
==== Front
Heliyon
Heliyon
Heliyon
2405-8440
Elsevier

S2405-8440(24)12288-8
10.1016/j.heliyon.2024.e36257
e36257
Review Article
Advancing trauma studies: A narrative literature review embracing a holistic perspective and critiquing traditional models
Zoromba Mohamed Ali zromba2010@mans.edu.eg
ab⁎
Selim Abeer b
Ibrahim Ateya Megahed ac
Elsehrawy Mohamed Gamal ac
Alkubati Sameer A. de
Abousoliman Ali D. af
EL-Gazar Heba Emad c
a College of Nursing, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
b Faculty of Nursing, Mansoura University, Egypt
c Faculty of Nursing, Port-Said University, Egypt
d Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail, Saudi Arabia
e Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida, Yemen
f Faculty of Nursing, Kafrelsheikh University, Egypt
∗ Corresponding author. Faculty of Nursing, Mansoura University, Egypt zromba2010@mans.edu.eg
16 8 2024
30 8 2024
16 8 2024
10 16 e362579 2 2024
2 8 2024
13 8 2024
© 2024 The Authors. Published by Elsevier Ltd.
2024

https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).
Background

Trauma is commonly understood as a psychological and emotional response to distressing events. The subjective nature of trauma experiences has led to ongoing debates about the best theoretical frameworks for understanding and addressing trauma. This review aims to comprehensively critique traditional biomedical and psychological models and advocates for more inclusive and culturally sensitive frameworks.

Methods

A narrative literature review was conducted, synthesizing data from 96 peer-reviewed journal articles, books, and authoritative reports from databases such as PubMed, PsycINFO, and Google Scholar. The review focused on studies related to trauma, post-traumatic stress disorder (PTSD), complex trauma, and related disorders, emphasizing both individual and socio-cultural aspects.

Results

The review identifies several key criticisms of trauma models. For biological models, critiques include the oversimplification of trauma experiences, insufficient developmental considerations, failure to capture diverse trauma responses, limited cultural sensitivity, and inadequacy of the categorical approach. For psychological models, criticisms encompass an overemphasis on internal processes, neglect of developmental impacts, limited focus on symptom diversity, challenges in addressing socio-cultural contexts, and incomplete integration of emotional and relational aspects. These findings underscore the need for more comprehensive, culturally sensitive, and developmentally informed trauma frameworks.

Conclusion

The findings emphasize the importance of adopting a holistic perspective in trauma research and treatment. By integrating individual, interpersonal, and socio-cultural dimensions, future research and interventions can better support trauma survivors. This approach necessitates ongoing interdisciplinary collaboration and the inclusion of diverse voices, including those of trauma survivors, to refine current methodologies and enhance therapeutic outcomes.

Keywords

Holistic approach
Narrative literature review
PTSD
Psychological model
Socio-cultural factors
Trauma
==== Body
pmc1 Introduction

1.1 Background

Trauma is a term commonly used in the field of psychology to describe the psychological and emotional response to a distressing or disturbing event. The term itself is derived from the Greek word “trauma,” which means a wound, hurt, or injury [1]. In psychological terms, trauma refers to an experience or event that overwhelms an individual's ability to cope, it is an emotional reaction to a shocking experience like a rape, accident, or natural disaster. It can manifest in various ways, including intrusive thoughts, nightmares, flashbacks, emotional numbing, hyperarousal, and avoidance of reminders associated with the traumatic event [1,2].

Traumatic events can vary widely in nature and can have a profound impact on individuals, disrupting their sense of safety, trust, and overall psychological well-being. Trauma can exert profound effects on an individual's perceptions regarding the future, which can be attributed to a variety of factors such as diminished hope, restricted life expectations, apprehension concerning premature mortality, and the belief that typical life events may not materialize as expected. According to the American Psychological Association, these enduring responses may manifest as unpredictable emotional states, intrusive flashbacks strained interpersonal connections, and even physical manifestations such as headaches or nausea [3].

While psychologists tend to associate trauma with a specific, objectively identifiable event like a fighter losing their legs in a bomb explosion, it's important to identify that the experience and impact of trauma are subjective. The term “trauma” refers to the subjective effect it has on the individual, akin to the supposed “wound” or “hurt” as described by the ancient Greeks [4]. Therefore, a distressing event that could deeply traumatize and disrupt the life of one person may have relatively minor effects on another. This varying response is influenced by several factors, such as the individual's age, gender identity, resilience prior to the event, previous experiences with trauma, the duration of the traumatic experience, familial history of trauma, ongoing stressors of life, available social support systems, and the individual's cultural, spiritual, or religious perspective on adversity [5].

The subjectivity of trauma has led to an ongoing and intense debate within the literature aiming to establish a widely accepted theoretical framework for understanding trauma. Both theoretical and empirical research have contributed to this discussion. Recently, there has been a growing emphasis on reevaluating and expanding our understanding of trauma with a focus on adopting a holistic perspective [[6], [7], [8]].

1.2 Literature review

The subjectivity of trauma is significantly influenced by coping styles, which can range from “emotionally expressive to reticent and from action-oriented to reflective”. From a clinical perspective, the specific coping style is less important than the effectiveness of coping strategies in enabling individuals to endure required activities, adjust emotions, maintain self-esteem, and foster and appreciate interpersonal connections. In the past, there was a misconception in the field of psychology of traumatic stress, particularly in relation to mass or group traumas, that all survivors needed to openly express emotions related to the trauma and extensively discuss their experiences [9]. However, the latest research specifies that individuals who choose not to extensively process their trauma can experience comparable levels of psychological well-being as those who do. Modern approaches to psychological debriefing emphasize the significance of honoring individuals' coping styles and avoiding favoritism towards any specific type of coping over others [10].

To provide context for our review, we have compared it with several existing review studies on trauma. Table 1 highlights the scope, focus, methodologies, and key findings of these studies, and explicitly points out how our review differs, particularly in its holistic and critical approach to traditional models. The current review's significance lies in its comprehensive literature review of trauma, critiquing traditional biomedical and psychological models. By embracing a holistic perspective, the study sheds light on the limitations of current models and advocates for a more inclusive approach. This contributes to advancing trauma literature, examining ongoing debates, diverse perspectives, evolving ideas surrounding trauma, understanding the limitations of traditional biomedical and psychological trauma models, fostering a deeper understanding of trauma complexity, and guiding future research and interventions to better support trauma survivors with culturally sensitive and effective approaches.Table 1 Comparative trauma reviews.

Table 1Study	Scope	Focus	Methodology	Key Findings	Differences	
Afari et al. (2014) [11]	Reported psychological trauma and PTSD with functional somatic syndromes	Determining the overall effect size of the association between trauma and functional somatic syndromes	Systematic review and meta-analysis of 71 studies	Individuals exposed to trauma are 2.7 times more likely to have FSSs; significant association with PTSD	Focused on the specific link between trauma/PTSD and functional somatic syndromes	
Center for Substance Abuse Treatment (2014) [12]	Behavioral health services on trauma-informed care	Trauma-informed care principles	Literature review	Highlighted importance of trauma awareness, screening, and assessment. Emphasized cultural responsiveness.	Focus on practical guidelines for behavioral health services. Emphasis on trauma-informed organizational practices.	
Cloitre et al. (2014) [13]	Complex PTSD	Empirical basis and treatment guidelines for Complex PTSD	Latent class analysis	Supports the inclusion of Complex PTSD as distinct from PTSD	Primarily empirical and treatment-focused without broader model critique	
Herman (1992) [14]	Complex PTSD in survivors of prolonged trauma	Theoretical foundation and distinct features of Complex PTSD	Theoretical review	Highlights the need for recognizing Complex PTSD due to prolonged trauma	Theoretical foundation without comprehensive model comparison	
Keyan et al., 2024 [15]	Predictors of response to trauma-focused psychotherapy for PTSD	Identify baseline factors associated with treatment outcome	Systematic review and meta-analysis of 114 studies	Poor treatment response is linked to lower fear-related brain activity, weak executive control, high trauma-related thoughts, anger, depression, genetic risk, and low social support. Tailored approaches are essential for better outcomes.	Focus on predictors of psychotherapy outcomes, systematic review and meta-analysis methodology	
Straussner & Calnan (2014) [1]	Life cycle trauma	Review of trauma literature through different life stages	Narrative review	Identifies trauma responses and interventions across the lifespan	Focuses on trauma through the life cycle without critiquing traditional models	
Current Study	Comprehensive review of trauma literature, integrating biomedical, and psychological, models	Holistic and critical review of trauma models and theories	Narrative review	Identifies evolution of trauma diagnoses in DSM and ICD, key criticisms of current models, and various psychological approaches to trauma. Emphasizes need for inclusive and nuanced understanding of trauma.	Holistic approach, critical analysis, narrative review methodology	

2 Methodology

2.1 Research design

This study utilized a narrative literature review approach to synthesize and critically analyze the existing literature on trauma. The narrative review method is chosen for its ability to provide a comprehensive overview of the subject, allowing for the identification of key themes, trends, and gaps in the literature. Unlike systematic reviews or meta-analyses, a narrative review is particularly suited for integrating diverse perspectives and evaluating various models and theories related to trauma. This approach enables a holistic critique of traditional biomedical and psychological models, highlighting their strengths and limitations in a nuanced manner.

