Trauma- and Stressor-Related Disorders

Post-Traumatic Stress Disorder
PTSD is a disorder that develops after exposure to a traumatic event that involves actual or threatened death or serious injury.

In psychology, trauma is a type of damage to the psyche that occurs as a result of a severely distressing event. Trauma is often the result of an overwhelming amount of stress that exceeds one’s ability to cope or integrate the emotions involved with that experience. A traumatic event can involve one experience or repeated events or experiences over time.

Traumatizing, stressful events can have a long-term impact on mental and physical health. Situations where an individual is exposed to a severely stressful experience involving threat of death, injury, or sexual violence can result in the development of post-traumatic stress disorder (PTSD). With this disorder, the trauma experienced is severe enough to cause stress responses for months or even years after the initial incident. The trauma overwhelms the victim’s ability to cope psychologically, and memories of the event trigger anxiety and physical stress responses, including the release of cortisol. People with PTSD may experience flashbacks, panic attacks and anxiety, and hypervigilance (extreme attunement to stimuli that remind them of the initial incident).


DSM-5 Diagnostic Criteria
To be diagnosed with PTSD according to the DSM-5 (2013), a person must first have been exposed to a traumatic event that involves a loss of physical integrity, or risk of serious injury or death, to self or others. In addition, the person must experience intrusions (persistent re-experiencing of the event through flashbacks, distressing dreams, etc.); avoidance (of stimuli associated with the trauma, talking about the trauma, etc.); negative alterations in cognitions and mood (such as decreased capacity to feel certain feelings or distorted self-blame); and alterations in arousal and reactivity (such as difficulty sleeping, problems with anger or concentration, reckless behavior, or heightened startle response). These symptoms must last for more than 1 month and result in clinically significant distress or impairment in multiple domains of life, such as relationships, work, or other daily functioning.

Not everyone who experiences trauma will develop PTSD: according to the National Center for PTSD, approximately 20% of women and 8% of men who experience a traumatic event will develop PTSD. Rates of PTSD are higher in combat veterans than than the average rate for men, with a rate estimated at up to 20% for veterans returning from Iraq and Afghanistan.

Treatment
A number of psychotherapies have demonstrated usefulness in the treatment of PTSD and other trauma-related problems. Basic counseling practices common to many treatment responses for PTSD include education about the condition and provision of safety and support. The psychotherapy programs with the strongest demonstrated efficacy include cognitive behavioral therapy (CBT), variants of exposure therapy, stress inoculation training (SIT), variants of cognitive therapy (CT), eye movement desensitization and reprocessing (EMDR), and many combinations of these procedures.

Reactive Attachment Disorder

Reactive attachment disorder (RAD) is described in clinical literature as a severe and relatively uncommon disorder that can affect children. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts.

DSM-5 Diagnostic Criteria
In order to be diagnosed with RAD under the DSM-5 criteria, a child under the age of 5 must:

• exhibit emotionally withdrawn and inhibited behaviors in relation to their caregivers (for example, not seeking comfort when they are sad or upset);
• exhibit some kind of emotional or social disturbance (for example, limited responsiveness, lack of positive affect, inexplicable instances of irritability or sadness, etc.); and
• have a history of significant neglect and/or unstable living situations in which they were unable to form stable and secure attachments.

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