What are Trauma and Stressor-Related Disorders?

Trauma and stressor-related disorders are a relatively recent category in the DSM that refers to disorders, traditionally belonging to anxiety disorders, caused by traumatic events.

Among these disorders, we have some that are well known, such as PTSD, and others associated with dysfunctional attachment or personality traits.

Below we will see in more detail this category of such a long title, in addition to its history and what disorders make it up.

Trauma and stressor-related disorders are a group of mental disorders in which exposure to a traumatic or highly stressful event is one of the main diagnostic criteria.

Currently, a stressor is understood to be any stressor that disturbs a person’s normal physiological, cognitive, behavioral, or emotional balance. The origin of this stressor can be of a different nature and can be physical, economic, social, or psychological.

For its part, a traumatic factor is any event that may cause serious damage to the physical and psychological integrity of the person, already in the form of a death threat, serious damage, sexual violence, both in the same person and in a family member or close friend.

Disorders in this category produce a high personal, economic and social cost. On a personal level, they cause discomfort, suffering, and a series of post-traumatic sequelae so serious that they can leave a mark on the person for life. In terms of economics, trauma and stressor-related disorders represent large costs for state institutions and companies, since those who suffer from them request long-term sick leave and disability pensions.

From a social point of view, disorders in this category have raised great concern. This has been especially the case in the Western world in the last two decades as a result of historically traumatic events such as 9/11, March 11, and other attacks, both Islamists and separatist paramilitary groups (p. e.g. ETA, IRA, and Crimean pro-Russian militias).

History

Since the publication of the fifth edition of the DSM (2013), disorders related to trauma and stress factors have their own and specific section, being formally separated from anxiety disorders, and affirming themselves as one of the large groups of psychiatric disorders.

As for the other major classification system for mental disorders, these disorders already had their own separate group since the ICD-10 was published in 1992, only here they are called severe stress reactions and adjustment disorders.

They can also be found, in part, in the section on personality disorders of the ICD-10 itself. There, the existence of the so-called persistent personality transformations after the catastrophic experience (PPT) is recognized, in which the consequences of a traumatic event are so devastating that they even manifest themselves decades after being exposed to the traumatic event. In order to be diagnosed, the event must have been so extreme that personal vulnerability is not required to explain the profound effect on personality.

Main disorders in this category

Next, we are going to see the main disorders that make up the category of disorders related to trauma and stressors.

Reactive Attachment Disorder (RAD)

Reactive Attachment Disorder (RAD) arises at approximately 5 years of age, having as its main feature a socially distorted ability to relate and not properly developed in most contexts.

Among the general characteristics that we can find in this disorder, we have poor social or emotional reactions towards others, very limited expressions of positive affection, and episodes of irritability, sadness, or fear for no apparent reason or reason.

Children with stress disorder have experienced some extreme pattern of insufficient care at some point in their lives. Whether due to neglect or social deprivation, they have not had their basic emotional needs covered, preventing the child from growing up feeling safe.

Disinhibited social relationship disorder also manifests itself in children. The little one shows indiscriminate sociability or lack of selectivity when choosing figures with whom they are attached.

Children with this disorder show verbal or physical behavior that is too familiar with people who are not part of their close circle, in addition to seeking affective contact with strangers. For example, they are excessively familiar with strangers, to whom they come to ask for things and show them affection.

The curious thing is that they resort little or nothing to their usual adult caregiver, that is, to their own mother, father, or guardian in charge of their care.

This disorder could be considered the uninhibited version of reactive attachment disorder, having a similar origin in its occurrence. Children who manifest it have not been able to develop a type of secure attachment during their early childhood, with which they develop different strategies to be able to face different deficiencies or threatening situations.

Post Traumatic Stress Disorder (PTSD)

One of the most prominent trauma-related disorders, Post-Traumatic Stress Disorder (PTSD), manifests itself quite frequently in the population, with a prevalence of between 1 and 3.5% in the world.

This disorder is especially high among the military and other people whose profession involves a high risk of exposure to traumatic events, such as police officers, emergency medical personnel, and firefighters, as well as victims of terrorist attacks, sexual violence, and natural disasters, or witnessing them.

PTSD is associated with high rates of social, occupational, and physical difficulties, as well as high economic costs and increased use of medical services.

Among what causes this most notable disorder we have:

Flashbacks of the traumatic event.
Sleeping difficulties and nightmares.
Feelings of loneliness.
Excessive reactivity: Irritability, aggressiveness, hypervigilance …
Mood disturbances, along with worry, guilt, and sadness.
Intrusive thoughts
Avoidance of memories.
Cognitive disturbances, such as irrational fears.
Depersonalization: the feeling of being an observer external to oneself.
Derealization: feeling that the world you live in is unreal.

Acute stress disorder

This disorder is characterized by the appearance of a set of anxiety symptoms that occur after being exposed to a highly traumatic event.

These alterations last more than two days, up to a maximum of four weeks, and appear the first month after the traumatic event has been experienced. If these four weeks are exceeded, the diagnosis of PTSD or adjustment disorder would be considered.

The most common symptoms of this disorder are similar to those of PTSD:

Derealization: feeling that the environment is unreal or strange.
Dissociative amnesia: inability to remember the traumatic event.
Daze.
Lack of concentration.
Sleeping problems.
Avoidance behaviors of people or places related to trauma.
One of the differences with respect to PTSD is that acute stress disorder is early-onset, that is, it begins to be felt shortly after being exposed to the traumatic event.

Adjustment disorder

Adjustment disorder is an asymptomatic manifestation derived from a clear and defined stressful event, with a duration of three months after its occurrence, but which cannot be classified as PTSD.

For it to be diagnosed, there must have been an extremely high discomfort, very disproportionate to what would be expected how a person without the disorder would react to the same stressful event, and that implied a deterioration in the work and social area.

There are several subtypes, including adjustment disorder with:

Depressed mood: hopelessness and sadness.
Anxiety: nervousness, agitation, and fear.
Anxiety associated with depressed mood: the combination of the above.
Antisocial: aggressiveness and impulsiveness.
Mixed emotional and antisocial: the combination of sadness and fear with aggressiveness.

Regardless of the modality, this disorder involves all kinds of problems, such as relationship and family problems, sexual dysfunction, financial difficulties, poor academic performance, health problems, and job changes.

This category is used to refer to disorders in which the characteristic symptoms of disorders related to trauma and stress factors predominate, causing clinically significant discomfort as well as social, occupational, and economic deterioration, but which do not meet the sufficient diagnostic criteria to have a pure diagnosis.

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Bibliographic references:

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
World Health Organization (1992). International Classification of Diseases and Health-Related Problems, Tenth Revision (ICD-10). Geneva, Switzerland.
Morales Rodríguez, PP, Medina Amor, JL, Gutiérrez Ortega, C., Abejaro de Castro, LF, Hijazo Vicente, LF, & Losantos Pascual, RJ. (2016). Disorders related to trauma and stress factors in the Psychiatric Medical Expert Board of the Spanish Military Health. Military Health, 72 (2),