2.2 Data sources and search strategy

The data sources for this literature review included 96 peer-reviewed journal articles, books, and authoritative reports from relevant databases such as PubMed, PsycINFO, and Google Scholar. The search strategy involved using specific keywords and phrases related to trauma, such as “trauma,” “post-traumatic stress disorder (PTSD)," “complex PTSD,” “trauma models,” “trauma interventions,” “holistic trauma approach,” and “psychological trauma."

The search was conducted in multiple phases: (a) Identifying broad categories of trauma-related literature. (b) Refining search terms to target specific aspects of trauma, such as biomedical and psychological models, socio-cultural impacts, and intervention strategies. (c) Reviewing references of selected articles to find additional relevant studies (Fig. 1).Fig. 1 Study flow-chart.

Fig. 1

2.3 Inclusion and exclusion criteria

Inclusion Criteria included studies, published in English, in peer-reviewed journals, focusing on trauma, PTSD, and related disorders, articles providing critical analysis or review of trauma models, and literature that addresses both individual and socio-cultural aspects of trauma. Exclusion criteria included; articles not peer-reviewed, studies focusing on trauma unrelated to psychological or emotional aspects, and literature without empirical or theoretical contributions to the understanding of trauma.

2.4 Data extraction and synthesis

The data extraction process involved identifying and summarizing key information from the selected articles, including study objectives, methods, findings, and conclusions. Each article was reviewed for its relevance to the research questions and the quality of its evidence.

The synthesis of the extracted data followed these steps including (a) Identifying common themes and patterns across the literature. (b) Assessing the strengths and limitations of different trauma models and interventions. (c) Comparing findings across studies to highlight consistencies and discrepancies. (d) Integrating the findings to provide a comprehensive understanding of the current state of trauma research.

3 Results

3.1 Biomedical trauma model

The American Psychiatric Association (APA) and World Health Organization (WHO) have always been the leading pioneer and most widely in studying the medical, biological, and experimental approaches to traumas through the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) [16]. As presented in Table 2, the term ‘trauma’ appeared in the third edition of the APA's classification then in the fifth edition, trauma was given a separate chapter in the manual, whereas previously it was included under the chapter on anxiety disorders [17].Table 2 Evolution of trauma recognition and classification in the DSM and ICD manuals.

Table 2Classification/Edition (Year)	Details	Classification/Edition (Year)	Details	
DSM-I and DSM-II (1952 and 1968)	Trauma-specific disorders weren't clearly outlined. However, conditions like ‘gross stress reaction’ could be linked to traumatic experiences [18,19].	ICD-6 (1948)	Recognized ‘gross stress reaction’, typically associated with military combat [20].	
DSM-III (1980)	Introduced Post-Traumatic Stress Disorder (PTSD) based on studies of Vietnam War veterans and other trauma survivors. This edition acknowledged that external stressors could lead to psychiatric issues [21].	ICD-7 (1955)	No distinct categorization for trauma-related disorders, but growing recognition of stress impact [20].	
DSM–III–R and DSM-IV (1987 and 1994)	Honed the definition of trauma and PTSD. Criteria for defining a traumatic event became more precise [22,23].	ICD-8 (1965)	Significant developments in understanding stress, but no specific classification for trauma-related disorders [24].	
DSM-IV-TR (2000)	Text update with limited changes to diagnostic criteria. Elaborated more on traumatic events and their impacts [25].	ICD-9 (1977)	'Transient situational disturbances' included acute responses to overwhelming stress [26].	
DSM-V (2013)	Added a new chapter titled ‘Trauma- and Stressor-Related Disorders', expanding the concept of traumatic events [27].	ICD-10 (1992)	Formal recognition of PTSD as a distinct category under ‘anxiety and stress-related disorders' [28].	
DSM-V-TR (2022)	Minor changes to capture the experiences and symptoms of children with posttraumatic stress disorder [29].	ICD-11 (2018)	Introduced the diagnosis of Complex PTSD (C-PTSD), recognizing the impact of prolonged traumatic stressors [30].	

The evolution of trauma recognition and classification in the DSM and ICD manuals highlights the growing understanding of the psychological impacts of traumatic experiences and the increasing precision in diagnosing and treating trauma-related disorders over the past several decades. The DSM, the initial editions, DSM-I and DSM-II (1952 and 1968), did not clearly outline trauma-specific disorders. However, they recognized conditions like “gross stress reaction,” which could be linked to traumatic experiences. This initial acknowledgment laid the groundwork for future developments in trauma classification.

The DSM-III (1980) marked a revolutionary change in the way mental disorders were diagnosed. It introduced Post-Traumatic Stress Disorder (PTSD) based on studies of Vietnam War veterans, Hiroshima atomic bombing survivors, and others. This was the first acknowledgment that external stressors could lead to psychiatric issues, introducing terms like "survivors' guilt.” Subsequent editions, DSM–III–R and DSM-IV (1987 and 1994) refined the definition of trauma and PTSD. The criteria for defining a traumatic event became more precise, classifying it as an event involving real or threatened death, serious harm, or a threat to physical well-being. The DSM-IV-TR (2000), a text revision of DSM-IV, made limited changes to diagnostic criteria but elaborated more on the impacts of traumatic events, enhancing the understanding of trauma-related disorders.

The DSM-V (2013) made significant updates, adding a new chapter titled “Trauma- and Stressor-Related Disorders.” This chapter expanded the concept of traumatic events to include continuous or extreme indirect exposure to distressing event details, such as those faced by first responders. The DSM-V-TR (2022) applied minor changes to better capture the experiences and symptoms of children with posttraumatic stress disorder, reflecting a more nuanced understanding of trauma in different populations.

In parallel, the ICD manuals have also evolved significantly. The ICD-6 (1948) recognized “gross stress reaction,” typically associated with military combat, as a crucial step in formally acknowledging trauma within the medical community. The ICD-7 (1955) did not introduce a distinct categorization for trauma-related disorders but saw growing recognition of the impact of stress on mental health, setting the stage for future classifications. By the time the ICD-8 (1965) was published, significant developments had been made in understanding stress and its psychological impacts, although a specific classification for trauma-related disorders was still absent. The ICD-9 (1977) included “transient situational disturbances,” which could encompass acute responses to overwhelming stress, reflecting an increasing awareness of stress-related disorders.

A major breakthrough came with the ICD-10 (1992), which formally recognized PTSD as a distinct category under “anxiety and stress-related disorders.” Influenced by the experiences of Vietnam War veterans and victims of various traumas, the diagnostic criteria included experiencing a traumatic event, persistent re-experiencing, avoidance, and hyperarousal. The latest revision, ICD-11 (2018), introduced the diagnosis of Complex PTSD (C-PTSD), recognizing the complex and enduring impact of prolonged traumatic stressors such as abuse, war, or severe deprivation. This reflected a deeper understanding of the diverse ways traumatic exposure can affect individuals.

3.2 Key themes and patterns

The trauma literature has been filled with criticisms towards the DSM’ APA and ICD WHO, and several key themes and patterns emerged as presented in Table 3.Table 3 Key criticisms of DSM and ICD models.

