Topic 4: TRAUMA AND STRESS-RELATED DISORDERS
Learning Objectives:
• You should be able to evaluate the effects of stress.
• Identify and describe the stages of general adaptation syndrome.
• Evaluate evidence on the relationship between life changes and psychological and physical health.
• Identify psychological factors that moderate the effects of stress.
• Define the concept of adjustment disorder and describe the key features of this disorder.
• Describe the key features of acute stress disorder and posttraumatic stress disorder.
• Describe ways of understanding and treating PTSD.
What is Stress?
Stress is the person’s biological and psychological response to adjustive demands from the environment.
Categories of Stressors:
1. Conflict- is the presence of two or more incompatible needs.
❑ Types of Conflict:
a. Approach-avoidance conflict- occurs when there is one goal or event that has both positive and negative effects
or characteristics that make the goal unappealing and appealing simultaneously. E.g. marriage
b. Double-approach conflict- choice between two or more desirable goals. E.g. Where to study? Which cell phone
brand do I choose?
c. Double-avoidance conflict- choice between undesirable alternatives (If you don’t have any desirable choice so
you just choose from whatever is available.)
2. Pressure- a force that requires one to speed up, intensify effort, or change the direction of behavior. E.g. time,
demands, deadlines.
3. Frustration- occurs when a person’s strivings toward a goal are blocked or by the absence of an appropriate goal.
Trauma and Stressor-Related Disorders
▪ DSM-5 consolidates a group of formerly disparate disorders that all develop after a relatively
stressful life event, often an extremely stressful or traumatic life event.
▪ This set of disorders—trauma and stressor-related disorders—include attachment disorders in
childhood following inadequate or abusive childrearing practices, adjustment disorders characterized
by persistent anxiety and depression following a stressful life event, and reactions to trauma such as
posttraumatic stress disorder and acute stress disorder.
POSTTRAUMATIC STRESS DISORDER
▪ DSM-5 describes the setting event for PTSD as exposure to a traumatic event during which an individual
experiences or witnesses death or threatened death, actual or threatened serious injury, or actual or threatened
sexual violation.
▪ Victims re-experience the event through memories and nightmares.
➢ When memories occur suddenly, accompanied by strong emotion, and the victims find themselves re-living the
event, they are having a flashback.
▪ Victims most often avoid anything that reminds them of the trauma.
▪ They are sometimes unable to remember certain aspects of the event. It is possible that victims unconsciously
attempt to avoid the experience of emotion itself, like people with panic disorder, because intense emotions could
bring back memories of the trauma.
▪ Victims typically are chronically over aroused, easily startled, and quick to anger.
▪ New to DSM-5 is the addition of “reckless or self-destructive behavior” under the PTSD E criteria as one sign of
increased arousal and reactivity.
▪ Also new to DSM-5 is the addition of a “dissociative” subtype describing victims who do not necessarily
react with the re-experiencing or hyper-arousal, characteristic of PTSD.
▪ Since many individuals experience strong reactions to stressful events that typically disappear within a
month, the diagnosis of PTSD cannot be made until at least one month after the occurrence of the
traumatic event.
▪ In PTSD with delayed onset, individuals show few or no symptoms immediately or for months after a
trauma, but at least 6 months later, and perhaps years afterward develop full-blown PTSD.
▪ As we noted, PTSD cannot be diagnosed until a month after the trauma. In DSM-IV a disorder called
acute stress disorder was introduced. This is really PTSD, or something very much like it, occurring within
the first month after the trauma, but the different name emphasizes the severe reaction that some
people have immediately.
***Refer to your DSM 5 for the diagnostic criteria of PTSD.
Statistics
▪ In the population as a whole, surveys indicate that 6.8% have experienced PTSD at some point in their life.
▪ The highest rates are associated with experiences of rape; being held captive, tortured, or kidnapped; or
being badly assaulted.
▪ What accounts for the discrepancies between the low rate of PTSD in citizens who endured bombing and
shelling in London and Beirut and the relatively high rate in victims of assaultive violence? Close exposure to
the trauma seems to be necessary to developing this disorder.
▪ Since a diagnosis of PTSD predicts suicidal attempts independently of any other problem, such as alcohol
abuse, every case should be taken very seriously.
Causes
▪ We know that intensity of exposure to assaultive violence contributes to the etiology of PTSD but does not account
for all of it.
▪ A family history of anxiety suggests a generalized biological vulnerability for PTSD.
▪ Nevertheless, as with other disorders, there is little or no evidence that genes directly cause PTSD.
▪ While all experienced the same traumatic experience, specific characteristics of what is referred to as the serotonin
transporter gene involving two short alleles (SS) described as increasing the probability of becoming depressed.
