Source: Journal of Affective Disorders
Read time: 2.5 minutes
 
This Happened
Complex PTSD was invented in 1992 on the premise that certain types of events were more damaging than single-event traumas by being repeated and prolonged (a dose-response theory) and interpersonal in nature. In the December 2024 issue, the Journal of Affective Disorders published a study claiming to show that being a civilian refugee with indirect exposure to war qualified as one of those extremely damaging types of events.
 
Who Did This?
Psychologist Karen-Inge Karstoft is an associate professor at the University of Copenhagen, and has published 15 first-author and approximately 36 secondary-author research articles, mostly on trauma or PTSD.
 
The Claim
Researchers sent requests to participate in their research study to all 18,389 adult Ukrainian refugees registered in Denmark. They received completed electronic surveys from 6,761 individuals. The types of experiences that counted as exposure to war included hometown was affected by war (with or without damage to their own homes), witnessed first-hand or just heard about combat, and lost a family member or close friend due to war.
Using ICD-11 diagnostic criteria, they found that 15.9% fulfilled criteria for PTSD but not complex PTSD, and 13.5% fulfilled criteria for both PTSD and complex PTSD.
 
They tested the dose-response premise by predicting that exposure to more war events would lead to more diagnoses of complex PTSD. This was not supported. Of the seven types of war exposure they measured, four significantly associated with PTSD, but only two significantly associated with complex PTSD.
 
The also tested the interpersonal premise by predicting that interpersonal trauma events prior to the war would lead to more diagnoses of complex PTSD. This was not supported. The authors claimed, however, this was supported with a misleading interpretation of their data: The odds ratio of interpersonal events with PTSD was 1.17, and for complex PTSD was 1.44, both of which were significant and similar in magnitude to each other.  The authors asserted that 1.44 was higher than 1.17, but they  did not conduct a significance test.
 
Analysis
There are multiple major flaws in this study. First, researchers did not gather information on whether events were repeated, prolonged, or interpersonal. These qualities seem to have been assumed.
Second, their assessment method did not determine the onset of any symptoms in relation to war exposure. They have no idea if PTSD symptoms, or the so-called complex PTSD symptoms, were present before or after war started.
​Third, they used self-report questionnaires which are prone to false positive diagnoses. The researchers nevertheless expressed zero reservations about the existence of complex PTSD in this sample. 

The absurdity of the evidence claimed by complex PTSD activists is described here and here. The proposed disorder was rejected by both DSM-IV and DSM-5 due to absence of evidence, but the ICD adopted it in 2019 for political reasons.
Despite the absence of validity, researchers frequently add new populations that allegedly have high rates of complex PTSD including prisoners in jail, gang members, violent criminals, prisoners of war, foster care children, soldiers, refugees without war exposure, domestic violence victims, police officers, North Korean defectors, and cardiac surgery patients.
 
As I wrote in my book, “The fundamental appeal of complex PTSD is moral, not scientific. To believe in complex PTSD is to believe in a mission to save weaker, disadvantaged people from being victims of stronger perpetrators. By supporting this mission, the believer is imbued with higher moral status. That is the true value of complex PTSD.” [1] The most enduring lesson of the complex PTSD scandal is that in the social sciences, where manipulation of soft data and misleading interpretations are chronic affronts, the most concerning aspect is that researchers seem to easily believe their own deceptions.

REFERENCES
[1] Scheeringa, M. S. The Trouble With Trauma: The Search to Discover How Beliefs Become Facts.  (Central Recovery Press, 2022).

Sources: Mother Jones magazine and Creators Syndicate
Read time: 2.0 minutes
 
This Happened
Within a span of two weeks in December 2024, two national outlets published opposite views on the famously controversial treatment recommendations for trauma in Bessel van der Kolk’s bestselling book The Body Keeps the Score. On December 18, Mother Jones magazine published an article titled “What the most famous book about trauma gets wrong,” noting how van der Kolk’s treatment claims are rubbish. On December 31, the advice column Dear Annie highly recommended van der Kolk’s book to a trauma survivor who was desperate after his previous therapists failed to help.
 
Who Did This?
Mother Jones magazine began in 1976. It was named after Mary Harris Jones, a union organizer and socialist. It currently publishes six issues per year and provides daily digital content. Content is highly progressive leftist.
Dear Annie (Annie Lane) is a nationally-syndicated advice columnist in the style of Ann Landers, “Dear Abby,” and others.
 
