Trauma- and Stressor-Related Disorders Overview

Trauma-Related Disorders

Disorders arising from traumatic or stressful events.

DSM-5

Diagnostic manual classifying mental disorders.

Post-Traumatic Stress Disorder (PTSD)

Disorder following exposure to traumatic events.

Acute Stress Disorder (ASD)

Symptoms occur within 3 days to 1 month post-trauma.

Adjustment Disorders

Emotional or behavioral symptoms in response to stressors.

Stressful Life Events

Common events impacting functioning but not trauma.

Traumatic Events

Events overwhelming physiological and psychological systems.

Does experiencing trauma always lead to PTSD?

No, many individuals experience normative responses that do not progress into PTSD.

What are common emotional responses to trauma?

Anxiety, fear, anger, numbness, denial, and survivor's guilt.

What are examples of cognitive symptoms after trauma?

Forgetfulness, difficulty thinking, scattered thoughts.

What physiological symptoms may occur after a traumatic event?

Dizziness, tingling, hyperventilation, nightmares, insomnia, shaking.

Why is it important to understand normative reactions to trauma?

To avoid unnecessary pathologization of normal stress responses.

What differentiates Acute Stress Disorder (ASD) from PTSD?

The duration of symptoms: ASD lasts between 3 days to 1 month, while PTSD lasts more than 1 month.

What characterizes a normative reaction to trauma?

It is short-lived, does not cause significant impairment, and allows time for natural recovery.

What are signs of extended reactions to trauma?

Persistent avoidance, extended physiological symptoms (hypervigilance, insomnia), and prolonged emotional distress.

At what point does trauma become a disorder?

When symptoms persist long-term and significantly impair daily functioning.

What are peritraumatic (Acute) symptoms?

The physiological, cognitive, emotional, and behavioral reactions that occur during and immediately after a traumatic event.

How long do peritraumatic symptoms typically last?

Minutes to hours.

What is the recommended management for peritraumatic symptoms?

Social support, processing emotions naturally, and avoiding suppression of feelings.

How long do Acute Stress Disorder (ASD) symptoms last?

Between 3 days and 1 month.

What are the five major categories of ASD symptoms?

Intrusion, negative mood, dissociation, avoidance, and arousal symptoms.

What percentage of ASD cases develop into PTSD?

43% within 3 months, 42% within 12 months.

Why does the classification of ASD is sometimes debated?

The classification of ASD is sometimes debated, as the 1-month cutoff is somewhat arbitrary.

How is PTSD diagnosed?

If trauma-related symptoms persist beyond 1 month.

What functional impairments must be present for a PTSD diagnosis?

Significant distress or impairment in social, occupational, or other important areas of functioning.

What is the primary criterion (Criterion A) for diagnosing PTSD?

Exposure to actual or threatened death, serious injury, or sexual violence.

This can occur through direct experience, witnessing, learning of a traumatic event affecting a close person, or repeated exposure to trauma details (e.g., first responders).

What are the four main symptom clusters of PTSD?

Intrusive symptoms, avoidance, negative alterations in cognition/mood, hyperarousal.

What are common intrusive symptoms in PTSD?

Re-experiencing trauma through flashbacks, nightmares, intrusive memories, intense distress when reminded of trauma, physiological reactions to trauma cues.

How do flashbacks differ from regular memories?

They feel as if the traumatic event is happening again, often leading to a loss of awareness of the present moment.

What are typical avoidance symptoms in PTSD?

Avoidance of trauma-related thoughts, emotions, places, people, activities, or situations that trigger memories of the event.

Why is avoidance problematic in PTSD?

It prevents trauma processing, reinforces fear, and maintains PTSD symptoms.

What are common cognitive and mood-related changes in PTSD?

Memory loss about the trauma, persistent negative beliefs ("I am broken"), self-blame, guilt, emotional numbing, social withdrawal.

What are some examples of negative beliefs in PTSD?

"The world is completely dangerous," "I will never recover," "It was my fault."

How does PTSD affect social relationships?

People with PTSD often feel disconnected from others, avoid social interactions, and struggle to maintain relationships.

What are common hyperarousal symptoms in PTSD?

Sleep disturbances, irritability, hypervigilance, exaggerated startle response, difficulty concentrating, reckless behavior.

How does hypervigilance manifest in PTSD?

Constantly scanning for threats, feeling unsafe even in secure environments.

