Understanding Trauma and Stressor-Related Disorders

• Trauma and stressor-related disorders are mental health conditions caused by traumatic or highly stressful events.
• These disorders manifest as maladaptive emotional and behavioral responses, including anxiety, fear, dissociation, avoidance, and hypervigilance.
• Disorders range in duration from short-term responses like Acute Stress Disorder, to chronic conditions like PTSD or Dissociative Identity Disorder.

Post-Traumatic Stress Disorder (PTSD)

• PTSD arises after experiencing or witnessing a life-threatening event such as combat exposure, sexual assault, serious accidents, natural disasters, terrorist attacks, or childhood abuse/neglect.
• It is characterized by intrusive memories, emotional distress, avoidance behaviors, and hyperarousal.
• Diagnosis requires symptoms to be present for more than 1 month, across four categories.

PTSD: Intrusion Symptoms

• Recurrent, involuntary, distressing memories of the trauma are common.
• Flashbacks, where the individual feels as if the trauma is recurring, can occur.
• Nightmares related to the trauma are also a symptom.
• Intense emotional or physical reactions to trauma reminders can be triggered.

PTSD: Avoidance Symptoms

• Efforts are made to avoid thoughts, memories, or conversations about the traumatic event.
• Individuals avoid places, people, or situations associated with the trauma.
• Emotional numbing and detachment from others can occur.

PTSD: Negative Alterations in Cognition & Mood

• Persistent negative beliefs about oneself, others, or the world are present.
• Individuals experience distorted blame of self or others for the trauma.
• There is an inability to experience positive emotions.
• Individuals experience loss of interest in activities.

PTSD: Hyperarousal Symptoms

• Symptoms include irritability and anger outbursts.
• Hypervigilance (constantly feeling on edge) is a symptom.
• Individuals may exhibit an exaggerated startle response.
• Difficulty concentrating and sleep disturbances can occur.

PTSD: Risk Factors

• Pre-trauma factors include pre-existing mental health disorders (depression, anxiety), a genetic predisposition to anxiety disorders, and childhood adversity (abuse, neglect).
• Peri-trauma factors are the severity of trauma and the level of perceived life threat.
• Post-trauma factors include a lack of social support, repeated exposure to trauma reminders, and maladaptive coping strategies like substance abuse or avoidance.

PTSD: Treatment Approaches

• SSRIs (Sertraline, Paroxetine) are first-line medications.
• Prazosin helps in treating PTSD-related nightmares.
• Mood stabilizers or atypical antipsychotics can be used for severe agitation.
• Cognitive-Behavioral Therapy (CBT) helps reframe negative thoughts.
• Prolonged Exposure Therapy reduces avoidance behaviors.
• Eye Movement Desensitization and Reprocessing (EMDR) uses guided eye movements to process traumatic memories.
• Trauma-Focused Therapy helps integrate traumatic experiences into one's personal narrative.

Acute Stress Disorder (ASD)

• ASD is similar to PTSD but occurs within 3 days to 1 month after trauma.
• If symptoms persist beyond 1 month, it may develop into PTSD.
• Dissociative symptoms (e.g., feeling detached from reality), intrusive thoughts, flashbacks, nightmares, avoidance of trauma-related stimuli, hyperarousal (sleep disturbances, irritability), and emotional numbing or amnesia are symptoms.
• Treatment includes short-term crisis intervention, trauma-focused CBT, and SSRIs or short-term benzodiazepines for severe anxiety.

Adjustment Disorder

• This involves maladaptive emotional or behavioral responses to a stressful life event, occurring within 3 months.
• Stressors can include divorce, job loss, chronic illness, and financial problems.
• Unlike PTSD, there is no requirement for a life-threatening event.
• Symptoms include depression, anxiety, anger, conduct problems, sleep disturbances, withdrawal from social interactions, excessive worry, and feelings of hopelessness.
• Impaired daily functioning is also a symptom.
• Treatment involves cognitive-behavioral therapy (CBT), supportive therapy and counseling, and short-term use of antidepressants or anti-anxiety medications.

Dissociative Disorders

• These disorders involve disruptions in memory, identity, emotion, perception, and behavior.
• They are commonly linked to severe childhood trauma and abuse.

Dissociative Amnesia

• This is the inability to recall important personal information, often following trauma.
  • Localized Amnesia: Inability to recall events during a specific period.
  • Selective Amnesia: Partial memory loss.
  • Generalized Amnesia: Complete memory loss (rare).
  • Dissociative Fugue: Sudden travel or wandering away from home with identity confusion.
• Treatment involves trauma-focused therapy and cognitive techniques to improve memory recall.

Dissociative Identity Disorder (DID)

• DID involves the presence of two or more distinct personality states ("alters").
• Each identity may have different memories, behaviors, and speech patterns.
• DID is often associated with severe, repeated childhood abuse.
• Symptoms include memory gaps, time loss, sudden shifts in mood, behavior, or identity, and self-injurious behaviors or suicidal tendencies.
• Treatment includes long-term psychotherapy (integrating identities), CBT, DBT (Dialectical Behavior Therapy), and hypnotherapy (in some cases).

Depersonalization/Derealization Disorder

• Depersonalization involves feeling detached from oneself (e.g., out-of-body experience).
• Derealization involves feeling that surroundings are unreal.
• Treatment includes CBT and grounding techniques, as well as SSRIs or benzodiazepines for anxiety symptoms.