The Claims
In the Mother Jones article, journalist and book author Emi Nietfeld explored how trauma victims were portrayed by van der Kolk in his popular book. Upon first reading it, Nietfeld felt “gross and ashamed” after noting how van der Kolk treated sexual assault survivors with disdain. When Nietfeld dug deeper, other scientists she spoke to said “van der Kolk mischaracterizes their research and steers survivors away from treatments that might help them.”
 
In Dear Annie, advice was proffered to a 45-year-old male who had suffered childhood traumas. He wrote that he had sought mental health help for 17 years, and gone through five therapists and as many psychiatrists. None of them could help him. Annie suggested that “the five therapists you saw were probably not trained in trauma. You might try and find a somatic therapist.” She had surmised somehow that talk therapy hadn’t worked because he needed to treat his post-traumatic stress “by releasing bodily sensations.” She recommended van der Kolk’s The Body Keeps the Score and Dr. Peter Levine's Waking the Tiger.
 
Analysis
Van der Kolk’s book has remained amazingly popular despite his false claim that psychological trauma embeds itself like demon possession into brains, bodies, and souls, as restated in the memorable title “the body keeps the score.” Based on this canard that trauma is entrenched in the body, he advocated ten bodily-based treatments (e.g., yoga, dance, theater, and Levine’s somatic experiencing therapy). Van der Kolk claimed that the best way, nay, the only way to treat trauma is with bodily-based, or somatic, treatments, none of which have decent research support, as I’ve described in detail here.

Nietfeld’s own therapist refused to engage in cognitive behavioral therapy, and cited van der Kolk’s work as one of the reasons.
 
(Disclaimer: I was interviewed by Nietfeld for the Mother Jones article, but I was chopped by the editor for space. I would have been surprised if my criticisms of van der Kolk’s view of human nature as being highly fragile had made it into a progressive leftist, neo-Marxist magazine.)

Source: BMJ Military Health
Read time: 2.5 minutes
 
This Happened
In the October 2024 issue, BMJ Military Health published a study that assessed inflammatory factors pre- and post-deployment in Australian soldiers to examine if trauma changes the biology of inflammation.
 
Who Did This?
The senior author was psychiatrist Alexander “Sandy” McFarlane, the Director of The University of Adelaide's Centre for Traumatic Stress Studies. He has received numerous awards and published over 250 articles and chapters and has co-edited three books. Dr. McFarlane’s work focused on the impact of disasters, longitudinal course, and cognitive deficits of PTSD.
The first author was a young psychologist, Neanne Bennett, who appears to be a post-doc. She has two first-author publications.
 
The Claim
The hypothesis of the study was that exposure to combat trauma would cause both high levels of psychological symptoms and increased levels of inflammation, measured as C reactive protein (CRP) and interleukin 6 (IL-6). This represents another test of the so-called toxic stress theory that trauma permanently damages brains and alters neurobiology.
Symptoms of PTSD and blood samples were gathered on personnel of the Australian military special forces one month prior to deployment to the Middle East. The deployment lasted for less than 6 months. They were able to collect the same measures on 63 of those personnel not more than 4 months post-deployment. All were male.
Changes in CRP levels from pre- to post-deployment did not associate with severity of pre-deployment PTSD symptoms but did positively correlate with post-deployment PTSD symptoms. This seemed to agree with their main hypothesis (but see below for problems).
Changes in IL-6 did not associate with severity of either pre- or post-deployment PTSD symptoms,  contrary to their hypothesis.
 
In a secondary analysis, they subdivided their modest size sample into four subgroups so that they could compare the least affected to the most affected individuals:
(1) High Function              (lower trauma symptoms, lower trauma exposure) n=35
(2) Resilient                       (lower trauma symptoms, higher trauma exposure) n=11
(3) Vulnerable                   (higher trauma symptoms, lower trauma exposure) n=9
(4) Risk                               (higher trauma symptoms, higher trauma exposure) n=7
The most affected (Risk) group showed a significantly greater decrease in CRP compared to the least affected (High Function) group. No difference was found for changes in IL-6. Both of these findings contradicted their hypothesis.
 
Despite the contradictions between hypotheses and findings, the authors concluded that “sustained and repeated exposure to a range of occupational stressors throughout a military member’s period of service are likely to have a cumulative impact...,” consistent with the toxic stress theory.
 
