Back in 1999 I was asked to write an editorial for the American Journal of Psychiatry about a group of articles in the journal on Acute Stress Disorder (ASD). Prior versions of the Diagnostic and Statistical Manual (DSM) had a PTSD, acute (less than one month) and chronic types. The DSM-IV dropped the acute type and added AS, which was like actue PTSD but with some dissociative symptoms (feeling out of your body, feeling like you are in a dream, and so on). The editorial introduced the concept of trauma-related disorders, and proposed taking posttraumatic stress disorder (PTSD) our of the category of the anxiety disorders and creating a new category of disorders related to trauma, that would include acute and chronic PTSD, with and without a dissociative subtype.

I further elaborated this idea in my book Does Stress Damage the Brain : Understanding Trauma-related Disorders from a Mind-Body Perspective (WW Norton, 2002) where on page 36 I introduce the term “Trauma Spectrum Disorders (TSD),” based on the concept that there are a group of disorders linked to trauma that have a great deal of overalp in terms of symptomatology, as well as in brain findings from imaging studies. These disorders include acute and chronic PTSD, Dissociative Identity Disorders (DID), borderline personality disorder (BPD), conversion disorder, traumatic grief (currently a “research” diagnosis in DSM-IV), and the adjustment disorders. I further pointed out that there is a subtype of depression that is linked to early childhood abuse, and that other disorders had a strong connection with trauma, including somatization disorders, alcohol and substance abuse, and eating disorders. Since then I have given a number of lectures on the imaging findings from our group and others (smaller hippocampal volume, depressed frontal lobe function) that characterize these disorders and suggest a common link, and we published a book chapter and an article with Trauma Spectrum Disorders as the title in 2006.

Trauma Spectrum Disorders

Others have had similar ideas. In 2002 Moreau and Zisook also wrote about a Posttraumatic Stress Spectrum Disorder, which looked similar to mine, and Bessel van der Kolk has long talked about complex PTSD, which is an extension of the more restrictive PTSD. It looks like the TSD tag has stuck, but interestingly the DOD and VA are now putting mild traumatic brain injury (TBI) into the mix. I don’t know if I agree with that, since TBI and psychiatric disorders are related to different traumas (one physical, the other psychological). I also get the feeling that the term has been passed around as being useful from a treatment and policy point of view, but that people may not know the background, which is why I wrote this post.

Today I got a call from a reporter who attended a conference on Trauma Spectrum Disorders last year conducted by the DOD, VA and NIH, so I guess the term and the ideas behind it have taken off over the years. He said there didn’t seem to be a clear idea of what disorders were included, so he was looking for clarification