Trauma and Stressor-Related Disorders

These flashcards cover key terms and concepts related to trauma and stressor-related disorders, focusing on definitions and essential characteristics of various disorders.

Reactive Attachment Disorder (RAD)

A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers.

Disinhibited Social Engagement Disorder (DSED)

A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults.

Posttraumatic Stress Disorder (PTSD)

A disorder triggered by exposure to a traumatic or stressful event characterized by symptoms including re-experiencing the trauma.

Acute Stress Disorder (ASD)

A temporary condition that occurs in response to a traumatic event, similar to PTSD but lasting from 3 days to 1 month.

Adjustment Disorders

A group of symptoms, such as stress, feeling sad, or hopeless that occur after a stressful life event.

Prolonged Grief Disorder

A condition characterized by intense yearning for the deceased and significant impairment in daily functioning for at least 12 months.

Anhedonia

A decreased ability to experience pleasure or interest in activities that once were enjoyable.

Dissociation

A defense mechanism that involves a disconnection from thoughts, identity, consciousness, and memory.

Hypervigilance

An enhanced state of sensory sensitivity and an exaggerated awareness of the surroundings.

Social neglect

The failure to meet a child’s emotional needs, often leading to attachment disorders.

Emotional availability

The responsiveness of caregivers in meeting the emotional needs of a child, crucial for healthy attachment.

Intrusive memories

Recurrent, involuntary distressing memories of a traumatic event.

Negative alterations in mood

Changes in feelings and cognitions after trauma, such as persistent negative beliefs about oneself or others.

Irritable behavior

Angry outbursts with little or no provocation, often seen in trauma-response conditions.

What is the prevalence of Reactive Attachment Disorder (RAD)?

RAD is rare, even among severely neglected children. It is estimated to affect less than 1% of children in the general population, but rates can be higher in populations with a history of severe neglect.

What is the etiology (causes) of Reactive Attachment Disorder (RAD)?

RAD results from severe social neglect, often characterized by:

1. Persistent disregard of the child's basic emotional needs: Lack of comfort, stimulation, and affection from caregivers.

2. Repeated changes of primary caregivers: Prevents the formation of stable attachments (e.g., frequent changes in foster care).

3. Rearing in unusual settings: Environments that severely limit opportunities for forming selective attachments with caregivers (e.g., institutions with high child-to-caregiver ratios).

What is the development and course of Reactive Attachment Disorder (RAD)?

Symptoms of RAD typically manifest before the age of 5, but the child must have a developmental age of at least 9 months to make the diagnosis. Without intervention, attachment difficulties can persist, though the specific presentation may change as the child develops. RAD is not diagnosed after age 5. The primary condition for diagnosis is a history of significant neglect.

What is the treatment for Reactive Attachment Disorder (RAD)?

Treatment for RAD focuses on:

1. Providing a stable, nurturing, and consistent caregiving environment: Often involves placing the child in a safe foster or adoptive home.

2. Caregiver education and support: Teaching caregivers how to respond sensitively to the child's emotional needs and how to promote healthy attachment.

3. Child-parent psychotherapy: Therapy focused on improving the child's attachment to the caregiver and repairing the effects of past neglect.

4. Addressing co-occurring conditions: Treating any other mental health issues that may be present.

What is the prevalence of Disinhibited Social Engagement Disorder (DSED)?

DSED is rare, affecting a small percentage of children, even among those who have experienced severe neglect. Its prevalence is higher in populations of children who have been institutionalized or experienced severe social neglect early in life.

What is the etiology (causes) of Disinhibited Social Engagement Disorder (DSED)?

DSED is caused by a history of severe social neglect or insufficient care, characterized by:

1. Persistent disregard of the child's basic emotional needs: Lack of comfort, stimulation, and affection from caregivers.

2. Repeated changes of primary caregivers: Prevents the formation of stable attachments.

3. Rearing in unusual settings: Environments that severely limit opportunities for forming selective attachments with caregivers (e.g., institutions with high child-to-caregiver ratios).