▪ Breslau, Davis, and Andreski demonstrated among a random sample of 1,200 individuals that characteristics such as a
tendency to be anxious, as well as factors such as minimal education, predict exposure to traumatic events in the first
place and therefore an increased risk for PTSD.
▪ Family instability is one factor that may instill a sense that the world is an uncontrollable, potentially dangerous place.
▪ The results from a number of studies are consistent in showing that, if you have a strong and supportive group
of people around you, it is much less likely you will develop PTSD after a trauma.
▪ Positive coping strategies involving active problem solving seemed to be protective, whereas becoming angry
and placing blame on others were associated with higher levels of PTSD.
▪ A number of studies show that support from loved ones reduces cortisol secretion and hypothalamic–
pituitary–adrenocortical (HPA) axis activity in children during stress
▪ It seems clear that PTSD involves a number of neurobiological systems, particularly elevated or restricted
corticotropin-releasing factor (CRF), which indicates heightened activity in the HPA axis.
Treatment
▪ In psychoanalytic therapy, reliving emotional trauma to relieve emotional suffering is called catharsis.
▪ Unlike the object of a specific phobia, a traumatic event is difficult to recreate, and few therapists want to try.
Therefore, imaginal exposure, in which the content of the trauma and the emotions associated with it are
worked through systematically, has been used for decades under a variety of names.
▪ At present, the most common strategy to achieve this purpose with adolescents or adults is to work with the
victim to develop a narrative of the traumatic experience that is then reviewed extensively in therapy.
▪ Cognitive therapy to correct negative assumptions about the trauma—such as blaming oneself in some way,
feeling guilty, or both—is often part of treatment.
▪ Some of the drugs, such as SSRIs (e.g., Prozac and Paxil), that are effective for anxiety disorders in general
have been shown to be helpful for PTSD, perhaps because they relieve the severe anxiety and panic attacks so
prominent in this disorder.
ADJUSTMENT DISORDER
▪ Adjustment disorders describe anxious or depressive reactions to life stress that are generally milder
than one would see in acute stress disorder or PTSD but are nevertheless impairing in terms of
interfering with work or school performance, interpersonal relationships, or other areas of living.
➢ The stressful events themselves would not be considered traumatic but it is clear that the individual
is nevertheless unable to cope with the demands of the situation and some intervention is typically
required.
➢ If the symptoms persist for more than six months after the removal of the stress or its consequences,
the adjustment disorder would be considered “chronic”
REACTIVE ATTACHMENT DISORDER
▪ Attachment disorders refers to disturbed and developmentally inappropriate behaviors in children, emerging
before five years of age, in which the child is unable or unwilling to form normal attachment relationships with
caregiving adults.
➢ These seriously maladaptive patterns are due to inadequate or abusive child-rearing practices.
➢ In either case the result is a failure to meet the child’s basic emotional needs for affection, comfort, or even
providing for the basic necessities of daily living.
▪ In reactive attachment disorder the child will very seldom seek out a caregiver for protection, support, and
nurturance and will seldom respond to offers from caregivers to provide this kind of care.
➢ Generally, they would evidence lack of responsiveness, limited positive affect, and additional heightened
emotionality, such as fearfulness and intense sadness.
▪ In disinhibited social engagement disorder, a similar set of child rearing circumstances— perhaps including
early persistent harsh punishment—would result in a pattern of behavior in which the child shows no inhibitions
whatsoever to approaching adults.
➢ Such a child might engage in inappropriately intimate behavior by showing a willingness to immediately
accompany an unfamiliar adult figure somewhere without first checking back with a caregiver.
Chapter Summary
• Stress is the person’s biological and psychological response to adjustive demands from the environment.
• Conflict is the presence of two or more incompatible needs.
• Frustration occurs when a person’s strivings toward a goal are blocked or by the absence of an
appropriate goal.
• Approach-avoidance conflict occurs when there is one goal or event that has both positive and negative
effects or characteristics that make the goal unappealing and appealing simultaneously.
• Trauma and Stress-Related Disorders are sets of disorders—trauma and stressor-related disorders—
include attachment disorders in childhood following inadequate or abusive childrearing practices,
adjustment disorders characterized by persistent anxiety and depression following a stressful life event, and
reactions to trauma such as posttraumatic stress disorder and acute stress disorder.
• In the population as a whole, surveys indicate that 6.8% have experienced PTSD at some point in their life.
• Adjustment disorders describe anxious or depressive reactions to life stress that are generally milder than
one would see in acute stress disorder or PTSD but are nevertheless impairing in terms of interfering with
work or school performance, interpersonal relationships, or other areas of living.
• Attachment disorders refers to disturbed and developmentally inappropriate behaviors in children,
emerging before five years of age, in which the child is unable or unwilling to form normal attachment
relationships with caregiving adults.
