2 April 2022 | New Scientist | 47Koenen at Harvard University. “When I
started in the field, if you said ‘trauma’, the
only thing people associated with it were
war veterans,” she says. “Now, the public
has a much broader view.”
This broader definition has been described
by some psychologists as “concept creep”.
“People use it indiscriminately now,” says
Bonanno. “Suddenly, people were saying they
were traumatised from relatively mundane
things.” That is a problem, because if a broader
range of human experiences are considered
traumatic, more people will meet the criteria
for a PTSD diagnosis – and some may receive
unnecessary treatment as a result. “It could
potentially harm them. At minimum, it would
waste their time,” says Bonanno.
For others, the criteria are too narrow. In
2017, Lisa van den Berg at Leiden University in
the Netherlands and her colleagues assessed
PTSD symptoms in 1433 volunteers who were
already participating in a study on depression
and anxiety. The team found that PTSD
symptoms following an event that wouldn’t
meet the latest DSM criteria (DSM-5) for being
traumatic were just as severe or more severe
than those following an event that would be
considered a trauma.
Atypical trauma
Koenen also wonders whether the criteria
should be broadened. Over her years of
research, she had seen women develop the
symptoms of PTSD following events that
wouldn’t have necessarily met the DSM-5 list,
including miscarriage and sexual harassment.
In one case, a woman had been through
aparticularly acrimonious divorce, during
which her ex-husband had kidnapped her
children. “Nothing she described in that
event fits on a typical trauma scale,” says
Koenen. “It really challenged my thinking.
How do we define trauma, and what questions
should we ask?”
So, between 2018 and 2021, her team surveyed
more than 33,000 current and former nurses
in the US about their experiences of trauma.
The survey encompassed traumas that would
fit the DSM-5 definition, but also included
an option for responders to describe “other”
events they felt were traumatic. “That ‘other’
category has the highest prevalence of PTSD
associated with it,” says Koenen. >