An Overview of Trauma and Stressor-Related Disorders

Trauma and stressor-related disorders are disorders triggered by environmental stressors and trauma. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders 5th Edition) considers these disorders to be abnormal responses to traumatic or stressful events.

Many mental disorders are associated with trauma and stress. What makes a disorder trauma and stressor-related are the types of events that may have caused the issue, the specific symptoms you're dealing with, and the duration of these symptoms.

Many researchers believe that these disorders need further exploration to determine treatment methods, a more expansive research collection, and clearer classifications in the DSM-5. Some researchers suggest revisions to the DSM-5 regarding most stressors and trauma-related disorders.

Types of Trauma and Stressor-Related Disorders

There are many types of trauma and stress-related disorders with different sub-categories, symptoms, and diagnostic criteria. You can explore these disorders below;

Stress Disorders

Post-traumatic stress disorder (PTSD) is the most recognized trauma and stress-related disorder, and acute stress disorder (ASD) is the temporary version of PTSD.

Post-Traumatic Stress Disorder (PTSD)

PTSD occurs as a result of a traumatic event. It is diagnosed in 5%-10% of the population and is recognized twice as much in women than men. Symptoms must persist for more than a month to be considered PTSD, and individuals must meet various diagnostic criteria, which we'll explore below.

PTSD vs. ASD

Post-traumatic stress disorder (PTSD) and acute stress disorder have the same symptoms but different duration in which symptoms persist. PTSD is when these symptoms are chronic, whereas, for ASD, symptoms are present for no more than a month.

To be identified as ASD, symptoms occur within a month of a traumatic event (between 2 days to 4 weeks). Most individuals diagnosed with ASD are eventually diagnosed with PTSD.

DSM-5 Diagnostic Criteria

Post-Traumatic Stress Disorder (PTSD)

Diagnostic criteria for PTSD pertain to those six years or older. There are multiple clusters and symptom specifications for PTSD.

1. The individual was exposed to a life-threatening event, caused serious injury, and involved some form of sexual violence or some other form of trauma. Whether experienced directly, witnessed, learned about by a loved one, or one was repeatedly exposed to explicit details of the event.
2. Having encountered one or more of the following intrusive symptoms that began after the experience of the traumatic event(s); Recurring distressing memories, recurring distressing dreams, "dissociative reactions (e.g., flashbacks), intense psychological distress when exposed to stimuli that resemble the event(s). physiological reaction when exposed to stimuli that resemble the event(s), or avoidance of stimuli related to the event(s).
3. The traumatic event(s) have a negative impact on the individual’s cognition and mood.
4. Apparent changes in arousal and reactivity in response to stimuli related to the event(s). This can be displayed in two or more of the following behaviors; angry or irritable behavioral outbursts, “reckless or self-destructive behavior”, hyperventilation, or “exaggerated startle response”. Trouble concentrating or sleep disturbance.
5. Symptoms have been present for over a month. 
6. Symptoms are not associated with another disorder or a response to a substance, like medication or alcohol.

Acute Stress Disorder

ASD has the same criteria as PTSD, except for the duration of symptoms and a few other minor differences, such as types of dissociative reactions.

PTSD dissociative subtype requires an individual to have experiences of derealization (feeling detached from self, like an outside viewer) or depersonalization (feeling detached from surroundings, as if in a dreamlike state). A person can meet criteria for PTSD without this specifier.

As for ASD, an individual must meet at least three dissociative reactions. Derealization and depersonalization are included in the list, along with; feeling numb, having a “reduced awareness of one’s surroundings”, and experiencing “dissociative amnesia”.

Adjustment Disorders

Research on adjustment disorders (AD) is expanding, but there is currently limited information about how to manage AD. It is typically characterized by mild depressive symptoms, anxiety, traumatic stress symptoms or a combination of these. Many individuals develop other mental health disorders along with adjustment disorder.

AD most often occurs during a period of time when the stressor of the trauma is present but subsides when that stressor is removed. These disorders are suspected of subsiding naturally once an individual adjusts to the traumatic event. However, stressors can remain in someone’s life for a long time.

One research study found that 36% of adult and 59% of adolescent participants experienced the stressor of their trauma for over a year. A follow-up assessment was conducted five years later, and most of the adult participants recovered in the past five years.

The study's adults (70%) improved more than adolescents (45%). Most of the other participants were diagnosed with other mental health disorders besides AD. There is also a correlation between having AD as a child or adolescent and developing other mental disorders as an adult.

