Trauma- & Stressor-Related Disorders

Not everyone who experiences a traumatic event will develop a type of psychiatric disorder. Most people who experience these events do not. But some people suffer such damage to their sense of self that they need professional help to cope with their experience. The sense of self is often referred to as the “psyche.”

Before 2013, the American Psychiatric Association (APA) listed all the different types of trauma-related disorders under anxiety disorders because it was believed that anxiety was the primary symptom that people with these disorders expressed.

After years of research studies, APA placed these disorders in their own category: trauma- and stressor-related disorders. These disorders were found to be separate from anxiety disorders, like panic disorder or phobias, even though anxiety is a component of them.

All of these disorders have one commonality: The person has had an experience of significant stress or trauma that is believed to have triggered many of the symptoms they express.

Again, simply experiencing trauma or stress does not guarantee that one will develop one of these disorders. Instead, these disorders are the result of numerous interacting factors. Their actual triggers are not known.

General Signs of Trauma and Stressor-Related Disorders

All of the trauma- and stressor-related disorders have symptom profiles that vary according to the particular disorder in question. 

However, some of the general signs of trauma- and stressor-related disorders include:

  • Having intrusive memories of the traumatic or stressful event that can include flashbacks (feeling as if you are reexperiencing the event) or very vivid dreams.
  • Avoidance of places, people, or activities that serve as reminders of the event.
  • Negative changes in mood and thinking that can include significant depression, feelings of hopelessness, feeling detached, a loss of interest in things, negative thoughts, suspiciousness, feeling emotionally numb, or not being able to experience pleasure.
  • Changes in emotional reactions that can include becoming easily frightened or startled, trouble sleeping, always feeling on guard or in danger, irritability, significant guilt or shame, or self-destructive behavior, such as substance abuse.

Types of Trauma & Stressor-Related Disorders

According to APA, the following major disorders are now placed in the category of trauma- and stressor-related disorders:

Post-Traumatic Stress Disorder (PTSD)

This is a mental health condition that’s triggered by either experiencing or witnessing one or more terrifying events. The prevalence of PTSD varies depending on the type of trauma, but the risk for PTSD is about 8.7 percent, according to APA. However, as many as a third or slightly more of people who are exposed to severe trauma like combat or rape may develop PTSD. 

PTSD Symptoms are usually grouped into four types:

Intrusive memories

  • Reoccurring, unwanted, distressing memories of the experience
  • Reliving the event as if it were happening again (flashbacks)
  • Distressing dreams or nightmares
  • Severe emotional distress or physical reactions to something that reminds you of the event

Avoidance

  • Avoiding talking or thinking about the traumatic event
  • Avoiding activities, places, or people that remind you of the event

Negative changes in thinking and mood

  • Negative thoughts about yourself, other people, or the world
  • Hopelessness about the future
  • Difficulty with memories, including not remembering specific aspects of the traumatic experience
  • Problems maintaining close relationships
  • Detachment from family and friends
  • Little interest in activities you used to enjoy
  • Difficulty experiencing positive emotions
  • Feeling emotionally numb

Changes in physical and emotional reactions

  • Being easily startled or frightened
  • Always on guard for danger
  • Behavior that is self-destructive like drinking too much or driving too fast
  • Sleep difficulties
  • Trouble with concentration
  • Angry outbursts or aggressive behavior
  • Overwhelming guilt or shame

It is critical to get effective treatment to reduce symptoms and improve daily functioning. If you are having severely upsetting thoughts and feelings about a traumatic event for more than a month, talk to a doctor or mental health professional. If you get treatment as soon as possible, it can help prevent PTSD symptoms from getting worse.

If you or someone you know has suicidal thoughts, get help immediately by:

  • Reach out to a close friend or loved one
  • Contact a spiritual leader
  • Call the National Suicide Prevention Lifeline at 1-800-273 8255 (TALK)
  • Acute Stress Disorder:

This is the acute expression of PTSD-like symptoms (not as severe), but symptoms only last for three days to one month. The prevalence varies depending on the type of stressful event.

