What are trauma-related disorders and stressors?

Summary of the mental disorders included in this diagnostic category.

Trauma and stress-related disorders are a relatively new category in the DSM. 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.

Next we will see more in detail this category of so long title, in addition to its history and which disorders compose it.

Disorders related to trauma and stress factors: characteristics.

The disorders related to traumas and stress factors are a set of mental alterations in which exposure to a traumatic or highly stressful event is one of its main diagnostic criteria..

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

A traumatic factor, on the other hand, is any event that can cause serious damage to the physical and emotional integrity of a person. serious harm to the physical and psychological integrity of the person, whether in the form of a threat of death or injury.The traumatic factor is any event that can cause serious damage to the physical and psychological integrity of the person, whether in the form of a death threat, serious harm, sexual violence, either in the person him/herself or 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 severe that they can leave the person marked for life. On the economic side, trauma-related disorders and stressors involve large expenditures for state institutions and companies, as sufferers claim long-term sick leave and disability pensions.

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

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

History

Since the publication of the fifth edition of the DSM (2013), disorders related to trauma and stress factors have their own specific section, being formally separated from anxiety disorders, and affirming themselves as one of the major groups of psychiatric disorders.

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

They can also be found, in part, in the section on personality disorders in the same ICD-10. There, the existence of so-called persistent personality transformations after catastrophic experience (PPT)The most common type of traumatic personality disorder, in which the aftereffects of a traumatizing event are so devastating that they manifest themselves decades after exposure to the traumatic event. In order to be diagnosed, the event must have been so extreme that personal vulnerability is not required to account for the profound effect on the personality.

Main disorders in this category

The following are the main disorders that make up the category of disorders related to trauma and stressors.

1. Reactive attachment disorder (RAD)

Reactive attachment disorder (RAD) emerges at about the age of 5 years, having as its main feature distorted and underdeveloped social relatedness in most contexts. in most contexts.

Among the general characteristics that can be found in this disorder are poor social or emotional reactions to others, very limited expressions of positive affect, and episodes of irritability, sadness or fear without apparent cause or reason.

Children who manifest stress disorder have been victims of some extreme pattern of insufficient care at some point in their lives. Whether due to neglect or social deprivation, they have not had their basic emotional needs metThis has prevented the child from growing up feeling secure.

2. Disinhibited Social Relationship Disorder

Disinhibited social relationship disorder also manifests itself in children. The child shows an indiscriminate sociability or lack of selectivity when choosing figures with whom they become attached.

Children with this disorder show overly familiar verbal or physical behavior with people who are not part of their close circle, in addition to seeking affectionate contact with strangers. For example, they are overly familiar with strangers, asking for things and showing affection.

What is curious is that they have little or no recourse to their usual adult caregiver, i.e., their own mother, father or guardian in charge of their care.

This disorder could be considered the uninhibited version of reactive attachment disorder, having similar origins in its occurrence.having a similar origin in its occurrence. Children who manifest this disorder have not been able to develop a secure attachment during their early childhood, so they develop different strategies to cope with different deficiencies or threatening situations.

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, with a prevalence of between 1 and 3.5% in the world. between 1 and 3.5% prevalence worldwide..

This disorder is especially high among the military and other people whose profession involves a high risk of exposure to traumatic events, such as police officers, emergency health personnel and firefighters, as well as victims of terrorist attacks, sexual violence and natural disasters, or witnessing them.

PTSD PTSD is associated with high rates of social, occupational and physical difficultiesPTSD is associated with high rates of social, occupational and physical difficulties, as well as high economic costs and increased use of medical services.

Among the most prominent causes of this disorder are:

• 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 outside observer of oneself.
• Derealization: feeling that the world one lives in is unreal.

4. Acute stress disorder

This disorder is characterized by the appearance of a set of anxiety symptoms that occur after having anxiety symptoms that occur after having been exposed to a highly traumatic event..

These alterations last more than two days, up to a maximum of four weeks, and appear in the first month after the traumatic event. If these four weeks are exceeded, a 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.
• Problems falling asleep.
• Avoidance behaviors of people or places related to the trauma.

One of the differences with respect to PTSD is that the disorder of acute stress is of early beginningthat is to say, it begins to be felt soon after being exposed to the traumatic event.

5. Adjustment disorder

Adjustment disorder is a symptomatic manifestation resulting from a clear and definite stressful event, with a duration of three months after the traumatic event.It lasts for three months after the occurrence of the event, but cannot be classified as PTSD.

In order to be diagnosed, there must have been an extremely high level of discomfort, very disproportionate to what would be expected how a person without the disorder would react to the same stressful event, and which implies a deterioration in the occupational and social area.

There are several subtypes, including adjustment disorder with:

• Depressive mood: hopelessness and sadness.
• Anxiety: nervousness, agitation and fear.
• Anxiety associated with depressive mood: combination of the above.
• Antisocial: aggressiveness and impulsivity.
• Mixed emotional and antisocial: combination of sadness and fear with aggressiveness.

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

6. Other specified and unspecified trauma-related disorders and stressors

This category is used to refer to disorders in which symptoms characteristic of disorders related to trauma and stress factors predominate, causing clinically significant distress as well as social, occupational and economic impairment, but which do not meet the diagnostic criteria sufficient 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). Trauma-related disorders and stress factors in the Psychiatric Medical Expert Board of the Spanish Military Health. Sanidad Militar, 72(2), 116-124.