Each DSM edition has widened what counts as a traumatic event
STUDY: Bar-Haim S, J Hist Behav Sci 2026
STUDY TYPE: Historical review
FUNDING: Independent Social Research Foundation
Background
When PTSD entered the DSM-III in 1980, a traumatic event had to be “outside the range of usual human experience,” such as war, rape, or the death camps. In this paper, sociologist Shaul Bar-Haim traces how the concept has changed since then.
Summary
The definition of trauma widened in steps:
- DSM-III-R (1987) added witnessing or hearing about harm to close relatives and friends
- DSM-IV (1994) dropped the “outside usual experience” rule and defined the event partly by the person’s emotional response
- Complex PTSD (in ICD but not DSM) extended the definition to chronic, repeated, trauma in relationships from which escape is difficult or impossible (eg, child abuse, prisoners of war).
- Insidious trauma extended the concept to include the cumulative, ongoing psychological harm caused by everyday systemic oppression, marginalization, and social devaluation (eg, microaggressions)
In the 1990s, psychiatrist Bessel van der Kolk revived Pierre Janet’s view of trauma as a memory disorder, and his bestselling book reshaped the concept (The Body Keeps Score). In this model, traumatic memories are dissociated, can’t be put into words, and return as flashbacks and physical symptoms set off by sensory reminders of the traumatic event. The idea raised flashbacks to a defining symptom of PTSD in popular culture.
From there, Bar-Haim argues, a “trigger culture” emerged. Since anything might register as traumatic, the effort shifted to preventing future reactions through trigger warnings and safe spaces.
The change is illlustrated in two stories of a college classroom. In 1984, a professor at Yale (Shoshana Felman) showed graduate students videos of Holocaust testimonies. Many students felt they were breaking down and called their professor in distress, but Dr. Felman welcomed the crisis as the point of the lesson and went ahead with the second tape.
Today, most professors give trigger warnings before showing videos like that. People disagree on whether that is necessary. Most studies show these warnings make no difference, and some show they can increase distress by priming the autonomic nervous system.
Practice Implications
- There are many types of stress and trauma. Where we draw the lines may change, but this point remains.
- While these distressing events can lead to PTSD, they can also set off other problems (addiction, bipolar, depression, psychosis, etc), and some people come out more resilient through them.
- Learn more in our Carlat podcast series on PTSD.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
