Traumatic stress

Last updated October 23, 2024

Traumatic stress is a common term for reactive anxiety and depression, although it is not a medical term and is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The experience of traumatic stress include subtypes of anxiety, depression and disturbance of conduct along with combinations of these symptoms. This may result from events that are less threatening and distressing than those that lead to post-traumatic stress disorder. The fifth edition of the DSM describes in a section titled "Trauma and Stress-Related Disorders" disinhibited social engagement disorder, reactive attachment disorder, acute stress disorder, adjustment disorder, and post-traumatic stress disorder.^[1]

Symptoms

Symptoms of traumatic stress can be both physical and emotional. Physical symptoms include trembling, shaking, a pounding heart, rapid breathing, choking feelings, stomach tightening/churning, dizziness/faintness, and cold sweats.^[2] Emotional symptoms include racing thoughts and excessive feelings of shock, disbelief, fear, sadness, helplessness, guilt, anger, shame and anxiety.^[2] Furthermore, many people revert to certain coping mechanisms.^[3] In children, that may include a loss of being able to take care of themselves (no longer able to eat on their own or be toilet trained).^[3] In adults, there can be an increase in impulsive behavior and dependence on others (leading to an inability for them to make "thoughtful, autonomous decisions".^[3]

Types

Dis-inhibited social engagement disorder

Dis-inhibited social engagement disorder is a stress-related disorder stemming from neglect during childhood.^[4] According to Erikson's work on the stages of psychosocial development, the psycho-social crisis of trust versus mistrust during infancy causes neglect during that period to have permanent effects because a neglected infant does not learn to trust his parent(s). Feelings of mistrust and anxiety may eventually lead to traumatic stress, especially through dis-inhibited social engagement disorder, among others.^[5] Symptom persistence is necessary for a diagnosis of dis-inhibited social engagement disorder: specific symptoms must be present for at least twelve months.

Reactive attachment disorder

Reactive attachment disorder is a trauma disorder that arises when a parent does not console an upset child. A repetition of this behavior causes sadness, irritability, and fear, which can then lead to the disorder.^[6] A cluster of symptoms relating to indiscriminate behaviors is regarded as dis-inhibited social engagement disorder rather than reactive attachment disorder; symptoms of reactive attachment disorder must be inhibited. Both dis-inhibited social engagement disorder and reactive attachment disorder are related to severe pathogenic care.^[7]^[8]

Acute stress disorder

Another disorder in this category is acute stress disorder, which is listed in DSM-5 under code 308.3, ICD-10, F43.0. According to the DSM-5 "Acute Stress Disorder is caused by trauma (traumatic stress) and lasts at least 3 days."^[9]

Adjustment disorder

Another disorder in this category is adjustment disorder DSM-5 code 309, ICD-10, F43-2. "Adjustment disorder is a manipulative reaction to identifiable psycho-social stressor(s) or life change(s) characterized by preoccupation with the stressor and failure to adapt."^[6]

Post-traumatic stress disorder

The last disorder listed in the DSM-5 is post-traumatic stress disorder. "Post-traumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault."^[10] Post-traumatic stress disorder is expressed through behavioral manifestations that resemble symptoms of PTSD. The diagnostic standards for PTSD encompass reliving the traumatic experience, avoiding triggers, and persistent hyperarousal.^[11] Post-traumatic stress disorder can affect people of all ages, including children as young as 2.^[12]

Related Research Articles

Neurosis is a term mainly used today by followers of Freudian thinking to describe mental disorders caused by past anxiety, often that has been repressed. In recent history, the term has been used to refer to anxiety-related conditions more generally.

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event and can include triggers such as misophonia. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion, and thought, which could possibly be understood as a mental disorder. Although many behaviors could be considered as abnormal, this branch of psychology typically deals with behavior in a clinical context. There is a long history of attempts to understand and control behavior deemed to be aberrant or deviant, and there is often cultural variation in the approach taken. The field of abnormal psychology identifies multiple causes for different conditions, employing diverse theories from the general field of psychology and elsewhere, and much still hinges on what exactly is meant by "abnormal". There has traditionally been a divide between psychological and biological explanations, reflecting a philosophical dualism in regard to the mind–body problem. There have also been different approaches in trying to classify mental disorders. Abnormal includes three different categories; they are subnormal, supernormal and paranormal.

Attachment disorder is a broad term intended to describe disorders of mood, behavior, and social relationships arising from unavailability of normal socializing care and attention from primary caregiving figures in early childhood. Such a failure would result from unusual early experiences of neglect, abuse, abrupt separation from caregivers between three months and three years of age, frequent change or excessive numbers of caregivers, or lack of caregiver responsiveness to child communicative efforts resulting in a lack of basic trust. A problematic history of social relationships occurring after about age three may be distressing to a child, but does not result in attachment disorder.

Reactive attachment disorder (RAD) is described in clinical literature as a severe disorder that can affect children, although these issues do occasionally persist into adulthood. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited form". In the DSM-5, the "disinhibited form" is considered a separate diagnosis named "disinhibited attachment disorder".

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones generally with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.

Acute stress reaction (ASR), also known as psychological shock, mental shock, or simply shock, and acute stress disorder (ASD), is a psychological response to a terrifying, traumatic, or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).