Table 3Key Criticism	Description	References	
Simplification of Trauma Experiences and Exclusion of Complex Trauma	DSM and ICD criteria often oversimplify trauma, excluding chronic or complex trauma.	Cloitre, 2020; Cloitre et al., 2014; Cloitre et al., 2012; Giourou et al., 2018; Hardy, 2017; Brewin, 2020; Giourou et al., 2018; Ponnamperuma & Nicolson, 2018; Radstone, 2007; WHO, 2018	
Developmental Considerations	Diagnostic criteria do not fully account for the developmental aspects of trauma.	Bremness & Polzin, 2014; Cruz et al., 2022; Schmid et al., 2013; Fariba & Gupta, 2023; Widom & Morris, 1997; van der Kolk, 2005.	
Failure to Capture Trauma Responses	The categorical approach fails to capture the diversity of trauma responses.	Clark et al., 2017; Friedman, 2013; Ogle et al., 2013; Maercker et al., 2013.	
Limited Cultural Sensitivity	Frameworks do not adequately consider cultural differences in trauma experiences.	Chentsova-Dutton & Maercker, 2019; Eyerman & Jamison, 1998; Hinton & Good, 2016; Kirmayer et al., 2011; Patel & Hall, 2021.	
Categorical vs. Dimensional Approach	Inadequacy of the categorical approach in accurately capturing the complexity and overlap of trauma-related symptoms.	Bryant, 2019; Clark et al., 2017; Resick & Miller, 2009; Zoellner et al., 2013.	

3.2.1 Simplification of trauma experiences and exclusion of complex trauma

Critics argue that the criteria for trauma-related disorders may oversimplify the diverse range of traumatic experiences individuals can face. The diagnostic criteria often focus on specific events or categories of trauma, potentially excluding individuals who have experienced chronic or complex trauma, cultural trauma, or other forms of adversity that may have lasting effects. For example, the DSM's definition of a “traumatic event” has been criticized for not adequately encompassing all types of trauma, such as prolonged and repeated emotional abuse [[31], [32], [33], [34]].

In a study by Cloitre et al. (2012), the researchers emphasize the significance of capturing the range of traumatic experiences beyond single-event traumas. They propose the concept of Complex PTSD (cPTSD) to address the consequences of chronic trauma exposure, such as prolonged interpersonal trauma, which often involves emotional, physical, or sexual abuse. This framework acknowledges that traumatic experiences can encompass a broader range of stressors than the DSM's nor ICD's criteria might suggest [35]. Complex trauma, which involves prolonged or repeated exposure to traumatic events, often accompanied by interpersonal trauma and disrupted attachment, has distinct features that may not be fully captured by the existing diagnostic categories [36].

A seminal work that addresses the need for recognizing complex trauma is the proposal by Herman (1992) that laid the foundation for understanding Complex PTSD. Herman argues that individuals who experience prolonged and repeated trauma, particularly within interpersonal relationships, often develop a distinct set of symptoms that extend beyond the criteria for traditional PTSD. These symptoms might include disturbances in self-identity, affect regulation, and interpersonal functioning. Herman's work emphasizes the necessity of distinguishing complex trauma from single-event traumas and acknowledges the need for a separate diagnostic category [14].

10.13039/100014337 Furthermore , the research by Cloitre et al. (2014) provides empirical support for the existence of Complex PTSD symptoms distinct from traditional PTSD. They conducted a study comparing the symptom profiles of individuals with Complex PTSD, PTSD, and those without any trauma-related disorder. The findings indicated that individuals with Complex PTSD exhibited a specific pattern of symptoms related to affective dysregulation, self-concept, and interpersonal difficulties. This study underscores the empirical basis for considering complex trauma as a separate diagnostic entity [13].

The debate surrounding the inclusion of C-PTSD gained further traction with the proposal by the International Classification of Diseases (ICD) in its 11th revision. The ICD-11 introduced a diagnostic category named “Complex PTSD” to address the unique symptomatology associated with prolonged trauma exposure. This recognition within a global classification system signifies the acknowledgment of the distinct features of complex trauma and the need for a comprehensive diagnostic approach [37].

3.2.2 Developmental considerations

Some critics assert that the DSM and ICD have not fully accounted for the developmental aspects of trauma. The critique presented regarding the developmental considerations approach to trauma is indeed a significant point, and it has been a subject of scholarly discourse in the field of trauma studies. However, the diagnostic criteria may not adequately capture these variations, potentially leading to underdiagnosis or misdiagnosis of trauma-related disorders in certain age groups, such as children or older adults. The developmental perspective emphasizes that trauma experienced at different stages of life can have diverse impacts and expressions, which might not be fully captured by the current diagnostic criteria provided by the biomedical model [[38], [39], [40]].

One study that delves into this concern is the work that highlighted the developmental complexities of trauma. The author argues that the criteria for trauma-related disorders often fail to address the unique developmental vulnerabilities and capacities of individuals at different life stages. This limitation is particularly notable in cases of children and older adults who may exhibit symptoms differently than adults. The study calls for a more nuanced framework that incorporates developmental considerations to ensure accurate diagnosis and appropriate treatment [41].

Likewise, research by Widom and Morris (1997) provides evidence for the enduring impact of childhood trauma and its potential influence on later developmental stages. They conducted a longitudinal study that followed individuals with a history of childhood abuse and neglect into adulthood. The findings revealed that childhood maltreatment was associated with a range of negative outcomes in adulthood, including mental health issues and dysfunctional interpersonal relationships. This study underscores the need for a developmental perspective in trauma studies to understand the long-term consequences of early traumatic experiences [42].

The developmental critique aligns with a broader understanding of trauma as not only an isolated event but a phenomenon that unfolds across the lifespan. This perspective has gained traction within the trauma field, as demonstrated by the conceptualization of Developmental Trauma Disorder (DTD) proposed by van der Kolk (2005). DTD emphasizes the impact of repeated and chronic trauma on development and highlights the need to consider developmental stages when diagnosing and treating trauma-related disorders [43].

3.2.3 Failure to capture the full range of trauma responses

The categorical approach to diagnose mental disorders may not fully capture the complexity and diversity of trauma responses. Trauma can elicit a wide spectrum of psychological, emotional, behavioral, and physiological reactions that may not neatly fit within the diagnostic criteria. This has led to calls for a more dimensional approach that acknowledges the wide range of trauma responses and their individual variability [[44], [45], [46]].

Furthermore, the research by Ogle et al. (2013) provides empirical evidence for the variability and complexity of trauma responses. They conducted a study on the diversity of responses following exposure to potentially traumatic events. The findings revealed a wide range of reactions, including resilience, delayed distress, and chronic distress. The authors emphasize that trauma responses are multifaceted and influenced by various individual, social, and contextual factors. This study underscores the need for a dimensional perspective that accommodates the heterogeneity of trauma experiences [47].

The call for a more dimensional approach to trauma responses is also echoed in the work of Maercker et al. (2013), who propose a framework for diagnosing and conceptualizing trauma-related disorders based on a dimensional approach. They suggest considering multiple dimensions, such as intensity, frequency, and duration of symptoms, as well as contextual factors, to capture the complexity of trauma reactions. This perspective aligns with the notion that trauma responses are not one-size-fits-all but rather exist along a continuum [24].

3.2.4 Limited cultural sensitivity

Critics argue that the framework for trauma-related disorders may not adequately consider cultural differences in the experiences and expression of trauma. Cultural factors, such as beliefs, values, and social contexts, can significantly influence the perception, reporting, and impact of trauma. Some argue for the inclusion of culturally specific symptoms and syndromes related to trauma to ensure greater cultural sensitivity and accuracy in diagnosis. The focus on individual symptoms may miss systemic factors, such as poverty, racism, or societal violence, that contribute to traumatic experiences and responses [48,49].

One influential work that addresses this concern is the research by Hinton and Good (2016). The authors highlight the cultural variations in the experience of trauma and the limitations of applying Western-centric diagnostic criteria to non-Western populations. They emphasize the importance of incorporating cultural nuances and idioms of distress when assessing trauma-related symptoms across different cultural groups. The study underscores that cultural differences can significantly impact the manifestation and reporting of trauma symptoms, necessitating a more culturally sensitive approach [50].

Furthermore, research by Kirmayer et al. (2011) delves into the concept of cultural syndromes and their relevance to trauma studies. The authors argue that certain cultural groups might have distinct ways of experiencing and expressing distress, which may not align with the DSM's symptom-based criteria. They advocate for a broader understanding of trauma that encompasses cultural syndromes and takes into account cultural variations in symptom presentation. This approach ensures greater cultural sensitivity and accuracy in diagnosing trauma-related disorders [51].

