Trauma on the exam: PTSD criteria, trauma-informed principles and the evidence-based treatments.
What counts as trauma in the DSM, the four symptom clusters, SAMHSA's principles and the therapies you should name.
By Dr. Andrew Wichterman · September 15, 2026 · 5 min read
Trauma appears across both exams, as diagnosis, as an ethical stance, and as treatment selection. The content is well defined and the cases are consistent about what they reward.
What the DSM counts as trauma
Criterion A for PTSD: exposure to actual or threatened death, serious injury or sexual violence, by direct experience, witnessing, learning it happened to a close person, or repeated exposure to details in the course of work (first responders, for example). Media exposure does not count unless work related. Emotional difficulty alone, such as a divorce, is not Criterion A trauma and points toward adjustment disorder instead.
The four clusters and the timeline
Intrusion (memories, nightmares, flashbacks, distress at cues), avoidance (of memories or of external reminders), negative alterations in cognition and mood (blame, persistent negative emotion, detachment, inability to feel positive emotion), and alterations in arousal and reactivity (irritability, recklessness, hypervigilance, startle, concentration, sleep). Duration more than one month. Acute stress disorder covers three days to one month. Delayed expression is a specifier when full criteria are not met until six months after the event. Dissociative subtype is specified when depersonalization or derealization is present. Children six and under have a separate criteria set. Complex PTSD is in the ICD-11, not the DSM.
Trauma-informed care
SAMHSA's six principles: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and attention to cultural, historical and gender issues. Trauma-informed does not mean trauma-focused treatment; it means every interaction assumes the possibility of trauma history and avoids retraumatization. On the exam, options that give the client control, explain procedures in advance, and avoid pressure to disclose are the trauma-informed ones.
Treatments to know
- Prolonged exposure (Foa): imaginal and in vivo exposure to trauma memories and avoided situations.
- Cognitive processing therapy (Resick): identifying and challenging stuck points, written accounts.
- Trauma-focused CBT (Cohen, Mannarino, Deblinger): for children and adolescents, with caregiver involvement; the PRACTICE components.
- EMDR (Shapiro): bilateral stimulation during recall; eight phases.
- Narrative exposure therapy, and present-centered therapy as a comparison condition.
- Psychological debriefing immediately after an event is not recommended; psychological first aid is.
Sequence in the case
Stabilization and safety before trauma processing. A client in an unsafe living situation, in active substance use that threatens safety, or in acute crisis is not ready for exposure work. Options that start exposure in the first session are wrong; options that build safety and coping first are right. Assess for dissociation and for suicide risk, which is elevated.
Practice this. The flashcards and practice tests on this site are sorted by content area, so you can drill this one until it holds.
Criterion A, four clusters, six principles, four or five named treatments, and safety before processing. The exam does not ask more than that.