Dissociative disorders (DDs) are a range of conditions characterized by significant disruptions or fragmentation "in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior." Dissociative disorders involve involuntary dissociation as an unconscious defense mechanism, wherein the individual with a dissociative disorder experiences separation in these areas as a means to protect against traumatic stress. Some dissociative disorders are caused by major psychological trauma, though the onset of depersonalization-derealization disorder may be preceded by less severe stress, by the influence of psychoactive substances, or occur without any discernible trigger.

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

The classification of mental disorders, also known as psychiatric nosology or psychiatric taxonomy, is central to the practice of psychiatry and other mental health professions.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In 2022, a revised version (DSM-5-TR) was published. In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has practical importance. However, some providers instead rely on the International Statistical Classification of Diseases and Related Health Problems (ICD), and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions. The DSM-5 is the only DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the only living document version of a DSM.

Disinhibited attachment disorder (DAD) according to the International Classification of Diseases (ICD-10), is defined as:

Thought blocking is a neuropsychological symptom expressing a sudden and involuntary silence within a speech, and eventually an abrupt switch to another topic. Persons undergoing thought blocking may utter incomprehensible speech; they may also repeat words involuntarily or make up new words. The main causes of thought blocking are schizophrenia, anxiety disorders, petit mal seizures, post-traumatic stress disorder, bradyphrenia, aphasia, dementia and delirium.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

Prolonged grief disorder (PGD), also known as complicated grief (CG), traumatic grief (TG) and persistent complex bereavement disorder (PCBD) in the DSM-5, is a mental disorder consisting of a distinct set of symptoms following the death of a family member or close friend. People with PGD are preoccupied by grief and feelings of loss to the point of clinically significant distress and impairment, which can manifest in a variety of symptoms including depression, emotional pain, emotional numbness, loneliness, identity disturbance and difficulty in managing interpersonal relationships. Difficulty accepting the loss is also common, which can present as rumination about the death, a strong desire for reunion with the departed, or disbelief that the death occurred. PGD is estimated to be experienced by about 10 percent of bereaved survivors, although rates vary substantially depending on populations sampled and definitions used.

Disinhibited Social Engagement Disorder (DSED), or Disinhibited Attachment Disorder, is an attachment disorder in which a child has little to no fear of unfamiliar adults and may actively approach them. It can significantly impair young children's abilities to relate with adults and peers, according to the Diagnostic and Statistical Manual of Mental Disorders, as well as put them in dangerous and potentially unsafe conditions. Common examples of this include sitting on a person's lap of which they do not know or leaving with a stranger.

The Clinically Administered PTSD Scale (CAPS) is an in-person clinical assessment for measuring posttraumatic stress disorder (PTSD). The CAPS includes 30 items administered by a trained clinician to assess PTSD symptoms, including their frequency and severity. The CAPS distinguishes itself from other PTSD assessments in that it can also assess for current or past diagnoses of PTSD.

Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses, which can be misdiagnosed. Misdiagnosis may involve erroneously assigning a BPD diagnosis to individuals not meeting the specific criteria or attributing an incorrect alternate diagnosis in cases where BPD is the accurate condition.

References

↑ "Trauma and Stressor-related disorders with DSM-5 & ICD 10 codes". TraumaDissociation.com. Retrieved 2019-09-06.
1 2 Smith M, Robinson L, Segal J. "Traumatic Stress". HelpGuide.org. Retrieved 2019-09-06.
1 2 3 Traumatic stress : the effects of overwhelming experience on mind, body, and society. Van der Kolk, Bessel A., 1943-, McFarlane, Alexander C., Weisæth, Lars. (Paperback ed.). New York: Guilford Press. 2007. ISBN 9781572304574. OCLC 76273307.{{cite book}}: CS1 maint: others (link)
↑ American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 5–25. ISBN 978-0-89042-555-8.
↑ Santrock JW (September 2018). Essentials of life-span development. McGraw-Hill Education. ISBN 9781260054309. OCLC 1048028379.
1 2 Black D (2014). DSM-5 Guidebook: The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing. ISBN 9781585624652.
↑ Lehmann S, Monette S, Egger H, Breivik K, Young D, Davidson C, Minnis H (September 2018). "Development and Examination of the Reactive Attachment Disorder and Disinhibited Social Engagement Disorder Assessment Interview". Assessment. 27 (4): 749–765. doi: 10.1177/1073191118797422 . PMC 7227130 . PMID 30175603.
↑ Lehmann S, Breivik K, Heiervang ER, Havik T, Havik OE (April 2016). "Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in School-Aged Foster Children--A Confirmatory Approach to Dimensional Measures". Journal of Abnormal Child Psychology. 44 (3): 445–57. doi:10.1007/s10802-015-0045-4. PMC 4785216 . PMID 26126635.
↑ Black DW, Grant JE (2014-02-01). DSM-5 Guidebook: The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Pub. ISBN 9781585624652.
↑ Parekh R (January 2017). "What Is PTSD?". American Psychiatric Association. Retrieved 2019-09-07.
↑ Robinson, Lauren K.; Sterling, Laura; Jackson, Joel; Gentry, Eric; Araujo, Fabiana; LaFond, Cynthia; Jacobson, Kristen C.; Lee, Royce (January 2022). "A Secondary Traumatic Stress Reduction Program in Emergency Room Nurses". SAGE Open Nursing. 8: 237796082210945. doi:10.1177/23779608221094530. ISSN 2377-9608. PMC 9096200 . PMID 35574270.
↑ National Collaborating Centre for Mental Health (2005). "Children and young people with PTSD". Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. NICE Clinical Guidelines, No. 26. Leicester (UK): Gaskell.