The Expansion of PTSD: Is Seeking Trauma Everywhere Beneficial?

The symptoms of PTSD can be generated from all types of trauma (war, abuse, death, shock, etc.), so in a medical sense, the definition is quite broad. Defined as a set of symptoms (including anxiety, emotional numbing, and intrusive memories) caused by disturbing past events, PTSD was first recognized by the American Psychiatric Association in 1980. The symptoms of PTSD were clearly recognized and codified, but the vague causal reference to a traumatic “stressor” in a victim’s past would be the focal point of future medical and political conflict (McNally 2003a, pp 8). Further research into the condition has only resulted in an expansion of the definition of trauma and the possible factors associated with PTSD.

This paper will investigate the definition of the causes of PTSD and its continuing expansion. Has it diluted and confused the concept of trauma? Or has it been beneficial for victims and the study of trauma in general? In order to answer this question, we will briefly cover the reasons behind the expanded definition of PTSD, as well as the social negativities associated with these new definitions. We will then discuss some of the benefits and new research that has been generated from the expansion. The expansion of PTSD research has certainly generated some social issues and academic difficulties, but a deeper understanding of stress, anxiety, and the risk factors for PTSD far outweigh those negativities.

Since its inception, scholars have noticed a “conceptual bracket creep” in PTSD studies, leading eventually to an extensive redefinition in 2000 (DSM-IV) of the idea of trauma and how it might cause PTSD (McNally 2003b, pp 231). There was a further redefinition in 2013 (DSM V), but it changed little regarding PTSD and there is little data on the practical effects. DSM-IV, however, further expanded an already vague concept of the types of events that cause trauma in an individual, going as far as to include indirectly hearing of shocking events as a sufficient trigger for the symptoms of PTSD. It is important to note that the expansion of PTSD research had already made waves in the 80s when it began to study victims of rape and child sexual abuse, opening up wounds that many thought should remain closed. It is not surprising then, to see criticism of researchers of PTSD digging even deeper to seek out pain where it might not actually exist.

Much of the criticism focuses on the idea of false positives and the effect those have on the clinical and social perception of trauma. Rosen and Taylor (2007) document the ways in which the expansion of the PTSD stressors can be exploited in clinical practice, both by people seeking to take advantage of the medical and financial benefits of PTSD diagnosis as well as those who insist on playing the victim in order to avoid dealing with life events. Though the first group is a serious issue that has been played out in many circles, especially in regard to benefits for veterans, the second is perhaps more sinister in terms of wider social effects. While the current clinical definition of PTSD makes a distinct difference between events considered trauma and those that are considered normal life events, Hoof et al (2009) argues that these definitions are often subjective. Whether justifiable or unjustifiable, the diagnosis of patients who have unusual reactions to typical events raises the question of whether or not the current definition of trauma encourages “victims” to seek medication or therapy when they should be able to cope with these situations themselves or with limited therapeutic help. By seeking trauma everywhere, are psychological experts emotionally crippling the population?

The answer to this question has sparked serious debate among experts in the field, some believing that the explosion of PTSD diagnosis has been the result of false positives and playing the victim, others believing that casting a wider net for PTSD has simply caught those suffering from the syndrome that would have been missed in earlier years. The answer here, as most scholars note, is highly subjective (Hoof et al 2009, pp 85). However, what is lost in the debate over the clinical rigor of the current PTSD definition is the large amount of research that this debate as sparked. More than ever, researchers and scholars are beginning to delve into the deep psychological causes of PTSD, as well as the general psychological relationship that individuals have to traumatic or adverse events. For example, in an attempt to codify the causes of PTSD significant research has been conducted on the risk factors that may incline an individual toward maladaptive reactions to stress (McNally 2003b, pp 237). Scholars have identified personality traits (Orr et al 2012), childhood socialization factors (Trickey et al 2012), and crucial periods of time (Norman et al 2011) that can inform an individual’s ability to cope with adversity, as well as their predisposition toward PTSD or other anxiety disorders. If the resulting definition of PTSD has been complex and confusing, it is really only a reflection of the results that researchers have met as they attempt to study complicated psychological stressors. Irrespective of the resulting conceptual confusion, these results are socially beneficial in their ability to articulate behavioral patterns in reaction to stress, especially as further research clarifies these complex psychological relationships.

In conclusion, we have argued that despite the conceptual and clinical negativities associated with the expansion of PTSD focus, the research that this expansion has contributed in terms of explaining psychological stress is invaluable. Psychological disorders are complex phenomena, and PTSD is no different. It is natural that the medical field would experience certain growing pains as the wealth of knowledge regarding PTSD expands. What is needed now, however, is less focus on the clinical definition of PTSD, and more future research to determine the causes the of stress and anxiety and the risk factors that inhibit and individuals ability to cope with adversity or trauma in his or her life, providing much needed clarity to the debate surrounding PTSD itself.

References

Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.

Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, DC: American Psychiatric Association.

Hooff, M. V., Mcfarlane, A. C., Baur, J., Abraham, M., & Barnes, D. J. (2009). The stressor Criterion-A1 and PTSD: A matter of opinion?. Journal of Anxiety Disorders, 23(1), 77-86.

McNally, R. J. (2003a). Remembering trauma. Cambridge, Mass.: Belknap Press of Harvard University Press.

Mcnally, R. J. (2003b). Progress and Controversy in the Study of Posttraumatic Stress Disorder. Annual Review of Psychology, 54(1), 229-252.

Norman, S. B., Trim, R. S., Goldsmith, A. A., Dimsdale, J. E., Hoyt, D. B., Norman, G. J., et al. (2011). Role of risk factors proximate to time of trauma in the course of PTSD and MDD symptoms following traumatic injury. Journal of Traumatic Stress, 24(4), 390-398.

Orr, S. P., Lasko, N. B., Macklin, M. L., Pineles, S. L., Chang, Y., & Pitman, R. K. (2012). Predicting post-trauma stress symptoms from pre-trauma psychophysiologic reactivity, personality traits and measures of psychopathology. Biology of Mood & Anxiety Disorders, 2(1), 8.

Rosen, G., & Taylor, S. (2007). Pseudo-PTSD. Journal of Anxiety Disorders, 21(2), 201-210.

Trickey, D., Siddaway, A. P., Meiser-Stedman, R., Serpell, L., & Field, A. P. (2012). A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clinical Psychology Review, 32(2), 122-138.