Trauma & Stress Related Disorders

By - Neeri batra
What is Trauma ?

Trauma is an emotional response to a terrible event like an accident, rape, or natural

disaster. Immediately after the event, shock and denial are typical. Longer term reactions
include unpredictable emotions, flashbacks,strained relationships, and even physical
symptoms like headaches or nausea. While these feelings are normal, some people have
difficulty moving on with their lives.
Trauma is a pervasive problem. It results from exposure to an incident or series of events that are emotionally disturbing or
life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, and/or
spiritual well-being.

Experiences that may be traumatic include:

1. Physical, sexual, and emotional abuse

2. Childhood neglect

3. Living with a family member with mental health or substance use disorders

4. Sudden, unexplained separation from a loved one

5. Poverty

6. Racism, discrimination, and oppression

7. Violence in the community, war, or terrorism

 Symptoms
Intrusive thoughts and memories: After a traumatic event, it is common to experience some intrusive thoughts and memories of
the traumatic event. This is especially likely to occur when you encounter something (for example, a person, place, or image) that
reminds you of the traumatic event.

Hypervigilance: It is also very natural to feel more on-guard and aware of your surroundings after a traumatic event. This is
actually a very protective symptom as your body is attempting to keep you safe by making you more aware of potential sources of
threat and danger. This natural safety mechanism is going to be more sensitive following a traumatic event.

Hyperarousal: Just as you are going to likely be more on-guard, you are also likely going to feel more on edge following a
traumatic event. This is again part of your body's natural protection system. Fear and anxiety tell us that there is some kind of
danger present, and all the bodily sensations that go along with fear and anxiety are essentially designed to help us respond to that
danger. They are preparing us to flee, freeze, or to fight. Following a traumatic event, your body's alarm system is going to be more
sensitive in an attempt to protect you from future traumatic events.

Feeling unsafe: After a traumatic event, our assumptions about the world being a safe and secure place are understandably
shattered. Consequently, people may feel as though any situation or place is potentially dangerous. Places or situations you once
felt secure in may now feel threatening and be anxiety-provoking. This is especially likely to occur in situations or places that
remind you of your traumatic event.
 "Normal" Trauma Response vs. PTSD

what is a "normal" symptom versus an "abnormal" symptom of trauma?

Post-traumatic stress disorder
(PTSD) is a mental health condition
that's triggered by a terrifying event —
either experiencing it or witnessing it.
Symptoms may include flashbacks,
nightmares and severe anxiety, as well
as uncontrollable thoughts about the
event.
Symptoms that are at risk of PTSD -
Loss of interest: It is important to keep an eye out for a loss of interest in activities that you used to once enjoy,
as well as feelings of being detached from others. This symptom can be a sign that you are at risk of becoming
depressed. This symptom may also cause you to isolate yourself from others, including important sources of
social support.

Avoidance: After a traumatic event, it is very common to avoid certain situations, activities, or people. However,
you must pay attention to avoidance behaviors. Avoidance usually leads to more avoidance as it reinforces the
belief that the world is not a safe place. This avoidance can then lead to a worsening of symptoms and eventually
PTSD.

Unhealthy coping behaviors: Just as avoidance of activities, situations, or people can be problematic, so can the
avoidance of thoughts and feelings. The symptoms people experience after a traumatic event can be very
distressing. As a result, people may rely on unhealthy coping strategies (for example, using substances) as a way
of avoiding these symptoms. Avoidance is only a short-term solution, and in the long-run, it can actually cause
your feelings and thoughts to become more intense.
Intrusive memories

Symptoms of intrusive memories may include:

● Recurrent, unwanted distressing memories of the traumatic event

● Reliving the traumatic event as if it were happening again (flashbacks)

● Upsetting dreams or nightmares about the traumatic event

● Severe emotional distress or physical reactions to something that reminds you of the traumatic event
Negative changes in thinking and mood

Symptoms of negative changes in thinking and mood may include:

● Hopelessness about the future

● Memory problems, including not remembering important aspects of the traumatic event

