TRAUMA AND STRESSOR-RELATED DISORDERS, PTSD

TRAUMA AND STRESSOR-RELATED DISORDERS

• A group of disorders that arise after a stressful or traumatic life event, often involving intense emotional responses

• Unlike anxiety disorders, these are directly linked to a proximal stressful/traumatic event

• Emotional Range: Broader than anxiety alone as it may include fear, anxiety, rage, horror, guilt, and shame

• Rationale for Separate Category

  • These disorders do not fit neatly under anxiety disorders.

  • They share the triggering role of stress/trauma as the central cause.

DISORDERS INCLUDED

• Attachment disorders

  • Occur in childhood, often due to inadequate or abusive caregiving

• Adjustment disorders

  • Marked by persistent anxiety or depression following a stressful life event

• Posttraumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD)

  • Develop after trauma exposure

POSTTRAUMATIC STRESS DISORDER (PTSD)

 A severe and long-lasting emotional disorder that develops after exposure to a traumatic event.

• PTSD is the best-known trauma- and stressor-related disorder

• It highlights the long-term psychological impact of trauma across both large-scale events (wars, disasters) and personal tragedies (assault, loss)

• Common Triggers

  • Wars (e.g., Iraq, Afghanistan)

  • Terrorist attacks (e.g., September 11, 2001)

  • Natural disasters (e.g., hurricanes such as Hurricane Sandy, 2012)

  • Physical assault (especially rape)

  • Serious accidents (e.g., car accidents)

  • Sudden death of a loved one

CLINICAL DESCRIPTION OF PTSD (DSM-5)

• Setting Events (Exposure to Trauma):

  • Directly experiencing or witnessing death, serious injury, or sexual violation

  • Learning of trauma happening to a close family member/friend

  • Repeated exposure to trauma details (e.g., first responders handling human remains)

• Core Symptoms:

  • Re-experiencing: intrusive memories, nightmares, flashbacks (reliving the trauma with intense emotion)

  • Avoidance: avoiding reminders of the trauma

  • Emotional Numbing: restricted emotional responsiveness, detachment, memory gaps about the event

  • Hyperarousal: chronic overarousal, being easily startled, irritability, quick to anger

• Reckless/Self-Destructive Behavior: added in DSM-5 under arousal/reactivity criteria.

DISSOCIATIVE SUBTYPE (DSM-5 ADDITION)

• Some people with PTSD don’t mainly show the usual hyperarousal (easily startled, always on edge) or constant re-experiencing (flashbacks, nightmares)

• Instead, they experience dissociation — feeling detached from reality, like the world isn’t real (derealization) or like they are outside of themselves (depersonalization)

• They also tend to have lower emotional arousal compared to typical PTSD cases

This matters because people with the dissociative subtype may need different treatment approaches, since standard trauma therapies (which rely on emotional processing) may not work the same way

DIAGNOSIS

PTSD cannot be diagnosed until a month after the trauma

ACUTE STRESS DISORDER

• Introduced in DSM-IV

• Similar to PTSD but occurs within the first month after trauma

  • About 50% of people with ASD later develop PTSD

  • However, 52% of those who developed PTSD never had ASD in the first month

  • Early severe reactions are not reliable predictors of PTSD

• Highlights severe immediate reactions to trauma

Psychological Interventions

Goal is to face trauma, process emotions, and develop coping strategies

Psychoanalytic therapy

• Catharsis: reliving trauma to relieve suffering

• Re-exposure must be therapeutic, not retraumatizing

Imaginal and Prolonged Exposure Therapy

• Patient develops a narrative of the trauma

• Systematic, repeated exposure to trauma memories/images

• Timing with sleep may enhance extinction learning

Cognitive Therapy

• Corrects negative assumptions, self-blame, and guilt

Handling repressed memories

• Memories may resurface dramatically during therapy

• Early structured interventions can prevent PTSD

Family or partner involvement

Improves PTSD symptoms and relationship satisfaction

Behavioral Interventions for Children

• radual exposure from least to most anxiety-provoking tasks

• Techniques:

  • Observing siblings first

  • Drawing or photographing experiences

  • Positive reinforcement after completion

• Focus on altering perceptions of traumatic experiences

Pharmacological Interventions

• SSRIs: effective for anxiety and panic, helpful in PTSD.

• d-cycloserine (DCS) augmentation of CBT

  • Enhances extinction learning

  • Mainly beneficial for severe cases or slow responders

  • Poor exposure can worsen outcomes → narrow therapeutic window

Early Structured Interventions

• elivered soon after trauma to prevent PTSD

• More effective than single debriefing sessions

Adjustment Disorders

• Mild anxious or depressive reactions to life stress

• Impair functioning but do not meet PTSD criteria

• Chronic if symptoms persist >6 months after stressor removal

Attachment Disorders

• Reactive Attachment Disorder (Inhibited Type):

• Emotionally withdrawn; seldom seeks caregiver comfort.

• Limited positive affect; heightened fear or sadness.

• Disinhibited Social Engagement Disorder:

  • Inappropriately approaches unfamiliar adults

  • Lack of normal social boundaries due to early neglect/abuse

• Both result from inadequate or abusive caregiving