The overlooked trauma: psychological violence and its impact on PTSD symptoms

Background: Psychological violence, defined as interpersonal acts intended to humiliate or diminish others without physical force, has been linked to significant psychological suffering. Despite its prevalence and association with mental health disorders, it is not classified as a potentially traumatic event under the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) criteria for post-traumatic stress disorder (PTSD) diagnosis.Objective: This study examines whether psychological violence, when identified as the index trauma, is associated with PTSD symptoms at levels comparable to those elicited by DSM-5-recognized traumas.Method: In this cross-sectional study, 530 Brazilian undergraduate students completed the Trauma History Questionnaire (THQ) and the PTSD Checklist for DSM-5 (PCL-5). Negative binomial regression and logistic regression models were used to examine associations between trauma type and PTSD symptom severity and probable diagnosis.Results: Compared to crime- and disaster-related trauma, psychological violence was associated with greater PTSD symptom severity and higher odds of probable PTSD diagnosis. Its impact was comparable to that of physical and sexual violence.Conclusions: These findings emphasize the importance of raising awareness about the emotional consequences of psychological violence and highlight the need for greater recognition of psychological violence as part of the spectrum of experiences associated with PTSD. Recognizing psychological trauma as a threat to the fundamental human need for social connection has critical implications for diagnostic refinement and treatment protocols.