● Difficulty maintaining close relationships

● Feeling detached from family and friends

● Lack of interest in activities you once enjoyed

● Difficulty experiencing positive emotions

● Feeling emotionally numb

● Negative thoughts about yourself, other people or the world

Changes in physical and emotional reactions

Symptoms of changes in physical and emotional reactions (also called arousal symptoms) may include:

● Being easily startled or frightened

● Always being on guard for danger

● Self-destructive behavior, such as drinking too much or driving too fast

● Trouble sleeping

● Trouble concentrating

● Irritability, angry outbursts or aggressive behavior

● Overwhelming guilt or shame

For children 6 years old and younger, signs and symptoms may also include:

● Re-enacting the traumatic event or aspects of the traumatic event through play

● Frightening dreams that may or may not include aspects of the traumatic event
 Case Studies
Case Study 1 Case Study 2

Sam grew up in a supportive family. Sam was Charley grew up in a violent household where Mum and
successful at school and had many friends. Whilst at Dad had violent arguments on a regular basis which
university Sam experienced a physical assault at a sometimes turned physical. Charley had some friends at
party, which led to a hospital admission. Since then, school but found it hard to concentrate in lessons and so
Sam has become anxious and feels threatened around was often called disruptive by teachers. Charley’s
other people. Sam no longer attends university and is current relationship is verbally violent with insults and
unable to find work. Sam has flashbacks and is swearing at each other the basis of how they
constantly vigilant when away from home. Sam has not communicate.
told anyone about these feelings due to feelings of
shame and self-blame. Charley has police cautions for fighting and is described
by some people as an angry person.
Sam’s parents say Sam has become moody, snappy,
and lazy.
How to understand Trauma ?

Case Study 1 -
During the assault Sam’s survival system took over choosing ‘flight’ mode and Sam’s
memory has been updated to include this traumatic event, meaning the world and the people
in it are not perceived as being as safe as previously. Due to Sam’s shift in perspective, safe
events which would have previously been ignored by the survival system, are now
perceived as potentially threatening and the primitive brain is on high alert whenever Sam is
around crowds of people. The survival system protects Sam by using ‘flight mode to keep
him away from potentially harmful situations and ‘fight’ mode when challenged.
How to understand Trauma ?

Case Study 2 -
For Charley growing up in a hostile household was terrifying.
Small children need stability, safety, and security. The Aggression
in the house made this impossible for Charley. Being afraid so
much of the time has meant Charley’s survival system is easily
triggered and Charley will slip into ‘fight’ mode.
 Case Study 3 -
Victor is a 27-year-old man who comes to you for help at the urging of his fiancée. He was an
infantryman with a local Marine Reserve unit who was honorably discharged in 2014 after serving
two tours of duty in Iraq. His fiancé has told him he has “not been the same” since his second tour
of duty and it is impacting their relationship. Although he offers few details, upon questioning he
reports that he has significant difficulty sleeping, that he “sleeps with one eye open” and, on the
occasions when he falls into a deeper sleep, he has nightmares. He endorses experiencing
several traumatic events during his second tour, but is unwilling to provide specific details – he
tells you he has never spoken with anyone about them and he is not sure he ever will. He spends
much of his time alone because he feels irritable and doesn’t want to snap at people. He reports
to you that he finds it difficult to perform his duties as a security guard because it is boring and
gives him too much time to think. At the same time, he is easily startled by noise and motion and
spends excessive time searching for threats that are never confirmed both when on duty and at
home. He describes having intrusive memories about his traumatic experiences on a daily basis
but he declines to share any details. He also avoids seeing friends from his Reserve unit because
seeing them reminds him of experiences that he does not want to remember.
Symptoms -

● Hypervigilance
● Intrusive Thoughts
● Irritability
● Loss of Interest
● Sleep Difficulties
● Trauma
Diagnosis

Post Traumatic Stress Disorder

Dissociative symptoms

You’ll have three or more of the following dissociative symptoms if you have ASD:

● feeling numb, detached, or being emotionally unresponsive

● a reduced awareness of your surroundings

● derealization, which occurs when your environment seems strange or unreal to you

● depersonalization, which occurs when your thoughts or emotions don’t seem real or don’t seem like they belong to
you.
Acute Stress Disorder

In the weeks after a traumatic event, you may develop an anxiety disorder called
acute stress disorder (ASD). ASD typically occurs within one month of a traumatic
event. It lasts at least three days and can persist for up to one month. People with
ASD have symptoms similar to those seen in post-traumatic stress disorder
(PTSD).