What is the development and course of Disinhibited Social Engagement Disorder (DSED)?

Symptoms of DSED typically manifest before the age of 5, but the child must have a developmental age of at least 9 months for diagnosis. The disorder may persist into middle childhood and adolescence, even after the child is placed in a supportive environment. The overly familiar behaviors may become less pronounced with age, but difficulties with peer relationships and attention problems can continue. A history of severe neglect is a prerequisite for diagnosis.

What is the prevalence of Posttraumatic Stress Disorder (PTSD)?

The lifetime prevalence of PTSD among adults in the general population is estimated to be around 6-9%. However, prevalence rates can vary significantly based on exposure to trauma (e.g., military combat veterans, survivors of sexual assault, or natural disasters) and demographic factors like gender, with women being more likely to develop PTSD than men.

What is the etiology (causes) of Posttraumatic Stress Disorder (PTSD)?

PTSD is caused by exposure to a traumatic event, which can include direct experience, witnessing an event, learning about an event that happened to a close family member or friend, or repeated or extreme indirect exposure to aversive details of traumatic events.

Factors that increase risk include:

1. Pre-traumatic factors: Prior trauma, existing mental health disorders, lower socioeconomic status, and childhood adversity.

2. Peri-traumatic factors: Severity, duration, and personal injury during the trauma; feeling helpless or terrified.

3. Post-traumatic factors: Lack of social support, subsequent stressful life events, and maladaptive coping strategies.

What is the development and course of Posttraumatic Stress Disorder (PTSD)?

PTSD can develop at any age, after any traumatic event. Symptoms typically begin within 3 months of the trauma, but there can be a delayed onset, occurring months or even years later. The course of PTSD is variable; about half of adults recover completely within 3 months, but for others, symptoms can persist for many years. Chronic PTSD can lead to significant impairment in social, occupational, and physical functioning. Factors influencing chronic course include severity and duration of trauma, pre-existing mental health conditions, and ongoing stressors.

What is the treatment for Posttraumatic Stress Disorder (PTSD)?

Treatment for PTSD typically involves psychotherapy and/or pharmacotherapy.

1. Psychotherapy:

   • Trauma-focused cognitive behavioral therapy (TF-CBT): Includes exposure therapy (e.g., prolonged exposure) and cognitive restructuring.

   • Eye Movement Desensitization and Reprocessing (EMDR): Aims to help process traumatic memories.

2. Pharmacotherapy:

   • SSRIs (Selective Serotonin Reuptake Inhibitors): Often considered first-line pharmacological treatment (e.g., sertraline, paroxetine).

   • Other medications may target specific symptoms like insomnia or nightmares.

What is the prevalence of Acute Stress Disorder (ASD)?

The prevalence of ASD varies widely depending on the type of trauma. For experiences such as motor vehicle accidents, physical assault, or industrial accidents, prevalence rates can range from 13-21% among those exposed. For interpersonal traumas, like rape, rates can be significantly higher, reaching 20-50%. Overall, ASD is less common than PTSD, partly due to its shorter diagnostic window.

What is the etiology (causes) of Acute Stress Disorder (ASD)?

ASD is caused by exposure to a traumatic event, which can include direct experience, witnessing an event, learning about an event that happened to a close family member or friend, or repeated or extreme indirect exposure to aversive details of traumatic events.

Factors that increase risk include:

1. Severity of trauma: More severe or prolonged trauma generally increases the risk.

2. Pre-existing psychological vulnerabilities: Prior mental health issues or a history of trauma.

3. Peritraumatic dissociation: Experiencing dissociation (a sense of unreality, detachment) during or immediately after the traumatic event is a strong predictor of ASD.

4. Lack of social support: Insufficient emotional or practical support after the trauma.

What is the development and course of Acute Stress Disorder (ASD)?