The concept of cultural trauma also adds weight to this critique. The work of Eyerman and Jamison (1998) discussed earlier in the context of cultural trauma is relevant here as well. They emphasize that societal and historical traumas, often rooted in systemic factors, can deeply affect cultural groups and shape their collective experiences. This perspective calls for a broader recognition of trauma beyond individual symptomatology, considering the broader social, political, and cultural contexts that contribute to trauma [52].

3.2.5 Categorical vs. dimensional approach

The traditionally categorical approach, which assumes that disorders are distinct from one another and from normal functioning. This has been criticized as it does not fully represent the complexity and overlap of symptoms, especially in trauma-related disorders. Some suggest a dimensional approach, which views disorders as extremes of normal behavior and allows for more symptom overlap, would be more appropriate [44,53,54].

A key publication that delves into this discussion is the work by Clark et al. (2017). They emphasize the limitations of the categorical approach and advocate for a dimensional perspective in psychiatric diagnosis. The authors argue that a dimensional approach acknowledges the continuum of symptoms, recognizing that mental health disorders often manifest as varying degrees of severity rather than binary categories. This perspective aligns well with the heterogeneity and overlapping symptoms often observed in trauma-related disorders [44]. A seminal publication that addresses this concern is the work of Resick and Miller (2009), they discuss the limitations of the DSM's categorical approach in diagnosing trauma-related disorders, particularly post-traumatic stress disorder (PTSD). The authors argue that PTSD symptoms often manifest along a continuum, with varying degrees of severity and expression. This dimensional perspective highlights the need to consider individual differences in trauma responses, rather than forcing them into predefined categories. Resick and Miller advocate for a more comprehensive assessment that takes into account the entire spectrum of trauma responses [55].

In the context of trauma, Bryant (2019) also critiques the categorical approach and suggests that it may not fully capture the spectrum of responses to trauma. The author argues that trauma responses can vary widely and encompass a range of emotional, cognitive, and physiological reactions. A dimensional approach would allow for more flexibility in capturing these variations and recognizing the overlap of symptoms across different disorders, leading to a more accurate representation of trauma-related experiences [53]. Zoellner et al. (2013) provide empirical support for the potential advantages of a dimensional approach. They conducted a study examining the symptom overlap across different anxiety disorders, including PTSD. The findings indicated that many symptoms were not unique to a single disorder but rather shared across multiple disorders [54].

3.3 Psychological trauma model

Table 4 provides a comprehensive overview of various psychological approaches and models used to understand and address trauma. Each approach offers a unique lens for interpreting and treating the complex effects of traumatic experiences. As the table illustrates psychodynamic Theory emphasizes the role of unconscious processes and early life experiences in shaping responses to trauma. Influenced by Freud's psychoanalysis, it explores how traumatic events can create unconscious conflicts and defense mechanisms. Techniques like free association, dream analysis, and interpretation are used to uncover and resolve these conflicts.Table 4 Overview of psychological approaches to trauma.

Table 4Approach/Model	Description	
Psychodynamic Theory	Psychodynamic theories, influenced by Sigmund Freud's psychoanalysis, emphasize the role of unconscious processes and early life experiences in shaping an individual's response to trauma. These theories suggest that traumatic experiences can lead to the formation of unconscious conflicts, defense mechanisms, and intrapsychic dynamics that impact psychological functioning. Psychoanalytic approaches aim to explore and resolve these underlying conflicts through techniques like free association, dream analysis, and interpretation [56,57].	
Attachment Theory	Attachment theory, developed by John Bowlby and expanded upon by subsequent researchers, examines the impact of early caregiver relationships on an individual's ability to regulate emotions and navigate relationships. Traumatic experiences can disrupt secure attachments, leading to difficulties in emotional regulation and interpersonal functioning. Attachment-based approaches to trauma focus on repairing and strengthening attachment relationships as part of the healing process [[58], [59], [60]].	
Cognitive-Behavioral Theory	Cognitive-behavioral theories view trauma as an interaction between traumatic events, cognitive appraisals, and behavioral responses. These theories emphasize how individuals' thoughts, beliefs, and interpretations about the trauma influence their emotional and behavioral reactions. Cognitive-behavioral approaches to trauma, such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE), aim to identify and modify maladaptive thoughts and behaviors associated with the trauma [61,62].	
Eye Movement Desensitization and Reprocessing (EMDR)	EMDR is a psychotherapy approach specifically developed for trauma. It integrates elements of cognitive-behavioral therapy with bilateral stimulation techniques, such as eye movements or tapping. EMDR aims to facilitate the processing of traumatic memories and reduce the emotional distress associated with them [[63], [64], [65]].	
Sensorimotor Psychotherapy	Sensorimotor psychotherapy focuses on the connection between traumatic experiences and the body. It recognizes that trauma can be stored in the body as sensory and motor patterns, leading to symptoms such as somatic complaints, dissociation, and dysregulation. Sensorimotor approaches aim to address trauma through body-centered interventions, somatic awareness, and movement techniques to facilitate the release and integration of traumatic experiences [[66], [67], [68]].	

Attachment Theory, developed by John Bowlby, highlights the impact of early caregiver relationships on emotional regulation and relationship navigation. Traumatic experiences can disrupt secure attachments, leading to emotional and interpersonal difficulties. Attachment-based approaches aim to repair and strengthen these relationships as part of the healing process. Cognitive-Behavioral Theory views trauma through the interaction of traumatic events, cognitive appraisals, and behavioral responses. It focuses on how thoughts and beliefs about trauma influence emotional and behavioral reactions. Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) are examples of approaches that modify maladaptive thoughts and behaviors linked to trauma.

Eye Movement Desensitization and Reprocessing (EMDR) is a specific therapy developed for trauma, combining cognitive-behavioral techniques with bilateral stimulation, like eye movements or tapping. EMDR aims to process traumatic memories and reduce associated emotional distress. Sensorimotor Psychotherapy addresses the connection between trauma and the body, recognizing that trauma can manifest as sensory and motor patterns. This approach uses body-centered interventions, somatic awareness, and movement techniques to release and integrate traumatic experiences, alleviating symptoms like somatic complaints, dissociation, and dysregulation.

The trauma literature addressed criticisms towards psychological approaches for addressing trauma. Several key themes and patterns have emerged, as summarized in Table 5.Table 5 Criticisms towards psychological approaches to trauma.

Table 5Key Criticism	Description	References	
Overemphasis on Internal Processes	Psychodynamic approaches may overemphasize unconscious processes and intrapsychic conflicts, neglecting social and environmental factors. Attachment theory may overlook broader socio-cultural contexts. Sensorimotor psychotherapy may not be culturally sensitive.	Chertoff, 1997; Krupnick, 2002; Schottenbauer et al., 2008; Wöller et al., 2012; van der Kolk, 2005; Cassidy et al., 2013; Osofsky et al., 2023; van der Kolk, 2014	
Neglect of Developmental Considerations	Psychodynamic, attachment, cognitive-behavioral, EMDR, and sensorimotor approaches may not fully address the developmental impacts of trauma across different life stages.	Chertoff 1997; Athanasiadou-Lewis 2019; Fonagy, 2018; Lahousen et al., 2019; Guérin-Marion et al., 2020; Cohen et al., 2016; de Roos et al., 2011; Ogden et al., 2006	
Limited Focus on Symptom Diversity	Attachment-based approaches may not address the full range of trauma symptoms. Cognitive-behavioral and EMDR approaches may not consider the broader psychological consequences of trauma.	Guérin-Marion et al., 2020; Lahousen et al., 2019; Herman, 2015; Cloitre et al., 2014; Luber, 2009; Scelles, & Bulnes, 2021; Barron et al., 2019; Levine, 2012	
Challenges in Addressing Broader Socio-Cultural Contexts	Psychodynamic and attachment theories often overlook the socio-cultural context of trauma. Sensorimotor psychotherapy needs to be culturally informed and adaptable.	van der Kolk, 2005; Cassidy et al., 2013; Osofsky et al., 2023; van der Kolk, 2014; Ogden & Minton, 2000; Pavlovic, 2009	
Incomplete Integration of Emotional and Relational Aspects	Cognitive-behavioral and EMDR approaches may not fully address the emotional and relational impact of trauma.	Herman, 2015; Cuijpers et al., 2019	

3.3.1 Overemphasis on internal processes

Critics argue that psychodynamic approaches may overemphasize unconscious processes and intrapsychic conflicts, potentially neglecting the social and environmental factors that contribute to trauma and its impact. This perspective often overlooks broader socio-cultural contexts, limiting its comprehensiveness [57,[69], [70], [71]]. Van der Kolk (2005) discusses the challenges of integrating psychodynamic approaches with the study of trauma, emphasizing the need for a more comprehensive understanding that includes external influences [43].

