Trauma and Stressor Related Disorders - Research Paper Example

Trauma and Stressor Related Disorders By Content Introduction Trauma and Stress-related Disorders Adjustment Disorder Disinhibited social reaction disorder Reactive attachment disorder Post-traumatic stress disorder Acute stress disorder Depersonalization Disorder Abstract Trauma and Stressor-Related Disorders are among the most common human disorders as the concepts of suffering, stress, and traumatic emotional and physical experience are inseparable from human life. Oddly enough, this direction of mental disorders still lacks accurate definitions and concrete symptoms. American Psychological Association strives to define the basic characteristics of trauma and stressor-related disorders enriching existing symptomatic criteria and deleting redundant. As for now it is possible to distinguish such stressor-related disorders as Adjustment Disorder, disinhibited social reaction disorder, and reactive attachment disorder. The subgroup of trauma-related disorders includes Post-traumatic stress disorder, Acute stress disorder, and Depersonalization Disorder. In this paper I will outline major differences between these disorders and describe the symptoms and the peculiarities of each of them. I will pay attention to the treatment of trauma-and stressor-related disorders as well. Trauma and stressor-related disorders are defined basing on the duration of the symptoms and the nature of the disorder. Traumatic events are usually connected to physical violation, terror, horror or threaten to life and are prolonged in timing. Such traumas discredit basic trust in human relationships and disrupt human personality evolution (Wheeler, 2010). These traumas and stresses are not necessarily connected to such outstanding human experiences as wars or sever catastrophes; they are often related to interpersonal traumatic events, sexual and psychological abuse, negligence, unexpected loss. Now there is more information about long-term effects of trauma, and there is knowledge about effective treatment, however, people who need this treatment sometimes neglect important symptoms. This can lead to mental disorder progression and worsening. The disorders which were stipulated by prolonged stresses and traumatic events are referred to the category of “Trauma and Stressor-Related Disorders”. According to APA diagnostic classification DSM-5 stressor-related disorders include Adjustment Disorder (AD), disinhibited social engagement disorder, and Reactive Attachment Disorder. The category of trauma related disorders includes Acute Stress Disorders, complex posttraumatic Stress Disorder, Depersonalization Disorder, and Posttraumatic Stress Disorder (PTSD). According to Friedman et al. uniting these disorders into subgroups allows specialists to see the difference between normal distress and acute exalted stresses pointing to AD or even more serious PTSD (2011). Stress as a complex psychological and physiological reaction of organism to the stressor is stipulated by a number of inner and outer factors. The mechanism of stressor-related disorder was explained by chemical factors. Excessive glucocortiod was named as the primarily cause of prolonged stress, insufficient amount of the hormone may as well cause this symptom. This reaction may be connected to immune system limiting activation of glucocorticoids. Raison and Miller state that “stress-related neuropsychiatric disorders were also associated with immune system activation/inflammation, high SNS tone, and CRH hypersecretion, which are all consistent with insufficient glucocorticoid-mediated regulation of stress hyperresponsiveness”(2004). Adjustment Disorder was distinguished into separate category in DSM-III. The diagnosis can be made if patients experience emotional distress and anxiety in response to stressful event but the symptoms described are not sufficient for diagnosing PTSD (Black & Grant, 2014). The stress factor is clear and identifiable in case of Adjustment Disorder. The stress prevails much an expected reaction. And leads to work or academic impairment persistent for more than three months. These factors are considered to be the main symptoms of AD (Diagnostic Criteria, 2014).The symptoms of AD can be emotional or behavioral, such as depression, anxiety and other. One of the important moments of this diagnosis is that AD is reaction of psyche to distress, thus, as soon as the stressing factor disappears the symptoms should not remain for more than six months (Black & Grant, 2014). Disinhibited social reaction disorder and reactive Attachment Disorder have much in common as the first one was differentiated only in the fifth edition of DSM as a subdivision of the second. As the disorder is prevalent among children, one of the most striking symptoms of disinhibited stress disorder is seeing no difference between close family and strange adults and treating all in the same way. The disorder is explained by severe negligence at early age. Children with this rear mental disorders are prone to contact with strangers easily even after pre-school years (when this behavior is perceived as normal). Nevertheless, relationships with other children seem to lack depth (Black & Grant, 2014).Problems with language skills, stereotypes are the consequences of severe negligence in early childhood. Among the symptoms of this disorder there are absence of reticence in interaction with adults and increased familiarity towards strangers in