Trauma and stressor-related disorders consist of disorders caused by exposure to traumatic and stressful events. They include post-traumatic stress disorder (PTSD), acute stress disorder (ASD), and adjustment disorders (AD). It is identified that the classification of trauma and stressor-related disorders immediately after traumatic events is a challenging exercise. Thus, lack of early intervention strategies may lead to non-developed efficacy of any early interventions to victims who do not exhibit PTSD symptoms.
The main focus of this essay is on PTSD and ASD as they have received the most attention regarding their proper psychiatric diagnosis, treatment, and management.
Trauma and stressor-related disorders represent a new rubric for the formerly identified anxiety and traumatic disorders. Even though they are historically related to combat situations, the exposure to traumatic and stressful situations could trigger associated symptoms. Traumatic events are possible causes of psychological darkness and are disastrous to human life. This spurs the motivation to identify and develop effective early interventions that reduce trauma and stressor-related disorders burden to both individuals and the society.
Conventionally, stress-induced disorders were put in the category of anxiety disorders. However, a new category (DSM-5) was created to fit into such disorders (American Psychiatric Association). One of the major issues leading to re-classification was the absence of anxiety symptoms in a number of cases, particularly in children. However, these disorders could present symptoms similar to other psychiatric conditions.
This paper will briefly analyze the treatment and management of trauma and stressor-related disorders with more emphasis on post-traumatic stress disorder (PTDS) and acute stress disorder (ASD).
Overview of Trauma and Stressor-Related Disorders in DSM-5
The classification of psychiatric disorders into DSM-5 has allowed their standardization and determination of individual psychopathology. DSM-5 conditions are characterized by shock that is experienced directly (American Psychiatric Association). These are stressful events which include transitions in life such as accidents, pregnancy or death of loved ones. PTSD and ASD were separated from anxiety disorders to form a new chapter “trauma and stressor-related disorders”, which has stricter diagnosis criterion as compared to the former DSM-IV (Möller).
The classification of “trauma and stressor-related disorders” is centered upon PTSD with an inclusion of a preschool type for young children and dissociative nature. Additionally, this category accommodates short-lived manifestations to traumatic and stressful events which are manifested in ASD. ASD is an adjustment disorder with similar features to PTSD and elements associated with anxiety and depression (American Psychiatric Association).
Post-Traumatic Stress Disorder (PTSD)
According to the American Psychiatric Association Diagnostic and Statistical Manual, version IV, PTSD develops after an extremely traumatic stressor (American Psychiatric Association). It is grouped as a major psychiatric disorder the occurrence of which is linked to the aftermath of the exposure to a traumatic event. Its symptoms are characterized with nightmares, distressing thoughts of past events, hyperarousal symptoms, sleep disturbance and emotional detachment from people. Therefore, PTSD onset point can be recognized as symptoms exhibiting themselves shortly after the exposure to a traumatic event.
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The prevalence of PTSD is more in the adult population as compared to young populations. Additionally, it is more prevalent among women as compared to males.
Acute Stress Disorder (ASD)
ASD involves emotional numbing and re-occurrence of stress through dreams or the prevention of motivation that leads to recalling the traumatic event. It is paramount to note that the symptoms are similar to those exhibited in PTSD but are shorter.
PTSD and ASD Diagnosis Criteria
- -PTSD diagnosis is guided by a number of satisfaction criteria that is determined by the mechanisms of symptoms presented after exposure to a traumatic event. This includes:
- -Constant re-experiencing of the event. This leads to physical imbalances in persons leading to injury of either self or others. Exposure of victims is direct and firsthand through facing the event directly including its details and not through third parties. Among the children population, the nature of exposure could not mean something to an adult.
- -Constant avoidance of reminders associated with the event. Manifestations are through regular disturbing of unconscious memories characterized with nightmares and reminders of traumatic events which may cause prolonged physiological effects.
- -Negative changes in cognitive and mood related elements related to the event. Persistent efforts to avoid thoughts or feelings related to traumatic events.
- -Increased stimulation involving at least two negative changes in mood and cognition. Symptoms are characterized with distorted negative beliefs about self and surroundings, continuous negative events related to the event, feelings of detachments from others, inability to express themselves and amnesia associated with head injuries or substance abuse.
- -Persistent symptoms for not less than a month involving at least two provocative behaviors associated with self-destruction, irritability, sleep disturbance and altered concentration.
- -Symptoms exhibit significant clinical distress.
- -Distress is not caused by any medical condition or substance abuse.
- -The presence of dissociative symptoms should be followed by depersonalization or derealization (American Psychiatric Association).
