Trauma disorders are mental illnesses that are caused by traumatic experiences or significant stress. Trauma or stress may come from violence or abuse, witnessing violence, being neglected as a child, being in a car accident, losing a loved one, and many other situations that vary by individual. Excessive and persistent reactions to trauma that cause impairment may be diagnosed as post-traumatic stress disorder, acute stress disorder, or adjustment disorder. Treatment through therapy, social support, and lifestyle changes can help an individual recover from trauma and restore function.
What Are Trauma Disorders?
Trauma disorders are mental disorders that include the experience of a traumatic or very stressful event. Not everyone who experiences a great deal of stress or trauma will develop a mental health condition, but for those who do the cause can be traced directly to that situation as a causal factor. Trauma disorders must be treated or they can lead to serious complications ranging from problems at work to social isolation to depression and suicide.
Disorders related to trauma and stress were once classified as types of, or related to, anxiety disorders. That classification has changed, because although experiencing anxiety is common with trauma disorders, there may be other, more prominent emotional symptoms depending on the individual. Someone struggling with a trauma may experience depression, anger, aggression, or anhedonia more so than anxiety.
Types of Trauma Disorders
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorizes trauma disorders under the heading of trauma- and stressor-related disorders. There are five distinct disorders outlined as well as a category for specified or unspecified other disorders that don’t neatly fit the criteria for the other conditions.
- Post-Traumatic Stress Disorder (PTSD). PTSD is triggered by a frightening and traumatic event, which may be directly experienced or witnessed. This condition causes nightmares and flashbacks, obsessive thoughts about the event, and a lot of fear and anxiety. PTSD can cause serious complications, especially when not treated. These include social withdrawal and isolation, depression, substance use disorders, and suicidal behaviors.
- Acute Stress Disorder (ASD). ASD is similar to PTSD, but it occurs between three and 30 days after a traumatic experience. When symptoms persist beyond one month they are typically diagnosed as PTSD. There are also some symptoms that are specific to PTSD, such as becoming withdrawn and having negative thoughts about the world. ASD does not always lead to PTSD, but it is a risk factor.
- Adjustment Disorders. Adjustment disorders are characterized by an abnormal response to stress. Situations like the death of a loved one, having a serious illness, or making a big move can cause stress, but most people adjust within a few months. When a person struggles to adjust and the resulting emotions and behaviors impact relationships and other areas of life, it may be diagnosed as an adjustment disorder.
- Childhood Trauma Disorders. Reactive attachment disorder is a very serious but rare disorder in infants and children that occurs when a child has not formed a healthy attachment to the primary caregiver. It causes withdrawal, listlessness, sadness, fear, and lack of social engagement. Disinhibited social engagement disorder is also caused by poor attachment and occurs in young children. It causes a child to be as comfortable with strangers as with anyone else and a lack of awareness of being safe with a caregiver. This can put a child at risk of being harmed.
Facts and Statistics
Why some people are better able to cope with stress and trauma and can adjust on their own with time while others cannot is not well understood. However, it is known that trauma disorders are not uncommon.
- Examples of trauma include sexual or physical abuse, sexual assault or rape, verbal abuse, witnessing abuse or violence perpetrated on someone else, neglect, vehicle accidents, natural disasters, the loss of a loved one, a serious injury, or being involved in or witnessing active combat in war.
- Approximately half of all Americans will be exposed to trauma at least once in their lives.
- About 19 percent of people who experience trauma develop acute stress disorder.
- Approximately 7.7 million Americans are affected by PTSD.
- Women are twice as likely as men to develop PTSD, and they experience symptoms for a longer period of time.
- Rates of PTSD among veterans include 30 percent in Vietnam veterans, 10 percent in Gulf War veterans, and between 11 and 20 percent in veterans who served in Iraq or Afghanistan.
- Although their prevalence has not been well studied, adjustment disorders are thought to be common.
