for diagnosing mental disorders.

The language used to describe various aspects of mental health and mental health conditions is continuously being refined. The definitions we offer in the current version of the Glossary may not yet reflect unanimous consensus by the contributors to the current document, because in some cases there is significant debate about definitions; however, in all cases we have tried to provide the most balanced and collaborative definition possible. Currently, only four terms in the current glossary are diagnostic categories in the current editions of the DSM or ICD: Burnout, Acute Stress Disorder (ASD), Posttraumatic Stress Disorder (PTSD), and Complex PTSD (C-PTSD). Many other related terms are currently in use, with varying degrees of support.

Separate definitions have been included for terms that are frequently used colloquially, many of which are often used inappropriately or could be subsumed within the definitions of other terms. Such terms have been included as part of an effort to help shift towards more accurate and less stigmatizing language. As the language shifts, we expect the less appropriate terms to drop from use. In the interim, suggestions have been made for alternative terms that would be more accurate or less stigmatizing, and in some cases we have explicitly recommended an alternative term because of historically inappropriate use, stigma, or confusion.

The use of language for mental health and mental health conditions often differs among professionals from various disciplines, and many words used in professional contexts have different meanings for people who are not health professionals. In addition, many cultural factors shape how we think about mental health and mental health conditions including values, preferences, clinical experience, and research results. For example, in recent years, the word “injury” has been used more often by many people to describe some mental health conditions, replacing the term “disorder,” which has important meaning for health professionals. On the one hand, the word “injury” helps to diminish stigma that can accompany the term “disorder.” On the other hand, the word “disorder” has a deep meaning for health professionals that communicates important information about a person’s condition, functional limitations, and optimum treatment.

The current Glossary is intended to promote a shared understanding of many of the common terms that are used to describe mental health and mental health conditions arising in the context of exposure to potentially psychologically traumatizing events and stressors. The intent is part of an ongoing effort to bridge any gaps that may exist between health professionals and the diverse communities they serve. The current Glossary focuses on Posttraumatic Stress Disorder and closely related terms, but that should not be misinterpreted as indicating other mental health conditions that can be caused by exposure to one or more potentially psychologically traumatic events, such depression, anxiety, psychosis, substance related harms, and suicide, to name only a few, are less important. As the fields of mental health and mental health conditions are ever-changing; the current Glossary is a “living document” that will be revised over time to reflect new understandings.

Preamble References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders( 5^th ed.). Arlington, VA: American Psychiatric Association.

Carleton, R. N., Afifi, T. O., Turner, S., Taillieu, T., Duranceau, S., LeBouthillier, D. M., Sareen, J., Ricciardelli, R., MacPhee, R. S., Groll, D., Hozempa, K., Brunet, A., Weekes, J. R., Griffiths, C. T., Abrams, K. J., Jones, N. A., Beshai, S., Cramm, H. A., Dobson, K. S., Hatcher, S., Keane, T. M., Stewart, S. H., & Asmundson, G. J. G. (2018). Mental disorder symptoms among public safety personnel in Canada. Canadian Journal of Psychiatry,63(1), 54-64. doi: 10.1177/0706743717723825

World Health Organization. (2018). Canadian coding standards for version 2018 ICD 11. Canada: World Health Organization.

Acknowledgements

CIPSRT is extremely grateful to all the contributors who assisted in the creation of this resource. We wish to highlight four individuals who went above and beyond to ensure the success of this document. Special thanks to: Alexandra Heber, James Thompson, Valerie Testa, and Kadie Hozempa.

Special thanks to Veterans Affairs Canada, the Canadian Institute for Military and Veteran Health Research (CIMVHR), Public Safety Canada, and the Public Health Agency of Canada for your support making this resource a reality. In addition, we would like to thank our contributor’s employers and universities who allowed committee members the time needed to complete this resource.