ASD diagnosis criteria are similar to PTSD, but the manifestations appear for a shorter time. Between two days to four weeks, victims present symptoms associated with depressing mood alteration and persistent arousal.
Treatment and Management of PTSD and ASD
The treatment of trauma and stressor-related disorders usually require the combination of pharmacological and non-pharmacological intervention therapies. Pharmacological methods are used to alleviate physiological symptoms by allowing the continuation of psychotherapy. Other common applied intervention techniques include cognitive therapy, exposure therapy, psychodynamic psychotherapy, eye movement desensitization and reprocessing, and inoculation training (Bisson & Andrew). Most of the treatment approaches employed aim at alleviating acute stress responses by eliminating them through delayed stress reactions.
Psychological intervention methods are intended to help victims to openly express their feelings by assessing traumatic experiences. However, the use of psychological approach is surrounded with a number of problems. According to Bryant, the major issue concerning the psychological method of treating PTSD symptoms is the harmonized element that presumes all trauma survivors are in need of assistance. While it may be true that all victims exposed to traumatic experience are more prone to stressors, the stress responses as well as the ability to retain or let go traumatic situation differs among people. The initial weeks following a traumatic exposure are characterized with high numbers of stress reactions, which reduce with time as stress responses are diminishing. Realistically, most people undergoing a traumatic event gradually recover as time elapses. With such cases presenting themselves, it is evidently true that there is a need for early interventions to traumatic events, but the uniformity of the interventions questions the ability to regain positive treatment to all clients.
The effectiveness of psychological interventions towards the treatment of ASD is questionable as the diagnostic and statistical manual of mental disorders (DSM – IV) provides for the diagnosis of PTSD at least one month after a trauma. The manual draws a distinguishing line between ASD and PTSD by creating a time frame distinction and emphasizing on disassociated trauma reactions. While ASD symptoms are manifested within a period of two to four weeks, PTSD can only be diagnosed after four weeks. Most ASD cases gradually develop to PTSD, an element that encourages focusing on earlier interventions to the latter.
Cognitive behavioral technique (CBT) is one of the main methods which have proven efficient in treating chronic PTSD. The technique involves the application of psycho-education, cognitive restructuring, exposure and management of anxiety with the aim of improving anxiety management skills while assisting victims to master fear and reduce levels of arousal. Research studies conducted by Sijbrandij revealed the effectiveness of CBT in accelerating the initial recovery of PTSD symptoms, depression, and anxiety after a week of intervention.
Pilot studies conducted to establish pharmacological effectiveness have yielded positive fruits as blocking sympathetic arousal of neuro-chemicals reduce the development of certain PTSD symptoms associated with fear conditioning (Ostrowski & Delahanty). Pharmacological techniques explain the possible genesis of PTSD as a neural sensitization and fear conditioning disorder.
Theoretically, traumatic events lead to unconditioned responses which subside with time. However, few people develop strong conditioned responses resulting in the release of stress neurochemicals in the cortex. To reduce the effects, pharmacological interventions aimed at blocking adrenaline enhancement have showed reduced PTSD levels. Based on these findings, the application of pharmacological preventive measures through the use of propranolol b-receptor focuses on reducing sympathetic arousal which, in turn, reduces leading factors of the condition such as fear (Ostrowski & Delahanty).
Psychotherapy is the standard treatment used in managing ASD, especially among children. While debriefing is used to reduce stress, its effectiveness in preventing depression and anxiety is minimal, as it has a possibility of increasing arousal of traumatized survivors. CBT is effective in reducing the likelihood of PTSD among ASD patients. In addition, pharmacologic therapy is used to reduced hyperarousal and insomnia.
Cognitive models indicate that trauma and stressor-related disorders emanate from differentiated trauma responses transiting from acute stress reactions depending on how people handle and manage their stress and memories of trauma over a period. From the discussion, it is clearly evident that the models suggest that stress disorders arise from negative judgments resulting from traumatic events. The development of pharmacological interventions is indeed an essential element in the biological field. However, the groupings of people with trauma and stressor-related disorders or relevant symptoms vary widely depending on their exhibited shock profiles. As a result, differential treatment and diagnosis complicate the intervention.
The classification of trauma and stressor-related disorders patients immediately after traumatic events has so far proved to be a difficult exercise. This presents a challenge to early intervention strategies that may lead to non-developed efficacy of any early interventions to victims who do not exhibit PTSD symptoms. The treatment of PTSD and ASD is surrounded with a number of challenges that might be solved through tailor-made intervention strategies that fit particular individual rather than classifying survivors.