What are Trauma - and Stressor - Related Disorders?

(as described by the Children’s Hospital of Philadelphia)

Trauma and stressor-related disorders are a group of emotional and behavioral problems that may result from childhood traumatic and stressful experiences.

These traumatic and stressful experiences can include exposure to physical or emotional violence or pain, including abuse, neglect or family conflict. Observing a parent being treated violently, for example, can be a traumatic experience, as can being the victim of violence or abuse. Stressors such as parental separation or divorce or even more severe stressors such as emotional or physical neglect can cause problems when they are prolonged or not addressed by caring adults. Even a move or the birth of a sibling can be a stressor that can cause significant difficulties for some children.

Common Types of Trauma - and Stressor - Related Disorders.

(as described by the Children’s Hospital of Philadelphia)

Post-traumatic stress disorder (PTSD). Children and adolescents with PTSD have symptoms such as persistent, frightening thoughts and memories or flashbacks of a traumatic event or events. Other symptoms may include jumpiness, sleep problems, problems in school, avoidance of certain places or situations, depression, headaches or stomach pains.

Acute stress disorder (ASD). The symptoms of ASD are similar to PTSD, but occur within the first month after exposure to trauma. Prompt treatment and appropriate social support can reduce the risk of ASD developing into PTSD.

Adjustment disorders. Adjustment disorders are unhealthy or unhelpful reactions to stressful events or changes in a child’s life. These reactions can be emotional, such as a depressed mood or nervousness, or behavioral, such as misconduct or violating the rights of others.

Reactive attachment disorder (RAD). Children with RAD show limited emotional responses in situations where those are ordinarily expected. This might show a lack of remorse after bad behavior or a lack of response to positive or negative emotional triggers. Children with RAD may not appear to want or need comfort from caregivers. They may not seem to care when a toy is taken away from them.

Disinhibited social engagement disorder (DSED). Children with DSED are unusually open to interactions with strangers. They can be over-eager to form attachments with others, walking up to and even hugging strangers. They may wander off with strangers without checking with their parents or caregiver.

Unclassified and unspecified trauma disorders. Some emotional and behavioral reactions to trauma do not fit in the diagnostic categories above. This category is used for those cases.

What Causes these Disorders and who is at a Higher Risk?

(as described by the Jed Foundation)

The damage of trauma differs depending on the event, stressor or experience that caused it. Here are a few examples:

Emotional Trauma

Emotional trauma is the end result of events or experiences that leave us feeling deeply unsafe and often helpless. It can result from a single event or be part of an ongoing experience, such as chronic abuse, bullying, discrimination or humiliation. While some traumatic experiences may also cause physical harm, like a car accident or a sexual assault, you do not have to sustain a physical injury to experience emotional trauma.

Emotional trauma is recognizable by a persistent sense of unsafety and other challenging emotions such as fear and/or anxiety. It is often accompanied by other physical symptoms as well, such as chronic insomnia, nightmares, and other health issues. The emotional damage from trauma can often be more harmful and harder to recover from than physical injuries since trauma can actually alter the way our brains function, especially when that trauma is chronic.

Complex Trauma

Many traumatic events are one-time events, like a violent attack or a near death experience related to a natural disaster. But trauma can also come from experiencing multiple different kinds of disturbing events. For example, individuals living in natural disaster zones or in chaotic or marginalized neighborhoods are likely to be at increased risk for poverty, displacement, or violence. Often, these situations leave us feeling like we have no control and no ability to escape, and often cause long-lasting effects to our mental health. This is called complex trauma, and it will almost always require therapeutic support to heal.

Secondary Trauma

Trauma doesn’t always involve experiencing a disturbing event ourselves. Being a witness to a traumatic event, such as watching a parent be violently attacked, can also have ongoing effects on our emotional health. This is called secondary trauma.

Causes for these Forms of Trauma

(as described by the Children’s Hospital of Philadelphia)

Physical, sexual or emotional abuse

Physical or emotional neglect

Household violence, substance abuse or mental illness

Parental separation or divorce

Incarceration of a family member

Who can Diagnose these Disorders?

In general, most mental (and many physical) health care professionals should be able to recognize the signs of trauma, if not able to diagnose it. The severity and complexity of the trauma caused by the event(s) will determine the level of care you will need. Treatment can begin with a General Practitioner and then progress through referral to other mental and behavioral health care professionals.

Treatment of the Disorders

(as described by the American Psychological Association)

Strongly Recommended

Four interventions are strongly recommended, all of which are variations of cognitive behavioral therapy (CBT). The category of CBT encompasses various types and elements of treatment used by cognitive behavioral therapists, while Cognitive Processing Therapy, Cognitive Therapy and Prolonged Exposure are all more specialized treatments that focus on particular aspects of CBT interventions.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy focuses on the relationships among thoughts, feelings and behaviors; targets current problems and symptoms; and focuses on changing patterns of behaviors, thoughts and feelings that lead to difficulties in functioning.

Cognitive Processing Therapy (CPT)

Cognitive processing therapy is a specific type of cognitive behavioral therapy that helps patients learn how to modify and challenge unhelpful beliefs related to the trauma.

Cognitive Therapy

Derived from cognitive behavioral therapy, cognitive therapy entails modifying the pessimistic evaluations and memories of trauma, with the goal of interrupting the disturbing behavioral and/or thought patterns that have been interfering in the person’s daily life.

Prolonged Exposure

Prolonged exposure is a specific type of cognitive behavioral therapy that teaches individuals to gradually approach trauma-related memories, feelings and situations. By facing what has been avoided, a person presumably learns that the trauma-related memories and cues are not dangerous and do not need to be avoided.

Conditionally Recommended

Three psychotherapies and four medications are conditionally recommended. Interventions that received a conditional recommendation all have evidence that indicates that they can lead to good treatment outcomes; however, the evidence may not be as strong, or the balance of treatment benefits and possible harms may be less favorable, or the intervention may be less applicable across treatment settings or subgroups of individuals with PTSD. Additional research may lead to a change in the strength of recommendations in future guidelines.

Brief Eclectic Psychotherapy

Brief eclectic psychotherapy combines elements of cognitive behavioral therapy with a psychodynamic approach. It focuses on changing the emotions of shame and guilt and emphasizes the relationship between the patient and therapist.

Eye Movement Desensitization and Reprocessing (EMDR) Therapy

A structured therapy that encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements), which is associated with a reduction in the vividness and emotion associated with the trauma memories.

Narrative Exposure Therapy (NET)

Narrative exposure therapy helps individuals establish a coherent life narrative in which to contextualize traumatic experiences. It is known for its use in group treatment for refugees.

Medications

Four medications received a conditional recommendation for use in the treatment of PTSD: sertraline (Zoloft), paroxetine (Aropax, Paxil, Pexeva, Seroxat, Sereupin and Brisdelle), fluoxetine (Prozac) and venlafaxine (Vensir, Vencarm, Venlalix, Efexor, Venlablue).