verbal and physical behavior, which cannot be explained by impulsivity (Black & Grant, 2014). According to Grohol, reactive attachment disorder has a number of significant differences in symptoms and treatment. It resembles “internalizing disorders” as children suffer from poorly developed attachment relationships with parents or primary caregivers (2014).Impaired contact between a child and his primary caregivers is regarded as a basic explanation and symptom of this mental disorder. This means that the child after nine months is incapable of creating attachment to an adult figure, he/she does not seek for care when distressed and does not respond to comfort. Another criterion include minimal emotional relation to the others, unexplained irritability or sadness. Separate attention should be paid to the quality of care of the children as it is one of the pathogenic factors of this mental disorder. If kids lacked basic comfort, affection, and stimulation or were raised in inappropriate conditions with frequent change of caregivers they are more likely to suffer from reactive attachment disorder. This criterion require a lot of information for a child and parents about first years of life which is sometimes difficult to retrieve (Black & Grant, 2014). As for trauma-related disorders it is necessary to define the concept of trauma first of all. Probably all the people have experience of trauma; nevertheless, when it comes to diagnostics it is important to have accurate definition in mind. According to the APA classification DSM-IV (1994) trauma is regarded as “actual or threatened death or serious injury, or a threat to the physical integrity of self or others”. However, some researchers claim that the concept of trauma must be broadened as traumatic events may include other negative events such as divorce or harassment at the workplace (Beck & Sloan, 2010). Post-traumatic stress disorder is one of the most serious and the most common trauma-related disorders. It can be experienced by people of different age and gender. Women are prone to get PTSD after sexual assault or physical violence while men usually become victims of military related traumas. The symptoms mostly appear in a short period after traumatic event but can also be postponed in time (Black & Grant, 2014). The intensity of the symptoms can vary greatly according to life periods, in more stressful times the symptoms might get acute form. Post-traumatic stress disorder is a serious mental condition which is a result of exposure to a single event or repeating traumatic situations such as, for example, exposure to unnatural death, injury, sexual violence, threat of death. These events are not a usual or normally experienced by all the people. In a fifth edition of DSM these mental disorders undergoes substantial changes (Grohol, 2014). Language stipulating was excluded from the disorder criterion as it turned out to be inutile for diagnostics. Moreover, it was stated that not all the people with PTSD have such reactions as fear, anxiety or horror. Some people especially those whose profession presupposes emotional traumas and who are trained to treat them in a trivial way turned out to be less susceptive to stressor-related and trauma-related disorders (Grant & Black, 2014). Among the significant symptoms of PTSD APA distinguishes exposure to serious traumatic event, such as death, serious injury or sexual violence or witnessing death, injury of a close person is a leading criterion. For instance, if a person finds out that the close person died naturally or became a witness of such a death it cannot be considered as a symptom. PTSD has several important characteristics which help to differentiate it from other disorders. Patients with PTSD are prone to re-experience the traumatic events by recalling the scenes, having dreams and flashbacks on this topic. These recollections and dreams are intrusive and involuntary, and the patient cannot control their intensity. Related sounds or objects can serve as an impetus to going through traumatic memories (Black & Grant, 2014) Emotional problems, such as self-destructive and suicidal behavior, aggression outbreaks; sleeping problems are also considered as the symptoms of PTSD. Patients with this mental disorder are tend to avoid disturbing memories and sometimes have certain gaps in memory. They deny talking about the problem or having it at all, they usually avoid visual images that can bring to memory traumatic events. On the other hand, patients may have amnesia connected to the traumatic events. Recurrent mood switches of the patients can go from self-accusation and guilt to emotional withdrawal and emptiness (Grohol, 2014). Patients can behave aggressively in physical or verbal way towards others. Post-traumatic stress disorder can be efficiently compared to acute stress disorder as they have traumatic experience as a common source. Acute stress disorder can be explained as a shocking state after experiencing certain traumatic events, such as witnessing death, severe injury or threat to physical integrity. In order to reveal acute stress disorder in patient it is important to make sure that intensive fear and horror was the result of traumatic event witnessing. Most important, dissociative symptoms make possible to differentiate PTSD from acute stress disorder. They include sense of numbness, emotional blurring or detachment (Black & Grant, 2014). People with ASD can experience loss of touch with reality, loss