Rethinking trauma: A case series and proposed refinements to criterion A for post-traumatic stress disorder in DSM-5

Abstract

The traumatic event is a core requirement in the diagnosis of Post-Traumatic Stress Disorder (PTSD), and is defined in the Diagnostic and Statistical Manual’s (DSM’s) criteria of PTSD as Criterion A. This remains the case, despite opposing views from prior literature that the trauma response can occur without Criterion A. This article explores a definition for psychological trauma, from its etymology to a historical perspective, before examining the evolution of PTSD’s Criterion A across time in various editions of the DSM. The concept of moral injury is also examined, in terms of its correlation with psychological trauma and its impact on the pathological trauma response. A case series of vignettes from the authors’ clinical experience is presented, where PTSD symptoms have been noted in the absence of Criterion A. This is supplemented by the authors’ analyses about how the various life adversities across the cases fall short of Criterion A. Two key features (the imminence of a perceived threat, and the perceived loss of control experienced as a result) of a traumatic event are proposed to refine the definition of psychological trauma. It is hoped that these would serve to improve the current understanding and definition of psychological trauma. Keywords: Psychological trauma; Traumatic event; PTSD.