A new paradigm for defining trauma: bridging interdisciplinary perspectives

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Scholarly debate in psychology and psychiatry about how trauma should be defined is extensive and contentious, with varying and often directly conflicting stances regarding the most accurate and appropriate definition. Much of the disagreement centres around trauma's definition within posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual for Mental Disorders (DSM). Since PTSD's introduction to the DSM-III in 1980, symptoms listed under the disorder (within Criterion B) have evolved and currently include alterations in mood, cognition and arousal, as well as symptoms of intrusion and avoidance (American Psychiatric Association [APA], 2022). However, the key point of disagreement centres on PTSD's Criterion A, which defines what type of stressors or events qualify as being traumatic. These events were first defined as those that 'evoke significant symptoms of distress' (APA, 1980), evolving in later editions of the DSM to those that are 'markedly distressing' and 'outside of the range of usual human experience' (APA, 1987) (see Table 1). On subsequent recognition that traumatic experiences are relatively common, the latter definition was removed in the DSM-IV in 1994. Since then, Criterion A has explicitly specified events that qualify as traumatic: those that involve actual or threatened death, serious injury or sexual violence (APA, 1994(APA, , 2000(APA, , 2013(APA, , 2022)). However, debate continues, and a recent review identified four main and opposing positions: to expand criterion A, to narrow it, to eliminate it, or to keep it unchanged (Marx et al., 2024). The review ultimately resulted in a call for more research before any criterion adjustments are made. Despite 40 years of attempts to refine this aspect of PTSD's definition, controversy remains.Meanwhile, in the interdisciplinary field of somatic trauma therapy, a different conceptualisation of trauma is proposed which can offer new perspective to this debate. There are multiple therapy modalities within the field, incorporating embodied aspects such as interoception, movement and touch, but sharing a common conceptualisation of trauma; it is defined only by the physiological impact upon the person, rather than by aspects related to the event. Trauma is understood to cause dysregulation in the autonomic nervous system (ANS) and accordingly, resolution of post-trauma symptoms is sought by working directly with the body, using 'bottom-up' approaches (Grassmann et al., 2025). For example, in Somatic Experiencing (SE; Levine, 1997), trauma is stated to occur when overwhelming sympathetic arousal activates a 'shut down' response in the ANS (to numb the experience), which traps the sympathetic charge and causes dysregulation. SE's corresponding intervention purports to resolve symptoms by developing attention to internal sensations and impulses and completing movement patterns associated with the original fight/flight arousal that were thwarted by the 'shut down' response. This mobilises the trapped sympathetic charge and stuck patterns of hyper-arousal and/or dissociation, returning the ANS to homeostasis (Payne et al., 2015;Dann, 2024). Similarly, in Sensorimotor Psychotherapy (Ogden et al., 2006), trauma is posited to be encoded developmentally in postures, bodily sensations and movement patterns. Via processes of interoception and adjustment of defensive developmental embodied habits and movements, a return to homeostasis is enabled (see Figure 1). A range of other somatic modalities offer nuanced embodied approaches to restoring autonomic regulation, but it is their shared shift away from defining trauma in terms of the event, combined with recognition for the role of the body in trauma, that offers potential to alleviate some key points of conflict in the current debate in psychology and psychiatry.Before outlining this potential contribution, it's important to note that despite decades' long practice, current evidence for the efficacy of somatic trauma therapies is only emergent, which may explain why the somatic conceptualisation of trauma has not featured greatly in the debate to date.Accounting for this limited data however, is an evolving methodological critique highlighting the poor fit between complex experiential PTSD treatments (such as somatic trauma therapies), and conventional methodology for intervention validation, i.e. the randomised control trial (RCT) (Smith, 2024). While somatic therapy techniques are well defined, they inherently adapt to the unique, complex and non-linear process of clients' post-trauma recovery, making them difficult to standardise (practically and ethically) for research purposes. This has led to a preference in the field for case studies (Kalisvaart and Ogden, 2025) and potential empirical under-representation of the range of clinically observed changes post-intervention, such as shifts in body awareness, selfreported regulation, resilience, vitality and relational safety (Heller and LaPierre, 2012;Holt and McClean, 202;Kuhfuß et al., 2021). Smith (2024) cautions that given the complex nature of PTSD, sole reliance on the RCT in PTSD research may actively hinder capacity to guide practice, and calls for inclusion of qualitative, process-oriented and practice-based studies better suited to more complex interventions. This approach would enable a more holistic understanding of the full impact of somatic trauma interventions and represents an important avenue for future research. Despite these methodological obstacles, evidence for the efficacy of somatic trauma interventions from controlled and uncontrolled studies (including the RCT) is promising, demonstrating clinically meaningful reductions in PTSD and related symptoms (Gene-Cos et al., 2016;Classen et al., 2020;Kuhfuß et al., 2021;da Silva et al., 2025;Pelixo et al., 2025). Something not definitively evidenced, is the mechanism by which somatic trauma therapies effect change. While enhanced autonomic regulation has been documented via self-report (Kuhfuß et al., 2021), research utilising direct biomarkers of autonomic change is a key area for further empirical study. Overall, however, the somatic paradigm's contention that trauma disrupts autonomic regulation, alters interoception and leaves the ANS stuck in patterns of hyperarousal and 'shut down' is supported by a growing body of evidence that interoceptive and autonomic dysregulation play a mechanistic role in post-traumatic symptomology (e.g. Williamson et al., 2015;Soder et al., 2019;Joshi et al., 2023;Leech et al., 2024). This increasing evidence for the role of the body and nervous system in trauma and trauma therapy, which has typically been absent within the psychiatric model, supports the contention of a 'paradigm shift' in the field (Riordan et al., 2017) and again underlines why further empirical exploration is warranted in this domain. 2 Useful aspects of the somatic paradigm for the trauma definition debateA criticism of the DSM's current framing of PTSD is that systemic and cultural bias is inherent in definitions of events that qualify as traumatic (and therefore who qualifies for trauma-related healthcare). For example, insidious systemic trauma to marginalised individuals (e.g. social displacement and oppression) has been rendered 'invisible' (Saraiya et al., 2025). A similar lack of visibility is noted for chronic and developmental traumas, which may not be based on identifiable or catastrophic events (Bureau et al., 2010). For example, the chronic and seemingly ordinary experience of early parental misattunement, whereby the parent/caregiver is not reliably responsive to an infant's expressed emotions, is a well-documented cause of emotional dysregulation and longterm physiological and psychological harm (Schore, 2009;Farina and Schimmenti, 2025), but is not acknowledged in current psychiatric definitions and rendered a 'hidden trauma' (Bureau et al., 2010).Here the somatic paradigm, by shifting the def

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