![]() ![]() Subsequent DSM editions both expanded (e.g., DSM-5 removed a requirement for peri-traumatic fear/helplessness/horror, and allowed for work-related exposure by pictures/video if repeated or extreme) and narrowed the trauma definition (e.g., DSM- 5 excluded learning about loved ones’ traumas unless violent or accidental, excluded non-immediate and non-catastrophic medical events related to natural causes, and replaced DSM- IV’ s “threat to the physical integrity of self or others” with “sexual violence”). These definitions highlight that unusually severe stressors can overwhelm individuals’ abilities to adapt/cope, but perhaps also fail to recognize how common trauma is considering an upwards of 90% lifetime prevalence in the USA. International Classification of Diseases ( ICD)- 11 maintains a similar definition : “exposure to a stressful event or situation of exceptionally threatening or horrific nature likely to cause pervasive distress in almost anyone”. DSM-III specifically defined trauma as one “outside the range of usual human experience and that would be markedly distressing to almost anyone”. ![]() Trauma- and stressor-related disorders are the only DSM diagnoses describing etiology and requiring an antecedent event. ![]() PTSD’s trauma definition and symptomatic criteria have changed somewhat in subsequent editions-most recently in DSM-5 (2013) -but the diagnosis still follows the same basic framework laid out by DSM-III. After lobbying by Vietnam veteran groups, PTSD criteria was first formalized in DSM-III. “Gross stress reaction” appeared in the first edition, to be replaced by “adjustment reaction of adult life” in DSM-II. Since 1952, the Diagnostic and Statistical Manual of Mental Disorders ( DSM)-which was created in part because of “an increasing psychiatric caseload” following World War II”-has become the primary classification system for mental disorders for much of the world. During the world wars, physicians recognized similar phenomena in male veterans, sometimes described as “physioneuroses” to encapsulate trauma-related somatic and affective symptoms. Neurologists Jean-Martin Charcot, Pierre Janet, and Sigmund Freud demonstrated that physical symptoms could be caused by psychological factors (“hysteria”), often in women who survived sexual traumas. Military physicians would name the mood and sleep disturbances they observed in combat veterans: “nostalgia” in the seventh century and “shell shock,” “combat fatigue,” “war neurosis,” or “exhaustion” in the twentieth century. Despite the ubiquity of trauma and written accounts acknowledging significant sequelae it can render, little clinical attention was afforded the topic until modern times. A myriad of historical and fictional manuscripts describe trauma reactions, from an ancient Mesopotamian tablet depicting war-related traumatic reactions to Shakespeare’s The Rape of Lucrece, both describing insomnia and nightmares as core reactions to psychological trauma. Natural disasters, injuries, illnesses, and interpersonal violence have been a perpetual part of human existence. Summaryīecause the human mind best comprehends categories, reliable classification generally necessitates using a categorical nosology but PTS defies categories (internalizing and/or externalizing, fear-based and/or numbing symptoms), the authors conclude that PTS-like DSM-5’ s panic attacks specifier-is currently best conceptualized as a specifier for other mental disorders. Recent FindingsĬonsidering that trauma is a risk factor for virtually all mental disorders (particularly depressive, anxiety, dissociative, personality), the multi-finality of trauma (some survivors are resilient, and some develop PTS and/or non-PTS symptoms), and the various symptoms that trauma survivors express (mood, cognitive, perceptual, somatic), it is difficult to classify PTS. This review summarizes the history of trauma-related nosology and proposed changes, within current categorical models (trauma definitions, symptoms/clusters, subtypes/specifiers, disorders) and new models. Since 1980, posttraumatic stress (PTS) disorder has been controversial because of its origin as a social construct, its discriminating trauma definition, and the Procrustean array of symptoms/clusters chosen for inclusion/exclusion. ![]()
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