Analysis
None of their hypotheses were satisfied. CRP levels did not increase in lockstep with increased symptoms. In their secondary analysis of tiny subgroups, CRP actually decreased in the most affected Risk group, which was opposite of their theory. IL-6 levels did not change in either direction with symptoms in any analysis.
How did the authors reconcile their conclusion of supporting the toxic stress theory with the complete absence of findings for IL-6? They did what nearly every supporter of toxic stress does. They spun the interpretation. They claimed that the nonsignificant IL-6 “elevations may represent an attempt to re-establish a homeostatic state,” which is a way of saying that they might have been unlucky in measuring variables at the wrong time.
 
It is noteworthy that they did not perform the test that should have been conducted. It would have been a much better test to create a change score in PTSD symptoms from pre- to post-, just like they created change scores for CRP and IL-6. Because the researchers tested pre-deployment PTSD symptoms and post-deployment PTSD symptoms separately, they did not know the direction of change in PTSD scores of individuals.
 
Prior Studies
When pre-trauma prospective studies are reviewed, they do not support the toxic stress theory [1, 2, 3]. Instead, they strongly support only the diathesis stress theory which posits that neurobiological differences found in individuals with PTSD exist prior to any trauma exposures, most likely due to genetic causes.

The Bennett et al. study represents another failure of the toxic stress theory, which has been vigorously promoted by Jack Shonkoff and his Harvard center (see here and here) and is the basis of the best-selling book The Body Keeps the Score (see here). 

REFERENCES
​[1] Julia A. DiGangi et al. (2013). Pretrauma risk factors for posttraumatic stress disorder: A systematic review of the literature. Clinical Psychology Review 33:728-744.
[2] Andrea Danese et al. (2017). The origins of cognitive deficits in victimized children: Implications for neuroscientists and clinicians. American Journal of Psychiatry 174:349-361.
[3] Michael S. Scheeringa (2020). Reexamination of diathesis stress and neurotoxic stress theories: A qualitative review of pre-trauma neurobiology in relation to posttraumatic stress symptoms. International Journal of Methods in Psychiatric Research 30:e1864. doi: 10.1002/mpr.1864

written by Michael S. Scheeringa
Read time: 2.5 minutes
 
Why is Trauma Dispatch posting a review of a book on a political philosophy? The following passage from the book provides the basis of an explanation:
“A political paradigm provides us with the basic concepts and relations needed to recognize events taking place in the political arena and to understand their significance.” Without an intellectual framework, individuals will neither see nor understand clearly what is happening. Trauma Dispatch has a similar aim—to recognize events taking place in research, clinical, and advocacy arenas that appear to be about trauma on the surface but have deeper motivations as partisan political acts.
 
Book Summary
Learning about the conservative paradigm (and its rival liberalism) is missing from the education of Americans. Hazony fills this gap, beginning with the origins of conservatism in the fifteenth through eighteenth centuries as England struggled to balance traditional monarchical rule with growing personal liberties. Hazony then follows this thread during the founding of the United States and on to modern times.
Hazony also described the liberal paradigm in detail. Today’s liberals do not call themselves by one name or manifesto. They disorient opponents with a shifting vocabulary including the Left, progressivism, social justice, anti-racism, anti-fascism, Black lives matter, critical race theory, identity politics, woke, and others. Hazony refers to them alternatively as Marxists and as Enlightened liberals.
An essential difference between the two paradigms is that liberals, embracing principles of the Enlightenment, believe humans can discover universal truths simply through reason, which, more than once, were used to justify revolutions. In contrast, conservatives value preserving tradition that has been borne of empiricism, i.e., it is worth keeping what has been proven to work through time and experience.
Hazony recounts the history of how a “liberal hegemony” was achieved in American politics through the 1960s reworking of the constitution via supreme court decisions, and the constant compromises conservatives made with liberals during the Cold War. As a result, many of today’s so-called conservatives are confused about the content and purposes of true conservatism. 

​Analysis
Trauma was never mentioned in Hazony’s book, but the relevance to trauma is realizing that pscyhologists in academia are nearly all liberals, clinicians in the field are mostly liberals, and many are of the progressive Marxist type [1]. A liberal hegemony in trauma paradigms has been achieved in the mental health professions (psychology, social work, counseling, and psychiatry) by a combination of their creation in the early twentieth century with social justice foundations, and the subsequent stranglehold through what has been described as the long march through the institutions [2]. This hegemony raises two concerns.