CIPSRT is grateful to the following individuals and organizations for their contributions to the development of this Glossary: CIPSRT is grateful to the following individuals and organizations for their contributions to the development of this Glossary:

[Alphabetically by last name]

Dr. Gordon Asmundson, Ph.D. R.D. Psych., Professor of Psychology, University of Regina; Fellow, Royal Society of Canada; Editor-in-Chief, Cognitive Behaviour Therapy

LCol Suzanne Bailey, Senior Social Work Officer, Social Work & Mental Health Training, Canadian Forces Health Services Group Head Quarters, Canadian Armed Forces

Dr. Suzette Brémault-Phillips, OT, Ph.D., DCA, Associate Professor, Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta; Director, HiMARC (Heroes in Mind, Advocacy and Research Consortium), University of Alberta

Dr. R. Nicholas Carleton, Ph.D., R.D. Psych., Professor of Psychology, University of Regina; Scientific Director, Canadian Institute for Public Safety Research and Treatment, University of Regina

Dr. Lina Carrese, Psy.D., Chief Psychologist, Mental Health Strategic Planning, Veterans Affairs Canada

Dr. Susan T. Dowler, Ph.D., C.Psych., Chief Clinical Psychologist, Canadian Forces Health Services Group Headquarters, Department of National Defence, Ottawa, Ontario

Dr. Deniz Fikretoglu, Ph.D., Defence Scientist, Defence Research and Development Canada, Toronto Branch, Individual Behaviour and Performance Section

Shelley Hale, RSSW, Director, Patient Care Services, Operational Stress Injury Clinic, Royal Ottawa Mental Health Centre

Dr. Kyle Handley, Lead Psychologist, York Regional Police, Chair of the Canadian Association Chiefs of Police Psychological Services Committee

Dr. Simon Hatcher, MMedSC MD FRCPC FRANZCP MRCPsych., Vice-Chair, Department of Psychiatry, University of Ottawa; Scientist, Ottawa Hospital Research Institute

LCol (Ret’d) Alexandra Heber MD. FRCPC., Chief of Psychiatry, Veterans Affairs Canada; Assistant Professor, Department of Psychiatry, University of Ottawa

Dr. Marnin J. Heisel, Ph.D., C.Psych., Associate Professor, Departments of Psychiatry and of Epidemiology & Biostatistics, University of Western Ontario; Scientist, Lawson Health Research Institute, London, Ontario

Kadie Hozempa, B.A. (Hons.), Research Project Coordinator, Canadian Institute for Public Safety Research and Treatment, University of Regina

Dr. Vivien Lee, Ph.D., C.Psych., Psychologist, Founder, Centre for Trauma Recovery & Growth; Clinical Advisor, Boots on the Ground, Toronto Beyond the Blue, Wounded Warriors Canada, Toronto, Ontario

Dr. Megan McElheran, PsyD., Clinical Psychologist, WGM Psychological Services, Calgary, Alberta

Dr. Ron Martin, Ph.D., R.D. Psych., Professor of Psychology, University of Regina

Dr. Rosemary Ricciardelli, Ph.D., Professor of Sociology; Coordinator for Criminology & Co-Coordinator for Police Studies, Department of Sociology, Memorial University of Newfoundland

Dr. J. Don Richardson, MD. FRCPC., Consultant Psychiatrist, Physician Lead, St. Joseph’s Operational Stress Injury Clinic, Parkwood Institute; Scientific Director MacDonald/Franklin OSI Research Centre; Associate Professor – Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University; Associate Scientist, Lawson Health Research Institute; Assistant Clinical Professor, Department of Psychiatry & Behavioural Neuroscience, McMaster University

Dr. Maya Roth, Ph.D., C.Psych., Clinical Lead and Psychologist, St. Joseph’s Operational Stress Injury Clinic – Greater Toronto Site; Associate Member, Yeates School of Graduate Studies, Ryerson University; Associate Scientist, Lawson Health Research Institute, London, Ontario

Valerie Testa, MSc(c), B.Ed., B.A. (Hons.), OCT, CCRP, Senior Clinical Research Associate, Clinical Epidemiology Program, Ottawa Hospital Research Institute; Special Advisor to the Scientific Director, CIPSRT; Interdisciplinary School of Health Sciences, University of Ottawa

Dr. James M. Thompson, MD. CCFP. (EM.) FCFP., Adjunct Associate Professor, Department of Public Health Sciences, Queens University; Research Medical Consultant, Canadian Institute for Military and Veteran Health Research

Dr. Anne C. Wagner, Ph.D., C.Psych., Adjunct Professor, Department of Psychology, Ryerson University; Founder, Remedy

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