Regarding attachment theory, while focusing on early caregiver relationships, attachment theory may not fully consider socio-cultural and contextual factors influencing attachment patterns and trauma responses, critics argue it fails to capture the broader impact of societal and systemic factors on trauma experiences [60,72]. On the other hand, sensorimotor psychotherapy approach emphasizes bodily interventions, which may not align with certain cultural or individual beliefs and practices, critics highlight the importance of culturally sensitive and adaptable trauma therapies [73].

3.3.2 Neglect of developmental considerations

Critics suggest that psychodynamic approaches may not adequately address the developmental aspects of trauma, such as early childhood trauma's impact on identity formation and self-concept [69,74]. Moreover, Fonagy (2018) calls for incorporating a developmental perspective into psychodynamic models [75]. Regarding, attachment theory, critics argue that attachment theory may not fully address the unique developmental consequences of trauma across different life stages [76]. Lahousen et al. (2019) and Guérin-Marion et al. (2020) emphasize the need to broaden attachment theory to encompass developmental impacts across the lifespan [[77], [78], [79]].

Cognitive-behavioral approaches may not consider the developmental implications of trauma or the unique needs of children and adolescents, Cohen et al. (2016) suggest integrating developmental considerations into cognitive-behavioral strategies for more effective interventions [80]. Additionally, critics argue that EMDR may need further adaptations to address the specific developmental considerations of trauma in children and adolescents [63,81]. Critics of sensorimotor psychotherapy highlight potential challenges in applying somatic interventions across different age groups, suggesting the need for an approach that integrates somatic, cognitive, and emotional aspects to address developmental needs [67].

3.3.3 Limited focus on symptom diversity

Critics suggest that attachment-based approaches may not adequately address the wide range of trauma symptoms beyond attachment difficulties, such as dissociation, hyperarousal, or intrusive memories Guérin-Marion et al. (2020) or in capturing complexities of trauma Lahousen et al. (2019) [77,78]. On the other hand, critics argue that cognitive-behavioral approaches may focus primarily on symptom reduction, potentially neglecting the broader impact of trauma on identity, meaning-making, and worldview [13,82].

Regarding EMDR, there are debates about whether EMDR adequately addresses the broader psychological consequences of trauma, such as changes in identity and interpersonal relationships [[83], [84], [85]]. At the same, critics suggest that sensorimotor Psychotherapy approaches may not explicitly focus on addressing cognitive aspects or providing specific cognitive strategies for managing trauma-related symptoms [86].

3.3.4 Challenges in addressing broader socio-cultural contexts

Van der Kolk (2005) and other critics argue that psychodynamic approaches often overlook the broader socio-cultural context in which trauma occurs [43]. While, attachment theory’ critics, argue for a more contextualized understanding of attachment and trauma that considers larger socio-cultural influences [60,72]. At the same time, researches about sensorimotor psychotherapy emphasizes the importance of tailoring trauma interventions to different cultural backgrounds, highlighting the need for culturally informed and adaptable approaches [73,87,88].

3.3.5 Incomplete integration of emotional and relational aspects

Critics argue that cognitive-behavioral approaches may fail to address the deeper emotional and relational aspects of trauma, Herman (2015) emphasizes the need to integrate emotional and relational considerations into trauma treatment [82]. Then again, while EMDR effective in processing traumatic memories, EMDR may not fully engage with the deeper processes of meaning reconstruction and identity transformation that can result from traumatic experiences [89].

4 Discussion

In the field of trauma studies, there is ongoing debate and evolution surrounding trauma, its definition, and appropriate models for understanding and addressing it. This dynamic nature reflects the complexity of trauma as a phenomenon, with diverse perspectives and theories being considered to better comprehend its nature and effects. Researchers and practitioners recognize the limitations of traditional models, such as the biomedical models, which may focus primarily on individual pathology and symptomatology. This review has identified several critical aspects in the field of trauma studies: 1) The ongoing debate about trauma definition and appropriate models for understanding it; 2) Limitations of traditional biomedical models; 3) The discrepancy between trauma exposure rates and PTSD diagnosis rates; 4) Critiques of various psychological models in fully capturing the complexity of trauma; and 5) The need for a more holistic, multidimensional approach to trauma.

4.1 Critique of biological models

Critics argue that the criteria for trauma-related disorders may oversimplify trauma experiences, potentially excluding individuals who have faced chronic or cultural trauma. Additionally, the DSM may not fully account for the developmental aspects of trauma, leading to potential underdiagnosis or misdiagnosis in certain age groups. The categorical approach employed by the DSM may not fully encompass the wide range of trauma responses and individual variability, warranting a call for a more dimensional perspective. Moreover, limited cultural sensitivity within the DSM framework may disregard the cultural influences on trauma experiences and expressions, potentially leading to misinterpretations and inaccuracies in diagnosis. The exclusion of Complex PTSD as a separate diagnosis has sparked ongoing debate, as this type of trauma involves distinct features that might not be adequately addressed by the existing diagnostic categories.

4.2 Prevalence and epidemiology of trauma

While the experience of trauma is common, as 70 % of the world's population exposed to one or more traumas in their lifetimes, PTSD diagnosis is comparatively unusual. In the United States, it is estimated that the lifetime prevalence rate of PTSD falls within the range of 6 %–12 %, with an average prevalence of approximately 9 % of the population [27,29,90]. Koenen et al. (2017) reported that the lifetime worldwide prevalence in the general population of PTSD is around 3.9 %, as prevalence of international annual proportions are supposed to be slightly less than those in the United States [91]. Moreover, the DSM, reported that the “highest rates (fluctuating from one-third to further than one-half of those bared) are found among survivors of military combat and captivity, rape, and culturally or politically inspired genocide and internment” [29].

4.3 Comparison of models and approaches

A large study conducted by WHO World Mental Health Surveys included 24 countries (n = 68,894) and assessed 29 lifetime traumas, reported that 70.4 % of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per individual [92]. Findings from the 1990s indicated that more than 60 % of men and 51 % of females in the US reported having encountered at least one traumatic event during their lifetime [93,94].

The biomedical model of trauma, as presented in the DSM-5-TR [29] and ICD-11 [37], focuses on pathology and overlooks the traumatic aspects of numerous pervasive and enduring human injuries. Rethinking and redefining trauma involves an epistemological process that demands more comprehensive insights into “how we know what we know.” This necessitates considering trauma from both broader and narrower perspectives and calls for a paradigm shift in how we approach trauma [95].

4.4 Critique of psychological models

While various psychological theories have provided valuable insights into trauma, each approach has limitations in offering a holistic definition. Psychodynamic theory, while exploring unconscious processes, tends to neglect broader social and cultural influences on trauma. Attachment theory, while highlighting early caregiver relationships, may overlook other contextual factors impacting trauma experiences. Cognitive-behavioral theory, though understanding thought-behavior interactions, can be reductionistic, sidelining socio-cultural contributors to trauma. EMDR effectively reprocesses traumatic memories but may not incorporate broader cultural and community-based practices. Sensorimotor psychotherapy recognizes the body-mind connection but might not fully address systemic oppression or socio-cultural dimensions of trauma [56,85,96].

4.5 Implications

The current review highlights that reconceptualizing trauma is not merely a matter of modifying diagnostic criteria but requires a deeper exploration of how knowledge about trauma is constructed and validated. This involves considering the epistemological foundations of trauma research and recognizing the potential biases and limitations that may arise. It touches upon the necessity of thinking differently and more broadly about how trauma is defined and understood. Research and clinical practice in the field of trauma continue to evolve, with ongoing efforts to address these limitations and develop more comprehensive and inclusive approaches to trauma treatment.

Overall, a holistic approach to trauma, encompassing individual, interpersonal, and socio-cultural factors, is essential for a more comprehensive understanding of trauma and the development of culturally sensitive interventions. This necessitates interdisciplinary collaboration and engagement with diverse voices, including trauma survivors, to refine our current understanding and improve therapeutic outcomes. This approach emphasizes the significance of trauma's sociocultural dimensions, acknowledging that traumatic experiences are not solely limited to individual events but are also influenced by broader social, cultural, and systemic factors. Trauma can affect entire communities, cultural groups, or societies, and its impact extends far beyond the individual level.