What causes acute stress disorder?

Experiencing, witnessing, or being confronted with one or more traumatic
events can cause ASD. The events create intense fear, horror, or helplessness.
Distress

The symptoms of ASD may cause you distress or disrupt important aspects of
your life, such as your social or work settings. You may have an inability to start
or complete necessary tasks, or an inability to tell others about the traumatic
event.
Case Study
Dylan is a male, 15-year-old high school student, who has recently been involved in a severe car
accident with two of his classmates. On the day of the accident, he was sat in the front passenger
seat, pulling out of a driveway. The accident occurred when a SUV ran a yellow light, and struck the
car on the driver’s side, causing the car to flip once. The driver of the car Dylan was in, was struck
unconscious and Dylan was witness to his friend bleeding out of the wound from his head. Adding to
this shock and stress of the initial accident, was the fear that the car would set alight, especially after
it took a while for all three passengers to escape the car, due to the doors becoming jammed. While it
seems correct to assert that the
car accident that Dylan and his friends were involved in, was the precipitating event leading to the
diagnosis of acute stress disorder, it is important to note that 5 years ago, Dylan did witness the near
drowning of his younger sister and this incident also coincides with the first anniversary of his
grandfathers death.
Diagnosis

Dylan has developed Acute Stress Disorder(ASD), which can be

described as a strand of anxiety/stress disorder, where fear or fear of the
event reoccurring is experienced soon after a traumatic event, which
lasts less than a month.
Adjustment Disorder

ADJUSTMENT DISORDER

To help diagnose an adjustment disorder, established guidelines include:

● Having emotional or behavioral symptoms within three months of a specific stressful

event.

● Having higher-than-expected stress in response to a stressful life event or having stress that
causes a lot of problems in connections with others, or at work or at school.

● Symptoms are not due to another mental health problem or part of the typical grieving
process.
Types of Adjustment Disorders

The guidelines list six types of adjustment disorders:

1. With a depressed mood. Symptoms mainly include feeling sad, tearful and hopeless, very tired, and taking no pleasure in
the things you used to enjoy.

2. With anxiety. Symptoms mainly include nervousness, worry, having a hard time concentrating or remembering things,
and feeling overwhelmed. Children may strongly fear being separated from their parents and loved ones.

3. With mixed anxiety and depressed mood. Symptoms include a blend of depression and anxiety.

4. With disturbed conduct. Symptoms mainly involve behavioral problems, such as fighting or reckless driving. Children
and teenagers may skip school or damage or destroy property.

5. With disturbed emotions and conduct. Symptoms include a mix of depression, anxiety and behavioral problems.
Case Study
Selena recently moved several states away from home to live on campus as a freshman. She grew up in a
tight-knit family in a small, rural community where she had close friends and positive relationships. She’d
chosen this university because it hadn’t seemed overwhelmingly large but now that she’s here, in a new living
situation, surrounded by people she doesn’t know, she feels overwhelmed anyway. Always a straight-A student,
Selena is halfway through the semester and having difficulty with her courses. She had a panic attack right
before a mid-term exam and was referred to counseling by her professor. At the counseling center, she talks to a
therapist about her feelings of sudden depression, anxiety, and the physical symptoms that she can’t explain:
chest pain, fatigue, and frequent headaches. Her therapist explains she is likely having some difficulty adapting
to and coping with all the adjustments she’s experienced (moving, starting college, etc.). After working for a
while with her therapist, learning new coping strategies, and getting more involved in the campus community,
Selena begins to regain confidence. By spring term, her grades are back up and her symptoms have nearly
resolved themselves.