Reactive Attachment Disorder (RAD) 

trauma treatment

This occurs in children. It is a condition in which a young child or infant does not form a secure, healthy emotional bond with the primary caregivers. The child shows a pattern of inhibited and emotionally withdrawn behavior directed toward adult caregivers. Its prevalence is unknown, but it is typically found in very young children who have been exposed to severe neglect. 

Common symptoms of RAD are:

  • Failure to show an expected range of emotions with others.
  • Failure to show “emotions of conscience” such as remorse, regret, or guilt.
  • Avoidance of eye contact and physical touch, especially with caregivers.
  • Irritability, anger, tantrums, sadness, disability, and arguing (beyond what would be typical for the age and situation of the child).
  • Showing inappropriate affection toward strangers while showing a lack of affection or fear of primary caregivers.

As children with RAD grow older, their symptoms typically fall into one of two general patterns of behavior:

  1. Inhibited RAD symptoms—The child is aware of what is going on around him but does not typically respond to outside stimulation. Children with inhibited RAD symptoms are withdrawn and emotionally reticent. They may not show or pursue affection from caregivers or others.
  2. Disinhibited RAD symptoms—These children may be improperly friendly toward strangers and do not prefer their primary caretakers to other people. Most of the time, these children act younger than their age and might look for affection from others in an unsafe manner.

Adjustment Disorder 

This is a group of symptoms, such as stress, sadness, or hopelessness, plus physical symptoms after you experience a stressful life event. You have a hard time coping, and reactions are stronger than expected for the type of event that occurred. Different events may trigger symptoms of an adjustment disorder. Whatever it is, the event may become just too much for you.

Events that might trigger adjustment disorder:

  • Death of a loved one
  • Divorce or relationship problems
  • Life changes
  • Illness or health issues for you or a loved one
  • Moving to a new home or a different city
  • Unexpected emergencies
  • Money worries

It is impossible to predict which people who are going through the same stress are likely to develop adjustment disorder. Your skills in dealing with stress before the event may play a role.

Complex Trauma (CT)

Complex trauma usually results from exposure to severe stressors that start during childhood or adolescence, occur repeatedly, and take place within the caregiver system. CT involves repeated mistreatment over a lengthy period. It includes emotional and physical abuse, sexual abuse, neglect, and witnessing violence in the family. 

Individuals with CT experience lifelong problems with :

  • Difficulties related to self-regulation
  • Relationships
  • Psychological symptoms
  • Changes in attention and consciousness
  • Self-injury
  • Identity and cognitive misinterpretation

People who experience trauma from an early age may protect themselves by “splitting off” the part of themselves that is experiencing the trauma. This causes a psyche that is split into pieces. The person develops different personas that are deep within the unconscious memory. Each persona is strictly committed to a lack of growth and causes a stunted emotional development.

The necessary personas show up as protectors when needed in response to the imminent trigger. When especially strong personas are present, personality conditions may develop. The clinical term for a person who has distinct and separate personalities developed because of childhood trauma is Dissociative Identity Disorder (DID).

Treating Complex Trauma

A good therapist can help the person identify their triggers and personas and help combine the parts into one integrated whole person. The goal is not to eliminate the personas, but to welcome and consolidate them into the person’s feeling of oneness.

Once the different parts are identified, the therapist can help the person understand the hidden, threatening beliefs that are in their psyche. 

Challenging the negative beliefs formed in childhood helps to evaluate the damage caused in childhood, and the triggers for the personas begin to make sense.

Causes of These Disorders

According to APA, all of the trauma- and stressor-related disorders must occur following some identifiable traumatic or stressful event. However, the event itself cannot be designated as the cause of the syndrome because most people who experience severe trauma are not diagnosed with these disorders.

Other interacting risk factors can predispose someone to a higher chance of developing a trauma- and stressor-related disorder. These include:

  • Being diagnosed with another psychiatric disorder.
  • Having a history of substance abuse.
  • Lack of a solid support system.
  • Being a victim of neglect or abuse as a child.

APA reports that there are some aspects of the traumatic or stressful event that may increase the risk that one could develop a trauma and stressor-related disorder.

