Trauma and Stressor Related Disorders
What is it?
It includes disorders in which exposure to traumatic or stressful events take place, these include reactive attachment disorder, disinhibited social engagement disorder, posttraumatic stress disorder, acute stress disorder, and adjustment disorders.
Reactive Attachment Disorder of infancy or early childhood is characterised by a pattern of markedly disturbed and developmentally inappropriate attachment behaviours, in which a child rarely or minimally turns preferentially to an attachment figure for comfort, support, protection, and nurturance.
The essential feature is absent or grossly underdeveloped attachment between the child and putative caregiving adults. Children show diminished or absent expression of positive emotions of fear, sadness, or irritability that are not readily explained.
The disorder has been found in young children exposed to severe neglect before being placed in foster care or raised in institutions. However, even in populations of severely neglected children, the disorder is uncommon, occurring in less than 10% of such children.
Disinhibited Social Engagement Disorder is a pattern of behaviour that involves culturally inappropriate, overly familiar behaviour with relative strangers. This overly familiar behaviour violates the social boundaries of the culture. Because of the shared etiological association with social neglect, disinhibited social engagement disorder may co-occur with developmental delays, especially cognitive and language delays, stereotypies, and other signs of severe neglect, such as malnutrition or poor care. The prevalence is not known but the disorder appears to be rare.
Post Traumatic Stress Disorder is the development of characteristics symptoms of following exposure to one or more traumatic events. An individual may experience this as emotionally or physically harmful or life-threatening and may affect mental, physical, social, and/or spiritual well-being.
Examples include natural disasters, serious accidents, terrorist acts, war/combat, rape/sexual assault, historical trauma, intimate partner violence and bullying. People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended.
They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.
PTSD affects approximately 3.5 percent of U.S. adults every year. The lifetime prevalence of PTSD in adolescents ages 13 -18 is 8%. An estimated one in 11 people will be diagnosed with PTSD in their lifetime. Women are twice as likely as men to have PTSD. Three ethnic groups – U.S. Latinos, African Americans, and Native Americans/Alaska Natives – are disproportionately affected and have higher rates of PTSD than non-Latino whites.
Acute Stress Disorder is the development of characteristic symptoms lasting from 3 days to 1 month following exposure to one or more traumatic events. People with acute stress disorder may relive the trauma, have flashbacks or nightmares and may feel numb or detached from themselves.
These symptoms cause major distress and problems in their daily lives. About half of people with acute stress disorder go on to have PTSD. Acute stress disorder has been diagnosed in 19%-50% of individuals that experience interpersonal violence (e.g., rape, assault, intimate partner violence).
Adjustment Disorder the essential feature of this disorder is the presence of emotional or behavioural symptoms in response to an identifiable stressor. The stressor may be a single event, or there may be multiple stressors. Stressors may affect a single individual, an entire family, or a larger group or community.
Symptoms can include feeling tense, sad or hopeless; withdrawing from other people; acting defiantly or showing impulsive behaviour; or physical manifestations like tremors, palpitations, and headaches. The symptoms cause significant distress or problems functioning in key areas of someone’s life, for example, at work, school or in social interactions.
Symptoms of adjustment disorders begin within three months of a stressful event and last no longer than six months after the stressor or its consequences have ended. An estimated 5% to 20% of individuals in outpatient mental health treatment have a principal diagnosis of adjustment disorder. A recent study found that more than 15% of adults with cancer had adjustment disorder.
Causes
Trauma and stressor-related disorders can be caused by various factors and are often a result of exposure to traumatic events or prolonged stressful situations. Here are some common causes :
- Traumatic Events : Experiencing or witnessing traumatic events can be a significant cause of trauma and stressor-related disorders. These events may include physical or sexual abuse, natural disasters, accidents, combat or warfare, acts of violence, or other life-threatening situations.
- Childhood Trauma : Early childhood experiences, such as neglect, physical or emotional abuse, or unstable environments, can have long-lasting effects and increase the risk of developing trauma-related disorders later in life. Adverse childhood experiences can disrupt normal development and impact the individual’s ability to cope with stressors.
- Complex Trauma : Prolonged or repeated exposure to traumatic events, particularly in interpersonal relationships, can lead to complex trauma. Examples include ongoing domestic violence, prolonged childhood abuse or neglect, or captivity situations. Complex trauma can have a cumulative impact on an individual’s well-being.
- Military Service : Military personnel who have experienced combat or other highly stressful situations during their service are at risk of developing trauma-related disorders, such as PTSD. The exposure to violence, loss, and life-threatening situations can have a profound impact on their mental health.
- Interpersonal Violence : Being a victim of interpersonal violence, such as physical assault, sexual assault, or domestic violence, can contribute to trauma-related disorders. The intentional harm inflicted by others can cause significant psychological distress and trauma symptoms.
- Chronic Stress : Persistent exposure to chronic stressors, such as ongoing work-related stress, financial difficulties, or relationship problems, can contribute to the development of stressor-related disorders. Prolonged stress can overwhelm an individual’s coping mechanisms and lead to significant psychological and physical health consequences.
- Other Adverse Life Events : Other adverse life events, such as the death of a loved one, serious illness or injury, divorce, or significant life transitions, can also be triggers for trauma and stressor-related disorders, particularly when the events are perceived as highly distressing or overwhelming.
It’s important to note that individual vulnerability factors, such as genetics, temperament, previous trauma history, and available support systems, can influence an individual’s susceptibility to developing trauma and stressor-related disorders. Additionally, the severity, duration, and proximity of the traumatic or stressful events can impact the likelihood of developing such disorders.
Treatment
The treatment for trauma and stressor-related disorders focuses on addressing the psychological and emotional impact of traumatic experiences. Here are some common approaches used in the treatment of these disorders :
- Trauma-Focused Psychotherapy : Trauma-focused psychotherapies, such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy, are evidence-based treatments for trauma-related disorders like Post-Traumatic Stress Disorder (PTSD). These therapies help individuals process their traumatic experiences, challenge distorted beliefs, and develop healthier coping strategies.
- Eye Movement Desensitization and Reprocessing (EMDR) : EMDR is a specialised therapy that utilises bilateral stimulation, such as eye movements or taps, to facilitate the processing of traumatic memories. It aims to reduce distress and the impact of traumatic experiences on the individual’s daily functioning.
- Cognitive-Behavioral Therapy (CBT) : CBT can be effective in treating trauma-related disorders by helping individuals identify and modify negative thought patterns and behaviours associated with the trauma. It may include techniques such as exposure therapy, cognitive restructuring, and skills training to manage distressing symptoms.
- Medication : In some cases, medications may be prescribed to help manage symptoms associated with trauma-related disorders, such as anxiety, depression, or sleep disturbances. Selective serotonin reuptake inhibitors (SSRIs) and other psychiatric medications may be used under the guidance of a healthcare professional.
- Group Therapy and Support Groups : Participating in group therapy or support groups with individuals who have experienced similar traumas can provide a sense of validation, support, and understanding. Sharing experiences and coping strategies in a safe and supportive environment can be beneficial.
- Self-Care and Stress Reduction Techniques : Encouraging self-care practices and stress reduction techniques, such as mindfulness, relaxation exercises, physical activity, and healthy lifestyle choices, can help individuals manage symptoms and improve overall well-being.
- Psychoeducation : Providing education about trauma and its effects can help individuals understand their symptoms and normalise their experiences. Psychoeducation may also include information on coping strategies, self-help techniques, and available resources.
