PTSD Awareness Month
Note: I reference Dr. Judith Herman and her book Trauma and Recovery. Dr. Herman is an amazing pioneer in the field of trauma, especially as it relates to survivors of abuse! That said, some language in her book (originally published in 1992) is no longer used.
June has a lot of awareness & heritage months:
Pride Month
Men’s Mental Health Awareness Month
Caribbean-American Heritage Month
Alzheimer’s & Brain Awareness Month
National Safety Month (admittedly had no idea what that was before research for this post)
National Immigrant Heritage Month
PTSD Awareness Month
This might seem somewhat backwards, but in honor of PTSD Awareness Month, I want to talk about my qualms and frustration with the diagnosis as written. Mainly, that is Criterion A, or the stressor criteria.
According to the DSM-5-TR[1] published by the American Psychiatric Association, or APA (2022), to be diagnosed with Posttraumatic Stress Disorder (or PTSD) as a person older than 6 years old, you need to have had
“Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
Directly experiencing the traumatic event(s)
Witnessing, in person, the event(s) as it occured to others
Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g. first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related” (p. 301).
My critique? What about experiences that never get physical? Some people experience abuse and/or violence where there are no actual threats of death, no ‘serious injury.’[2]
There are children who grow up in homes where they are demeaned and devalued, but technically experienced no physical harm, no threats of physical harm. Children who experienced demands, ridicule, humiliation, and/or little-to-no affection, but were never beaten. Children who were excessively verbally bullied (whether at home or at school), but never shoved, never punched. Though even if they were, that may not meet the mark of a “serious” injury.
There are victims/survivors of IPV where the abuse may have never gotten physical, or never physical “enough” to cause serious injury. But they may have been degraded, insulted, and manipulated; perhaps there were some threats, but they weren’t of death or “serious” physical injury.
And yet the APA fails to expand their definition to include trauma that is not physical or sexual in the DSM. It is great that they at least include threats of physicality, again, not all emotional abuse includes threats of death or serious harm. Plus, even with the (s), it still gives very one-time-event vibes.
Dr. Judith Herman first coined Complex Posttraumatic Stress Disorder, or cPTSD, in 1988, as there were no diagnoses that properly captured the experiences of those who survived prolonged, repeated experiences of trauma (1992; 2022). While cPTSD does better define experiences for individuals who experienced ongoing trauma rather than single events, I’d argue that both Herman’s original criteria and the current criteria in the ICD-11[3] still miss the mark. (Not even getting into the fact the APA doesn’t recognize cPTSD as a diagnosis—insert eye roll here—that’s a post for another day).
Herman’s first criterion for cPTSD, as written in Trauma and Recovery (2022), is:
“A history of subjection to totalitarian control over a prolonged period (months to years). Examples include hostages, prisoners of war, concentration-camp survivors, and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including survivors of domestic battering, childhood physical or sexual abuse, and organized sexual exploitation” (p. 176).
In the ICD-11 (WHO, 2019), the first essential feature of diagnostic requirements for cPTSD is:
“Exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible. Such events include, but are not limited to, torture, concentration camps, slavery, genocide campaigns and other forms of organized violence, prolonged domestic violence, and repeated childhood sexual or physical abuse.”
Once again, the parameters feel very limited. Sure, there’s growing understanding that abuse takes many forms beyond physical, but that is still a work in progress. And yes, the argument could be made that I’m being picky since, at least for the ICD-11, it even says “not limited to.” But when “repeated childhood sexual or physical abuse” is specifically stated, it’s easy to assume emotional/psychological abuse “doesn’t count.” And with how specific other aspects can be, there may be professionals out there who may not factor in emotional abuse, especially when it fails to be mentioned in both PTSD and cPTSD diagnostic criteria. There may be individuals on their own journeys who may discount their trauma because they never experienced “serious” physical abuse, or may not have experienced physical abuse at all.
Ultimately, while I have issues with diagnosing as a whole, especially as I am actively engaging in liberation and decolonizing work, I still know that there can be so much relief that can come from having a therapist or other mental health professional name your experience. I know that both from my work as a therapist, but also from having my own therapist verbally state that PTSD does align with my experiences. Also from listening to Stephanie Foo speak about her experiences in What My Bones Know[4].
So, during this PTSD Awareness Month, for those who may wonder if your experiences can count because the abuse wasn’t physical, or at least not “that” physical, I want you to know that I, and many other trauma professionals, believe it does—even if the APA and WHO are behind the times.
Footnotes:
[1] DSM-5-TR is the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision.
[2] While I did attempt to find a definition of ‘serious injury’ in order to write this, I have struggled to find an official one, at least outside of legal or medical/hospital definitions. That said, it appears a general consensus that a serious injury means a serious physical injury.
[3] ICD is the International Statistical Classification of Diseases and Related Health Problems, published by the World Health Organization (WHO).
[4] A heavy read/listen, but I very much do recommend if you are in the space for it. A blend of research and memoir, it is informative, tear-jerking, and thought-provoking.
References:
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.)
Foo, S. (2022). What my bones know: A memoir of healing from complex trauma. Ballantine Books.
Herman, J.L. (2022). Trauma and recovery: The aftermath of violence—From domestic abuse to political terror. Basic Books.
World Health Organization. (2019). 6B41 Complex post traumatic stress disorder. In International statistical classification of diseases and related health problems (11th ed.) https://icd.who.int/browse/2026-01/mms/en#585833559
Additional author’s note: I lost an hour of the writing for this yesterday (6/10/26), and I fear I may have lost some of the original juice when that happened. . . But c’est la vie!