Overview – Trauma and Stressor Related Disorders
Trauma- and Stressor-Related Disorders include those in which a stressful event is listed explicitly as a diagnostic criterion. This may involve a situation in which a person experiences or witnesses an event that triggers fear for their own or another’s safety. It may be one specific event or a prolonged series or situation. It may involve a human-triggered or natural disaster; being kidnapped or taken hostage; being in a war-torn environment; combat exposure; a threatened or actual physical or sexual assault; being in a serious accident or witnessing any such events. Symptoms may last longer when the trauma is interpersonal and intentional (e. g. in-person or cyberbullying, sexual violence, torture). Emotional and behavioral alterations of some type are to be expected following any traumatic event. For some, however, the reaction(s) can result in significant distress that impairs personal, social, and occupational functioning. Reactions are varied and can include anxiety or fear-based symptoms, aggression or anger-based symptoms, or dissociative symptoms. Anxiety symptoms are not always prominently displayed, however, especially in children. It has been suggested that Trauma- and Stressor-Related Disorders may represent a spectrum, like many other psychiatric conditions.
Hans Selye has been credited as outlining the acute and chronic physiological effects of mental and situational stress. Richard S. Lazarus, Ph.D., has pointed out that stress is a condition, sense, or feeling that is experienced by individuals who perceive that the demands upon them exceed the personal and social resources they are able to mobilize. According to Dr. Al Siebert, there is no stress in any situation until the individual human feels strain—and this differs for every brain. The distress perceived is less the result of what actually exists objectively, and more about what an individual brain perceives is happening.” If symptoms last longer than 30 days, the individual is considered to now be exhibiting PTSD, Post-Traumatic Stress Disorder.
Two main categories of Trauma- and Stressor-Related Disorders have been described. One is PTSD, which is dealt with separately in Module #6. The other involves four different types of Trauma and Stressor Related Disorders, one type presented each day for four days.
Reactive Attachment Disorder (RAD)
Reactive Attachment Disorder is a trauma and stress-related condition of early childhood caused by social neglect and maltreatment. It is characterized by failure to form a healthy and secure trusting bond with parents or caregivers. The disorder is most common among children between 9 months and 5 years who have experienced physical or emotional neglect or abuse. Behaviorally, affected children are unpredictable, difficult to console, and difficult to discipline. Moods fluctuate erratically, and children may seem to live in a fight-flight or freeze mode. Most have a strong desire to control their environment and make their own decisions. Such situations limit a young child’s opportunity to establish healthy attachments with parents or caregiver.
Features of Reactive Attachment Disorder develop within the first 5 years of life. However, the disorder cannot be diagnosed before the age of 1 year (or a mental age of less than 9 months), when the capacity for selective attachments may not be fully developed, or in the context of Autism spectrum disorder.
Disinhibited Social Engagement Disorder (DSED)
Disinhibited Social Engagement Disorder is an attachment disorder in which a child may actively approach and interact with unfamiliar adults—while often ignoring adults who are familiar. Adults and other children are put-off by verbal and behavioral over-familiarity. A child with disinhibited social engagement disorder may sit on the lap of a stranger, which creates a very uncomfortable situation for the adult. It can be diagnosed when a child has reached a developmental age of at least nine (9) months and is not diagnosed after age five (5).
Acute Stress Disorder
Acute Stress Disorder is a trauma and stress-related disorder that resembles PTSD, but its duration is over a shorter period of time. Symptoms may occur after an individual either experiences personally or witnesses or experiences a disturbing event indirectly. Symptoms begin or worsen after the trauma occurs and can last from three days to one month. If symptoms persist after a month, the diagnosis becomes a Post-Traumatic Stress Disorder.
Adjustment disorders can be described as an adverse reaction in an individual who is unable to cope with stressful life changes. Adjustment Disorder represents a stress-response syndrome to what the individual perceives as some type of life stressor whether traumatic or not. The person exhibits an inability to adjust to the stressor, such as a major life event.
Adjustment Disorder is characterized by emotional or behavioral features of anxiety, depression, and post-traumatic stress in various combinations, and may represent a subthreshold syndrome in which the person does not meet the full criteria for PTSD, or major depression. Exhibited behaviors can include recklessness, ignoring family and friends, neglecting tasks and duties, and suicide attempts.
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