Understanding Trauma And Other Stressor-Related Disorders

Trauma affects children and adults in different ways. After experiencing a traumatic event, some people may develop a trauma or stressor-related disorder.

There are several types of trauma and stressor-related disorders that are slightly different in their causes, symptoms, and treatment options.

What are trauma disorders? 

Trauma and stressor-related disorders are a group of emotional and behavioral conditions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 

Trauma and stressor-related disorders can cause: 

• Fear

• Anxiety

• Anger

• Flashbacks

• Other mental health challenges in your personal life and relationships

Around 60% of men and 50% of women will experience some kind of trauma during their lives, although women are more likely to develop.¹

Trauma affects people differently, and not everyone will develop a trauma disorder. Many recover with time by developing healthy coping strategies and reaching out for support, reducing the effects of trauma on their everyday lives. 

Causes of trauma disorders

The underlying cause of trauma disorders is trauma due to a deeply distressing or traumatic event. Trauma is an emotional response where you react with fear, helplessness, or horror. 

Violence, abuse, neglect, witnessing death, and natural disasters are some examples of what can cause trauma, but the specific trauma disorders differ in how they arise. 

You may be more likely to develop a trauma disorder if you:

• Have another mental illness

• Previously experienced trauma 

• Lack good social support 

• Experience more than one stressful or traumatic event simultaneously

• Have a family history of mental illness

• Misuse drugs and other substances 

Types of trauma and stressor-related disorders

There are several types of trauma and stressor-related disorders. 

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) occurs after directly experiencing or witnessing a traumatic event. It can also happen when you learn about a traumatic event happening to a close friend or family member. 

The event can involve actual or threatened death, serious injury, or sexual violence. 

PTSD affects around 8% of people during their lives. 

In PTSD, the stress response that activates during the traumatic event remains switched on even when you’re no longer in danger, causing a range of symptoms,  

The diagnostic criteria involve having all of the following symptoms for at least one month after the traumatic experience. 

There are four main clusters of PTSD symptoms, including:

Re-experiencing symptoms

Re-experiencing symptoms include flashbacks, nightmares, intrusive thoughts, and memories. They are recurrent and involuntary, and triggers include physical, emotional, or sensory reminders from the traumatic experience. 

Avoidance symptoms

If you have PTSD, you may make changes in your life to avoid reminders of the event. This could include avoiding memories, thoughts, or feelings about the event and external reminders such as places, conversations, objects, people, and situations. 

Changes in arousal and reactivity

People with PTSD may always feel tense, have trouble concentrating, or be easily startled and frightened. You may become angry and stressed, have sleep disturbances, be hypervigilant, or display reckless and self-destructive behaviors. These symptoms are often constant. 

Changes in mood and cognition

You may experience memory loss from the traumatic event. It can also affect your mood, causing an inability to experience positive emotions and having negative beliefs about yourself and others. You may also feel guilt or blame for what you went through. 

You may lose interest in things you once enjoyed and feel detached from others. 

Treating PTSD 

Some of the ways medical professionals treat PTSD include:

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) sertraline (Zoloft) and paroxetine (Paxil) are FDA-approved for treating PTSD.

• Anti-anxiety medications 

• Prazosin, which doctors sometimes prescribe for PTSD nightmares 

• Cognitive-behavioral therapy (CBT) teaches techniques to help you understand the connections between thoughts, feelings, and behaviors and how these influence each other. 

• Eye movement desensitization and reprocessing (EMDR) involves practicing exposure therapy while simultaneously making side-to-side eye movements. This helps you process traumatic memories and change how you respond to them. 

• Exposure therapy helps you overcome traumatic situations or memories by gradually facing your traumas in real life or thinking about them.

Complex PTSD

Complex PTSD is an enhanced version of traditional PTSD. It typically occurs after experiencing or witnessing prolonged or repetitive traumatic events. It can also develop after going through a series of single traumatic events one after another. These traumas may include domestic violence, childhood sexual or physical abuse, torture, or slavery. 

Trauma often begins early in a child’s life when they cannot remove themselves from the situation. 

Like PTSD, someone with complex PTSD may develop symptoms such as re-experiencing, avoidance, hyperarousal, reactivity, mood disruption, and cognition symptoms. 

In addition, the International Classification of Diseases, 11th Edition (ICD-11) states there are other main symptoms of complex PTSD, including:

Severe and extensive emotional dysregulation: You may have difficulty controlling your emotions if you have complex PTSD. 

