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Preamble and Acknowledgements

Background

Posttraumatic stress disorder (PTSD) is a potentially disabling condition that is now widely recognized as a public health issue.1 PTSD and other mental disorders are more common among first responders and other public safety personnel (PSP), Canadian Armed Forces members, Veterans, and health care personnel than among the general population in Canada.2 The COVID-19 pandemic increased our reliance on the health care workers and public safety personnel and took an additional toll on their physical, mental, and emotional health.3

In 2018, the Federal Framework on Post-Traumatic Stress Disorder Act (Act C-211) was passed by the Parliament of Canada 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.”4 Act C-211 is the only national government legislation, to the best of our knowledge, that acknowledges the importance of work-related risk factors that disproportionately affect the development of PTSD in certain occupations.

The Act also called for the creation of a federal framework on PTSD. The Public Health Agency of Canada (PHAC) was mandated to lead the development of this framework.4

Early in the development of the Federal Framework on Posttraumatic Stress Disorder: Recognition, collaboration and support,1 it was recognized that there was a need to identify relevant terminology in order to mobilize knowledge and increase understanding of the nature of PTSD. With PHAC and other national partners, the Chief Psychiatrist of Veterans Affairs Canada (VAC) and the Scientific Director of the Canadian Institute for Public Safety Research and Treatment (CIPSRT) led the development of the first version of the glossary of terms in 2019, for a national meeting organized to develop the Federal Framework on PTSD.

Prevalence of PTSD

The first nationwide research investigating the proportion of Canadian PSP reporting symptom clusters consistent with various mental disorders found that 23.2% of the total sample screened positive for PTSD.2 By contrast, estimates of the prevalence of PTSD in the general population range from 1.1% to 3.5%.2 Prior to the COVID-19 pandemic, pan-Canadian research, using the Carleton et al.1 online survey and the same psychiatric scales, reported rates of PTSD similar to those found in PSP among the regulated nurses (i.e. registered nurses, licensed practical nurses, registered practical nurses, registered psychiatric nurses, nurse practitioners) who participated in the survey, with almost one-quarter of respondents (23%) screening positive for current symptoms consistent with PTSD.5-7 Recent research suggests that since the start of the COVID-19 pandemic, rates of PTSD have increased among both health care providers and PSP.3

Evolution of the glossary of terms

Discussions around PTSD and related mental health conditions often lack a common language for people living and working in different contexts. This glossary is intended to bridge those gaps by promoting a shared understanding of many of the common terms used to describe mental health challenges arising from exposure to potentially psychologically traumatic events and stressors. Assembling and defining the terms that describe mental health and mental health conditions is a substantial challenge. No universally accepted list works for every person and every situation. In addition, words used to describe mental health and mental illness have different meanings for different people in different contexts. As the fields of psychiatry, psychology, mental health, and behavioural health are ever-changing, the glossary is a “living” document that will be revised over time to reflect new information and understanding. The list of key experts, partners, and stakeholders contributing to each iteration will also continue to evolve.

The first version of the glossary was planned and developed to facilitate open discourse among the many academics, researchers, clinicians, policy experts, non-governmental organization members, PSP, serving and veteran Canadian Armed Forces members, and people with lived experience of PTSD who attended the 2019 National Conference on PTSD; to assist in the development of the Federal Framework on Posttraumatic Stress Disorder;1 and to address key priority areas in Supporting Canada’s Public Safety Personnel: An action plan on post-traumatic stress injuries.8  A revised version of the glossary was released the same year, based on feedback on the first version, and version 2.1, with minor editorial revisions, was posted on the CIPSRT website in 2020.

Development of version 3.0 of the glossary began in 2021. Given the pandemic’s far-reaching effects on all facets of the health care and public safety workforce, the focus of this glossary has been expanded to include health care professionals as well as serving Canadian Armed Forces members and Veterans.

The glossary focuses on PTSD and closely related terms; the senior authors team have no intention of minimizing the importance of other mental health challenges (e.g. depression, anxiety, psychosis, substance misuse, and suicidality) that can arise from exposure to one or more potentially psychologically traumatic events.

