Should the current DSM-IV-TR definition for PTSD be expanded to include serial and multiple microtraumas as aetiologies?


R. Seides
College of Nursing
Seton Hall University
400 South Orange Avenue
South Orange
NJ 07079


Accessible summary

  • • The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) has diagnostic criteria for post-traumatic stress disorder that includes the experience of a major threat to life or physical integrity, and does not include a series of non-life-threatening traumatic events as a causative factor.
  • • A review of the literature shows that multiple non-life-threatening emotional traumas occur more frequently and are often more psychologically harmful than a single catastrophic event.
  • • DSM-IV-TR adoption of expanded criteria for the diagnosis of post-traumatic stress disorder should be considered.


Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops from events that are interpreted as traumatic. It may be secondary to witnessing trauma to someone close, an event that threatens one's life or childhood sexual trauma. Resultant feelings can be fear, helplessness or horror. Thresholds at which traumatic events cause PTSD, the individual's coping ability and support systems help determine occurrence and severity of symptoms. According to DSM-IV-TR (DSM) definition, PTSD can occur after childhood sexual abuse or a single trauma threatening life or safety. However, it is becoming clearer that symptoms of PTSD can arise from multiple less severe traumas (‘microtraumas’), which can be a consequence of a history of longstanding emotional neglect, humiliation or inaccurate attribution of blame. The DSM should consider modifying the criteria to include multiple microtraumas that can lead to PTSD symptoms and may even be more destructive to psychological health.