Neglected causes of post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) has been defined by successive editions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (most recently DSM-5). The diagnosis requires an objectively traumatic event that involves exposure to “death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.” This focus on objective event characteristics maintains PTSD as a response to extreme rather than everyday stress, but it overlooks mounting evidence that subjective responses to traumatic events predict PTSD just as or more strongly.1 Groups of patients who are at risk of developing PTSD might be overlooked because the triggering event is subjectively rather than objectively traumatic. We describe three such groups here, but there are undoubtedly others.

Traumatic events, both objective and subjective, are common in the lives of patients with psychosis. Experiences, such as being forcibly sedated or admitted to hospital during an acute episode, can be terrifying to someone who cannot understand fully what is happening or appreciate the motives of those involved. …