DSM-5 Diagnostic Criteria

AD has six diagnostic criteria in the DSM-5:

1. Emotional and behavioral issues develop as a reaction to the stressor(s) during a three-month period of the onset of the stressors.
2. Behaviors or symptoms are visible to the clinician in one and/or two of the following ways; The individual’s displayed distress is more intense than expected for the stressor. The individual experiences “significant impairment in social, occupational, or other important areas of functioning,” according to the DSM.
3. Behaviors and symptoms do not “meet criteria for other mental disorders” and also aren’t an extension of a pre-existing disorder.
4. Symptoms aren’t a result of standard grievance.
5. Once the stressor(s) is removed from the individual’s life, symptoms subside within six months.
6. The disorder can be classified as either acute, in which symptoms occur no longer than months, or chronic, meaning symptoms are present for six months or longer.
   

Dissociative Disorders

According to the DSM-5, dissociation is a disconnect from ‘‘usually integrated functions of consciousness, memory, identity, or perception.” With dissociative behavior, you may experience some form of detachment from yourself, others, your surroundings, or your perspective of reality. Research has shown that dissociation also impacts “thinking, emotions, sensorimotor functioning, and/or behavior”.

DDs can be diagnostic criteria for other disorders like PTSD and ASD. Symptoms of DDs are also associated with mood disorders, personality disorders, and substance abuse.

DSM-5 Diagnostic Criteria

To meet the DSM-5’s criteria for a DD, one must experience the following dissociative symptoms; 

1. “Unbidden and unpleasant intrusions into awareness and behavior, with accompanying losses of continuity in subjective experience.”
2. “An inability to access information or control mental functions that are normally readily available to access or control.”

Attachment Disorders

Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) have recently been acknowledged in the DSM-5 as two separate subtypes of attachment disorders classified as stress and trauma-related disorders.

Children are usually diagnosed with one of these disorders when behavioral problems are present. Those with either disorder have most likely experienced some form of childhood trauma and a history of abuse with a caregiver.

A journal study found that 12-year-old children in institutional settings in early childhood displayed more symptoms of RAD and DSED than those who were placed and foster care. The group of children who were not institutionalized at all had even fewer signs of these attachment disorders.

Reactive Attachment Disorder

Reactive attachment disorder is a trauma- and stressor-related condition of early childhood caused by social neglect and maltreatment. Trauma leading to RAD often stems from neglect attributed to “institutional settings, such as overcrowded orphanages, foster care, or in homes with mentally or physically ill parents.”

Evidence of RAD is often present before the age of 5. Children with RAD often find it difficult to form healthy relationships, exhibit unpredictable behaviors, and often react in a fight, flight or freeze response.

RAD vs. DSED

Both RAD and DSED are associated with being emotionally and socially withdrawn. However, RAD is more associated with being emotionally withdrawn because of the lack of attachment related to inhibited behavior. Individuals are inhibited from forming emotional attachments.

Whereas those with DSED, who are socially withdrawn, engage in disinhibited behaviors. They find it difficult to produce social connections.

DSM-5 Diagnostic Criteria

Although RAD and DSED have been identified as different forms of attachment, they have similar criteria and symptoms such as;

1. Emotionally withdrawn (more so in RAD)
2. Socially withdrawn (more so in DSED)
3. Abnormal reactions to normative stress
4. Has a history of insufficient care and/or neglect 
5. Cannot meet criteria for autism spectrum disorder (ASD)
6. Symptoms must occur before the age of 5

Treatment

Although much research has developed on PTSD throughout the years, there is little research on managing most trauma and stressor-related disorders.

Some research considers recovery time a treatment method for certain trauma and stressor-related disorders, like AD. “Treatment generally involves recovering and working through ostensibly repressed or dissociated memories of trauma”.

Psychotherapy and counseling may be considered for those diagnosed with AD.

Cognitive behavioral therapy (CBT) has shown to be an effective treatment method for trauma and stressor-related disorders. An article conducted a systematic review of the impact of CBT on these symptoms. After reviewing a collection of 84 studies, researchers discovered that 65.9% found a dramatic reduction in symptoms.

Other forms of talk therapy, support groups, and psychiatric medication have been used in treating PTSD. Recently, other treatments like cognitive-processing therapy, prolonged exposure therapy, and EMDR have also been explored for PTSD, but more research is needed.

Prevention

It is believed that prevention of such disorders can be established by addressing trauma and stressors before they trigger symptoms. Research on prevention strategies for stress-related disorders has taken several avenues, including intervention before and after trauma and using both psychosocial and somatic approaches.

Research in resilience—the ability to adapt in the face of adversity—has also been explored as a preventive measure for post-traumatic stress disorder and other mental illnesses.

There is no surefire way to prevent trauma, however, given that many of the events that may cause it occur without warning. In many cases, the best we can do is act fast to ensure the inciting event does not have long-lasting consequences for our mental health.

Final Thoughts

If you believe your child or yourself may have a trauma and stressor-related disorder, it would be beneficial to contact a mental health professional to gain further insight into these disorders. Speaking with a psychologist or psychiatrist can provide you with an accurate diagnosis and potential treatment methods.

It can be difficult adjusting to stressors, so identifying traumas and stressors in your life is important to practice preventive measures.