Trauma and Stressor-Related disorders

All share a proximal instigating stressful event followed by intense emotional responses. Also, a wider
range of emotions—such as rage, horror, guilt, and shame, in addition to fear and anxiety—may be
implicated in the onset, particularly for posttraumatic stress disorder
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Posttraumatic Stress Disorder (PTSD) - Enduring, distressing emotional disorder that follows exposure to
a severe helplessness- or fear-inducing threat. The victim re-experiences the trauma, avoids stimuli
associated with it, and develops a numbing of responsiveness and an increased vigilance and arousal
Clinical Description
 Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the
following ways:
o Directly experiencing or witnessing the traumatic event(s)
o learning that the event(s) occurred to a close relative or close friend
o experiencing repeated or extreme exposure to aversive details of the traumatic event(s)
(e.g., first responders collecting human remains).
 Presence of one (or more) of the following intrusion symptoms associated with the traumatic
event(s), beginning after the traumatic event(s) occurred:
o recurrent, involuntary and intrusive distressing memories of the traumatic event(s)
o recurrent distressing dreams in which the content and/or affect of the dream are
related to the traumatic event(s)
o dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the
traumatic event(s) were recurring
o marked physiological reactions to internal or external cues that symbolize or resemble
an aspect of the traumatic event(s).
 Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the
traumatic event(s) occurred, as evidenced by one or both of the following:
o avoidance of or efforts to avoid distressing memories, thoughts, feelings, or
conversations about or closely associated with the traumatic event(s)
o avoidance of or efforts to avoid external reminders that arouse distressing memories,
thoughts, or feelings about or closely associated with the traumatic event(s)
o inability to recall an important aspect of the trauma
o markedly diminished interest or participation in significant activities
o feeling of detachment or estrangement from others
o Restricted range of affect
o sense of a foreshortened future.
 Negative alterations in cognitions and mood associated with the traumatic event(s), beginning
or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the
following:
o inability to remember an important aspect of the traumatic event(s)
o persistent and exaggerated negative beliefs or expectations about oneself, others, or
the world
o persistent distorted cognitions about the cause or consequences of the traumatic
event(s) that lead the individual to blame himself/herself or others
o persistent negative emotional state
o markedly diminished interest or participation in significant activities
 o feelings of detachment or estrangement from others
o persistent inability to experience positive emotions.
 Duration of the disturbance is more than one month and causes clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
 With delayed onset: individuals show few or no symptoms immediately or for months after a
trauma, but at least six months later, and perhaps years afterward, develop full-blown PTSD
 Acute stress disorder – Similar to PTSD with severe early reaction to traumatic stress but occurs
within the first month after the trauma; including amnesia about the event, emotional
numbing, and derealization. Many victims later develop post-traumatic stress disorder.
Statistics
 Low prevalence of PTSD in populations of trauma victims
o In war veterans of Iraq and Afghanistan, PTSD had a prevalence rate of 30% or more; in
women military personally during the Vietnam war, the lifetime prevalence rate of PTSD
was 20.1%; in another study, out of 47,000 members of the armed forces, 4.3% had
PTSD
 In the general population, 6.8% experienced PTSD at some point in their life
 Highest rate associated with PTSD was the following: 1) rape, 2) being held captive, tortured, or
kidnapped, and 3) being badly assaulted
o Rate was higher for women experience a single sexual assault or rape
 Possible explanations behind the low rate of PTSD among citizens who endured bombing and
shelling and high rate of PTSD among victims of assaultive violence:
o Closer exposure to trauma
 In Vietnam veterans who had combat exposure, 18.7% had PTSD
 Among citizens who lived close to the World Trade Center, the prevalence rate
for PTSD was 20%
Causes
o Generalized biological vulnerability – a family history of anxiety; having a monozygotic
(identical) twin; diathesis stress model; history of externalizing (acting out) problems in children;
lower intelligence
o Generalized psychological vulnerability – family instability
o Biomarkers through emotional reactivity
o Social factors: having social support from parents, friends, classmates, and teachers was an
important protective factor (reduces cortisol secretion and HPA activity). Positive coping
strategies was also protective; being angry and placing blame on others was associated with
higher levels of PTSD
o Elevated CRF (heightened activity in HPA axis) = chronic arousal
o Damage to the hippocampus (persistent and chronic hyperarousal, disruptions in learning and
memory)
o In PTSD, initial alarm is true and real danger is present (true alarm). If the alarm is severe
enough, we may develop a conditioned or learned alarm reaction to stimuli that remind us of
the trauma (learned alarm)
Treatment
o Psychoanalytic therapy - reliving emotional trauma to relieve emotional suffering is called
catharsis; arranging the re-exposure so that it will be therapeutic rather than traumatic
o Imaginal exposure - the content of the trauma and the emotions associated with it are worked
through systematically
 o Prolonged exposure therapy - work with the victim to develop a narrative of the traumatic
experience and to expose the patients for an extended period of time to the image
o Cognitive therapy – correcting the negative assumptions about the trauma—such as blaming
oneself in some way, feeling guilty, or both
o there is evidence that subjecting trauma victims to a single debriefing session, in which
they are forced to express their feelings as to whether they are distressed or not, can be
harmful
o Cognitive processing therapy - based on the idea that PTSD symptoms stem from a conflict
between pre-trauma beliefs about the self and world and post-trauma information. For
example, a pre-trauma belief could be the world is a safe place, and nothing bad will happen to
me, while post-trauma information may suggest that the world is, in fact, dangerous and
hazardous. These conflicts are called "stuck points" and are addressed through various
techniques such as writing about the traumatic event.
o SSRIs – Prozac and Paxil; helpful for PTSD because they relieve the severe anxiety and panic
attacks so prominent in this disorder. Promising, but mixed
OTHER trauma and stressor-related disorders
Adjustment Disorder - Anxious or depressive reactions to life stress that are generally milder than in
acute stress disorder or post-traumatic stress disorder but that are nevertheless impairing in terms of
interfering with work or school performance, interpersonal relationships, or other areas of living
o If the symptoms persist for more than six months after the removal of the stress or its
consequences -> “chronic”
Attachment Disorder - Developmentally inappropriate behaviors in which a child is unable or unwilling
to form normal attachment relationships with caregiving adults; due to inadequate or abusive child-
rearing practices; pathological reactions to early extreme stress
o Reactive attachment disorder - Attachment disorder in which a child with disturbed behavior
neither seeks out a caregiver nor responds to offers of help from one; fearfulness and sadness
are often evident.
o Disinhibited social engagement disorder – Attachment disorder which is a pattern of behavior
in which the child shows no inhibitions whatsoever to approaching adults. Such a child might
engage in inappropriately intimate behavior by showing a willingness to immediately
accompany an unfamiliar adult figure somewhere without first checking back with a caregiver.

Reference:

Barlow, D. H., Durand, V. M., Lalumiere, M. L., & Hofmann, S. G. (2021). Abnormal
psychology: An integrative approach. Nelson Education Ltd.

Comer, R. J. (2016). Fundamentals of Abnormal Psychology. Worth Publishers.