First, Enlightened liberalism is so attractive because they think they’ve discovered the secrets of understanding why disadvantaged humans exist. The simplicity of their approach (all you need to do is use reason) allows adherents to feel like they have “grasped an immensely powerful truth” that explains a vast array of effects. This, in a nutshell, also describes the remarkable trauma hype around beliefs in toxic stress, Adverse Childhood Experiences, complex PTSD, and dozens of other dogmatic beliefs.
The secret cause is oppression in nearly all cases. As Hazony noted, “In every society, there will always be plenty of people who have reason to feel they’ve been oppressed or exploited…And those who are troubled by such apparent oppression will frequently find a home among the Marxists.” The same dynamic applies to trauma activists who believe they have finally grasped that trauma is the cause of every disadvantaged group, every bad behavior, and nearly every type of mental dysfunction. The trauma hype claims are not based in evidence. They were constructed to be consistent with a liberal political paradigm. 

Second, is what Hazony calls the dance of liberalism and Marxism. Center-left liberals are trying to conserve their traditions, while Marxism is bent on destroying any tradition. But liberals, trying to appease Marxists to turn them into allies, find that Marxists cannot be appeased. Hence, the dance moves in only one direction towards more Marxism. Some liberals want to speak out about absurd disinformation but are afraid of being purged by the Marxist mobs. This describes why hardly anyone ever seriously criticizes trauma hype. Not only are there few conservative scholars around to speak out, the liberal scholars who want to speak out know they may not survive a purge.


References
[1] Neil Gross, Solon Simmons (September 24, 2007). The social and political views of American professors (working paper). ResearchGate.
[2]  Christopher F. Rufo (July 20, 2023). How the Radical Left Conquered the Culture. Substack.

Source: The University Star
Read time: 2.5 minutes
 
This Happened
Starting September 1, 2024, to be eligible for a state contract in Texas, a family violence shelter must use a trauma-informed service delivery model.
 
Who Did This?
The main sponsor of the bill was Juan Hinojosa, a Democrat who has served in the Texas House or Senate nearly continuously since 1981. The other four co-sponsors were three Democrats and one Republican.
 
The Premise
Family violence agencies are typically known primarily as shelters for domestic violence victims in times of crisis. Certain aspects of how they must operate have been regulated by Texas code to receive state funding. Senate bill 1841, which was passed in 2023, amended a section of the Texas code to require these services:

• Advocacy focused on physical, behavioral, and mental health
• Safety planning services
• Community education regarding family violence and family violence prevention efforts
• Counseling services

 
The bill also slipped in a stipulation that a shelter must “demonstrate that the center is using a voluntary and trauma-informed advocacy service model that respects an individual's needs.”
 
What is a trauma-informed advocacy service model? The bill defined it as the service “is provided in a manner that recognizes and responds to the signs and symptoms of trauma in, and the risks of trauma to, a victim of family violence to better support the victim and promote the victim's choice, trust, dignity, connection, and healing.”
 
Analysis
Why was the phrase “trauma-informed” inserted into the bill? During brief testimony for the bill in the Criminal Justice Committee of the Senate, Hinojosa described the bill as simply a modernization of law that had not been updated in fifteen years. Hinojosa mentioned the trauma-informed model as almost an afterthought at the end of his remarks.
Providing testimony were a director of a shelter and a former client who survived domestic violence. Neither mentioned trauma-informed care. No evidence was provided that some shelters were not providing the services in the bill.
 
Contrary to the testimony about the bill, the language of trauma-informed represents a specific social agenda that has little to do with trauma or with appropriate services. The definition of trauma used in psychiatry for diagnosis and research on posttraumatic stress disorder is that an event must rise to the level of life-threatening. Episodes of domestic violence almost always rise to this level. Shelters have de facto always operated on a model of dealing with physical and psychological trauma. So, it may seem confusing about why a law was needed to add trauma-informed language.

Despite gaining traction in the U.S., Europe, and Australia for the past twenty-five years, there is no evidence that trauma-informed practices improve effectiveness (see here).
The services required in the new law have been staples of shelter services for decades and represent nothing revolutionary. The concern is that the new law creates a formal link to the trauma-informed concept, which has a much wider and disturbing agenda. What usually happens in these situations is that many shelters will scramble to document how they have transformed themselves into being trauma-informed. They will require their staff to participate in trauma-informed workshops provided, for a fee, by outside consultants who travel the country. 

Source: Parksville Qualicum Beach News
Read time: 1.9 minutes
 
This Happened
In September 2024, a non-profit organization in Canada opened an indigenous-specific trauma-informed daycare center.
 
Who Did This?
Hulitan Family & Community Services Society is a non-profit based in Victoria, British Columbia. Their mission is to help Indigenous families heal from the damage of colonization and develop resilience through culturally-rooted programs. Services include counseling and supports to reunite children with families, and prevent children from being placed in out-of-home care. Their website opens with a land acknowledgment. At least half of their $2.2 million (Canadian) budget (approximately $1.6 million U.S.) is funded by the Canadian government. The executive director, Kendra Gage, has been with the non-profit for over twenty years.
 
