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What is a traumatic event?

Published online by Cambridge University Press:  02 January 2018

J. D. Elhai
Affiliation:
Disaster Mental Health Institute, The University of South Dakota, 414 East Clark Street –SDU 114, Vermillion, South Dakota, USA. E-mail: jelhai@usd.edu
T. B. Kashdan
Affiliation:
Department of Psychology, George Mason University Fairfax, Virginia, USA
B. C. Frueh
Affiliation:
Charleston Veterans Affairs Medical Center and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Abstract

Type
Correspondence
Copyright
Copyright © 2005 The Royal College of Psychiatrists 

Olff et al (Reference Olff, Koeter and Van Haaften2005) sampled farmers during a foot and mouth epidemic, concluding that half whose livestock were culled had ‘post-traumatic stress at levels requiring professional help’, and ‘the high prevalence of post-traumatic stress symptoms is an underestimation of the real levels of psychopathology’ (p. 166). What was the ‘traumatic event’ implicated in these ‘post-traumatic’ reactions? According to DSM-IV-TR criteria for post-traumatic stress disorder (PTSD) (American Psychiatric Association, 2001), a traumatic event requires that ‘the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others’ (further requiring that ‘others’ must be persons, not animals) and that ‘the person's response involved intense fear, helplessness, or horror’ (p. 467). We seriously question livestock loss as a traumatic event.

Loosening criteria for a traumatic event represents a progressive ‘conceptual bracket creep’ in defining trauma (Reference McNallyMcNally, 2003). Will the next study examine PTSD in children ‘traumatised’ by their pet hamster's death, or from watching Bambi die in the famous Disney movie? What about being exposed to offensive remarks by others (Reference Avina and O'DonohueAvina & O'Donohue, 2002)? With the current trajectory all negative experiences will be synonymous with traumatic events, trivialising the experiences of real trauma victims. We ask where will researchers finally draw the line in what is considered traumatic? Continued disregard for the criteria will lead to anyone being considered trauma-exposed and eligible for a PTSD diagnosis. With healthcare resource limitations, truly trauma-exposed and symptomatic patients could consequently be denied care (at a minimum subjected to extensive waiting lists), and our courts would be crippled with unnecessary PTSD litigation.

Olff et al (Reference Olff, Koeter and Van Haaften2005) claim that ‘Although the foot and mouth crisis is not a traumatic event in the usual sense, the consequences do resemble features of PTSD’ (p. 166). This statement minimises (without justifying) the authors' disregard for trauma criteria, and poses a circular argument in contending that the presence of PTSD symptoms confirms trauma exposure. However, trauma exposure must be distinguished from PTSD, since minor stressors (e.g. taking a nightshift job) can result in symptoms (e.g. difficulties in sleeping, problems concentrating) that are aetiologically distinct from PTSD.

References

American Psychiatric Association (2001) Diagnostic and Statistical Manual of Mental Disorders (4th edn, revised) (DSM–IV–TR). Washington, DC: APA.Google Scholar
Avina, C. & O'Donohue, W. (2002) Sexual harassment and PTSD: is sexual harassment diagnosable trauma? Journal of Traumatic Stress, 15, 6975.Google Scholar
McNally, R.J. (2003) Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology, 54, 229252.Google Scholar
Olff, M., Koeter, M. W. J., Van Haaften, E. H., et al (2005) Impact of a foot and mouth disease crisis on post-traumatic stress symptoms in farmers. British Journal of Psychiatry, 186, 165166.Google Scholar
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