Evolution of the terms

Clinicians use words with care to describe and summarize complex signs, symptoms, and diagnoses, and to connect patients and clients with the treatments most likely to help them. Careful use of language also helps researchers understand the need for and ways to develop better tools for the assessment, treatment, diagnosis, and mitigation of mental health problems. The Diagnostic and Statistical Manual of Mental Disorders (DSM 5-TR)9 and the International Classification of Diseases, 11th Revision (ICD-11)10 each provide widely used criteria for diagnosing mental disorders.

The language used to describe various aspects of mental health and mental illness is continually being refined. Approximately 20 terms have been added to version 3.0 of the glossary. Some of the terms have not been unanimously agreed upon by contributors, and debate about definitions is ongoing; regardless, in all cases we have provided the most balanced and collaborative definition possible. Only four terms are diagnostic categories in either the DSM-5-TR or ICD-11: burnout (only included in ICD-11), acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and complex PTSD (C-PTSD). Many related terms are in use, with varying degrees of support and shared understanding.

The glossary identifies terms that are frequently used colloquially or that could be subsumed within the definitions of other terms. These terms are included as part of an effort to shift towards more accurate and less stigmatizing language. In some cases, alternatives have been suggested, or explicitly recommended, because of historically inappropriate use, stigma, or confusion.

As mentioned previously, many terms have different meanings for people in fields other than health care. In addition, cultural factors, including values, preferences, clinical experience, and research results, shape how we think about mental health and mental illness. For example, “injury” is increasingly replacing “disorder” to describe some mental health conditions. On the one hand, this shift may help diminish the stigma associated with “disorder” by aligning the symptoms or experiences more closely with physical injuries, which are often considered more “acceptable” or “honourable.” On the other hand, “disorder” communicates important information to health care providers about a person’s condition, functional limitations, and the optimal lines of treatment.

The senior authors and contributors wrote version 3.0 to promote a shared understanding of the common terms used to describe mental health challenges arising from exposure to potentially psychologically traumatic events and stressors. We hope that this is the next step toward reducing stigma, increasing access to evidence-based care, and supporting improvements in the tools, training, and treatments intended to benefit all Canadians.

How to use this glossary

Terms in the current glossary are arranged alphabetically by the most commonly used synonym. Most of the terms have two complementary definitions: a “general public definition” or introductory definition, geared towards a wider readership, and an “academic definition,” which may be more detailed, or “expert.” There is some overlap between the definitions, and readers may choose to read either or both.

Acknowledgements

We thank the following partner organizations (in alphabetical order) for their support in making this resource a reality: the Atlas Institute for Veterans and Families, the Canadian Institute for Military and Veteran Health Research (CIMVHR), the Canadian Institute for Pandemic Health Education and Response (CIPHER), the Canadian Institute for Public Safety Research and Treatment (CIPSRT), Department of National Defence Terminology Board, McMaster University, the Public Health Agency of Canada, Queen’s University, and Veterans Affairs Canada. In addition, we would like to thank our contributors’ employers and universities who allowed their members the time needed to contribute to this glossary.

The senior authors team wishes to acknowledge all the people with lived experience and other stakeholders who dedicated their time and provided thoughtful contributions in collaboratively defining military sexual trauma.

The senior authors team is grateful to the following individuals for their contributions to the development of this glossary (contributors are listed alphabetically by last name):

LCol (Ret’d) Suzanne Bailey, Curriculum Development Lead, Road to Mental Readiness, Canadian Forces Health Services Group, Department of National Defence

Dr. Mary Bartram, PhD, RSW, Director, Policy, Mental Health Commission of Canada, Adjunct Research Professor, School of Public Policy and Administration, Carleton University

Dr. Suzette Brémault-Phillips, OT, PhD, 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. Lori Buchart, PhD, DBA, Co-Founder and Former Co-Chair, It’s Not Just 20K (INJ20K, formerly It’s Not Just 700)

Col Marilynn S. Chenette, CD, CHE, Deputy Commander, Health Services Division (HS Div), Canadian Armed Forces

