Trauma, PTSD and stressor-related disorders

 According to all Mental Health Diagnostic Manuals, psychological trauma and post-traumatic stress disorders are classified as anxiety reaction that can develop in response to severe physical, mental or emotional distress. Psychological trauma is an emotional response to severe distressing events, with short-term reactions of psychological shock and psychological denial and long-term reactions such as flashbacks, panic attacks, insomnia, nightmares, difficulties with interpersonal relationships and developing post-traumatic stress disorder (PTSD).

In a lifetime, every person experiences at least one psychological trauma. The consequences may vary from "unpleasant disturbance" to a significant reduction of the quality of life (ICD10).

Sometimes, the trauma is an isolated, one-off event or could also be prolonged - over a short or long period.

Some traumas are unexpected, others are expected, anticipated, and dreaded.

There is no specific description of what kind of situations or experiences can cause trauma or PTSD. What can cause psychological trauma in one individual may not be affecting another in the same way.

Not everyone exposed to distressing events develops trauma or post-traumatic stress disorder. The development of the condition depends on the nature of the trauma, demographics, prior -traumatic experience, sequele of the trauma, aftermath support, mental health, physical health, and other individual, social, physiological, and neurological factors.

The experience of trauma also varies in terms of intensity and presenting symptoms.

Adults, teenagers, and children can be affected equally.

Some people are exposed to traumas due to their profession, like military or emergency service personnel.

Mental health professionals use as references for classifying, diagnosing, or/and identifying symptoms associated with traumas, either the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) or the International Classification of deceases, Tenth Edition (ICD-10).

According to ICD 10, psychological trauma is defined as "an extremely threatening or horrific event or series of events".

According to the DSM-V, trauma and stress-related disorders are " exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: directly experiencing the traumatic event(s); witnessing in person, (the event(s) as they occurred to others; learned that the traumatic event(s) occurred to a close family member or close friend".

Mental health diagnostic manuals differentiate traumatic experience as trauma, acute stress disorder (ASD), post-traumatic stress disorder (PTSD), complex post-traumatic stress disorder (CPTSD), etc.

Sometimes, the symptoms associated with psychological trauma may reside naturally. Still, often, if untreated, the symptoms man worsen with time and manifest as panic, specific phobia, social phobia, GAD, etc. OCD, body dysmorphic disorder, hoarding, hair pulling, skin picking etc., PTSD, ASD, reactive attachment, depersonalization, etc.

  Some of the most common reactions to trauma are:

• Re-experiencing - very vivid memories of the traumatic event that the sufferer can re-experience in any sense (s) - sight, sound, smell, taste, touch.

• Flashbacks – unwanted memories of the event(s) that can feel as though the event is happening at present.

• Nightmares – bad dreams or unwanted memories during the night.

• Present physical reactions in the body that are the same or similar to what they were felt at the time of the traumatic experience.

• Increased arousal ('hyperarousal) -fear and anxiety lasting for a long time after the trauma is over, anxiety that occurs out of the blue, being jumpy, jittery, and hard to concentrate.

• Avoidance of people, places, or situations that remind of the trauma, including avoidance of having specific thoughts, sensations or feelings associated with the trauma.

• Changes in beliefs about self, others, the world and the future.

• Strong emotions - irritability, anger, guilt, grief, depression, numbness, etc.

  What is Acute Stress Disorder (ASD)?

Acute stress disorder is a mental health problem that can occur in the first month after a traumatic event. The symptoms are similar to those of post-traumatic stress disorder. If the symptoms of ASD persist up to one month after the trauma, the condition is classified as Acute Stress Disorder. If the symptoms persist for more than one month after the traumatic event, then the condition is classified as Post-traumatic Stress Disorder.

  What is post-traumatic stress disorder (PTSD)?

Post-traumatic stress disorder is characterized by a cluster of symptoms commonly named THE BIG FOUR. They are reliving, hyperarousal, hypervigilance and negative thoughts and mood.

