REVIEW OF: Scoglio AAJ et al, Eur J Psychotraumatol 2025;16(1):2506759
STUDY TYPE: Parallel mixed methods study

What if the most distressing event in someone’s life doesn’t show up on a trauma checklist—or even meet the DSM’s Criterion A definition of trauma? Under the DSM-5, trauma requires exposure to actual or threatened death, serious injury, or sexual violence, yet many life events that patients find shattering—like a loved one’s illness, a painful breakup, or a moral injury at work—don’t qualify. That gap was the focus of this study, which analyzed 2,653 female nurses in the Nurses’ Health Study II who had listed an “other” event as their worst lifetime trauma.

Researchers classified traumatic events using the Brief Trauma Questionnaire (combat, car accidents, natural disasters, life-threatening illnesses, child abuse, sexual abuse, serious injuries, losing a close family member to violence, or witnessing violence) plus five additional items (miscarriage or stillbirth, traumatic complications of pregnancy or birth, death of one’s child, sexual harassment at work, or treating civilian trauma). Events that didn’t fit these checkboxes were the sole focus of this study. PTSD symptoms were assessed using DSM-5 criteria, excluding functional impairment or duration.

A total of 56 types of trauma were grouped into 6 categories: a family member being harmed (35.8%), a non-violent death of a family member or close friend (31.1%), a personally distressing event or problem (16.3%), a family member managing a distressing problem (11.3%), problems with an intimate partner (8.5%), and a distressing event occurring in the workplace (7.2%).

Despite not appearing on standard trauma checklists, in this study these events were associated with significant distress and PTSD symptom rates comparable to, or higher than, Criterion A events. The percentage of women experiencing events in each of these categories who met criteria for provisional lifetime PTSD ranged from 19% to 33.7%, and for past-month PTSD from 2.7% to 7.6%. Women who experienced verbal or emotional abuse or harassment had the highest prevalence of both lifetime (43.8%) and past-month (7.9%) PTSD. The authors note that prior evidence is mixed regarding whether non-Criterion A events lead to comparable rates of PTSD as official traumas.

CARLAT TAKE
We can’t rely entirely on the DSM to tell us what counts as a trauma. Ask open-ended questions, give patients room to describe what has truly shaken them, and focus on treating the symptoms of trauma rather than whether something should be called PTSD vs adjustment disorder or an unspecified trauma-related disorder. Be especially vigilant for distress among female patients reporting verbal or emotional abuse.