What Does the Literature Say? A Content Analysis of How Trauma Is Defined in Highly Cited Research Articles

Background and Purpose: There has been ongoing scholarly debate about how, in what ways, and for what purposes the concept of psychological trauma should be defined. Researchers have considered relative benefits and drawbacks of empirically defining and measuring trauma for clinical purposes versus using a broader definition that recognizes variety in the subjective nature of traumatic experiences. Research guides the direction of clinical assessment processes and interventions for trauma-related mental health challenges. As such, it is important to understand how researchers define the concept of trauma. Existing research has explored personal narratives and definitions of trauma among the general public. Our current study builds upon this foundation with a systematic analysis of how researchers have defined trauma in the most influential scholarly publications over time.

Method: For each year from 2006 to 2018, we conducted searches to find the top 10 most-cited articles including the terms [“trauma is defined” OR “definition of trauma”] (n=130). Using Google Scholar, which indicates the number of citations for each article, we conducted separate searches for each year. Each article was reviewed for the number of times it was cited, and the 10 top-cited articles for each year were retained for analysis. The top ten articles per year excluded books and book chapters, articles on medical and emergency unit trauma, and articles specific to traumatic brain injury. A content analysis was conducted on these highly-cited articles to analyze how the term “trauma” was defined and identify features of those definitions.

Results: Three main themes and their corresponding subthemes were identified: 1) definitions of trauma (subthemes: institutional definitions, trauma type, population- or context-specific definitions, author-generated definitions, and measurement-specific definitions); 2) different perspectives on how trauma is defined (subthemes: broad versus narrow definitions, objective versus subjective nature of trauma, trauma exposure versus symptoms, and adverse childhood experiences (ACE)-specific considerations); and 3) implications of how trauma is defined (subthemes: consequences related to diagnosis and assessment of trauma and attention to historic, racial, cultural, or gender-based trauma). Concerns about mitigating diagnostic inaccuracies were explored. Some scholars posited that an overly broad approach may contribute to “conceptual creep” where diagnostic criteria of post-traumatic stress disorder (PTSD) are erroneously applied. However, other researchers report that adverse experiences beyond the current clinical definition of trauma can also lead to symptoms of PTSD. Proponents of a more inclusive approach were divided on whether defining historic, racial, cultural, or gender-based oppressive experiences as traumatic would be needlessly pathologizing on the one hand versus validating and accurately reflecting the interplay between micro and macro level influential factors on the other.

Conclusions and Implications: There is evidence supporting an expansion of the clinical definition of trauma to include a broader variety of experiences like historic, racial, cultural, or gender-based oppression, while still maintaining diagnostic accuracy. Future studies in this area may provide additional validation. It is important for scholars to consider how the ways in which a dominant group in society defines trauma can exacerbate the trauma already experienced by people who experience systemic marginalization.