The Premise
Their annual report described the daycare services as having spaces for 24 infant-toddlers and 24 three-to-five-year-old children, providing space for parent workshops, and “…the centre, classrooms, toys, books, and outdoor spaces will be reflective of Indigenous cultures so that children and their families can see themselves reflected in the environment around them, supporting a sense of belonging.”
 
A local news report described the specific trauma-informed practices as:

• Large, airy spaces
• Windows accessing green space
• Lots of natural light
• A calming sea foam color for the walls
• Furniture—from tables to play kitchens—are made of wood for an organic, natural feel
• High staff-to-children ratio
• A therapist on staff

 
Analysis
The ‘trauma’ these children experienced differs from the psychiatric definition of trauma used for defining and researching post-traumatic stress reactions which is that events must involve life-threat. Rather, it is assumed that any indigenous child has experienced ‘trauma’ by nature of being indigenous through historical trauma or perceived discrimination in current society. 

​There is no clear and consistent definition of what counts as trauma-informed practice, so, the definition can be almost whatever each program wants, such as asserting that wood furniture and sea foam color have healing properties. Reviews of trauma-informed practices have demonstrated there are no high-quality studies and no evidence that they work (see here).
 
Why Is This Happening?
This is one of dozens, and perhaps hundreds, of projects branding themselves as trauma-informed in the  past decade. The label ‘trauma-informed’ provides an imprimatur of scientific authenticity but it has no evidence-based meaning. The leaders of these projects do not seem to care about research evidence. The purpose is to leverage the concept that trauma has been miraculously discovered as the cause of all disadvantaged groups in society.
​This daycare represents another example of how so-called trauma-informed practices are manifesting in support services, architecture design, education, medicine, addiction, and courts. ​

​Their concept of trauma is baffling and the meaning of trauma-informed practices is vague. These attempts to control language are purposeful attempts to install a false intellectual framework (see here); the more confusing they are, the more complex it seems, the harder it is to grasp, but it gives the impression there must be some basis of truth to their premise.

Source: NBC Today
Read time: 2.1 minutes plus 30-second video
 
This Happened
In a TikTok video in August 2024, social worker Patrick Teahan asserted that there is a definitive sign of childhood trauma.
 
Who Did This?
Patrick Teahan, LICSW, is a clinical social worker who developed a large social media following by focusing on childhood trauma. His claim to expertise is based partly on his own childhood during which he endured a narcissistic parent “trauma.” His YouTube channel has dozens of videos, nearly all on childhood trauma, and 763,000 subscribers. His personal website offers a monthly subscription of $69.99 which provides twice per month Zoom calls for group Q&A sessions, access to his library of pre-recorded “E-courses,” weekly journaling prompts by email, and the opportunity to connect with other subscribers in an online “Monthly Healing Community.”
Teahan was the center of a mild controversy in July 2024 when clinicians criticized his tendency to recommend clients cut off all contact with difficult parents, what he calls “going no-contact” (see here and here)
 
The Claim
The TikTok video was a brief clip from a longer conversation during an episode on The Dr. Ramani Network, a podcast run by psychologist Ramani Durvasula, a specialist in narcissism.
 
Durvasula: What do you consider to be the definitive sign of childhood trauma?
Teahan: I think for a lot of us it’s about trying to get the difficult person to be good to us in our adult lives.
Durvasula: (Interrupting) Wait! Say that again! Say that again. That’s so important. Say that again.
Teahan: A definitive sign of childhood trauma is about trying to get a difficult person to be good to us.
Durvasula: So, that’s it, right? I mean that right there. If we stop the show right here, you just gave us wisdom for the ages, right?
 
When the video garnered over 4.8 million views and nearly 500,000 likes, a health reporter for NBC’s Today show declared, “Teahan's answer was a mic-drop moment for many.” When the reporter interviewed Teahan, he explained that individuals who grew up with difficult parents become so interpersonally warped that their “inner child” is trying to please difficult people in the present just as they tried to please their parents in childhood.

Analysis
Teahan is among a large group of clinicians who believe that almost any type of everyday stressor qualifies as “trauma.” This contrasts with the definition used in posttraumatic stress disorder in which traumas are life-threatening events. According to Teahan, narcissistic mothers who are self-absorbed and criticize their children are a form of trauma and childhood maltreatment. His overly expansive use of trauma is consistent with the Adverse Childhood Experiences (ACE) narrative which also conflates stress with trauma.
 