  • The traumatic or stressful event was unexpected.
  • The person was not prepared for the event.
  • When the event was occurring, they felt they had no control over what was happening.
  • They experienced severe emotional distress or emotional detachment during or after the event.

It should be understood that risk factors are not guaranteed. They only increase the probability, often very slightly, that a person may develop a disorder or disease. However, if someone has multiple risk factors, their chances of developing the disorder increase.

Co-Occurring Substance Abuse

Research studies have indicated that there is a high rate of substance abuse among people who suffer from trauma- and stressor-related disorders. The rate has been estimated to be between 40 percent and 60 percent.

Obviously, for the childhood disorders listed above, the rate would be significantly lower (near 0). For adolescents and adults who develop PTSD, acute stress disorder, or adjustment disorders, the rate is higher.

Being predisposed to develop any form of mental illness also makes a person at greater risk of developing other forms of mental illness, including substance use disorders. Simply having a mental health disorder, such as a trauma- and stressor-related disorder, makes it more likely that someone will also struggle with substance abuse. And again, a history of substance abuse makes it more likely that someone will develop a trauma- and stressor-related disorder in response to trauma.

The major drugs of abuse among those with trauma- and stressor-related disorders are alcohol abuse and prescription medications. Pain medications and benzodiazepines or other types of drugs to control anxiety are often abused.

Treatment Approaches for Co-Occurring Disorders

Currently, certain drugs are being investigated to treat disorders like PTSD, but there is no specific drug that can treat any of the trauma- and stressor-related disorders. Medications are often used to address specific symptoms, such as depression, anxiety, or even psychosis.

Medications will typically be used in conjunction with behavioral interventions like different types of psychotherapy.

Dual Diagnosis

If someone has a co-occurring trauma- and stressor-related disorder and a substance use disorder, the two must be treated at the same time. It is essentially impossible to achieve success by addressing one disorder first, even if the clinician thinks that the trauma- and stressor-related disorder is triggering abuse of alcohol or drugs.

People with dual diagnoses are most often treated by a team of specialists. Each professional addresses the client’s issues separately. They then work together to ensure that the client is treated consistently and comprehensively.

Types of Behavioral Treatments for Trauma- & Stressor-Related Disorders

Psychotherapy for trauma helps the person adjust to their experience of the traumatic or stressful event and to slowly alleviate the effects of the event. The treatment protocols are often very complicated and require significant training. Most of these apply a cognitive-behavioral approach (CBT), where dysfunctional thoughts and beliefs are identified and restructured.

The following are other types of approaches that might be used:

  • The self-trauma model uses a mixture of CBT and psychodynamic therapy (Freudian-based principles) to understand the reaction to trauma and help the person adjust it.
  • Exposure therapies and systematic desensitization are cognitive-behavioral techniques that help the person revisit the traumatic or stressful event and experience it repeatedly to slowly reprogram their reaction to it. 
  • Support group participation can also be useful. These are not forms of therapy, but they are run by people with similar problems. They don’t replace therapy, but they offer a good form of long-term support.

All psychotherapeutic techniques for trauma- and stressor-related disorders attempt to work on the relationship between the client and therapist as the mechanism of change. This relationship (often referred to as the therapeutic alliance) is one of mutual respect, trust, and sharing.

Treatment for Substance Abuse

Treatment for substance use disorder should be delivered along with the treatment for the trauma- and stressor-related disorder. Addiction treatment is delivered in its standard format, but with the addition of other interventions to address the dual diagnosis. Overall, addiction treatment will include the following, as appropriate for the particular situation:

  • Medical detox
  • Medication management
  • Traditional therapy
  • Complementary therapies
  • Peer support groups
  • Family involvement

Length of Treatment

The time someone spends in treatment for trauma and stressor-related disorder depends on the severity of the disorder. A disorder like PTSD typically requires extensive and lengthy treatment.

Treatment for a substance use disorder is considered a long-term endeavor, and the person should be involved in treatment for years. Many people will remain in some form of care, like support groups or therapy, for several years.

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