Negative self-cognition: You may have disrupted belief systems and see yourself as diminished and worthless. You may also have feelings of shame, guilt, or failure. 

Interpersonal relational dysfunction: This may include difficulty forming and maintaining healthy and meaningful relationships. You may distrust others, making you feel uncomfortable being close to them.  

Treating complex PTSD 

Medical professionals treat complex PTSD with similar methods to traditional PTSD. This may include medications, CBT, EMDR, and exposure therapy. 

Acute stress disorder

Acute stress disorder (ASD) is similar to PTSD and complex PTSD because it occurs after experiencing or witnessing a highly distressing and traumatic event. 

One specific trauma often causes ASD instead of longer-term exposure to multiple and chronic trauma. 

However, ASD is a much more rapid response to trauma than PTSD. The onset of symptoms is three days, but less than one month after the trauma. In many cases, symptoms arise immediately. 

ASD is usually a transient disorder that resolves. However, it can lead to PTSD without early intervention. 

ASD involves many of the same symptoms as PTSD, such as:

Intrusion/re-experiencing symptoms

These symptoms are similar to PTSD. They may involve distressing memories, repetitive dreams, flashbacks, or prolonged or intense distress in response to triggers. 

Negative mood

If you have ASD, you may have difficulty experiencing positive emotions such as happiness, success, or love. 

Dissociative symptoms

You may experience dissociation, which people commonly describe as feeling like they’re outside their body and watching themselves on autopilot. It can also feel like emotional detachment, and you may feel disconnected from the world around you. 

Avoidance symptoms

You may avoid or suppress your thoughts, feelings, and internal and external reminders of the trauma, such as people, sounds, and places. 

Arousal symptoms

You may experience sleep disturbances, insomnia, irritability, hyperalertness, being easily distracted, and intense reactions to sudden events. 

Treating ASD

Like PTSD and complex PTSD, Doctors can treat ASD with psychotherapies such as CBT and exposure therapy.

Secondhand trauma

Secondhand trauma, also known as vicarious or secondary traumatic stress, develops after you hear about another person’s first-hand trauma. This typically involves repeated or extreme indirect exposure to the trauma. 

Anyone can get secondhand trauma, but it commonly occurs in:

• Mental health providers and social workers 

• People who work in medicine, such as emergency room nurses and physicians, surgeons, oncology nurses, intensive care nurses, and nurse-midwives 

• First responders, such as police officers, firefighters, and paramedics 

Secondhand trauma can involve the same trauma symptoms as first-hand trauma. 

However, the symptoms may vary depending on the direct trauma you’ve experienced previously.

Secondhand trauma can have negative impacts on your personal and professional life. It can lead to emotional depletion, insomnia, and impaired work relationships. 

Treating secondhand trauma 

Studies note that trauma-focused CBT can help you work through secondhand trauma.²

These tips may help you prevent or manage secondhand trauma:

• Take time off work

• Set boundaries and limits

• Reflect on the meaning of your work

• Plan for future instances where a traumatic event may happen again

Reactive attachment disorder

Reactive attachment disorder (RAD) is a rare condition that affects 1–2% of children. It describes the inability of a child to form healthy emotional bonds with their parental figures. 

RAD occurs when caregivers don’t meet the needs of young children between nine months and five years. 

Reasons can include:

• Neglect or abuse

• Removal from their parents after forming an emotional bond 

• Many changes in caregivers (such as living in several foster care homes)

• Experiencing traumatic losses

• Growing up in a setting without a loving parental figure 

Signs of RAD in children include:

• Being withdrawn, sad, fearful, or irritable 

• Not wanting comfort from others

• Showing violence or no response when receiving comfort from others

• Not engaging in social interactions or interactive games 

• Not seeking support or assistance 

• “Breaking rules” by finding things in their environment that they can control 

• Being difficult to discipline or console 

• Fluctuating moods 

RAD can have long-lasting consequences. Without early childhood interventions, it can lead to relationship problems, poor mental and physical health, delays in intellectual development, and substance abuse. 

Treating RAD 

Medical professionals typically treat RAD with:

• Individual or family therapy, such as child-parent psychotherapy 

• Social skills lessons for the child 

• Parenting skills classes to help caregivers learn how to bond with the child 

Disinhibited social engagement disorder

Like RAD, disinhibited social engagement disorder (DSED) occurs in children whose care is inadequate, so they cannot form good emotional connections with others. Social neglect early in life is a crucial contributing factor. 