4.6 Limitations

Although the current manuscript provides a holistic approach to analyzing concept of trauma, it has several limitations. The narrative review approach might not capture the full breadth of existing research, risking selection bias. Inclusion and exclusion criteria may omit relevant studies, limiting global perspectives. The review may not fully address the heterogeneity of trauma responses across different populations and might underemphasize recent advancements in trauma models. Relying on secondary data could lead to inconsistencies, and the subjective interpretation inherent in narrative reviews introduces potential bias. Additionally, the review may lack empirical evidence to support some theoretical critiques, highlighting the need for future empirical validation.

5 Conclusion

In conclusion, this review underscores the need for a paradigm shift in how we approach trauma. Adopting a holistic perspective for trauma may consider three key dimensions. The first dimension explores the diverse range of traumatic experiences, including their severity, types, duration, repetition, and predictability. The second dimension focuses on how trauma affects individuals at different developmental stages, impacting cognitive, emotional, and social development within their psychosocial environment. Lastly, the third dimension examines the various responses individuals may have to trauma, including resilient, reactive, and complex responses, encompassing symptoms beyond PTSD. Additionally, this perspective considers the societal impact of trauma on social relationships, roles, and community participation.

Funding statement

This study is supported via funding from 10.13039/100009392 Prince Sattam bin Abdulaziz University  project number (PSAU/2024/R/1445 ).

Ethical statement

In preparing this review article, we acknowledge that it does not encompass primary research data, but rather synthesizes and analyzes existing published literature. Given the nature of a review article, traditional ethical concerns associated with primary research, such as participant consent and ethical approval, are not directly applicable. However, we have adhered to ethical standards in scientific writing by ensuring accuracy in the representation of the research findings, giving proper credit through citations, and avoiding plagiarism. We have critically evaluated and objectively presented the findings from existing studies, ensuring that our interpretations and conclusions are supported by the cited literature.

Data availability

This article is a narrative review and does not contain any original data. All data referenced in this article are from previously published sources, which have been cited appropriately throughout the text.

CRediT authorship contribution statement

Mohamed Ali Zoromba: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Resources, Project administration, Methodology, Investigation, Data curation, Conceptualization. Abeer Selim: Writing – review & editing, Methodology, Conceptualization. Ateya Megahed Ibrahim: Writing – review & editing, Validation. Mohamed Gamal Elsehrawy: Writing – original draft, Visualization, Validation. Sameer A. Alkubati: Writing – original draft, Formal analysis. Ali D. Abousoliman: Writing – original draft, Methodology, Formal analysis. Heba Emad EL-Gazar: Writing – review & editing, Writing – original draft, Supervision, Methodology, Investigation, Funding acquisition.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

This study is supported via funding from 10.13039/100009392 Prince Sattam bin Abdulaziz University project number (PSAU/2024/R/1445 ).
==== Refs
References

