Defining trauma is tricky, but the DSM-5 can help. Beyond PTSD, a few other disorders can result from distressing experiences, too.
Trauma is an ever-expanding topic of our time.
It’s commonly used in our collective speech to describe any number of responses to a difficult event, from temporary distress to life changing symptoms.
With the word tossed around so much, it may help to understand how experts define trauma and how they diagnose post-traumatic stress disorder (PTSD). Understanding trauma is one step toward finding the right treatment and moving toward healing.
Trauma impacts everyone differently, so no two cases will look exactly alike. Still, there are some common symptoms — for example, most people experience intrusive memories.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), the manual licensed clinicians use to consider and diagnose mental health disorders, offers some guidance.
To receive a diagnosis of PTSD, you must have experienced a traumatic event (called a “stressor”) such as a disaster, violence, accident, or other physically life threatening situation.
Also, your symptoms must be ongoing for at least a month. They also must interfere with multiple areas of your life, like your work, school, relationships, or home life.
What is the definition of trauma?
Trauma is an emotional or physical response to one or more physically harmful or life threatening events or circumstances with lasting adverse effects on your mental and physical well-being, according to the Substance Abuse and Mental Health Services Administration (SAMSHA).
This could be an event you’ve personally experienced, witnessed happening to someone else, heard about happening to a close loved one, or heard about through your job (e.g., first responder, social worker, therapist).
For more information and support tools, you can read Psych Central’s Finding a Path Through Trauma resource.
The symptoms of PTSD fall into four main groups:
- intrusion symptoms
- avoidance behaviors
- changes in cognition and mood
- physical reactivity
After a traumatic event, you may experience at least one of these intrusion symptoms:
- intrusive memories about what happened
- dissociation (which may include flashbacks)
- distress when you’re reminded of the incident
- physical reactions to stress, like increased heart rate and blood pressure
The “avoidance” cluster of symptoms is your way of protecting yourself from being reminded about what happened.
This may include:
- avoiding thoughts or memories about what happened
- avoiding people, places, events, or other external reminders
Changes in cognition and mood
You may notice changes in your mood or how you process information (called cognition) following a traumatic incident.
This may include:
- difficulty recalling details of what happened
- negative beliefs
- cognitive distortions
- persistent difficult emotions, like anxiety, guilt, rage, and shame
- difficulty enjoying the things you used to (called anhedonia)
- feeling detached or isolated from those you love, your community, or humanity
- lack of positive emotions, like happiness, love, and joy
PTSD changes your brain and how it communicates with the rest of your body, meaning you may experience several physical reactions.
- angry outbursts that are difficult to control
- actions or behaviors that endanger you or others
- feeling on edge much of the time (called hypervigilance)
- heightened response to things that startle you, like jumping at sudden noises
- trouble focusing
- sleep changes
Experts are always learning more about the nature of trauma. As such, there have been several significant changes between the DSM-4 and the DSM-5.
- more specific language about what constitutes trauma
- four clusters of symptoms instead of the previous three
- a new subtype for children under the age of 6, called “PTSD Preschool Subtype”
- a second subtype for those who frequently experience dissociation or depersonalization/derealization, called “PTSD dissociative subtype”
In the DSM-4, your response to a traumatic event was factored into the diagnosis, namely whether you felt overwhelming fear, helplessness, or horror.
In the DSM-5, this criterion was removed because many felt it’s such a common symptom that it can’t accurately predict whether you’ll develop PTSD.
Apart from PTSD, other conditions fall under “trauma and stressor-related disorders” in the DSM-5. They include:
We all have a hard time adapting to changes from time to time.
On the spectrum of change-induced stress, an adjustment disorder is considered a more serious emotional or behavioral change in adults or children. It usually occurs in response to a big shift in your life, such as a divorce, job loss, or the death of a loved one.
