Big T or Little T: Navigating the Fuzzy Edges of Criterion A
Dr. Kelly Chrestman

 Accurately diagnosing PTSD is the first step in getting a patient connected with the best care.  But understanding and applying Criterion A (of the DSM-5) can be a challenge for even the most experienced clinician.  The process can give Goldilocks vibes: are you being too lenient or too strict with the definition of “trauma?” 

On this episode, Drs. Carin Lefkowitz and Kevin Holloway are joined by Dr. Kelly Chrestman, a subject matter expert in PTSD.  She helps us navigate the blurry edges of Criterion A as we try to get it “just right.”

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Show Notes

Guest Bios:
Kelly Chrestman, Ph.D., is a clinical psychologist with over 30 years of experience specializing in evidence-based treatments for trauma and stress-related conditions. As a Senior Military Mental Health Psychologist at the Consortium for Defense Psychology (CDP), she provides consultation and training both domestically and internationally, concentrating on stress and trauma, Cognitive Behavioral Therapy (CBT), and Prolonged Exposure Therapy.

She is co-author of Prolonged Exposure for Adolescents with PTSD and co-developed the PTSD Learning Center and Operation AVATAR, an immersive learning platform hosted in Second Life. Her work merges rigorous scientific research with culturally informed practices, aiming to translate psychological principles into practical, actionable, and accessible tools for practitioners.

Resources Mentioned in This Episode

Dr. Chrestman references several articles. You can find them here:

  • Brewin, C.R., Lanius, R.A., Novac, A., Schnyder, U., Galea, S., 2009. Reformulating PTSD for DSM-V: life after criterion A. J. Trauma Stress 22 (5), 366–373. https://doi.org/ 10.1002/jts.20443.
  • Gradus, J.L., Galea, S., 2022. Reconsidering the definition of trauma. Lancet Psychiatry 9 (8), 608–609. https://doi.org/10.1016/S2215-0366(22)00196-1.
  • Gradus, J.L., Galea, S., 2023. Moving from traumatic events to traumatic experiences in the study of traumatic psychopathology. Am. J. Epidemiol. 192 (10), 1609–1612. https://doi.org/10.1093/aje/kwad126.
  • Marx, B.P., Hall-Clark, B., Friedman, M.J., Holtzheimer, P., Schnurr, P.P., 2023. The PTSD Criterion A debate: a brief history, current status, and recommendations for moving forward. J. Trauma Stress 37 (1), 5–15. https://doi.org/10.1002/jts.23007.
  • Saraiya, T. C., Bauer, A. G., Banks, D. E., Brown, D. G., Jarnecke, A. M., Ebrahimi, C. T., & Bernard, D. L. (2025). Are we gatekeeping trauma? A conceptual model to expand criterion A for invisible, identity-based, and systemic traumas. Social Science & Medicine, 375, 118090. https://doi.org/10.1016/j.socscimed.2025.118090

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