of identity. The patients with acute stress disorder also have recurrent intrusive memories, flashbacks and dreams that cannot be controlled in time and intensity. Again, following the symptoms of PTSD patients with ASD are prone to avoid images, sounds, objects that can trigger associations, recollections, and flashbacks. Their emotional state is characterized by fluctuations (Mental Disorders Symptoms, 2014). Clear indications of anxiety symptoms such as problems with sleeping, high level of irritability, problems with concentration, restless motor motions also serve as an important criterion for distinguishing ASD. Patients with this mental disorder, however, suffer less from perspective of time, the symptoms have to pursue up to four weeks from traumatic event. The disturbance and anxiety cause serious social, academic or working impairment. Patients may experience difficulty with telling about this disorder to their relatives (Black & Grant, 2014). Depersonalization Disorder can be diagnosed when a person feels emotionally detached from himself/herself and has no control of his/her body. It is another disorder in trauma-related subcategory. The person experiences his/her feelings as not belonging to him/her, a perception of reality reminds a dream. Depersonalization Disorders leads to inability of a patient to perform his academic, social, and professional tasks on a normal level. As this mental disorder can serve as a symptom of Schizophrenia, Acute Stress Disorder or Dissociative Disorder, it is necessary to make sure that the symptoms are limited to the mentioned above (Mental Disorders Symptoms, 2014). According to Beck and Sloan, treatment of stressor and trauma-related disorders should be directed on helping the patient gaining control over overwhelming emotions. Counseling can have a form of personal meetings or group discussions of traumatic experience. It depends on the type of disorder; thus, patients with PTSD are reluctant to bringing their experience to attention. It is important to build trustful relationships with the patient, as people suffering from such disorders are prone to remain detached and sensitive to traumatic experience (2012). The clinician should guarantee safety, attention, and deep concern. When treating children or adolescents, it is important to invite parents or primary caregivers as they give necessary support for the child and are valuable in proving information. It is necessary to respect already existing relationships between a child and a caregiver. Counseling must help the patient to elaborate certain defensive mechanisms against intrusive memories and emotions. Moreover, it is important to seek for personal combination of psychotherapy and medication prescriptions. Cognitive therapy is perfect for those suffering from trauma-related disorders since it allows altering unpleasant emotions and memories, which are harmful for psyche. Exposure therapy is more radical as it presupposes recurrent discussion of the same experience until it becomes insignificant and does not involve emotional outbreaks. This kind of counseling requires preparation and readiness from a patient (Foa et al., 2012). Medication treatment presupposes hormone production levels correction which will help the patients to cope with depression and anxiety. Medication therapy consists of SSR (selective serotonin reuptake inhibitors) which are a type of antidepressant medicine (Beck & Sloan, 2012). Stressor and trauma-related disorders are subdivided into special subgroups according to DSM-5 classification. Stressor-related disorders include Adjustment Disorder (AD), disinhibited social engagement disorder, and Reactive Attachment Disorder. The category of trauma related disorders includes Acute Stress Disorders, complex posttraumatic Stress Disorder, Depersonalization Disorder, and Posttraumatic Stress Disorder (PTSD). The disorders of stress-related subgroup have stress factor as a common symptom for diagnostics. For trauma-related disorders the prevalence of traumatic experience is crucial for defining any of the mentioned disorders. For treatment of almost all the disorders counseling is combined with antidepressants medicine prescription. References Beck, J. & Sloan, D. (2012). The Oxford handbook of traumatic stress disorders. Oxford: Oxford University Press Black, D. & Grant, J. (2014). DSM-5 Guidebook: The Essential Companion to the Diagnostic and Statistical manual of mental disorders. Fifth Edition. Arlington: American Psychiatric Publishing. Diagnostic Criteria for Mental Disorders. Mental Disorders. Retrieved from: http://behavenet.com Foa, E., Kean, T., Friedman, M., & Cohen, J. (2009). Effective treatment for PTSD. New York: The Guilford Press. Friedman MJ, Resick PA, Bryant RA, Brewin CR. Considering PTSD for DSM-5. Depress Anxiety (2011)28:750–6910.1002/da.20767  Grohol, J. (2014). DSM-5 Changes: PTSD, Trauma & Stress-Related Disorders. Psych Central Professional. Retrieved from: http://pro.psychcentral.com/dsm-5-changes-ptsd-trauma-stress-related-disorders/004406.html Raison, C. & Miller, A. (2004). When Not Enough Is Too Much: The Role of Insufficient Glucocorticoid Signaling in the Pathophysiology of Stress-Related Disorders, American Journal of Psychiatry, American Journal of Psychiatry, 160, 1554-1565 Wheeler, K. (2010). Trauma, Stressor-related, and Dissociative Disorders. Evolve. Retrieved from: http://www.elsevieradvantage.com/samplechapters/9781455753581/Sample%20Chapter.pdf Read More