Assignment 4: Trauma & Co

Trauma & stressor-related disorders

Is it a Trauma or stressor-related disorder – which is which?

We look at three disorders.

1. Adjustment disorder (Stressor-related disorder)
2. Acute stress disorder (Trauma-related disorder)
3. Post traumatic stress disorder (Trauma-related disorder)

Reactive attachment disorder and disinhibited social engagement disorder are stress disorders from childhood trauma.

1. Adjustment disorders

This is when someone has problems adjusting to a specific life stressor.

Adjustment disorders can accompany any medical disorder and most mental disorders. They are also associated with an increased risk of suicide attempts and have a high rate of completed suicides.

Also involve subjective distress and impaired functioning.

Possible stressors that could trigger AD

• Interpersonal problems – betrayal, loss, ending of a relationship
• recurrent stressors (exams)
• continuous stressors – disability, crime, chronic pain
• developmental events: leaving home, having a baby, divorcing, losing a job etc…
• stressors related to the death of a loved one
  • This may be related to another disorder: Persistent Complex Bereavement Disorder

To diagnose AD, a person needs to have:

1. Exposure to an identifiable stressor that led to emotional or behavioral symptoms within 3 months of the event.
2. Emotional distress and behavioral symptoms that are out of proportion to the severity of the stressor, and result in impairment in life functioning
3. The symptoms last no longer than 6 months

As you can see from this, the AD diagnosis is a way of differentiating a person’s symptoms from other diagnoses.

1. The stressor is not necessarily intensely threatening (traumatic) as in PTSD or in Acute Stress Disorder, but may be terribly distressing none the less.
2. It may be out of proportion, so it is not normal adaptive stress.
3. It is between 1 and 6 months unlike Depression and Anxiety Disorders, and starts within 3 months of the stressor.

The prevalence is between 7 and 28% amongst people seeking help – so it is a significant category.

It is common for people with a life-threatening medical diagnosis, and also more common amongst women and the disadvantaged.

2. Acute Stress Disorder

A condition characterized by flashbacks, hyper vigilance and avoidance symptoms lasting up to 1 month after exposure to a traumatic stressor.

A traumatic stressor involves actual or threatened death, serious injury or sexual violence

This may include:

1. direct experience
2. witnessing the events happening to others
3. Learning that a traumatic event has happened to a close family member or friend
4. Experiencing repeated or extreme exposure to details of traumatic events – eg: first responders

Nine or more symptoms involving:

Intrusion symptoms

1. recurrent, intrusive & distressing memories of the event (in children, this may take the form of repetitive play.
2. recurrent distressing dreams related to the traumatic events
3. Dissociative reactions such as flashbacks, in which the trauma feels like it is being relived – most extremely the person may lose awareness of present surroundings
4. Intense or prolonged psychological distress or physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic events

Negative mood

1. Persistent inability to experience positive emotions

Dissociative symptoms

1. An altered sense of reality or of oneself (seeing yourself from the outside, being in a daze, time slowing)
2. Being unable to remember important aspects of the events due to dissociative amnesia

Avoidance symptoms

1. Avoiding distressing memories, thoughts and feelings about or associated with the traumatic events.
2. Avoiding external reminders (people, places, conversations, activities, objects, situations) that may trigger memories, thoughts or feelings about what happened

Arousal symptoms

1. sleep disturbances
2. irritable behavior and angry outbursts
3. hypervigilance
4. difficulty concentrated
5. exaggerated startle response

Over half of people with acute stress disorder have symptoms lasting longer than a month and later receive a PTSD diagnosis.

3. Post-traumatic Stress Disorder

A condition characterized by flashbacks, hyper vigilance and avoidance symptoms lasting more than 1 month after exposure to an extreme trauma.

Extreme trauma involves actual or threatened death, serious injury or sexual violence

This may include:

1. direct experience
2. witnessing the events happening to others
3. Learning that a traumatic event has happened to a close family member or friend
4. Experiencing repeated or extreme exposure to details of traumatic events – eg: first responders,

Note that the symptoms are almost the same as for acute stress disorder, but there are additional negative thoughts and emotions.

1 or 2 symptoms involving the symptoms listed for Acute Stress Disorder, with the significant addition of negative alterations in cognition and mood among the list of possible symptoms:

Negative alterations in cognition and mood

• Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted”, “The world is completely dangerous”, “My whole nervous system is permanently ruined”).
• persistent distorted cognitions that lead the person to blame themselves or others
• Persistent negative emotions (fear, anger, horror, guilt, shame)
• Lack of desire to do things
• Feeling detached and estranged from others
• Persistent inability to experience positive mentions

The prevalence figures are odd. About 9% lifetime and about 4% 12 month prevalence. So there is a strange and interesting discrepancy here. Prevalence is twice as high for women.

The person may have PTSD with or without dissociative symptoms:

• depersonalization: I am not me. I am not in my body or it is not me. Time moving slowly
• derealisation: The world is not real. it feels like a dream, distorted or distant.

And the person may have delayed expression – at least 6 months after the event.

Etiology

Only some people develop disorders after stress or trauma.

Factors that increase risk:

• severe physical injuries/personalized trauma carry increased risk
• stroke, head injuries, or injured hands or feet, major burns, rape or assault all carry increased risk.
• The closer the perpetrator is to the survivor, the greater the chances that PTSD will develop.
• cognitive style
• childhood trauma
• genetic vulnerability
• lack of social support

Treatment of trauma related disorders

• Antidepressants seem to help almost 60% of people but do not lead to a full recovery in most of these.
• Psychological interventions help the extinguish the fear response and correct dysfunctional cognitions
  • Exposure therapy
    • reimagining and retelling the story of what happened
  • CBT
  • trauma-focused CBT
    • Identify and change dysfunctional cognitions about the event and themselves
  • EMDR Eye movement desensitization and reprocessing
    • By moving the eyes, tactile or auditory awareness from left to right, traumatic memories lose their charge and become more biographical, so that they can be recalled as in the past rather than triggering a fear response in the present.
    • Negative cognitions are also replaced with positive ones.

Psychophysiological Disorders and Symptoms

A psychophysiological disorder is any physical disorder than has a strong psychological basis or aspect.

• Broken heart syndrome – a rush of adrenaline (epinephrine) can send the heart into cardiac distress.
• impaired or over-active immune system
• coronary heart disease
• hypertension
• headaches (migraine, tension & cluster)
• asthma