Defining the concept of psychological trauma

Over 40 years ago, post-traumatic stress disorder was recognized as a formal psychiatric diagnosis by the American Psychiatric Association and was defined in the Diagnostic and Statistical Manual of Mental Disorders by characteristic signs and symptoms following exposure to an objectively defined traumatic event. This recognition led not only to a surge in research but also to debate about what constitutes psychological trauma. In this Review, we present the ongoing problems with the concept of ‘traumatic event’ as currently defined and link this discussion to empirical findings and theoretical models of trauma, specifically regarding direct and indirect causality, cognitive-behavioural approaches and active inference. These findings and theories have become particularly relevant in the current geopolitical and sociocultural context characterized by the impact of the COVID-19 pandemic, ongoing wars, racism-related stressors and the ubiquity of distressing stimuli on social media. We discuss the clinical utility of a more encompassing definition of psychological trauma, and we reflect on the positive and negative clinical and societal implications of this revised conceptualization.