Trauma That Isn't Trauma: PTSD and the Science of Causation

Nassir Ghaemi, MD, MPH

Disclosures

November 06, 2015

In This Article

Introduction

When the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) radically changed diagnoses in US psychiatry, one of its main goals was to directly remove Freudian or psychoanalytic causes from diagnostic definitions. The term "neurosis" was removed in general for that reason. In contrast, psychoanalytic ideas were reintroduced in psychiatric diagnoses more descriptively, with new diagnostic terms that had never existed before, such as borderline personality disorder and posttraumatic stress disorder (PTSD).

The original definition of PTSD included the important description that the traumatic experience must be something that was outside the bounds of usual human experience. This was done for two reasons. First, military trauma, such as occurred in during the Vietnam War, was an important influence on the drafters of DSM-III's definition of PTSD. And second, military trauma is by definition not a routine experience that happens to the general population, but rather a unique experience that happens to some soldiers during periods of war. Another factor contributing to this definition was the (mistaken) belief that childhood sexual trauma was uncommon.

In the years that followed DSM-III, the concept of PTSD evolved during a period of relative peace, with no active wars from the end of Vietnam in 1975 until the start of Middle Eastern wars after 2001. Instead of being used in its military application, PTSD was applied mostly to domestic trauma, usually sexual in nature and typically related to childhood. At the same time, PTSD work had become central to feminist-inspired theories in psychiatry. Research from these sources led to the observation that childhood sexual trauma (and indeed adult sexual trauma) was much more common than previously appreciated, reportedly occurring in 20% or more of the general population—and probably more, if one takes into account biases in memory or reporting of such events.[1]

As a result, by the time the DSM-IV was published in 1994, a strong movement existed to remove the descriptor limiting trauma to unusual human experiences. This apparently small change had huge effects.

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