Severe PTSD or just PTSD?

Although the widespread of trauma exposure, post-traumatic stress disorder (PTSD) remains a prevalent and disabling mental disorder. Yet, access to appropriate care, particularly for individuals with more severe forms, remains limited. The expression 'severe PTSD' is widely used in clinical practice, yet no shared or psychometrically grounded definition has been established. Unlike other psychiatric disorders such as depression, validated instruments are still lacking to reliably determine the degree of severity of PTSD. Furthermore, relying solely on symptom scores may obscure key differences in functional impairment, or clinical relevance, as emphasized by the <i>Project Harmony</i> initiative. This lack of clarity may hinder the development of targeted therapeutic interventions. In this letter, we call for a shift toward a dimensional and integrative approach to assess PTSD severity. Instruments such as the Clinical Global Impression (CGI) scale could provide more ecologically valid and meaningful ways to capture the full spectrum of severity. Clarifying how severity is conceptualized may also support stepped-care approach by better identifying those who would benefit more from intensive trauma-focused interventions. Thus, reassessing how we define and measure PTSD severity requires moving away from counting symptoms toward a more nuanced, personalized understanding of the disorder.