What Are Trauma And Stressor Related Disorders

Introduction

Trauma and stressor-related disorders are the effects of a traumatic event. Symptoms include irritability, dysphoria, dissociation, substance misuse, and insomnia. These features often vary in severity and duration.¹

The effects of traumatic events often place a heavy burden on people who are suffering and their families. Many individuals who often experience traumatic events will continue with their lives without long-term negative effects. However, some individuals will have great difficulty and will experience traumatic stress reactions.²

Research has suggested that traumatic experiences have been found to be associated with behavioural health and chronic physical health conditions, especially when the traumatic event occurs during an individual’s adolescence.²

Types of trauma and stressor-related disorders

Post-Traumatic Stress Disorder (PTSD) is an effect of very stressful, distressing, or frightening events that could occur in an individual’s life. PTSD was officially defined in 1980 by APA of the 3^rd edition of the diagnostic classification DSM-III. However, the criteria changed over time. According to the DSM-5 in order to be able to fulfil the criteria for a diagnosis of PTSD, the individual should have witnessed or experienced a traumatic event that involves actual or threatened death, sexual violence, or serious injury. Although, according to the ICD-11, for an individual to be diagnosed with PTSD, the individual must encounter something that is ‘extremely threatening or horrific’.³

Symptoms of PTSD:

According to the DSM-5, the symptoms include:

• Intrusions
• Changes in cognition and mood
• Reactivity and arousal
• Avoidance³

For this to be accurately diagnosed, the symptoms should persist for more than 1 month. The individual must clinically show significant levels of distress or impairment to functions and this can only be diagnosed due to a specific event and not psychological effects of substance misuse or a medical condition.³

However, according to the ICD-11, the symptoms include,

• Avoidance
• Persistent perceptions of intensified current threats
• Re-experiencing³

For this to be diagnosed, these symptoms should last for several weeks, and the individual must show significant impairment in personal, social, family, and other important areas of functioning life.

Despite PTSD being very difficult for an individual to come to terms with, it is always important to seek help in confronting feelings and getting the correct treatment.⁴

Treatment options:

It has been found that it is possible to treat PTSD after many years of the traumatic event, which shows that it is never too late to get the help and support to overcome this. Before getting treatment, a detailed assessment will be carried out to ensure that the treatment is tailored to the individual and their needs. This would be carried out by a psychologist, psychological therapist, community psychiatric nurse, or psychiatrist.⁴

Some treatments would include:

• Active monitoring: This treatment is provided to a person if their symptoms are mild, and it allows them to see if the symptoms improve or become worse.⁴
• Talking therapies: This form of treatment is often the first recommended treatment for an individual. A GP will refer you for talking therapy or this could be done through self-referral.⁴   
• CBT: Trauma-based CBT: This consists of a therapist supporting the individual to cope with their beliefs and allowing the individual to gain control of the fears and distress.⁴
• Medication: Often, with PTSD, there are two recommended medications in adults, which are sertraline or paroxetine. These are selective serotonin reuptake inhibitors (SSRIs).⁴

Acute stress disorder (ASD)

Acute Stress Disorder (ASD) occurs within the first month after an individual has experienced a traumatic event. It is often found that individuals with ASD are likely to develop PTSD. Research has found that around 80% of individuals who suffer from ASD have developed PTSD after 6 months. However, not everybody who has ASD will develop PTSD.⁵

The symptoms of ASD often include stress responses like:

• Anxiety
• Experience flashbacks or nightmares
• Numbness or detachment.
• Avoidance
• Intense feelings of hopelessness or fear.⁵

Treatments:

There is no specific test to diagnose ASD. A healthcare professional would be able to make a diagnosis after conducting a psychosocial assessment. They will ask and discuss the individual’s history and current symptoms. This will be used through the DSM-5. Once this can be diagnosed, treatment options will be available. These could include:

• Talking therapies or CBT: These are often the most common treatments for ASD, where the individual would be able to challenge negative thoughts and identify problematic thinking while learning about the body's response to trauma and stress.
• Medication: Although there is not much evidence to show that medication is used to treat ASD, some medications lessen symptoms. These would include selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs).⁵ 

Other trauma and stressor-related disorders

Reactive attachment disorder (RAD)

Reactive attachment disorder (RAD) is a condition where a child does not form a healthy attachment or a healthy emotional bond with their caregivers. This is often where the child is neglected emotionally or abused at a young age. Children who suffer from RAD often have trouble managing their emotions and struggle to form meaningful relationships with other people.⁶

According to the DSM-5, children often show a decreased ability to experience positive emotions, are unable to seek and accept emotional or physical closeness, and often react violently when held, touched, or cuddled. Children who suffer from RAD can be unpredictable, difficult to console, and hard to discipline.⁶

Symptoms of RAD in children:⁷

• Not responding to other people with a range of emotions.
• Not being able to express emotions.
• Not making eye contact.
• Avoidance of physical touch.
• Often throw tantrums and appear more irritable.
• Unhappy and sad.

When children grow older, their RAD could take on two patterns. This would be inhibited or disinhibited.

Inhibited RAD symptoms:

• Detachment
• Unresponsive to comfort
• Withdrawal
• Keeping to themselves

Disinhibited RAD symptoms:

• No preference for a caregiver
• Indiscriminate sociability
• Tendency to act younger than their age for attention and affection⁷

Treatment:

When treating a child who has RAD, there are two significant goals one of which is to ensure that the child is within a safe environment. This is very important as the child has been neglected or abused. The second goal is to ensure that there is support for the child to develop healthy relationships and attachments to an appropriate caregiver.⁷

The main form of treatment for children who have RAD is counselling. This allows the caregiver and child to address the issues and behaviour towards the child. It is also important as it allows the teaching of parenting skills that support the improvement of the relationship and the development of an attachment. This form of treatment also allows the child to express their fears and needs in a safe environment.⁶

There is no medication to treat RAD. However, some medical professionals can use some medications to manage behavioural symptoms such as sleeping problems.⁷

If reactive attachment disorder is not treated, it can harm the child’s emotional, physical, social, moral, and behavioural development. With treatments, children can learn to trust others and to live a healthy lif.⁶

Support systems and resources

Many charities can provide support and advice for trauma and stressor-related disorders. Here are a few:

• Combat stress- Military charity for ex-women and men who served.
• Rape Crisis- a UK charity for women and girls who have experienced abuse, domestic violence, and sexual violence.
• Young minds- for young children and youths.

Conclusion

Trauma and stressor-related disorders are developed through traumatic events. The symptoms often include irritability, dysphoria, dissociation, substance misuse, and insomnia. These symptoms often vary in severity and duration. There are many types of trauma and stressor-related disorders. This includes PTSD, ASD, and RAD. It is important to seek support when needed. Knowing this, many treatment options are available to support the individual who is suffering from any of these disorders. These treatments include talking therapies, CBT, and medication.

It is always important to go to a healthcare professional to seek support and get the correct diagnosis and support.