Children with DSED display behaviors that increase their risk of harm. These behaviors may include:

• Being overly comfortable and familiar with strangers. They may have no fear of approaching or interacting with them.

• Their behavior may be age-inappropriate

• Being willing to leave a safe place with a stranger without hesitation  

• Not checking in with their trusted adult before leaving a safe place 

• Being overly excited to meet or interact with unfamiliar adults or strangers

Treating DSED 

Like RAD, treatment of DSED often uses a family-based approach to strengthen the relationship between the child with DSED and their caregivers. 

Routine and stability in the child’s life are vital when managing and treating DSED. 

Adjustment disorders 

Adjustment disorders (AD) are associated with emotional or behavioral reactions to stressful or difficult experiences. The experienced stress is disproportionate and greater than what would normally be expected from the experience. 

While many people learn how to adjust to significant life changes and stressors, people with AD can have difficulty coping with these stressors. 

Stressors include:

• Moving to a new city or country

• Sudden illness

• Work problems

• The death or serious illness of loved ones

• Money problems

• Divorce

The symptoms of AD typically arise within three months of a stressful event. 

Symptoms lasting less than six months indicate acute AD, whereas symptoms lasting longer than six months and continuing to affect your life are considered chronic AD. 

AD symptoms can vary by subtype, and there may be some overlap. 

The subtypes and associated symptoms of AD are:

Adjustment disorder with depressed mood

If you have this subtype, you may feel hopeless, sad, and cry often. You may not enjoy the things you used to. 

Adjustment disorder with anxiety

This subtype is common in children and may present as separation anxiety. Possible symptoms of this subtype are:

• Feeling nervous, worried, anxious, or overwhelmed

• Problems with concentration or memory

Adjustment disorder with mixed anxiety and depressed mood

Symptoms include a combination of depression and anxiety. 

Adjustment disorder with disturbance of conduct

Disturbance of conduct means that people may show behavioral issues, such as:

• Being rebellious

• Acting reckless

• Destructive tendencies

• Impulsivity

They may violate the rights of others or societal rules and norms. 

Adjustment disorder with mixed disturbance of emotions and conduct

People with this subtype experience depression and anxiety and display the behavioral issues associated with the disturbance of conduct subtypes. 

Adjustment disorder unspecified

This subtype causes physical symptoms, like: 

• Headaches

• Stomach aches

• Body aches

• Heart palpitations

• Insomnia

Treatments

Doctors may treat adjustment disorders with antidepressants or anti-anxiety drugs, depending on your symptoms. However, psychotherapy is the main form of treatment. 

The specific type of psychotherapy that is best suited depends on the subtype of AD. Studies recommend CBT, EMDR, and developing problem-solving techniques and emotional regulation skills.³

Other specified or unspecified trauma and stressor-related disorder 

Sometimes, you may experience a stressful or traumatic event and only have some symptoms that meet the diagnosis criteria for a trauma or stressor-related disorder. 

In these instances, a doctor will diagnose you with a trauma and stressor-related disorder that is either “other specified” or “unspecified.” 

Trauma and stressor-related disorders in children 

RAD and DSED are most common in children. However, children can also experience other trauma and stressor-related disorders, and they often present differently than the symptoms displayed by adults. 

One example is PTSD. A doctor can diagnose a child aged two or above with PTSD. When the child is under six, it is known as PTSD in preschool children in the DSM-5.

A child with PTSD may experience:

• Intrusive and re-experiencing symptoms, such as re-enacting the trauma through play, talking about it often, or being distressed by reminders

• Negative mood and cognition symptoms, such as being socially withdrawn, blaming, or having restricted positive emotions 

• Hyperarousal symptoms, such as having poor concentration, temper outbursts, being reckless or self-destructive, and being easily startled

The lowdown

When trauma impacts your day-to-day life, it may be a sign that you have a trauma or stressor-related disorder. 

Knowing the symptoms of different disorders and how they arise could help you understand that you may need treatment. Early intervention is often preferable since it can prevent symptoms from worsening.

If you think you may have a trauma or stressor-related disorder, reach out to a professional and a trusted friend or family member. You don’t have to go through this alone.