There is no such thing as a definitive sign of any childhood event. The claim is logically and scientifically hollow. Many people try to please difficult people and experienced neither true childhood trauma nor narcissistic parents. Also, many people have suffered childhood trauma or narcissistic parents, and do not have trouble dealing with difficult people.
 
Teahan’s methods of reaching his audience include videos of him playing guitar and drums, singing, dancing, role playing as narcissistic parents, and dressing up as the famous painter Bob Ross. If you do not share Teahan’s worldview or disagree with his teaching methods, he seems easy to dismiss. Below is a clip from one of his videos showing his many talents:

But simply dismissing him would miss the context that he is obviously popular. A substantial portion of the population shares his worldview and desires his unique way of blaming parents for their adult relational problems.
 
Why Did This Happen?
Teahan is among a growing group of clinicians who are trying to make their living as internet experts. They do not provide therapy. Instead, they use their clinical expertise to coach, enlighten, and entertain.
The attractiveness of the TikTok video seems partly due to the underlying ideology of the claim. By asserting childhood trauma can make permanent changes to one’s personal relationship style, it assumes that humans are highly fragile. This is the same ideology of other false claims that have great appeal to a segment of the population including the bestseller book The Body Keeps the Score (see here), the contrived complex PTSD disorder, and the ACE movement (see here). These are all provably wrong but that is not a concern for some individuals whose personal worldviews are seamless with these fabricated worlds.

Source: Australian Institute of Family Studies
Read time: 2.0 minutes
 
This Happened
In August 2024, an Australian government agency issued a “practice guide” for researchers on how to conduct trauma-informed research.
 
Who Did This?
The first author on the report was psychologist Jasmine MacDonald, a Research Fellow in the Australian Institute of Family Studies (AIFS). She has six first-author and five secondary-author research papers. Her first-author papers include literature reviews on depression and post-traumatic stress purportedly caused by the mental stress of being a journalist. She has conducted one study involving original data collection of trauma reactions (an online questionnaire of TV camera operators).
Her four co-authors on the report have conducted zero studies on trauma reactions.
The AIFS is an Australian Government agency. Its mission is “to conduct high-quality, impartial research into the wellbeing of Australian families” that can influence government policy and services for families.

​Most of the recommendations are already part of common sense IRB guidelines on how to obtain informed consent and respect participants’ privacy. But many recommendations were novel. The five sections used to organize the report and some of the more unique recommendations follow:
1. Planning and design
Consider how your research can be strengthened by “anti-oppressive” and “decolonising” frameworks.
2. Participant screening and recruitment
When recruiting a victim of trauma, the individual must be called “victim-survivor,” not “victim.”
3. Data collection
When collecting data, “use a location that is familiar.”
If participants would rather interact with their clinician rather than a research assistant, that should be accommodated.
Let participants choose where they sit.
Make sure recording devices are positioned so they do not “reinforce power imbalance.”
Encourage participants to bring support persons during the research.
Avoid “asking ‘why’ questions as these may be perceived as judgmental.”
“Start with the least sensitive questions and gradually move to questions about sensitive content.”
4. Analysis and dissemination
“Consider applying an intersectional lens to the data.”
5. Project team self care
As a researcher, “Reflect on your own traumatic experiences” throughout the research project and have a self-care strategy in place to keep you “grounded and calm.”
 
Analysis
The authors added a not-so-small caveat on the final page: “To date, there is a lack of evaluation of the impact of trauma-informed strategies on outcomes for participants in research and evaluation projects. We do not yet know if these approaches are achieving their intended goal and purpose of minimising negative impacts on participants or whether there are any unintended outcomes.” In other words, there are no data to show these recommendations are effective for any outcome and may instead by harmful (see similar conclusions here).
The authors provided assurance, however, that they were experts because “The literature informing this practice guide was mostly based on the experiential learnings that authors have had while conducting their own case study or research/evaluation projects.” They neglected to mention that none of the authors have experience interacting with a live human research participant who has experienced trauma.
This guide is the nightmare for most clinical researchers. If university IRB committees adopted these practice guides, standardized or efficient research would not be feasible on any clinical population.

Source: Journal of Psychiatric Research
Read time: 2.5 minutes
 
This Happened
In March 2024, a study was published using an eight-factor model of posttraumatic stress disorder (PTSD) symptoms. Previously, seven had been the highest number of factors considered to be the best model. In contrast, for more than three decades, PTSD had been diagnosed as just three clusters of symptoms.
 