Symptoms and Diagnosis of Trauma Disorders
The symptoms of trauma and stress disorders that affect adults are similar. PTSD typically causes the most severe and longest-lasting symptoms, while ASD and adjustment disorders are less severe. Symptoms of PTSD can set in within a month of a traumatic event or may not appear for years later. They last longer than a month and cause significant impairment. PTSD symptoms are grouped into four clusters:
- Intrusions: recurring and distressing memories, nightmares, flashbacks
- Avoidance: avoiding situations or people that trigger memories of trauma, and avoiding talking about it
- Negative thoughts or mood: negative thoughts about the world or oneself, hopelessness, lack of positive emotions, lack of interest in activities, emotional numbness, withdrawal from friends and family
- Reactions: startling or scaring easily, difficulty sleeping or concentrating, self-destructive behaviors, being on guard, angry or aggressive outbursts
To be diagnosed with acute stress disorder, the trauma-related symptoms must last between three days and one month. If they persist longer it is not considered ASD but may be diagnosed as PTSD. Another difference between ASD and PTSD is that a diagnosis of PTSD must include at least one symptom from each cluster, while ASD may cause any combination of the symptoms:
- Intrusive memories
- Intense reactions and distress in response to memories of the trauma
- Lack of positive emotions
- Forgetting aspects of the trauma
- Feeling dissociated from one’s self or surroundings
- Avoiding distressing memories
- Avoiding external cues and reminders of trauma
- Difficulty concentrating
- Startling easily
- Difficulty sleeping
To be diagnosed with an adjustment disorder a person must experience symptoms that are severe enough to impair one or more areas of life but that do not meet the criteria for other disorders. The symptoms go beyond what would be an expected reaction to stress or trauma and persist. Symptoms may include sadness, hopelessness, anxiety, difficulty sleeping, feeling overwhelmed, loss of appetite, social withdrawal, avoiding responsibilities, crying a lot, and difficulty functioning normally.
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Causes and Risk Factors
The underlying cause of trauma and stress disorders is an experience or multiple experiences that are traumatic or extremely stressful. The exact event or experience can vary widely depending on the person. Not everyone will respond to trauma or stress in these ways, but there are certain risk factors that can make one person more susceptible than another.
For instance, more severe or multiple traumas can increase the risk of developing a disorder. Having a job that increases the likelihood of trauma, such as being in the military or working as a police officer, is also considered a risk factor. Other risk factors include the presence of other mental illnesses, lack of a good support system, having a family history of trauma disorders, and struggling with drugs or alcohol.
The experience of trauma and actually having a trauma disorder can both increase the risk that a person will have another mental illness or a substance use disorder. Substance use is commonly linked with trauma disorders, because alcohol or drugs may be used as a way to self-medicate or to try to cope with the repercussions of trauma. Other mental illnesses that may precede or result from experiencing trauma include anxiety disorders and depression.
Treatment and Prognosis of Trauma Disorders
Trauma disorders do not get better without treatment, and they can cause significant and harmful complications if not treated. These may include depression, job loss, social dysfunction, and even suicide. Getting diagnosed and getting professional treatment is important. With treatment, someone with a trauma disorder can recover, learn to process and cope with the traumatic memories, and begin to live a normal life again.
Treatment largely involves specialized, trauma-focused therapy, although medications for depression or anxiety may also help some patients. Cognitive behavioral therapy (CBT) is often used to treat trauma disorders. This is a type of therapy that focuses on becoming more aware of triggers, negative emotions, and unhelpful responses, and learning to change them. CBT can also be specialized for trauma, helping patients to face and cope with the experience in more productive ways.
Exposure therapy is used specifically for traumatic disorders and involves helping patients face trauma and bad memories in a safe environment. Avoidance is a major feature for people suffering because of trauma, but facing the memories and learning to cope with them in positive and healthy ways can help the healing process. Another treatment, called eye movement desensitization and reprocessing, combines eye movements with facing traumatic memories to help change them.
With an accurate diagnosis, professional treatment, support from loved ones, dedication to facing bad memories, and lifestyle changes, most people with trauma disorders can recover and have a good prognosis.