What are trauma and stressor-related disorders?

Trauma and stressor-related disorders They are a relatively recent category in the DSM that refer 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.

• Related article: "Mental health: definition and characteristics according to psychology"

Trauma and stressor-related disorders: characteristics

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

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

On the other hand, a traumatic factor is any event that can cause serious damage to the physical and psychological integrity of the person, already being in the form of a threat of death, serious damage, sexual violence, both in that 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. Economically, trauma- and stressor-related disorders are costly for women. State institutions and companies, given that those who suffer from them request long-term sick leave and pensions for disability.

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

This is why developed countries, especially Western Europe and the United States, have designed and applied programs to reduce the incidence of these disorders and alleviate its consequences.

Story

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

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

They can also be found, in part, in the section on personality disorders of the ICD-10 itself. There the existence of the calls is recognized persistent personality transformations after catastrophic experience (PPT), in which the aftermath of a traumatic event is so devastating that it even manifests 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.

1. Reactive Attachment Disorder (RAD)

Reactive Attachment Disorder (RAD) arises at approximately 5 years of age, having as its main feature a socially distorted and not properly developed ability to relate 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 without cause or reason apparent.

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

2. Disinhibited social relationship disorder

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

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 in 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 he 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 secure type of attachment during their early childhood, with which they develop different strategies to be able to face different deficiencies or situations threatening.

3. 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, finding a prevalence of between 1 and 3.5% in the world.

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

PTSD is associated with high rates of social, occupational and physical difficulties, as well as high economic costs and greater 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: feeling of being an observer external to oneself.
• Derealization: feeling that the world you live in is unreal.

4. 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 those 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 from PTSD is that acute stress disorder is early-onset, that is, it begins to be felt shortly after being exposed to the traumatic event.

• You may be interested: "What is trauma and how does it influence our lives?"

5. Adjustment disorder

Adjustment disorder is a symptomatic manifestation derived from a clear and defined stressful event, with a duration of three months after the occurrence of the same, but that cannot be classified as a PTSD.

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

There are several subtypes, including adjustment disorder with:

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

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

6. Other specified and unspecified stressor and trauma-related disorder

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

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, P.P., Medina Amor, J.L., Gutiérrez Ortega, C., Abejaro de Castro, L.F., Hijazo Vicente, L.F., & Losantos Pascual, R.J.. (2016). Disorders related to trauma and stress factors in the Psychiatric Medical Expert Board of the Spanish Military Health. Military Health, 72 (2), 116-124.