1 Straussner S.L.A. Calnan A.J. Trauma through the life Cycle: a review of current literature Clin. Soc. Work. J. 42 2014 323 335 10.1007/s10615-014-0496-z
2 Morganstein J.C. West J.C. Ursano R.J. Work-associated trauma Physician Ment. Heal. Well-Being Res. Pract 2017 33 60 10.1007/978-3-319-55583-6_2
3 American Psychological Association Trauma 2022 https://www.apa.org/topics/trauma
4 Gayraud F. Auxéméry Y. Identification of the marks of psychic trauma in spoken language: definition of the “SPLIT-10” diagnostic scale Ann. Médico-Psychologiques, Rev. Psychiatr. 180 2022 195 212 10.1016/j.amp.2021.09.016
5 C. for S.A.T. (US) Trauma Awareness 2014 https://www.ncbi.nlm.nih.gov/books/NBK207203/
6 Krupnik V. Trauma or adversity? Traumatology 25 2019 256 261 10.1037/trm0000169
7 Bonanno G.A. Mancini A.D. Beyond resilience and PTSD: mapping the heterogeneity of responses to potential trauma Psychol. Trauma Theory, Res. Pract. Policy 4 2012 74 83 10.1037/a0017829
8 Joseph S. Murphy D. Trauma: a unifying concept for social work Br. J. Soc. Work 44 2014 1094 1109 http://www.jstor.org/stable/43687716
9 Jenzer T. Meisel S.N. Blayney J.A. Colder C.R. Read J.P. Reciprocal processes in trauma and coping: bidirectional effects over a four-year period Psychol. Trauma 12 2020 207 218 10.1037/tra0000500 31414867
10 Arancibia M. Leyton F. Morán-Kneer J. Muga A. Ríos U. Sepúlveda E. Vallejo-Correa V. Psychological debriefing in acute traumatic events: evidence synthesis Medwave 22 2022 1 10 10.5867/medwave.2022.01.002538
11 Afari N. Ahumada S.M. Wright L.J. Mostoufi S. Golnari G. Reis V. Cuneo J.G. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis Psychosom. Med. 76 2014 2 11 10.1097/PSY.0000000000000010 24336429
12 C. for S.A.T. (US) Understanding the Impact of Trauma 2014 https://www.ncbi.nlm.nih.gov/books/NBK207191/
13 Cloitre M. Garvert D.W. Weiss B. Carlson E.B. Bryant R.A. Distinguishing PTSD, complex PTSD, and borderline personality disorder: a latent class analysis Eur. J. Psychotraumatol. 5 2014 10.3402/ejpt.v5.25097
14 Herman J.L. Complex PTSD: a syndrome in survivors of prolonged and repeated trauma J. Trauma Stress 5 1992 377 391 10.1002/jts.2490050305
15 Keyan D. Garland N. Choi-Christou J. Tran J. O'Donnell M. Bryant R.A. A systematic review and meta-analysis of predictors of response to trauma-focused psychotherapy for posttraumatic stress disorder Psychol. Bull. 2024 10.1037/bul0000438
16 Deacon B.J. The biomedical model of mental disorder: a critical analysis of its validity, utility, and effects on psychotherapy research Clin. Psychol. Rev. 33 2013 846 861 10.1016/j.cpr.2012.09.007 23664634
17 Pai A. Suris A.M. North C.S. Posttraumatic stress disorder in the DSM-5: controversy, change, and conceptual considerations Behav. Sci. 7 2017 10.3390/bs7010007
18 APA Mental disorders Diagnostic and Statistical Manual 1952 10.1097/00001888-195209000-00035
19 APA Diagnostic and Statistical Manual of Mental Disorders-II 1968 American Psychiatric Association Washington, DC Text Revision (DSM-IV-TR)
20 Kleber R.J. Trauma and public mental health: a focused review Front. Psychiatr. 10 2019 451 10.3389/fpsyt.2019.00451
21 APA Diagnostic and Statistical Manual of Mental Disorders-III first ed. 1980 Washington (DC)
22 APA Diagnostic and Statistical Manual of Mental Disorders : DSM-III-R third ed. 1987 American Psychiatric Association Washington, DC SE - https://doi.org/LK-worldcat.org/title/16395933
23 APA Diagnostic and statistical manual of mental disorders 4th ed., Diagnostic Stat. Man. Ment. Disord fourth ed. 1994 886 xxvii, 886–xxvii
24 Maercker A. Brewin C.R. Bryant R.A. Cloitre M. Reed G.M. van Ommeren M. Humayun A. Jones L.M. Kagee A. Llosa A.E. Rousseau C. Somasundaram D.J. Souza R. Suzuki Y. Weissbecker I. Wessely S.C. First M.B. Saxena S. Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11 Lancet (London, England) 381 2013 1683 1685 10.1016/S0140-6736(12)62191-6 23583019
25 APA Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR fourth ed. 2000 American Psychiatric Association Washington, DC SE - https://doi.org/LK-worldcat.org/title/43483668
26 Casey P. Casey P. History of the Concept of Adjustment Disorders, Adjust. Disord. From Controv. To Clin. Pract. 2018 10.1093/med/9780198786214.003.0001 0
27 APA, Diagnostic Statistical Manual of Mental Disorders fifth ed. 2013 10.1176/appi.books.9780890425596.893619
28 Lovaasen K.R. Schwerdtfeger J. ICD-10-CM/PCS Coding: Theory and Practice 2014 Elsevier/Saunders https://books.google.com.sa/books?id=mTg1mQEACAAJ
29 APA Diagnostic and Statistical Manual of Mental Disorders : DSM-5-TR fifth ed. 2022 American Psychiatric Association Publishing Washington, DC SE - https://doi.org/LK-worldcat.org/title/1288423302
30 Tyrer P. Making Sense of the ICD-11: for Mental Health Professionals 2023 Cambridge University Press https://books.google.com.sa/books?id=_jfdEAAAQBAJ
31 Ponnamperuma T. Nicolson N.A. The relative impact of traumatic experiences and daily stressors on mental health outcomes in Sri Lankan adolescents J. Trauma Stress 31 2018 487 498 10.1002/jts.22311 30058730
32 Cloitre M. ICD-11 complex post-traumatic stress disorder: simplifying diagnosis in trauma populations Br. J. Psychiatry 216 2020 129 131 10.1192/bjp.2020.43 32345416
33 Hardy A. Pathways from trauma to psychotic experiences: a theoretically informed model of posttraumatic stress in psychosis Front. Psychol. 8 2017 https://www.frontiersin.org/article/10.3389/fpsyg.2017.00697
34 Radstone S. Trauma theory: contexts, politics, ethics Paragraph 30 2007 9 29 10.3366/prg.2007.0015
35 Cloitre M. Courtois C.A. Ford J.D. Green B.L. Alexander P. Briere J. Van der Hart O. The ISTSS Expert Consensus Treatment Guidelines for Complex PTSD in Adults 2012
36 Giourou E. Skokou M. Andrew S.P. Alexopoulou K. Gourzis P. Jelastopulu E. Complex posttraumatic stress disorder: the need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World J. Psychiatr. 8 2018 12 19 10.5498/wjp.v8.i1.12 29568727
37 WHO International classification of Diseases (ICD) Int. Classif. Dis. 2018 https://www.who.int/standards/classifications/classification-of-diseases
38 Bremness A. Polzin W. Commentary: developmental trauma disorder: a missed opportunity in DSM V J. Can. Acad. Child Adolesc. Psychiatry = J. l’Academie Can. Psychiatr. l’enfant l’adolescent 23 2014 142 145
39 Cruz D. Lichten M. Berg K. George P. Developmental trauma: conceptual framework, associated risks and comorbidities, and evaluation and treatment Front. Psychiatr. 13 2022 https://www.frontiersin.org/articles/10.3389/fpsyt.2022.800687
40 Schmid M. Petermann F. Fegert J.M. Developmental trauma disorder: pros and cons of including formal criteria in the psychiatric diagnostic systems BMC Psychiatr. 13 2013 3 10.1186/1471-244X-13-3
41 Fariba K.A. Gupta V. Posttraumatic stress disorder in children 2023 StatPearls https://www.ncbi.nlm.nih.gov/books/NBK559140/
42 Widom C.S. Morris S. Accuracy of adult recollections of childhood victimization, Part 2: childhood sexual abuse Psychol. Assess. 9 1997 34 46 10.1037/1040-3590.9.1.34
43 van der Kolk B.A. Developmental Trauma Disorder: toward a rational diagnosis for children with complex trauma histories Psychiatr. Ann. 35 2005 401 408 10.3928/00485713-20050501-06
44 Clark L.A. Cuthbert B. Lewis-Fernández R. Narrow W.E. Reed G.M. Three approaches to understanding and classifying mental disorder: ICD-11, DSM-5, and the national institute of mental health's research domain criteria (RDoC) Psychol. Sci. Publ. Interest 18 2017 72 145 10.1177/1529100617727266
45 Friedman M.J. Finalizing PTSD in DSM-5: getting here from there and where to go next J. Trauma Stress 26 2013 548 556 10.1002/jts.21840 24151001
46 Zoromba M.A. EL-Gazar H.E. Salah A. El-Boraie H. El-Gilany A.-H. El-Monshed A.H. Effects of emotional intelligence training on symptom severity in patients with depressive disorders Clin. Nurs. Res. 2022 10547738221074064 10.1177/10547738221074065
47 Ogle C.M. Rubin D.C. Siegler I.C. The impact of the developmental timing of trauma exposure on PTSD symptoms and psychosocial functioning among older adults Dev. Psychol. 49 2013 2191 2200 10.1037/a0031985 23458662
48 Patel A.R. Hall B.J. Beyond the DSM-5 diagnoses: a cross-cultural approach to assessing trauma reactions Focus 19 2021 197 203 10.1176/appi.focus.20200049 34690583
49 Chentsova-Dutton Y. Maercker A. Cultural scripts of traumatic stress: outline, illustrations, and research opportunities Front. Psychol. 10 2019 https://www.frontiersin.org/articles/10.3389/fpsyg.2019.02528
50 Hinton D.E. Good B.J. The culturally sensitive assessment of trauma: eleven analytic perspectives, a typology of errors, and the multiplex models of distress generation Cult. PTSD Trauma Glob. Hist. Perspect. 2016 50 112 10.9783/9780812291469-002
51 Kirmayer L.J. Narasiah L. Munoz M. Rashid M. Ryder A.G. Guzder J. Hassan G. Rousseau C. Pottie K. Common mental health problems in immigrants and refugees: general approach in primary care C. Can. Med. Assoc. J. = J. l’Association Medicale Can. 183 2011 E959 E967 10.1503/cmaj.090292
52 Eyerman R. Jamison A. Music and Social Movements: Mobilizing Traditions in the Twentieth Century 1998 Cambridge University Press Cambridge 10.1017/CBO9780511628139
53 Bryant R.A. Post-traumatic stress disorder: a state-of-the-art review of evidence and challenges World Psychiatr. 18 2019 259 269 10.1002/wps.20656
