Trauma or Adversity?

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Cochrane Database of Systematic Reviews recognizes several trauma-focused therapies as evidence-based and thus recommended treatments for posttraumatic stress disorder (Bisson, Roberts, Andrew, Cooper, & Lewis, 2013). However, there is no consensus on the definition of trauma, and controversy persists about its meaning, which brings into question the specificity and the target of trauma-focused treatments. The construct of trauma is often linked to posttraumatic stress disorder and Criterion A of trauma-related disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychiatric Association, 2013). In other instances, it is understood as a broader phenomenon covering much if not most of human suffering. In this report, I address the dichotomy between the narrow and broad views of trauma and review considerations for a tighter definition of trauma on the grounds of clinical philosophy, methodology, and practice. I suggest that the construct of trauma should be grounded in the general theory of stress, where trauma is considered a particular kind of stress response alongside with adversity and normative stress. Following such conceptualization, I formulate a working definition of what trauma is and, more importantly, is not.

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