The Problem with "Post" Traumatic Stress

The term _Post-Traumatic Stress Disorder_ (PTSD) is a relic of the 1980s, born from a narrow understanding of trauma as a linear, isolated event. Yet research consistently shows that trauma is rarely confined to the past:

  • For survivors of domestic violence, systemic racism, or chronic illness, trauma is _ongoing_. The "post" erases their reality (Herman, 1992; van der Kolk, 2014).
  • Moral injury—a collapse of one’s ethical framework due to betrayal by trusted institutions (e.g., military, clergy)—blurs the line between "event" and "aftermath" (Litz et al., 2009).
  • Anticipatory trauma / 'Pre-TSD' (e.g., police violence, climate anxiety) creates stress _before_ harm occurs, a phenomenon documented in marginalized communities (Carter, 2007).
The DSM’s "post" framing centers combat veterans while excluding those for whom trauma is cyclical or persistent.

**Every Letter of "PTSD" Fails Survivors

"P" (Post): Trauma Isn’t Linear

The myth of "post" trauma ignores:

  • Ongoing Traumatic Stress Disorder (OTSD): Proposed by advocates for refugees and abuse survivors (Briere & Spinazzola, 2005).
  • Pre-Traumatic Stress: Marginalized groups live with hypervigilance toward _future_ harm (e.g., transgender youth fearing harassment).

"T" (Traumatic): The DSM’s Narrow Definition

The DSM-5 requires trauma to involve "actual or threatened death, serious injury, or sexual violence." This excludes:

  • Structural trauma: Poverty, racism, or ableism (APA, 2013; Williams et al., 2021).
  • Emotional abuse: Gaslighting or coercive control, which can be as debilitating as physical violence (Stark, 2007).

"S" (Stress): More Than a Stress Response

Trauma reshapes the brain and body:

  • Neurobiological changes: Hippocampal shrinkage, dysregulated HPA axis (Yehuda et al., 2015).
  • Dissociation: A survival strategy, not a "symptom" (Lanius et al., 2010).

"D" (Disorder): Pathologizing Survival

Calling trauma responses "disordered" ignores their adaptive roots:

  • Hypervigilance: A rational response to danger (Perry, 2006).
  • Post-Traumatic Growth: Many survivors integrate trauma into resilience (Tedeschi & Calhoun, 2004).

From "Shell Shock" to "PTSD": A Political History

The term _PTSD_ replaced _Shell Shock_ (WWI) and _Gross Stress Reaction_ (WWII) not for scientific clarity, but to:

1. Medicalize suffering, shifting blame from war to individual "disorder" (Young, 1995). 2. Exclude non-combat trauma, particularly affecting women and minorities (Scott, 1990).

"Shell Shock"—with its visceral imagery of shattered bodies—was arguably _more accurate_ for trauma’s systemic impact.

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A Call for Reform: Alternatives to "PTSD"

Adopt More Precise Language

  • For chronic trauma: _Persistent Traumatic Stress Disorder_ (PTSD) or _Complex Trauma_ (Herman, 1992).
  • For moral injury: _Betrayal Trauma Syndrome_ (Freyd, 1996).
  • For structural harm: _Structural Trauma Syndrome_ (Galtung, 1969).

Decouple Trauma from "Disorder"

  • Trauma Spectrum Condition: Acknowledges diversity in responses.
  • Injury Model: _Traumatic Stress Injury_ (TSI) mirrors physical trauma frameworks.

Center Lived Experience in Diagnosis

Survivor-led frameworks, like the Power Threat Meaning Framework (Johnstone & Boyle, 2018), reject pathologizing labels and ask:

  • _What happened to you?_
  • _How did you survive?_
  • _What meaning did you make of it?_

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Language as Liberation

The term _PTSD_ is outdated, exclusionary, and often harmful. By redefining trauma language, we can:

  • Validate ongoing and anticipatory suffering.
  • Challenge systems that cause trauma (e.g., militarism, racism).
  • Empower survivors to frame their own experiences.
Our words shape our world. It’s time to speak trauma into truth.

References

  • Herman, J. (1992). _Trauma and Recovery_.
  • van der Kolk, B. (2014). _The Body Keeps the Score_.
  • Litz, B. et al. (2009). "Moral injury and moral repair in war veterans."
  • Carter, R. (2007). "Racism and psychological and emotional injury."
  • Johnstone, L. & Boyle, M. (2018). _The Power Threat Meaning Framework_.
  • Briere, J. & Spinazzola, J. (2005). "Ongoing traumatic stress disorder."
  • Stark, E. (2007). _The Batterer as a Parent_.
  • Yehuda, R. et al. (2015). "Neurobiological consequences of early-life trauma."
  • Lanius, R. et al. (2010). "Dissociation and the dissociative disorders: past, present, and future."
  • Perry, B. (2006). _The Boy Who Was Raised as a Dog_.
  • Tedeschi, R. & Calhoun, L. (2004). _Posttraumatic Growth_.
  • Young, J. (1995). _The Harmony of Illusions_.
  • Scott, J. (1990). _Only Connect_.
  • Freyd, J. (1996). "Betrayal trauma theory."
  • Galtung, J. (1969). "Violence, peace, and peace research."
  • Dr. Joy De Gruy Leary's work on Post Traumatic Slave Syndrome.
  • Crocq MA, Crocq L. From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology. Dialogues Clin Neurosci. 2000 Mar;2(1):47-55. doi: 10.31887/DCNS.2000.2.1/macrocq. PMID: 22033462; PMCID: PMC3181586.