Article reviews old debate on how to define trauma events. But what is the debate really about?

CATEGORY: CONTROL OF LANGUAGE AND IDEAS

Brian P. Marx, Ph.D., National Center for PTSD, and Department of Psychiatry, Boston University

Source: Marx et al., 2024 [1]
Read time: 2.5 minutes
 
This Happened
In February 2024, the leading trauma research journal published a review article attempting to bring some clarity to the controversy about how a traumatic event ought to be defined.
 
Who Did This?
Brian P. Marx, Ph.D. is a psychologist who specializes in posttraumatic stress disorder (PTSD). His work has focused on the assessment of and effective treatment for PTSD.
 
The Premise
When making the diagnosis of PTSD, the first gatekeeper criterion is whether an individual experienced a truly traumatic event or not. In the diagnostic criteria, the event is called Criterion A. If the definition of Criterion A is too narrow, individuals with PTSD won’t get the diagnosis. If the definition is too broad, individuals will be falsely diagnosed, potentially receive the wrong treatment, and contaminate the validity of research studies.

The controversy about how to define traumatic events is as old as PTSD itself, stemming to its birth in 1980. Marx argued that a new review was needed because of current events—race-related events and the COVID-19 pandemic presented new quandaries with energetic challengers.

Marx organized the evidence by noting that there are four sides in the debate:
(1) Keep criterion A the way it is, which is restricted to life-threatening events that are either directly experienced, witnessed happening to others, or learning about events secondhand that happened to loved ones.
(2) Broaden criterion A to include non-life-threatening events, such as divorce, expected death of a loved one, financial stress, giving birth, and racial discrimination.
(3) Narrow criterion A to only events that are directly experienced and witnessed, and exclude events that are learned about secondhand.
(4) Eliminate criterion A because any attempt to comprehensively define all events will always leave some ambiguity.
 
Marx and colleagues recommended option #1—keeping criterion A the way it is—because the evidence for the other options is too weak or logically indefensible.

Analysis
The review covered the relevant issues thoroughly and without bias, and came to a sensible (mostly) conclusion supported by evidence. As review articles go in psychiatry, it's one of the better ones.
The authors respected all opinions by creating four sides to the argument, but, in reality, there are only two main sides—those who want to keep it the way it is (#1) and those who want to broaden it (#2).
 
Option #3 for narrowing criterion A probably should have been the recommendation, but it’s close to splitting hairs. The gatekeeping is implemented according to #3 in all good studies based on common sense, so it does not generate many vocal supporters.
Option #4 for eliminating criterion A comes from a small but vocal, radical group who advocate for a range of other extraordinary ideas.

What’s missing was an analysis of why this debate was stoked in the first place.
 
Why Is This Happening?
Nearly all the heat, and a swarm of weak studies, for changing criterion A comes from the efforts of those who want to broaden it to include non-life-threatening events. This effort is largely ideologically-driven, not science-driven.

The strategic benefit for non-life-threat events to gain standing within PTSD is that it gives the appearance of authenticity to the premise that human nature is highly malleable to everyday stressful events of modern society (as opposed to the less common, truly terrifying, life-threatening events). This is fundamentally a difference in how one views human nature.

This view of high malleability is key to progressive leftist advocacy movements that fighting for the care of disadvantaged and minority groups must trump other personal rights and societal obligations. The same skewed moral sentiment that drives the redistribution of wealth in the welfare state and socialism to rectify harms done to the disadvantaged is the same sentiment that attempts to elevate everyday stressors—including poverty, neglect, parental incarceration, pollution, racial discrimination, transgender discrimination, and historical treatment of minority groups—to be considered harmful, traumatic events, and sometimes even public health crises, as in the cases of COVID-19 and climate change. No good research evidence exists, however, that those types of stressors cause the harm of PTSD.

If academia can control the language and ideas of science by redefining stress as life-threatening trauma, it controls an important narrative for leveraging policy, laws, and public health mandates. The attempt to redefine trauma has almost never been about science; it’s about conflating social justice with research.

 
REFERENCES
[1] Marx, Brian P; Hall-Clark, Brittany; Friedman, Matthew J; Holtzheimer, Paul; Schnurr, Paula P (2024). The PTSD Criterion A debate: A brief history, current status, and recommendations for moving forward. Journal of Traumatic Stress 37(1):5-15, doi 10.1002/jts.23007

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