Trauma and Stressor-Related Disorders

Trauma and Stressor-Related Disorders Overview

• Five disorders are in this category.
• The lecture focuses on the first three disorders, with emphasis on adjustment disorders and posttraumatic stress disorder (PTSD).

Childhood Disorders

• Reactive attachment disorder and disinhibited social engagement disorder are childhood disorders grouped due to children experiencing extreme social or caregiving situations.
• These situations involve neglect or frequent changes in caregivers.
• Along with the mentioned caregiver situations characterized by changes or neglect, a response to it is necessary.
• The disorders differ in how children respond to these situations.

Reactive Attachment Disorder

• Children with reactive attachment disorder, due to changes or neglect in caregiving, do not seek caregiving from adults.
• They are inhibited/withdrawn, rarely seeking comfort when distressed.
• They minimally respond to comfort from caregivers/adults and display minimal social/emotional responses.
• Children may exhibit unexplained irritability, sadness, or fearfulness, even in non-threatening situations.
• Caregivers are seen as a source of abuse, neglect, or instability, leading the child to distrust others' ability to provide comfort and meet emotional needs.
• The instability can make the world seem more chaotic, leading to the emotional ups and downs.

Disinhibited Social Engagement Disorder

• Children with this disorder experience social neglect or changes in caregivers.
• They are overly involved with caregivers and any adults, showing no fear approaching unfamiliar adults.
• They display overly familiar verbal/physical behavior with any adults.
• Children do not check back with caregivers when engaging with new adults to ensure safety.
• The behavior is inappropriate for the child's developmental level/cultural norms.
• Children show no hesitation going off with unfamiliar adults.
• Due to neglectful caregivers, the child learns not to trust them. As a result, the child either doesn’t trust anyone or trusts everyone else.

Adjustment Disorder: Background and Criteria

• Adjustment disorder was a "catch-all" diagnosis for individuals not meeting criteria for other disorders.
• In the DSM, it's now grouped with trauma and stressor-related disorders, requiring a cause or source for the individual's difficulties.
• The individual develops emotional or behavioral symptoms due to an identifiable stressor.
• Symptoms appear within 3 months of the stressor.
• Symptoms impair functioning: the distress is disproportionate to the stressor or the response to the stressor causes impairment.
• The disorder typically resolves within 6 months once the stressor ends, if it's not ongoing.
• The individual doesn't meet criteria for another disorder.
• The presentation can resemble depression, anxiety, or a mix of both.
• Conduct problems may arise in children.

Adjustment Disorder: Prevalence and Stressors

• It is one of the most common diagnoses.
• 20% of individuals in outpatient mental health settings and 50% in hospital settings receive the adjustment disorder diagnosis.
• Common stressors include loss of romantic relationships, job loss, starting college, increased work demands, marriage, and retirement.
• The stressor doesn't have to be negative--difficulty adjusting to change can be hard even when positive.
• The duration depends on the event's duration; acute events often lead to briefer durations.

Adjustment Disorder: Coping Resources and Treatment

• Adjustment disorder often arises when coping resources are inadequate to meet stressors.
• This can lead to demoralization and loss of hope.
• Solution-focused therapy is a treatment where individuals use existing resources to face new problems.
• It focuses on strengths rather than problems/illnesses.

Solution-Focused Therapy: Stages

• Brainstorming segment: The individual thinks about their resources:
• Miracle Question: If the problem was gone, what would they be doing?
• Scaling Question: When do they handle it well vs. not so well? What's different?
• Search for Exceptions: Times when they coped well or had no problems with the stressor?
• Focus on the individual's actions.
• Assign tasks:
• Do more of what worked in the past.
• Make a plan to try something new.
• Take small steps and build on successes.
• Follow-up:
• See how the plan worked and adjust as needed.

Posttraumatic Stress Disorder (PTSD): Event Criteria

• Individuals must have been exposed to an event involving a threat, possibly death, serious injury, sexual violence, or threat to their identity.
• Exposure can be direct, witnessing an event happening to others, learning about it happening to close family/friends, or repeated exposure to aversive details of events.
• First responders, police officers, firefighters, and psychologists are examples of people experiencing repeated exposure and can have PTSD for themselves.

