Trauma and Stress-Related Disorders

Trauma and Stress-Related Disorders

• Shared Feature: Exposure to traumatic or stressful events is a diagnostic criterion. Symptoms can include anhedonia, dysphoria, anger/aggression, dissociation, or anxiety.

Reactive Attachment Disorder (RAD)

• Essential Feature: Absent or grossly underdeveloped attachment between the child and caregivers.
• Diagnostic Criteria: Limited early opportunities for attachment lead to a lack of comfort-seeking & nurturance-seeking behavior. Children show diminished or absent positive emotions during caregiver interactions.
• Development: Manifests between 9 months and 5 years, often due to social neglect from infancy.
• Risk Factors: Severe social neglect, but not all severely neglected children develop RAD. Prognosis depends on post-neglect caregiving.
• Differential Diagnosis: Distinguish from autism (similar social behaviors, but no neglect history) or intellectual developmental disorder (social/emotional skills match cognitive abilities).

Post-Traumatic Stress Disorder (PTSD)

• Classification: No longer an anxiety disorder, now categorized under Stress and Trauma-Related Disorders.
• Rates: Vary based on trauma type (e.g., rape higher than car accidents). About 13-20% in US soldiers.
• Essential Feature: Characteristic symptoms developing after exposure to trauma. Symptoms may be fear-based, anhedonic/dysphoric, arousal/reactive, or dissociative (or a combination).
• Etiology: Fear conditioning, information processing, and neurobiological factors.
• Risk Factors:
• Pre-traumatic: Female gender, Hispanic race, younger age, lower education, lower intelligence, negative emotionality, prior family/personal psych history.
• Peri-traumatic: High trauma exposure, dissociation, physiological activation.
• Post-traumatic: Dysfunctional coping (avoidance), low social support, subsequent stressors.
• Resilience: Not everyone exposed to trauma develops PTSD. Factors conducive to recovery.
• Neurobiological: Robust stress response with rapid return to baseline; containing CRF, optimistic dopamine reward system, non-overreactive amygdala, strong cortical executive function.
• Psychosocial: Optimism, humor, social support, active coping, openness, extraversion.
• Cognitive: Reframing problems and finding meaning in stressful situations, leading to threat reduction and self-efficacy.
• Genetics: Moderately heritable, associated with dopaminergic, serotonergic, noradrenergic, and HPA axis systems.
• Epigenetics: External and internal stimuli (social support, fear, stress) can affect gene expression (turning genes on/off).
• Diagnostic Criteria:
• Exposure to trauma.
• Intrusion symptoms.
• Avoidance of trauma-related stimuli.
• Negative alterations in mood/cognitions.
• Marked alterations in arousal/reactivity.
• Duration over 1 month.
• Clinically significant distress/impairment.
• Not due to substance use or medical condition
• Associated Features: Pseudo-hallucinations, paranoid ideation, poor emotion regulation/interpersonal relationships, and/or dissociative symptoms (especially in prolonged trauma). Grief can involve combined PGD and PTSD (violent death).
• Differential Diagnosis:
• Adjustment Disorders (less severe, non-violent trauma.)
• Acute Stress Disorder (symptoms last <1 month).
• Major Depressive Disorder (distress may or may not be preceded by a traumatic event).

Acute Stress Disorder (ASD)

• Essential Feature: Similar to PTSD, symptoms last 3 days to 1 month post-trauma.
• Differential Diagnosis: Adjustment Disorder and PTSD (distinguish by symptom duration).

Adjustment Disorders

• Essential Feature: Emotional/behavioral symptoms within 3 months of a stressor , resolving within 6 months of stressor's end.
• Stressor: Single or multiple, recurring or continuous.
• Consequences: Decreased performance, social relationship changes, co-morbidity in medical conditions.
• Differential Diagnosis: MDD (if stressors trigger sx), PTSD, Bereavement (distress disproportionate/impaired by grief).

Prolonged Grief Disorder (PGD)

• Essential Feature: Maladaptive grief reaction 12+ months post-death of a significant other.
• Symptoms: Intense yearning, sorrow, preoccupation, avoidance of reminders, emotional numbness, difficulty reintegrating.
• Characteristics: Disbelief, guilt, diminished expectations.
• Comorbidity: PTSD (common after violent death).
• Differential Diagnosis: Normal grief (severe sx persist for 12+ months), Depressive disorders (loss-focused distress), PTSD (intrusive memory is related to specific traumatic event in PGD while in PTSD is related to the trauma).

This quiz explores Trauma and Stress-Related Disorders, focusing on Reactive Attachment Disorder (RAD). It emphasizes diagnostic criteria, developmental factors, and the significant impact of early attachment experiences. Test your knowledge on how these disorders manifest and their risk factors.