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.
All of the trauma- and stressor-related disorders have symptom profiles that vary according to the particular disorder in question.
According to APA, the following major disorders are now placed in the category of trauma- and stressor-related disorders:
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.
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.
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.
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.
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.
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 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.
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).
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.
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.
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.
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.
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.
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.
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:
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 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:
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.
If you have an issue with substance addiction, maybe you are using the substance to soothe something else. You are truly not the only person who has trouble coping with life. No matter when your stressors or trauma occurred, there is help for you now. Footprints to Recovery is waiting for you to contact us.