INTRODUCTION

Trauma disorders are grouped together in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as trauma- and stressor-related disorders. These disorders are similar to each other in that they are all caused, triggered, or worsened by a traumatic event or experience.

Trauma disorders cause fear, extreme anxiety, stress, depression, and other negative emotions. They may even cause nightmares and flashbacks. A trauma disorder also affects a person’s behaviors and may cause anger, violent outbursts, social withdrawal, loss of interest in activities, and many other negative repercussions, such as loss of work and relationships. Trauma disorders are manageable and can be overcome with consistent, professional treatment.

These traumatic and stressful experiences can include exposure to physical or emotional violence or pain, including abuse, neglect or family conflict. Observing a parent being treated violently, for example, can be a traumatic experience, as can being the victim of violence or abuse. Stressors such as parental separation or divorce or even more severe stressors such as emotional or physical neglect can cause problems when they are prolonged or not addressed by caring adults. Even a move or the birth of a sibling can be a stressor that can cause significant difficulties for some children.

Traumatic events—such as an accident, assault, military combat or natural disaster—can have lasting effects on a person’s mental health. While many people will have short term responses to life-threatening events, some will develop longer term symptoms that can lead to a diagnosis of Posttraumatic Stress Disorder (PTSD). PTSD symptoms often co-exist with other conditions such as substance use disorders, depression and anxiety. A comprehensive medical evaluation resulting in an individualized treatment plan is optimal.

TYPES OF TRAUMA DISORDERS:

There are several types of trauma disorders, all characterized by the fact that some type of trauma is an underlying cause. Trauma is an subjective experience, so while one event may be easy for one person to cope with, it can be very traumatic for another. Examples of trauma include abuse, neglect, witnessing violence, losing a loved one, a car accident, or sexual assault. The DSM-5 includes criteria for five distinct trauma- and stressor-related disorders:

• Post-Traumatic Stress Disorder (PTSD). PTSD is a disorder that develops after a traumatic experience, such as witnessing a murder or being assaulted. It causes flashbacks, nightmares, fear, and avoidance of anything reminiscent of the trauma. PTSD can cause significant impairment in a person’s life.
• Acute Stress Disorder (ASD). ASD is similar to PTSD, and it is also triggered by trauma. The reaction to trauma in ASD is sudden and much briefer than in PTSD. It may last between a few days and one month, while the symptoms of PTSD persist for more than a month.
• Adjustment Disorders (AD). Adjustment disorders cause excessive reactions to stressful or difficult experiences, like a death in the family or loss of a relationship. The stress in response to such a situation is greater than what would be expected and indicates a poor ability to cope. There are six types of AD, each characterized by dominant symptoms: anxiety, depression, anxiety and depression together, inappropriate behaviors, inappropriate behaviors with depression and anxiety, and unspecified.
• Reactive Attachment Disorder (RAD). RAD occurs rarely but is seen in children who fail to develop a healthy attachment to a parent or caregiver. This occurs when the child’s needs aren’t met. This neglect is a type of trauma. Babies or children with RAD may be withdrawn, sad, afraid, listless, and unengaged with others.
• Disinhibited Social Engagement Disorder (DSED). Similar to RAD, this is an attachment disorder that affects children who have been neglected or otherwise traumatized. The symptoms are less severe than RAD, but DSED does make it difficult for a child to develop relationships or to engage in appropriate ways.
• Other and Unspecified Trauma- and Stressor-Related Disorders. A psychiatrist may diagnose someone as having other or unspecified disorders in this category if the person has some but not all the symptoms of one of the specific condition, or if there is not enough information to make a more specific diagnosis.

SYMPTOMS

Each type of trauma disorder causes unique symptoms and has a list of criteria from the DSM-5 that is used to make a diagnosis. However, these related conditions cause many symptoms and characteristic signs that are similar across each different type:

• Flashbacks, intrusive thoughts, nightmares
• Avoiding any reminders of trauma
• Depression and hopelessness
• Extreme anxiety and fear
• A feeling of being overwhelmed
• Loss of interest in once-enjoyed activities
• Withdrawal from friends, family, and social events
• Emotional numbness and difficulty feeling pleasure
• Difficulty sleeping
• Lack of appetite
• Angry or violent outbursts
• Trouble concentrating or thinking
• An exaggerated startle response, being on edge constantly
• Impulsive behaviors
• Difficulty engaging with others or forming relationships
• Suicidal thoughts and behaviors

CAUSES

While most mental illnesses have no definite or single cause, trauma disorders can almost always be traced to one or more traumatic experiences. For instance, many men and women returning from active service in the military experienced or witnessed traumatic events, and in some of them these experiences trigger PTSD later.

Not everyone who experiences trauma will develop a trauma disorder. Two people may experience or witness the same trauma, and one may develop a disorder while the other does not. Why this happens is not fully understood, but there are risk factors that make some people more prone to trauma disorders:

• Having another mental illness
• Having experienced trauma previously, especially in childhood
• Misusing substances
• Lacking good social support
• A family history of mental illnesses of any type
• Experiencing multiple stressful events at the same time

DIAGNOSIS

Symptoms of PTSD usually begin within three months after experiencing or being exposed to a traumatic event. Occasionally, symptoms may emerge years afterward. For a diagnosis of PTSD, symptoms must last more than one month. Symptoms of depression, anxiety or substance use often accompany PTSD.

TREATMENT

Though PTSD cannot be cured, it can be treated and managed in several ways.

• Psychotherapy, such as cognitive processing therapy or group therapy
• Medications
• Self-management strategies, such as self-soothing and mindfulness, are helpful to ground a person and bring her back to reality after a flashback
• Service animals, especially dogs, can help soothe some of the symptoms of PTSD