ASD symptoms typically emerge immediately after a traumatic event and must last for a minimum of 3 days and a maximum of 1 month. If symptoms persist beyond 1 month, the diagnosis may shift to Posttraumatic Stress Disorder (PTSD). The presence of ASD is a significant predictor of later PTSD. Early intervention during the ASD phase can potentially prevent the development of chronic PTSD. The course can be influenced by factors like the nature of the trauma, individual coping mechanisms, and access to support and treatment after the event.

What is the etiology (causes) of Adjustment Disorders?

are caused by an identifiable psychosocial stressor. These stressors can be single events (e.g., job loss, breakup, natural disaster) or multiple/recurrent events (e.g., ongoing marital problems, chronic illness). The stressor does not have to be severe or traumatic, but for the individual, it leads to significant emotional or behavioral symptoms that are not proportional to the stressor and cause clinically significant distress or impairment.

Factors that increase risk include:

1. Severity and nature of the stressor: More intense or prolonged stressors may heighten risk.

2. Pre-existing vulnerabilities: Personality traits (e.g., neuroticism), prior mental health issues, or inadequate coping skills.

3. Lack of social support: Insufficient support from family or friends can impair adaptation.

4. Socioeconomic factors: Financial difficulties or challenging living conditions.

What is the development and course of Adjustment Disorders?

Symptoms of Adjustment Disorder typically begin within 3 months of the onset of the stressor. By definition, the symptoms do not persist for more than 6 months after the termination of the stressor or its consequences. However, if the stressor is chronic or recurrent, the Adjustment Disorder can also be chronic, lasting longer than 6 months. Adjustment Disorders can occur at any age, and their course is generally positive once the stressor is resolved or the individual develops effective coping strategies. For individuals with chronic stressors, the disorder may persist until the stressor is alleviated.

What is the etiology (causes) of Prolonged Grief Disorder?

Prolonged Grief Disorder is caused by the death of a loved one, but its development is influenced by several factors that hinder the natural grieving process. These factors include:

1. Severity of loss: The sudden, unexpected, or violent nature of the death, or the loss of a child or spouse, can increase risk.

2. Pre-loss factors: Prior mental health conditions (especially depression, anxiety, or previous traumatic experiences), insecure attachment styles, and pre-existing personality traits.

3. Peri-loss factors: High dependency on the deceased, perceived lack of preparedness for the death, or feeling responsible for the death.

4. Post-loss factors: Lack of social support, concurrent life stressors, avoidance of grief-related thoughts or feelings, or persistent negative cognitions about the grief or self.

What is the development and course of Prolonged Grief Disorder?

Prolonged Grief Disorder is diagnosed when intense yearning for the deceased and preoccupation with the loss persist for at least 12 months after the death for adults, or 6 months for children and adolescents, causing significant distress or impairment in functioning. While acute grief is expected and normal, PGD represents a distinct, persistent, and debilitating pattern. If left untreated, the disorder can become chronic, impacting relationships, occupational functioning, and overall quality of life. The course can be influenced by the ongoing nature of the stressor (the absence of the loved one) and the individual's coping mechanisms and support systems.

What is the treatment for Prolonged Grief Disorder?

Treatment for Prolonged Grief Disorder primarily focuses on psychotherapy specifically tailored to address complicated grief. Key approaches include:

1. Complicated Grief Treatment (CGT): A specialized form of psychotherapy that helps individuals adapt to the loss, regulate emotions, and re-engage with life. It often involves psychoeducation, revisiting the loss, imagining the future, and strengthening relationships.

2. Cognitive Behavioral Therapy (CBT): Adapted CBT techniques can help challenge maladaptive thoughts related to the loss and grief.

3. Supportive Psychotherapy: Providing a safe space for expression of grief and validation of feelings.

4. Pharmacotherapy: While no medication is specifically approved for PGD, antidepressants (e.g., SSRIs) may be considered to treat co-occurring depression or anxiety, which can complicate the grief process. However, psychotherapy remains the first-line treatment for PGD itself.