- anxiety symptoms
- depression symptoms
- physical symptoms, like headaches
- sleep changes
- social withdrawal
If those emotional or behavioral changes last for a prolonged period, a mental health professional may diagnose a long-term or recurring condition, such as major depression or an anxiety disorder.
Reactive attachment disorder
Diagnosed in childhood, reactive attachment disorder (RAD) impacts children under 5 years old.
Mental health professionals believe RAD is caused by abuse, neglect, or maltreatment in the home, often at the hands of primary caregivers, foster parents, or other trusted adults.
Children who live with RAD may experience:
- difficulty connecting with people
- a negative or unpleasant reaction to attempts to be emotionally comforted
- challenges in the classroom
- fewer positive emotions, like happiness and excitement
- frequent mood changes
- a heightened or violent response to discipline
Disinhibited social engagement disorder
In many cases, children go through a distinct phase of “stranger anxiety.” It’s an important developmental milestone to help them learn about intuition and boundaries.
Children living with disinhibited social engagement disorder (DSED), on the other hand, may not be afraid of unfamiliar people or strangers.
Children living with this diagnosis may:
- appear overly affectionate with acquaintances
- feel comfortable leaving their caregivers
- wander off with unfamiliar people
Acute stress disorder
It may be helpful to think of acute distress disorder as a more temporary form of PTSD, usually lasting between 3 days and a month. That said, qualifying for an ASD diagnosis doesn’t mean you’ll go on to develop PTSD.
Of those diagnosed with acute stress disorder, roughly
Acute distress disorder is caused by the same events and circumstances as PTSD, including:
- physical or sexual assault
- natural disasters
No, complex PTSD (C-PTSD) is not listed in the DSM-5, published in 2013, or the DSM-5-TR, published in 2022.
C-PTSD is, though, mentioned in the
For now, as its status is hotly debated in the psychology community, complex trauma falls under “unspecified trauma- and stressor-related disorder” in the DSM-5. It previously appeared as “disorders of extreme stress, not otherwise specific (DESNOS)” in the DSM-4.
Understanding complex trauma
Complex trauma often involves similar symptoms to PTSD, with additional adaptations that impact your personality or relational style, like:
- difficulty with self-concept or identity
- challenges with emotional regulation
- interpersonal difficulties
The symptoms of C-PTSD may develop from ongoing traumatic situations over a long period, often originating in childhood.
Many symptoms of complex trauma overlap with borderline personality disorder (BPD), though there are some key differences.
For example, those with complex trauma may not have an intense fear of abandonment, considered a hallmark symptom of BPD. In fact, some trauma survivors may feel threatened by connection.
PTSD is a severe but manageable mental health condition.
In the DSM-5, the definition of PTSD expanded to include more clusters of symptoms, along with subtypes related to childhood and dissociation.
Children may be diagnosed with a similar trauma-related disorder, such as RAD (characterized by a reduced need for connection) or disinhibited social engagement disorder (which features a lack of stranger danger).
Adults and children alike can be diagnosed with an adjustment disorder (difficulty adapting to changes) or acute stress disorder, considered a temporary form of PTSD.
If you’re experiencing PTSD symptoms or a related condition, you don’t have to go through this alone, and recovery is possible. There are several effective types of therapy for trauma.
After developing PTSD, it’s difficult to resolve your symptoms alone. It can be very helpful to work with a therapist who can support you. For further insight on healing from trauma, some helpful books may include:
- “Complex PTSD: From Surviving to Thriving” by Pete Walker
- “The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma” by Bessel van der Kolk
- “Trauma and Recovery” by Dr. Judith Herman
- “Waking the Tiger: Healing Trauma” by Peter A. Levine and Ann Frederick
- “What Happened to You?: Conversations on Trauma, Resilience, and Healing” by Bruce D. Perry and Oprah Winfrey
With patience, support, psychoeducational, and the help of a mental health professional, it’s possible to overcome your symptoms and access post-traumatic growth.