PTSD: Intrusive Symptoms

• After the traumatic event has passed and the individual is safe, symptoms include intrusive symptoms related to the traumatic event.
• Intrusive symptoms feel like what happened is happening repeatedly.
• Intrusive symptoms include recurring memories, dreams, flashbacks.
• intense distress when exposed to sounds, sights, or smells reminiscent of the event.
• Physiological reactions associated with cues of the event.

PTSD: Avoidance Symptoms

• After exposure to the trauma and experiencing intrusions, individuals try to avoid anything that would cause more distress or flashbacks.
• Specifically, they try to avoid:
• Memories
• Thoughts
• Feelings associated with trauma
• Also, they try to avoid:
• Situations related to the trauma
• People, places, objects, and activities are also avoided.

PTSD: Negative Alterations and Arousal Symptoms

• Individuals experience negative thoughts and mood alterations:
• Dissociation or amnesia related to the event
• Negative thoughts or beliefs about themselves and others in relation to the event
• Inaccurate beliefs about why the event happened to them, which are distorted and out of reality
• Avoid engaging with others or participating in activities/positive experiences.
• Individual's arousal and reactivity changes:
• Increased irritability and anger outbursts
• Reckless behavior
• Hypervigilance
• Startle response
• Problems concentrating
• Sleeping problems

PTSD: Duration, Onset, and Prevalence

• Symptoms must last more than 1 month for a PTSD diagnosis.
• Onset can be immediate or delayed.
• PTSD affects 8-10% of adults at some point in their lives, with 3-4% affected in a given year.
• Higher rates are seen in survivors of rape (33-50%), military combat, and ethnically/politically motivated imprisonment or genocide.
• Onset typically occurs within 3 months of the trauma, but can be delayed further, even decades later.
• Reactions can start to manifest based on threatening cues.
• PTSD, once classified as an anxiety disorder, is now separate, although treatments overlap.

PTSD Reactions and Causes

• PTSD reactions are typically more extreme, involving significant intrusions.
• PTSD usually stems from a specific traumatic event or series of events.
• PTSD is a common disorder that's well-understood, allowing for focused study and treatment.

Cognitive-Behavioral Treatments for PTSD

• Cognitive-behavioral treatments for PTSD utilize exposure principles and cognitive processing.
• Prolonged exposure therapy focuses on repeated exposure to the traumatic event.
• Exposure can be imaginal (talking about the event) or actual (returning to the location or cues).
• Caution: Prolonged exposure should only be administered by trained professionals, as improper exposure can worsen PTSD.
• Cognitive processing therapy involves talking through the event and challenging beliefs about why the trauma occurred.
• A heavier cognitive component is used to challenge the beliefs about why the trauma occurred and the meaning it now has for the client.
• Present-centered therapy focuses on current symptoms and coping mechanisms.
• Clients often prefer present-centered therapy because they do not need to relive the trauma.
• Stress inoculation training teaches coping skills for stress, such as muscle relaxation, breathing, and guided self-dialogue.
• These coping skills are used when triggers or cues are present, not skills from the time of the trauma.

EMDR

• Eye Movement Desensitization and Reprocessing (EMDR) is a controversial treatment with research support.
• EMDR involves talking about the trauma while moving the eyes back and forth.
• The eye movement is believed to stimulate both sides of the brain, helping to fully process the trauma.
• Some believe the eye movement aspect of EMDR doesn't add anything to the exposure component.

Medications for PTSD

• Medications for PTSD include anti-anxiety medications and antidepressants.
• Anti-anxiety medications, such as benzodiazepines, act as tranquilizers to slow down the individual’s response system.

Acute Stress Disorder

• Acute Stress Disorder is similar to PTSD but differs in timing.
• Symptoms must start within 1 month of the event and cannot last longer than 1 month.
• Acute Stress Disorder can often lead to PTSD.
• Immediate treatment focuses on safety and feeling safe, rather than processing the trauma.
• Psychological First Aid is a treatment for Acute Stress Disorder, designed for use during or immediately after a trauma.
• It involves 7 steps, the first 3 of which focus on offering support by listening and empathizing.
• The problem is defined from the individual’s perspective, understanding why they are having trouble coping.
• A plan is developed with the individual, and a commitment to follow through is obtained with follow-ups afterwards.

Key Differences in Treatment

• Treatments for PTSD involve fully processing the trauma and disconnecting reactions from trauma cues.
• Treatments for acute stress disorder are more focused on immediate actions.