Case Vignette 1: Reactive Attachment Disorder (RAD)

Sarah, a 4-year-old girl, was adopted after spending her first three years in an orphanage with a high child-to-caregiver ratio. Her adoptive parents report that Sarah rarely seeks comfort from them, even when she falls and scrapes her knee, she will quietly cry but pulls away if they try to hold her close. She seldom makes eye contact or smiles spontaneously, and often seems indifferent to their presence, showing minimal emotional responsiveness when they try to engage her in play.

Case Vignette 2: Reactive Attachment Disorder (RAD)

Michael, a 30-month-old boy, was removed from his biological parents due to severe neglect where his basic emotional needs for comfort and affection were consistently unmet. In his new stable foster home, Michael exhibits a guarded and detached demeanor. When his foster mother tries to console him after a loud noise frightens him, he stiffens and avoids her gaze, not allowing himself to be soothed. He frequently displays unexplained bouts of sadness or irritability, even when nothing threatening is present, and has

Case Vignette 1: Disinhibited Social Engagement Disorder (DSED)

Liam, a 5-year-old boy, was recently adopted after spending his early years in an institutional setting with limited individual attention. His new parents are concerned because Liam will readily greet and hug strangers in the park, offer to hold their hands, and even ask to go home with them. He shows no hesitation in walking away from his parents to talk to new people and doesn't check to see if his parents are watching or if they approve of his interactions with unfamiliar adults.

Case Vignette 2: Disinhibited Social Engagement Disorder (DSED)

Chloe, a 3-year-old who was removed from a neglectful home environment, is now in a stable foster home. Despite the consistency, her foster parents observe that when they go to the grocery store, Chloe will often approach unfamiliar adults, sit on their laps in the checkout line without invitation, and accept food or toys from them. She rarely seeks reassurance or permission from her foster parents during these interactions and appears equally comfortable with familiar caregivers and complete strangers.

Case Vignette 1: Posttraumatic Stress Disorder (PTSD)

John, a 45-year-old combat veteran, has been struggling for the past two years since his deployment. He experiences recurrent, vivid nightmares about a roadside bomb explosion that killed several of his fellow soldiers. During the day, sudden loud noises or the smell of diesel fuel can trigger intense flashbacks, making him feel as if he's back in the warzone, leading to panic attacks. He avoids crowded places and refuses to talk about his military service with anyone, feeling detached from his family and losing interest in hobbies he once enjoyed. His wife reports that he is constantly on edge, easily startled, has angry outbursts, and struggles to sleep through the night.

Case Vignette 2: Posttraumatic Stress Disorder (PTSD)

Maria, a 30-year-old teacher, was involved in a severe car accident six months ago where she sustained serious injuries. Since then, she has been plagued by intrusive thoughts and images of the crash. She now takes extensive detours to avoid the intersection where the accident occurred and is terrified of driving, preferring to walk everywhere. Maria often feels numb and disconnected from her friends, constantly blames herself for not avoiding the accident, and has difficulty concentrating at work. Her colleagues have noticed she's become irritable and withdrawn, jumpy around sudden noises, and often complains of insomnia.

Case Vignette 1: Acute Stress Disorder (ASD)

Sarah, a 28-year-old barista, witnessed a violent robbery at her coffee shop two weeks ago. Since the event, she has been plagued by recurrent, vivid memories of the robber's face and the sounds of shouting. She finds herself constantly replaying the scene in her mind, even when she tries to focus on other tasks. She feels detached, as if the world isn't real, and has trouble remembering exactly what she said to the police immediately after the incident. Sarah avoids walking past the coffee shop and has called out sick, saying she feels numb and can't enjoy anything, even her favorite hobbies. She is constantly on edge, easily startled by unexpected noises, and has been having severe difficulty falling asleep, often waking up multiple times throughout the night. Her symptoms began a few days after the robbery and continue to impact her daily life significantly.