Who Did This?
Psychologist Robert H. Pietrzak was the senior author on the study. He is a professor of Psychiatry and of Public Health at Yale University, and works at the U.S. Department of Veterans Affairs, National Center for PTSD. He has over 400 research publications, including at least twelve using factor analysis of PTSD symptoms.
 
The Premise
In this study, researchers collected data from 3,847 veterans on the twenty symptoms in the PTSD diagnostic criteria [1]. They created eight groupings of those symptoms to replicate an 8-factor model that recently had been created by the same research group [2]. Researchers found that three of the eight factors correlated with depression, four of the eight factors correlated with anxiety, and four of the eight factors correlated with suicidal ideation.
The authors concluded that these findings demonstrated validity of the 8-factor model. They suggested that this model may lead to better assessment, treatment, and prevention of PTSD.
The details of this study are summarized very briefly here because they are inconsequential. As the analysis below reveals, this study is emblematic of a larger problem in trauma research.
 
Analysis
This study is one of approximately six hundred studies over the past four decades using the results of a statistical technique to discover or confirm factors of PTSD. The statistical technique is usually some variation of factor analysis.
Briefly, factor analysis works by calculating how frequently each symptom is present with every other symptom. The mathematics then reduces a large number of items into a handful of factors by grouping items that tend to co-occur with each other into a factor, and separating those that co-occur relatively less frequently into other factors.
The premise of factor analysis is that there exists a latent model of a construct that cannot be directly measured. This type of premise is unprovable with current technology. Whether the latent model exists is a theoretical question.
 
Why is this important? When criteria for psychiatric disorders were revised for the 2013 publication of DSM-5, a tragic decision was made that has gone barely noticed. The old three cluster algorithm of symptoms used to make a diagnosis was thrown out and replaced by a four-cluster algorithm. The sole reason for this momentous change was because many factor analysis studies had shown four factors was the best mathematical solution. For the first time in history, factor analysis research was used to change diagnostic criteria.
 
There have been at least seven important reviews of the massive factor analysis of PTSD literature. In the most recent review, I analyzed 206 studies on different metrics of whether factor analysis is a useful technique for designing diagnostic criteria [3]. There were too many interesting findings to summarize here, so, I’ll mention only two highlights.
1. In sixty-six confirmatory factor analysis studies with adults using DSM-5 criteria, researchers found twelve different best-fitting models that ranged from one to seven factors. A four-factor model was best-fitting most often, however, that was in only 59% of studies. With this variety of outcomes, factor analysis is closer to stamp collecting than a valid method of discovering human nature.
2. Results were contingent on which models researchers opted to study. Whenever four-factor models were tested against models with more than four factors (five, six, or seven factors), the four-factor model was best fitting in only 12.8%! Because factor analysis tries to find the model that accounts for the most mathematical variance, the model with a higher number of factors is almost always the best fitting. That is probably why the new 8-factor model was best-fitting in its inaugural test. When someone creates a 9-factor model, that will be best-fitting.
 
So, how many underlying factors really exist in a model of PTSD? Schmitt and colleagues probably have the answer. They conducted perhaps the most rigorous factor analysis possible, trying to avoid methodology pitfalls that have snared less careful researchers [4]. They concluded overall the “results provide greater evidence for a one-factor model.”
 

References 
[1] Stiltner B, Fischer IC, Duek O, Polimanti R, Harpaz-Rotem I, Pietrzak RH (2024). Functional correlates of a novel 8-factor model of PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study, Journal of Psychiatric Research 171:69-74. DOI: 10.1016/j.jpsychires.2024.01.017.
[2] Gross GM, Spiller TR, Duek O, Pietrzak RH, Harpaz-Rotem I (2023). Clinical significance of novel 8-factor model of DSM-5 PTSD in national VA PTSD residential treatment data: Internally- v. externally-cued intrusions, Journal of Affective Disorders, 328:255-260. DOI: 10.1016/j.jad.2023.02.046.
[3] Scheeringa MS (2024). Is factor analysis useful for revising diagnostic criteria for PTSD? A systematic review of five issues ten years after DSM-5. Journal of Psychiatric Research 176:98-107. DOI: 10.1016/j.jpsychires.2024.05.057.
[4] Schmitt T A, Sass DA, Chappelle W, Thompson W (2018). Selecting the "best" factor structure and moving measurement validation forward: An illustration. Journal of Personality Assessment, 100(4), 345-362. DOI: 10.1080/00223891.2018.1449116.