Dr. Heidi Cramm, PhD, OT Reg. (Ont.), Professor, School of Rehabilitation Therapy, Queen’s University

Department of National Defence Terminology Board

Michelle Douglas, Executive Director, LGBT Purge Fund

Dr. Susan Dowler, PhD, CPsych, Chief Clinical Psychologist, Canadian Forces Health Services Group, Department of National Defence

A/Superintendent Lorraine Downey, BBA, Operations, Peer Support Coordinator, Ottawa Paramedic Service

Gabrielle Dupuis, MSc, Director, Research Partnerships, Atlas Institute for Veterans and Families

Dr. Maya Eichler, PhD, Associate Professor, Political and Canadian Studies, Women’s Studies, Mount Saint Vincent University; Canada Research Chair in Social Innovation and Community Engagement and leader of the Centre for Social Innovation and Community Engagement in Military Affairs, Mount Saint Vincent University

Dr. Murray Enns, MD, FRCPC, Professor, Department of Psychiatry, University of Manitoba; Medical Director and Staff Psychiatrist, Operational Stress Injury Clinic; Staff Psychiatrist, Adult, Health Sciences Centre; Adjunct Scientist, Manitoba Centre for Health Policy

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

Dr. Marnin J. Heisel, PhD, CPsych, Professor, Departments of Psychiatry and of Epidemiology & Biostatistics, University of Western Ontario; Scientist, Lawson Health Research Institute

Christine Hutchins, Senior Director, Office of Women and LGBTQ2 Veterans, Veterans Affairs Canada

Dr. Ruth Lanius, MD, PhD, FRCPC, Professor, Department of Psychiatry; Director of Posttraumatic Stress Disorder research unit; Harris-Woodman Chair in Psyche and Soma, Schulich School of Medicine & Dentistry, Western University; Collaborating Clinical Scientist, Homewood Research Institute

Dr. Vivien Lee, PhD, CPsych, Chief Psychologist, Commander, Healthy Workplace Team, Ontario Provincial Police; Clinical Advisor, Boots on the Ground

Sgt. Brent MacIntyre, BA (Hons.) Criminology, BA Sociology, Respect, Ethics and Values, Ottawa Police Service

Dr. Randi McCabe, PhD, CPsych, Professor, Department of Psychiatry & Behavioural Neurosciences, McMaster University; Co-Founder, Hamilton Centre for Cognitive Behavioural Therapy

Dr. Megan McElheran, RPsych, Clinical Psychologist, Wayfound Mental Health Group

Dr. Margaret McKinnon, PhD, CPsych, Homewood Chair in Mental Health and Trauma, Professor and Associate Chair, Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University; Research Lead, Mental Health & Addictions Services, St. Joseph’s Healthcare Hamilton; Senior Scientist, Homewood Research Institute

Dr. Anthony Nazarov, PhD, PMP, Associate Scientific Director, MacDonald Franklin OSI Research Centre; Research Scientist and Adjunct Research Professor, Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University; Adjunct Scientist, Lawson Health Research Institute; Adjunct Research Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University

Dr. Andrew Nicholson, PhD, Assistant Professor, School of Psychology, University of Ottawa; Director of Clinical Research, Atlas Institute for Veterans and Families

Lt. Scott Patey, OFS Peer Support Co-Coordinator, Ottawa Fire Services

Alain Pellegroms, Training Coordinator, OFS Medical Program Coordinator, OFS Peer Support Coordinator, Training Division, Ottawa Fire Service

Dr. Jill Price, PhD, Postdoctoral Fellow, Canadian Institute for Public Safety Research and Treatment (CIPSRT); Sessional Professor, Campion College, University of Regina

Dr. Rosemary Ricciardelli, PhD, Professor and Research Chair in Safety, Security, and Wellness, School of Maritimes Studies, Fisheries and Marine Institute, Memorial University of Newfoundland

Dr. J. Don Richardson, MD, FRCPC, Consultant Psychiatrist, Medical Director, St. Joseph’s Health Care London’s Operational Stress Injury Clinic; Scientific Director, MacDonald Franklin OSI Research Centre; Medical Advisor, Atlas Institute for Veterans and Families; Professor and Wellness Lead, Tanna Schulich Chair in Neuroscience and Mental Health, Schulich School of Medicine & Dentistry, Western University; Associate Scientist, Lawson Health Research Institute