• Reliving manifests as flashbacks (memories, images, sensations)

• Hyperarousal manifests as irritability, startled response and sleeping/relaxing problems

• Hypervigilance - constant vigilance for traumatic reminders like  the trauma site or reminders of similar situations, including conversations, TV triggers, and others

• Negative thoughts and mood – ruminations, difficulties remembering elements of the traumatic situation, blame, detachment, etc.

What causes PTSD?

The leading cause of PTSD and Complex PTSD is being exposed to traumatic, life-threatening, or frightening events. Not everybody who experiences trauma develops PTSD.

What keeps PTSD going?

• Unprocessed memories- involuntary and unwelcomed memories of the trauma, which are vivid, emotionally powerful and provoke feelings as the trauma is happening right now in the present. The unprocessed memories are intrusive and detailed. They might be re-experienced in any of the senses: sight, sound, touch, smell, taste. Those memories are often fragmented (parts of the trauma cannot be retrieved from the memory).

• Beliefs about trauma and its consequences that make the individual feel that the danger is still present. Psychologists believe that one of the most essential focuses of trauma therapy is working with the meaning that the individual made of the trauma.

• Current Coping strategies - avoiding situations that trigger unwanted memories, emotions and sensations.

How is PTSD assessed?

Primary care PC-PTSD Screen ( PC-PTSD), self-administrated PTSD checklist (PCL), interview – Clinician Administrated PTSD scale (CAPS).

Treatments for trauma, PTSD and stress-related disorders

With time, most people recover from their experiences without professional help. However, for a significant proportion of people, the effects of trauma last longer and worsen as symptoms and speed in different domains of their lives. Subsequently, they may develop PTSD.

  Psychological treatments

Psychological treatments which have strong research support include:

• Cognitive Behavioural Therapy (CBT) / Trauma-focused CBT

• Eye Movement Desensitization and Reprocessing (EMDR)

• Cognitive Processing Therapy (CPT)

• Prolonged Exposure (PE)

• Narrative Exposure Therapy (NET)

Although these therapies differ slightly, they all contain exposure to traumatic memories, work on interpretations and meanings and reduction of avoidance behaviour.

Medical treatments for trauma and PTSD

The UK National Institute of Health and Care Excellence (NICE) Guidelines have found evidence that a class of medications are effective in the treatment of PTSD. However, these medications are less effective than psychological treatments, and should not be offered as a first-line treatment.

References:

American Psychiatric Association. (2022). Bipolar and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.) https://doi.org/10.1176/appi.books.9780890425787.x07_Trauma_and_Stressor_Related_Disorders

Behavioural and Cognitive Psychotherapy, 30(1), 37–56. [10] National Institute for Health and Care Excellence (2018). Post-traumatic stress disorder. Retrieved from: https://www.nice.org.uk/guidance/ng116/resources/posttraumatic-stress-disorder-pdf-66141601777861

Ehlers, A., & Clark, D. M. (2000). A post-traumatic stress disorder cognitive model. Behaviour Research and Therapy, 38(4), 319–345.

Grey, N., Young, K., & Holmes, E. (2002). Cognitive restructuring within reliving: A treatment for peritraumatic emotional "hotspots" in post-traumatic stress disorder.

International Classification of Diseases, Eleventh Revision (ICD-11), World Health Organization (WHO) 2019/2021 https://icd.who.int/browse11. Licensed under Creative Commons Attribution-NoDerivatives 3.0 IGO licence (CC BY-ND 3.0 IGO).

Matthew J. Friedman; National Center for PTSD Giesel School of Medicine at Dartmouth" Trauma and Stress-related Disorders in DSM-5. International Society for Traumatic Stress Disorder at https;//istss.org, media>slides.

National Institute for Health and Care Excellence(NICE), Post-traumatic stress disorder,NICE guideline [NG116]Published: 05 December 2018. Retrieved from https://www.nice.org.uk/guidance/ng116

 Post-Traumatic Stress Disorder (PTSD) Self-Help | Psychology Tools. https://www.psychologytools.com/self-help/post-traumatic-stress-disorder-ptsd/

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URL: https://www.psychologytools.com/resource/understanding-post-traumaticstress-disorder-ptsd Resource format: Guide