Source: NCTSN
Read time: 2.1 minutes
 
This Happened
On September 6, 2024, the National Child Traumatic Stress Network (NCTSN) newsletter announced a new webpage reiterating their support of trauma-informed pediatric psychiatry.
 
Who Did This?
The NCTSN was founded in 2000 and has been continuously funded by the Substance Abuse and Mental Health Administration. Funding supports two sites—UCLA and Duke University—that co-direct a network of hundreds of sites that have been supported to create and disseminate knowledge about assessment and treatment of trauma in children and adolescents.
 
The Premise
The new webpage outlined the premise and guiding principles of trauma-informed care, and included links to other resources on its website.
The premise is that trauma causes such a wide range of problems for victims that the only type of credible care requires consideration of biological, psychological, social, and cultural factors. Most importantly, these considerations must extend across all of society where trauma victims make points of contact for services. Humanitarian ethics demand this special treatment because thoughtless healthcare practices, such as careless comments at the check-in desk or judgmental attitudes in the office, can retrigger victims and compound their suffering [1].
 
The six principles of trauma-informed care, as defined by SAMHSA, are [2]:
Safety
Trustworthiness and Transparency
Peer Support
Collaboration
Empowerment
Cultural and Historical Awareness
 
Analysis
There are numerous major concerns that have been expressed about trauma-informed care.
Lack of evidence. A recent review of trauma-informed care implementations could locate only six studies of decent quality, and none were randomized [1]. The review concluded: “We found limited, mixed, and conflicting evidence for the effects (or perceived effects) of trauma-informed organisational change interventions…” Another recent review that was written to critique the premature embrace by the Scottish government for establishing trauma-informed care in national policy also found a lack of evidence [3].
Conceptual. Nearly a decade after appearing on the scene out of the blue, the concept is still vague. People are still not sure what it is [3].
Control of Language and Ideas. The vagueness of the concept seems on purpose. Trauma-informed care is not simply treatment by a doctor or therapist who understands how to treat psychological trauma, although proponents place their umbrella over such care (imagine how impish it would seem to extend this type of language to surgeons who operate on broken bones as skeleton-informed care). The broad and vague conceptualization makes sense when understanding that trauma-informed care is a movement, not a science-based intervention. Trainers who provide workshops on trauma-informed care are careful to emphasize that becoming trauma-informed is a transformation process (see here). The long-term aim is to change the culture for professionals to think and talk about trauma victims as highly fragile humans.
Misrepresentation of science. According to proponents of trauma-informed care, the situation is urgent because trauma causes permanent biological damage to victims’ brains and bodies. Despite this being a common belief among trauma experts, this belief has been repeatedly debunked (see here, here, and here).
Unintended consequences. Framing of suffering in a way that humans are highly fragile has the possible unintended consequences of creating false beliefs of how people understand themselves and creates a sense of feeling less resilient than they really are [4].
 
Why Is This Happening?
This movement is consistent with the moral foundation of progressive liberals that human nature is almost completely molded by life experiences—such that individual differences in success or failure are caused by experiences, not unchanging heritable traits—and care for the disadvantaged must supersede all other moral concerns (such as tradition, loyalty, patriotism, and liberty). The progressive sensibility yearns for a predictability that the movement of life and society can be controlled, to be able to point at one thing and say with certainty, “This is the oppression that caused all my problems.” That is a false certainty that has little prospect of truly helping individuals with deep-seated problems.
 
 
References
[1] Natalia V. Lewis, Angel Bierce, Gene S. Feder, John Macleod, Katrina M. Turner, Stan Zammit, Shoba Dawson, "Trauma-Informed Approaches in Primary Healthcare and Community Mental Healthcare: A Mixed Methods Systematic Review of Organisational Change Interventions", Health & Social Care in the Community, vol. 2023, Article ID 4475114, 18 pages, 2023. DOI: 10.1155/2023/4475114.
[2] SAMHSA, “SAMHSA’s concept of trauma and guidance for a trauma-informed approach,” HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
[3] Mark Smith, Sebastian Monteux, and Claire Cameron (2021). Trauma: An ideology in search of evidence and its implications for the social in social welfare. Scottish Affairs 30(4):472–492 DOI: 10.3366/scot.2021.0385.
[4] Mark Smith and Sebastian Monteux (March 2023). Trauma-informed approaches: A critical overview of what they offer to social work and social care. Insights: A Series of Evidence Summaries. The Institute for Research and Innovation in Social Services.