What is an exaggerated startle response?

A heightened reaction to unexpected sounds, movements, or stimuli (e.g., jumping when hearing a loud noise).

Why do people with PTSD experience reckless or self-destructive behavior?

They may engage in dangerous activities (e.g., substance abuse, reckless driving) as a way to cope with distress.

What is a key feature of hyperarousal in PTSD?

Increased startle response, irritability, sleep disturbances, hypervigilance.

What are dissociative symptoms in PTSD?

Depersonalization (feeling detached from oneself) and Derealization (feeling like the world is unreal).

Why do dissociative symptoms develop in PTSD?

They act as a defense mechanism to emotionally distance oneself from the trauma.

What factors influence natural PTSD recovery?

Strong social support, healthy coping mechanisms, and access to a safe and stable environment.

What does "PTSD with delayed expression" mean?

PTSD where symptoms appear 6 months or more after the traumatic event rather than immediately.

What percentage of people with PTSD remain symptomatic after 3 years?

33% of individuals with PTSD continue to experience symptoms beyond 3 years.

Why does PTSD become harder to treat after 3 years?

It becomes chronic, deeply ingrained in brain function and behavior, requiring intensive intervention.

What conditions must be ruled out before diagnosing PTSD?

Substance-induced symptoms, head trauma, generalized anxiety disorder, major depressive disorder, dissociative disorders, malingering.

Which gender has a higher prevalence of PTSD?

Women, due to higher exposure to interpersonal trauma (e.g., sexual and physical abuse).

Intimate partner sexual violence has one of the highest PTSD risks (42.7% of person-years).

How does PTSD differ from generalized anxiety disorder (GAD)?

GAD involves chronic, excessive worry about everyday life, while PTSD is trauma-specific with flashbacks, avoidance, and hyperarousal.

How does PTSD differ from Major Depressive Disorder (MDD)?

MDD lacks trauma-related re-experiencing symptoms like flashbacks and hyperarousal.

What is malingering in PTSD diagnosis?

When someone fakes PTSD symptoms for personal gain, such as financial compensation or legal benefits.

How is C-PTSD different from PTSD?

involves prolonged trauma, severe emotional dysregulation, negative self-perception, and interpersonal difficulties.

What are the three main symptom categories in C-PTSD that overlap with PTSD?

Intrusion symptoms, avoidance, and hyperarousal.

What types of trauma typically cause C-PTSD?

Prolonged and repetitive trauma such as childhood abuse, captivity, or domestic violence.

Greater functional impairment and psychological distress than standard PTSD.

What is a key diagnostic difference between PTSD and C-PTSD?

C-PTSD includes additional features such as extreme emotional dysregulation, persistent negative self-perception, and chronic interpersonal difficulties.

What are additional symptoms in C-PTSD not found in PTSD?

Affective Dysregulation (Severe Emotional Instability), Negative Self-Perception, Interpersonal Difficulties and Social Dysfunction

What is affective dysregulation in C-PTSD?

Extreme difficulty regulating emotions, often leading to sudden emotional outbursts or emotional shutdown.

How does emotional dysregulation in C-PTSD differ from PTSD?

In C-PTSD, emotional instability is more severe, persistent, and often includes extreme mood swings.

What are examples of self-destructive behaviors in C-PTSD?

Self-harm, suicidal thoughts, reckless behaviors, and emotional dissociation.

How do individuals with C-PTSD perceive themselves differently from those with PTSD?

They often experience deep feelings of worthlessness, shame, and guilt.

What are some common negative self-beliefs in C-PTSD?

"I am broken," "I am unlovable," "I will never be okay."

How does self-blame manifest in C-PTSD?

Individuals may hold themselves responsible for the trauma, even when it was beyond their control.

Why do individuals with C-PTSD struggle with relationships?

They may experience extreme mistrust, avoidance of social interactions, and difficulty maintaining relationships.

What is a common fear among individuals with C-PTSD?

Fear of abandonment, leading to either clinginess or withdrawal from relationships.

How does chronic loneliness affect individuals with C-PTSD?

It reinforces their negative self-perception and sense of unworthiness.

What are common relationship patterns seen in individuals with C-PTSD?

They may engage in unstable relationships, avoid intimacy, or struggle with feelings of detachment and alienation.

Why is C-PTSD not officially in the DSM-5?