54 Zoellner L.A. Bedard-Gilligan M.A. Jun J.J. Marks L.H. Garcia N.M. The evolving construct of posttraumatic stress disorder (PTSD): DSM-5 criteria changes and legal implications Psychol. Inj. Law 6 2013 277 289 10.1007/s12207-013-9175-6 24470838
55 Resick P.A. Miller M.W. Posttraumatic stress disorder: anxiety or traumatic stress disorder? J. Trauma Stress 22 2009 384 390 10.1002/jts.20437 19774665
56 Spermon D. Darlington Y. Gibney P. Psychodynamic psychotherapy for complex trauma: targets, focus, applications, and outcomes Psychol. Res. Behav. Manag. 3 2020 119 127 10.2147/PRBM.S10215
57 Schottenbauer M.A. Glass C.R. Arnkoff D.B. Gray S.H. Contributions of psychodynamic approaches to treatment of PTSD and trauma: a review of the empirical treatment and psychopathology literature Psychiatry 71 2008 13 34 10.1521/psyc.2008.71.1.13 18377203
58 Bretherton I. The origins of attachment theory: John Bowlby and mary ainsworth Attach. Theory Soc. Dev. Clin. Perspect. 2013 45 84 10.4324/9780203728017-9
59 Doyle C. Cicchetti D. From the cradle to the grave: the effect of adverse caregiving environments on attachment and relationships throughout the lifespan Clin. Psychol. a Publ. Div. Clin. Psychol. Am. Psychol. Assoc. 24 2017 203 217 10.1111/cpsp.12192
60 Cassidy J. Jones J.D. Shaver P.R. Contributions of attachment theory and research: a framework for future research, translation, and policy Dev. Psychopathol. 25 2013 1415 1434 10.1017/S0954579413000692 24342848
61 Kaczkurkin A.N. Foa E.B. Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence., Dialogues Clin Neurosci 17 2015 337 346 10.31887/DCNS.2015.17.3/akaczkurkin
62 de Arellano M.A.R. Lyman D.R. Jobe-Shields L. George P. Dougherty R.H. Daniels A.S. Ghose S.S. Huang L. Delphin-Rittmon M.E. Trauma-focused cognitive-behavioral therapy for children and adolescents: assessing the evidence Psychiatr. Serv. 65 2014 591 602 10.1176/appi.ps.201300255 24638076
63 Shapiro F. The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences Perm. J. 18 2014 71 77 10.7812/TPP/13-098
64 Every-Palmer S. Flewett T. Dean S. Hansby O. Colman A. Weatherall M. Bell E. Eye movement desensitization and reprocessing (EMDR) therapy for posttraumatic stress disorder in adults with serious mental illness within forensic and rehabilitation services: a study protocol for a randomized controlled trial Trials 20 2019 642 10.1186/s13063-019-3760-2 31753032
65 de Roos C. van der Oord S. Zijlstra B. Lucassen S. Perrin S. Emmelkamp P. de Jongh A. Comparison of eye movement desensitization and reprocessing therapy, cognitive behavioral writing therapy, and wait-list in pediatric posttraumatic stress disorder following single-incident trauma: a multicenter randomized clinical trial JCPP (J. Child Psychol. Psychiatry) 58 2017 1219 1228 10.1111/jcpp.12768 28660669
66 Finn H. Warner E. Price M. Spinazzola J. The boy who was hit in the face: somatic regulation and processing of preverbal complex trauma J. Child Adolesc. Trauma 11 2018 277 288 10.1007/s40653-017-0165-9 32318157
67 Ogden P. Pain C. Fisher J. A sensorimotor approach to the treatment of trauma and dissociation Psychiatr. Clin. 29 2006 263 279 10.1016/j.psc.2005.10.012
68 Kearney B.E. Lanius R.A. The brain-body disconnect: a somatic sensory basis for trauma-related disorders Front. Neurosci. 16 2022 1015749 10.3389/fnins.2022.1015749
69 Chertoff J. Psychodynamic assessment and treatment of traumatized patients J. Psychother. Pract. Res. 7 1997 35 46 9407474
70 Krupnick J.L. Brief psychodynamic treatment of PTSD J. Clin. Psychol. 58 2002 919 932 10.1002/jclp.10067 12115715
71 Wöller W. Leichsenring F. Leweke F. Kruse J. Psychodynamic psychotherapy for posttraumatic stress disorder related to childhood abuse--Principles for a treatment manual Bull. Menninger Clin. 76 2012 69 93 10.1521/bumc.2012.76.1.69 22409207
72 Osofsky J.D. Fields-Olivieri M.A. Frazer A.L. Graham R.A. McCurdy B.H. Weems C.F. What to Look for in Relationships: development, inter-rater reliability, and initial validity estimates for a young child-caregiver relationship assessment Front. Psychol. 14 2023 1157665 10.3389/fpsyg.2023.1157665
73 van der Kolk B. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma 2014 Penguin Publishing Group https://books.google.com.sa/books?id=3Q3UAgAAQBAJ
74 Athanasiadou-Lewis C. A relational perspective on psychological trauma: the ghost of the unspent love Psychol. Trauma 2019 IntechOpen 10.5772/intechopen.86375
75 Fonagy P. Attachment Theory and Psychoanalysis 2018 Taylor & Francis https://books.google.com.sa/books?id=JJNXDwAAQBAJ
76 Lahousen T. Unterrainer H.F. Kapfhammer H.-P. Psychobiology of attachment and trauma—some general remarks from a clinical perspective Front. Psychiatr. 10 2019 10.3389/fpsyt.2019.00914
77 Lahousen T. Unterrainer H.F. Kapfhammer H.-P. Psychobiology of attachment and trauma-some general remarks from a clinical perspective Front. Psychiatr. 10 2019 914 10.3389/fpsyt.2019.00914
78 Guérin-Marion C. Sezlik S. Bureau J.-F. Developmental and attachment-based perspectives on dissociation: beyond the effects of maltreatment Eur. J. Psychotraumatol. 11 2020 1802908 10.1080/20008198.2020.1802908
79 Zoromba M.A. EL-Gazar H.E. Elkalla I.H.R. Amr M. Ibrahim N. Association between cumulative trauma and severity of psychotic symptoms among patients experiencing psychosis Arch. Psychiatr. Nurs. 51 2024 54 61 10.1016/j.apnu.2024.05.008 39034095
80 Cohen J.A. Mannarino A.P. Deblinger E. Treating Trauma and Traumatic Grief in Children and Adolescents 2016
81 de Roos C. Greenwald R. den Hollander-Gijsman M. Noorthoorn E. van Buuren S. de Jongh A. A randomised comparison of cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) in disaster-exposed children Eur. J. Psychotraumatol. 2 2011 10.3402/ejpt.v2i0.5694
82 Herman J.L. Trauma and Recovery: the Aftermath of Violence--From Domestic Abuse to Political Terror 2015 Basic Books https://books.google.com.sa/books?id=TVw4DgAAQBAJ
83 Eye movement desensitization and reprocessing (EMDR) scripted protocols: basics and special situations Luber M. Eye Mov. Desensitization Reprocess. Scripted Protoc. Basics Spec. Situations. 2009 450 xxx, 450–xxx
84 Scelles C. Bulnes L.C. EMDR as treatment option for conditions other than PTSD: a systematic review Front. Psychol. 12 2021 644369 10.3389/fpsyg.2021.644369
85 Barron I. Bourgaize C. Lempertz D. Swinden C. Darker-Smith S. Eye movement desensitization reprocessing for children and adolescents with posttraumatic stress disorder: a systematic narrative review J. EMDR Pract. Res. 13 2019 270 283 10.1891/1933-3196.13.4.270
86 Levine P.A. Maté G. In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness 2012 North Atlantic Books https://books.google.com.sa/books?id=OdjwjyDbp0wC
87 Ogden P. Minton K. Sensorimotor psychotherapy: one method for processing traumatic memory Traumatology 6 2000 149 173 10.1177/153476560000600302
88 Pavlovic R. Trauma and the body: a sensorimotor approach to psychotherapy Br. J. Guid. Counsell. 37 2009 514 516 10.1080/03069880903166509
89 Cuijpers P. Quero S. Dowrick C. Arroll B. Psychological treatment of depression in primary care: recent developments Curr. Psychiatr. Rep. 21 2019 129 10.1007/s11920-019-1117-x
90 Kessler R.C. Sonnega A. Bromet E. Hughes M. Nelson C.B. Posttraumatic stress disorder in the national comorbidity survey Arch. Gen. Psychiatr. 52 1995 1048 1060 10.1001/archpsyc.1995.03950240066012 7492257
91 Koenen K.C. Ratanatharathorn A. Ng L. McLaughlin K.A. Bromet E.J. Stein D.J. Karam E.G. Meron Ruscio A. Benjet C. Scott K. Atwoli L. Petukhova M. Lim C.C.W. Aguilar-Gaxiola S. Al-Hamzawi A. Alonso J. Bunting B. Ciutan M. de Girolamo G. Degenhardt L. Gureje O. Haro J.M. Huang Y. Kawakami N. Lee S. Navarro-Mateu F. Pennell B.-E. Piazza M. Sampson N. Ten Have M. Torres Y. Viana M.C. Williams D. Xavier M. Kessler R.C. Posttraumatic stress disorder in the world mental health Surveys Psychol. Med. 47 2017 2260 2274 10.1017/S0033291717000708 28385165
92 Kessler R.C. Aguilar-Gaxiola S. Alonso J. Benjet C. Bromet E.J. Cardoso G. Degenhardt L. de Girolamo G. V Dinolova R. Ferry F. Florescu S. Gureje O. Haro J.M. Huang Y. Karam E.G. Kawakami N. Lee S. Lepine J.-P. Levinson D. Navarro-Mateu F. Pennell B.-E. Piazza M. Posada-Villa J. Scott K.M. Stein D.J. Ten Have M. Torres Y. Viana M.C. V Petukhova M. Sampson N.A. Zaslavsky A.M. Koenen K.C. Trauma and PTSD in the WHO world mental health Surveys Eur. J. Psychotraumatol. 8 2017 1353383 10.1080/20008198.2017.1353383
93 Seedat S. Stein D.J. Trauma and post-traumatic stress disorder in women: a review Int. Clin. Psychopharmacol. 15 Suppl 3 2000 S25 S33
94 Howgego I.M. Owen C. Meldrum L. Yellowlees P. Dark F. Parslow R. Posttraumatic stress disorder: an exploratory study examining rates of trauma and PTSD and its effect on client outcomes in community mental health BMC Psychiatr. 5 2005 21 10.1186/1471-244X-5-21
95 Holton M.J. Snodgrass J.L. A theoretical and theological reframing of trauma Pastor. Psychol. 72 2023 337 351 10.1007/s11089-023-01063-1
96 Hayes A.M. Yasinski C. Grasso D. Ready C.B. Alpert E. McCauley T. Webb C. Deblinger E. Constructive and unproductive processing of traumatic experiences in trauma-focused cognitive-behavioral therapy for youth Behav. Ther. 48 2017 166 181 10.1016/j.beth.2016.06.004 28270328