Case Vignette 2: Acute Stress Disorder (ASD)

Mark, a 35-year-old construction worker, was involved in a scaffolding collapse at a construction site five days ago, where a colleague was seriously injured. Although Mark was physically unharmed, he has since experienced intense anxiety. He has disturbing dreams about the collapse and often feels like it's happening again (flashbacks), especially when he hears loud metallic noises. Mark actively avoids talking about the incident and has refused to return to the job site. He feels a persistent sense of dread and can't shake the feeling that he should have done something differently. He's irritable with his family, has trouble concentrating on conversations, and his wife reports he's been jumpy and constantly checking his surroundings, as if danger is imminent. He has also lost interest in going to the gym, an

Case Vignette 1: Adjustment Disorder

Maria, a 35-year-old marketing executive, was recently laid off from her job of 10 years due to company downsizing. Within weeks of the job loss, she developed persistent low mood, frequent crying spells, and significant anxiety about her financial future. She finds herself unable to concentrate on job applications, rarely leaves her house, and has pulled away from her friends, stating she feels too overwhelmed and embarrassed to socialize. Her symptoms started within 2 months of losing her job and are causing considerable distress and impairment in her daily life, beyond what might be expected for job loss.

Case Vignette 2: Adjustment Disorder

David, a 20-year-old college student, experienced a difficult breakup with his girlfriend of two years a month ago. Since then, he has been constantly ruminating about the relationship, struggling to sleep, and feeling overwhelmingly anxious. He has stopped attending classes regularly, his grades are plummeting, and he avoids social gatherings, preferring to isolate himself in his dorm room. His friends note that he's unusually irritable and withdrawn. While grieving a breakup is normal, David's level of distress and impaired functioning is significantly impacting his academic performance and social life.

What are the diagnostic features of Prolonged Grief Disorder?

Prolonged Grief Disorder is diagnosed when:

1. A loved one has died at least 12 months ago for adults (or 6 months for children and adolescents).

2. The bereaved individual experiences intense yearning for the deceased and/or preoccupation with the deceased.

3. The grief response is characterized by at least three of the following for a significant portion of days since the death:

   • Identity disruption (e.g., feeling as though part of oneself has died).

   • Marked sense of disbelief regarding the death.

   • Avoidance of reminders that the person is dead (e.g., avoiding places, people).

   • Intense emotional pain (e.g., sadness, sorrow, guilt, anger).

   • Difficulty with reintegration into one’s life (e.g., problems engaging with friends, pursuing interests, planning for the future).

   • Emotional numbness (absence or marked reduction in emotional experience).

   • Feeling that life is meaningless.

   • Intense loneliness.

4. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

5. The duration and severity of the bereavement reaction clearly exceed expected social, cultural, or religious norms for the individual's cultural and developmental context.

6. The symptoms are not better explained by another mental disorder (e.g., major depressive disorder, PTSD) and are not attributable to substance use or another medical condition.

Case Vignette 1: Prolonged Grief Disorder

Sarah, a 40-year-old woman, lost her husband in a car accident 18 months ago. She continues to experience an overwhelming and constant yearning for him, stating she feels a part of herself died with him. Her home remains exactly as he left it, and she spends hours looking at his photos, unable to engage in new activities or interests. She frequently talks to his urn, saying she misses him terribly. Her friends have tried to involve her in social events, but she declines, feeling detached and constantly preoccupied with her loss. She struggles to concentrate at her job, leading to a recent warning from her supervisor, and reports feeling a deep, persistent sadness that interferes with all aspects of her daily life. She believes her life is meaningless without him, and this level of distress is far beyond what would be expected given the time that has passed.

Case Vignette 2: Prolonged Grief Disorder

Robert, 55, lost his beloved sister to a sudden illness 14 months ago. Since then, he has felt a profound sense of disbelief and emptiness about her death, making it difficult for him to accept that she is truly gone. He spends most of his days visiting her grave, meticulously tending to it, and carries a locket with her picture, which he often holds and talks to. He constantly feels a part of him is missing and reports that everyday tasks feel meaningless. He has stopped attending family gatherings, which he once loved, because they remind him too much of her absence. His adult children are worried because he neglected his health and household chores, and his previously vibrant social life has completely dwindled. He expresses intense emotional pain and sorrow that has not diminished, despite the passage of time, significantly impacting his ability to function and adapt