Dr. Maya Roth, PhD, CPsych, Clinical Psychologist, St. Joseph’s Healthcare London’s Operational Stress Injury Clinic; Affiliated Scientist, MacDonald Franklin OSI Research Centre; Associate Member, Yeates School of Graduate Studies, Toronto Metropolitan University; Adjunct Clinical Professor, Schulich School of Medicine and Dentistry, Western University; Associate Scientist, Lawson Health Research Institute

Martine Roy, Chair, Board of Directors, LGBT Purge Fund

Capt Sam Samplonius, Co-Founder, INJ20K

PC Benny Seto, BBE, Mobile Crisis Intervention Team, Toronto Police Service

Dr. Norman Shields, PhD, CPsych, National Chief Psychologist, Occupational Health and Safety Branch, Royal Canadian Mounted Police

Dr. Lorraine Smith-MacDonald, PhD, MA, MDiv, CCC, Postdoctoral Fellow, Heroes in Mind, Advocacy, and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta

Dr. Heather Stuart, PhD, FRSC, CM, Professor, Department of Public Health Sciences, Department of Psychiatry and the School of Rehabilitation Therapy, Queen’s University; Bell Canada Chair Mental Health and Anti-Stigma Research, Queen’s University

LCol Dr. Andrea Tuka, CD, MD, FRCPC, Clinical Assistant Professor, Department of Psychiatry, University of British Columbia; Chief of Psychiatry, Canadian Armed Forces

Senior authors team

The senior authors team includes the following (listed alphabetically by last name):

Elizabeth Bose, MSc, Knowledge Translation Coordinator, Canadian Institute for Pandemic Health Education and Response (CIPHER)

R. Nicholas Carleton, PhD, RD Psych, Scientific Director, Canadian Institute for Public Safety Research and Treatment (CIPSRT), University of Regina; Professor of Psychology, Department of Psychology, University of Regina

Dr. Dianne Groll, PhD, Adjunct Associate Professor, Departments of Psychiatry and Psychology, Queen’s University

LCol (Ret’d) Dr. Alexandra Heber, FRCPC, Chief of Psychiatry, Veterans Affairs Canada; Executive Director, Canadian Institute for Pandemic Health Education and Response (CIPHER); Associate Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University

Yasaman Jabbari, PhD, Research Coordinator, Trauma and Recovery Research Unit, Department of Psychiatry and Behavioural Neurosciences, McMaster University; PhD Student, Cognitive Psychology, Department of Psychology, Neuroscience, and Behaviour, McMaster University

Jillian Lopes, MSc, Clinical Psychology, Department of Psychology, Neuroscience, and Behaviour, McMaster University; Research Assistant, Trauma and Recovery Research Unit, Department of Psychiatry and Behavioural Neurosciences, McMaster University

Ashlee Mulligan, MSc, Director, Partnerships and Stakeholder Engagement, Atlas Institute for Veterans and Families, The Royal

Dr. Kimberley Ritchie, PhD, MN, BScN, Assistant Professor, Trent/Fleming School of Nursing, Trent University; Adjunct Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University

Amber Schick, MA, Research Associate, Canadian Institute for Pandemic Health Education and Response (CIPHER)

Emily Sullo, MMASc, BSc (Hons), Research Assistant, Trauma and Recovery Unit, Department of Psychiatry and Behavioural Neurosciences, McMaster University; PhD Student, Clinical Psychology, Department of Psychology, Neuroscience, and Behaviour, McMaster University

Dr. Linna Tam-Seto, PhD, OTReg (Ont.), Assistant Professor, Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto

Valerie Testa, MSc, BEd, BA (Hons), OCT, CCRP, Senior Policy Analyst, Trauma Supports and Wellbeing Unit, Prevention Division, Centre for Mental Health and Wellbeing, Public Health Agency of Canada

Statement

The content and views expressed in this article are those of the authors and do not necessarily reflect those of the Government of Canada.

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