It is recognized in the ICD-11 but not yet included as a separate diagnosis in the DSM-5.

What is an adjustment disorder?

A condition where a person experiences distress that is disproportionate to a stressor and affects daily functioning.

How soon do symptoms of adjustment disorders appear after a stressor?

Within three months of the stressor.

How long do symptoms of an adjustment disorder typically last?

Symptoms resolve within six months after the stressor is removed or adapted to.

What types of life stressors can lead to adjustment disorders?

Job loss, divorce, financial struggles, relocation, illness, or interpersonal conflicts.

What peritraumatic factors increase PTSD risk?

Long duration of trauma exposure and perceived life threat.

How does adjustment disorder differ from PTSD?

Adjustment disorder is triggered by any life stressor, while PTSD results from a traumatic event.

What is Prolonged Grief Disorder (PGD)?

A condition where intense grief symptoms persist for over a year after the death of a loved one, causing significant impairment.

It was officially added in DSM-5-TR.

What are key symptoms of PGD?

Intense yearning or longing for the deceased, preoccupation with the deceased, and dysfunction in daily life.

How does PGD differ from normal grief?

PGD is more persistent, intense, and disruptive, lasting over a year and interfering with daily activities.

Why is PGD considered a distinct mental health disorder?

Because its symptoms go beyond typical bereavement, leading to prolonged impairment in functioning.

What are common risk factors for developing PGD?

Sudden or traumatic loss, losing a child, lack of social support, and pre-existing mental health conditions.

Which disorder has a specified duration threshold for diagnosis?

PGD (grief lasting over a year)

adjustment disorder resolves within six months.

How can clinicians differentiate between PGD and Major Depressive Disorder (MDD)?

PGD is centered on loss and longing for the deceased, while MDD involves a broader sense of sadness, worthlessness, and loss of interest in activities.

Why is adjustment disorder sometimes controversial?

Some argue the definition is too broad and may overlap with other disorders, particularly somatic symptom disorders in medical patients.

How does social support affect PTSD risk?

Strong social support reduces risk; lack of support worsens symptoms.

Why do avoidance coping strategies increase PTSD risk?

They prevent trauma processing, leading to prolonged distress.

Amygdala

Brain region involved in threat response.

Which brain regions are involved in PTSD?

Amygdala (fear response), Prefrontal Cortex (emotional regulation), Hippocampus (memory processing).

Prefrontal Cortex

Regulates fear responses and decision making.

Hippocampus

Involved in memory and contextualizing trauma.

HPA Axis Dysfunction

Dysregulation affecting stress hormone levels.

How does PTSD affect the amygdala?

It becomes hyperactive, causing excessive fear responses.

What happens to the hippocampus in PTSD?

It may shrink, leading to memory fragmentation and difficulty distinguishing past from present.

How does PTSD affect the the hippocampus?

Gray matter reductions in left one

What is the first-line treatment for PTSD?

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).

Helps patients process trauma and develop coping strategies.

What are other evidence-based psychotherapies for PTSD?

Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), and Eye Movement Desensitization and Reprocessing (EMDR).

Cognitive Processing Therapy (CPT)

Restructures negative beliefs related to trauma.

Focus on Challenging maladaptive trauma-related beliefs, Reducing self-blame and negative self-appraisals and Encouraging meaning-making and life engagement.

Prolonged Exposure Therapy (PE)

Uses gradual exposure to trauma-related memories and environments to reduce avoidance and distress.

Desensitization.

When is PE contraindicated for PTSD?

Contraindicated with extreme avoidance/dissociation, suicide risk, acute grief.

Why are these psychotherapies strongly recommended?

They have strong evidence supporting their effectiveness in treating PTSD.

What is the common goal of CBT, CPT, CT, and PE in PTSD treatment?

To help individuals process trauma, reduce avoidance behaviors, and develop coping strategies.

Which psychotherapies are conditionally recommended for PTSD treatment?

Brief Eclectic Psychotherapy (BEP), Eye Movement Desensitization and Reprocessing Therapy (EMDR), and Narrative Exposure Therapy (NET).

What is the goal of Eye Movement Desensitization and Reprocessing (EMDR)?

Uses eye movements to process traumatic memories.

To help process trauma through guided eye movements.

What does it mean when a therapy is "conditionally recommended" for PTSD?

It has some evidence of effectiveness but is not as well-supported as strongly recommended therapies.