The view of trauma adopted in the DSM-V is a reflection of the Cartesian dualism that still permeates mainstream psychology. The diagnosis of post-traumatic stress disorder, or PTSD, requires that a direct, physical threat to someone’s life occur; emotional abuse doesn’t seem to count, despite research studies indicating that emotional distress can exert the same effects as physical abuse. If emotional abuse results in the same biochemical responses as physical abuse or life-threatening accidents, then it should be included as a criterion for PTSD or other psychiatric disabilities that arise from stress or trauma. Limiting the aetiology to direct physical threats prevents survivors of emotional abuse or other forms of sustained maltreatment from receiving the help they need.
Drawing a bright line between the two seems entirely predicated on the idea that the mind and body are two separate entities. This kind of crude dualism reflected in the DSM is not in keeping with current neuroscientific findings. Rather, the states of the mind and the rest of the body work in concert with one another. For example, anxiety and depression lead to the increased production of stress hormones like cortisol and adrenaline, which can ultimately overload the body and lead to a variety of adverse health consequences like stroke and heart disease (McEwen, 2005). The idea of a mind wholly separate from the rest of the body is an epiphenomenon of our cognition, not a tangible reality; while we may feel a separation between our thoughts and the rest of our body, the brain is still inextricable from the rest of our flesh, blood and bones. Our selfhood is immanent within the corporeal; it neither transcends it nor is reducible to it.
Admittedly, this frustration is deeply personal; I myself have PTSD symptoms from surviving years of emotional abuse and neglect, but if diagnosticians adhered strictly to the DSM, I couldn’t even be diagnosed with it. There is no official name for what I’ve gone through, even though the effects of this maltreatment still linger. Some psychologists and psychiatrists have suggested adding complex PTSD, or C-PSTD, to the DSM, but it hasn’t been added as of 2013. Leaving the scars of emotional trauma unnamed creates the potential for gaslighting, denial, and manipulation. While I’m not an unalloyed supporter of the medical model to name and identify trauma, I do think that we need ways to discuss what we’ve gone through as survivors in a systematic way. I hope the DSM-6 actually catches up with the literature and recognises the effects of long-term emotional trauma.
McEwen, B (2005). Stressed or stressed out: What is the difference? Journal of Psychiatry and Neuroscience 2006, 30(5).
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) (2013).