Therefore, a textbook answer to the question can be “no”, but again, this is not necessarily the only answer. Diagnostic Criteria in general can change in the course of time, and they should be highly culture-dependent. The diagnostic criteria of PTSD are even more complicated as the definition of trauma itself can be changing. As I discussed elsewhere (Okano, 2009), the definition of trauma in DSM has shifted remarkably from objective to subjective, in the course of the past few decades from DSM-III (1980) to DSM-III-R(1987) to DSM-IV(1994). As a result, the definition of the trauma responsible for PTSD became quite broad and less objectively definable. The criterion A for PTSD in DSM-IV has two parts; A (1) and A (2). A (1) states that “the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.” A (2) states “the person’s response involved intense fear, helplessness, or horror”. Obviously A (1) defines the trauma very broadly and diffusely. A person might only “learn about” (“be confronted with” is paraphrased as such in fine prints of the DSM-IV textbook (American Psychiatric Association, 1994)) “someone” being threatened to be injured to meet this criterion. However, A (2) narrows down trauma once broadly defined by A (1). The person should find it “fearful, helpless, or horrifying”.
If this broadening of the definition continues onto DSM-V which is expected to be issued in 2013, criterion A might even disappear, as eventually any apparently insignificant “incident” might be traumatizing if he/she finds it “fearful, helpless, or horrifying”. If it is so, the answer that I gave to the young psychiatrist ten years ago might not have been that bad.
By the way, luckily or unluckily, the draft of DSM-V now available on line indicates that further broadening of the definition of trauma might not occur, but rather they are attempting to define the A criteria more in detail. Here is what is available on their website. (American Psychiatric Association, 2010, http://www.dsm5.org/Pages/Default.aspx).
A. The person was exposed to one or more of the following event(s): death or threatened death, actual or threatened serious injury, or actual or threatened sexual violation, in one or more of the following ways: (For children, inclusion of loss of a parent or other attachment figure is being considered.)
1. Experiencing the event(s) him/herself
2. Witnessing, in person, the event(s) as they occurred to others
3. Learning that the event(s) occurred to a close relative or close friend; in such cases, the actual or threatened death must have been violent or accidental
4. Experiencing repeated or extreme exposure to aversive details of the event(s) (e.g., first responders collecting body parts; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.）
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