Trauma- and stress-related disorders: Pathology review

Definitions & Key takeaways

Trauma- and stress-related disorders are a group of mental health conditions that can occur as a result of exposure to traumatic or stressful events. This group of disorders includes post-traumatic stress disorder (PTSD), acute stress disorder, adjustment disorders, and reactive attachment disorder.

Both PTSD and acute stress disorder can affect individuals who have experienced prolonged traumatic events, especially involving a close family member or friend. Symptoms include recurrent, involuntary, and intrusive memories associated with nightmares or flashbacks; as well as intense psychological distress or physical reactions. People with these two disorders can also present with hypervigilance or hyperarousal; avoidance behavior; and negative alterations in thinking or mood. What differentiates PTSD from acute stress disorder is that in PTSD, the symptoms must last for more than one month, while in acute stress disorder, they should last at least three days but less than one month following the traumatic event.

Next, we have adjustment disorder, which is characterized by emotional or behavioral symptoms in response to a stressor or life change. Symptoms typically develop within three months of a stressful or life-changing event and resolve within six months. There is also reactive attachment disorder, which typically affects infants or young children who don't get attached to their caregivers. The symptoms appear following the lack of adequate care or neglect and are often evident in young children between the age of nine months and five years. Treatment of trauma and stress-related disorders typically includes cognitive behavioral therapy and lifestyle changes. It can also involve medications like selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Chapters:

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Case study0:00–0:33

A 31 year old female named Amelia comes to the mental health clinic complaining of trouble sleeping due to vivid nightmares recounting an armed bank robbery she witnessed 4 months ago.
Ever since that event, she has avoided going to crowded places that remind her of the bank, to the point where she had to give up her job at the mall.
Suddenly, your phone starts ringing and Amelia jumps from her seat. You apologize, and she then mentions that this happens whenever she hears sudden or loud noises.Okay, based on the initial presentation, Amelia seems to have some form of trauma or stress-related disorder.

Pathology0:33–1:57

Many individuals at some point in their lives experience trauma, which can be thought of as a distressing event that causes an overwhelming amount of stress, exceeding one’s ability to cope or process the emotions caused by that experience.
Trauma can be caused by one single event, such as a serious car crash or sexual assault or abuse; or can last for a more prolonged period of time, such as experiencing poverty, neglect during early childhood, or military combat.
Most of the time, with support from loved ones, individuals are able to recover from a traumatic experience. Unfortunately, some individuals may develop trauma and stress-related disorders, where traumatic experiences lead to symptoms like flashbacks, nightmares, and anxiety, all of which can interfere with day-to-day activities like working, studying, eating, and sleeping.
Now, the underlying cause of trauma and stress-related disorders is poorly understood; but what you need to remember is that individuals affected usually have altered levels and response to stress hormones like adrenaline and cortisol.
For your exams, the most high-yield trauma and stress-related disorders are post-traumatic stress disorder, acute stress disorder, and adjustment disorder.

Post- traumatic stress disorder (PTSD)1:57–3:36

Okay, let’s start with post-traumatic stress disorder, or PTSD for short. This usually occurs in individuals who have either directly experienced a traumatic event or witnessed as it happened to others, but it can also affect someone who just heard that a close family member or friend was involved.
In a test question, make sure to also keep an eye out for someone with prolonged or extreme exposure to graphic details of traumatic events, such as a police officer or paramedic, as well as a military veteran.
Now, symptoms of PTSD must last for at least one month and they mainly include recurrent, involuntary, and intrusive memories of the traumatic experience through nightmares or flashbacks.
When exposed to physical or mental reminders of their trauma, these individuals typically experience intense psychological distress or physical reactions, such as sweating and heart palpitations.
For your exams, what’s important to remember is that this may cause them to feel a sense of hypervigilance, meaning that they are constantly on guard, as well as hyperarousal, where they have this exaggerated startle response to the smallest of triggers, such as sudden or loud noises.
Another high yield fact is that individuals with PTSD may start avoiding environments and situations that remind them of their trauma, such as certain places, activities, or even other people.
Finally, thinking and mood might be negatively affected, so individuals may have exaggerated negative beliefs about oneself, others, or the world, like thinking the world is completely dangerous and no one can be trusted; or persistent negative emotions such as fear, distress, or shame.
Moving on to acute stress disorder, this also occurs in individuals who have either directly experienced or witnessed one or repeated traumatic events, or heard about it through a close family member or friend.

Acute stress disorder3:36–4:03

Acute stress disorder causes many of the same trauma-related symptoms as PTSD, but a key difference you need to remember for your exams is that the symptoms only last between 3 days and up to 1 month following the traumatic event.Last but not least, there’s adjustment disorders, which are a group of disorders that occur after an individual goes through a stressful or life-changing event, to which they have a hard time adjusting or coping.

Adjustment disorders4:03–4:55

Now, events can range from a divorce or losing a job to being diagnosed with an illness. Individuals with adjustment disorder typically present with emotional symptoms, such as anxiety, depression, feeling hopeless or powerless, and even suicidal ideation; which can lead to behavioral symptoms, such as an aggressive or rebellious outburst.
Now, keep in mind that, to diagnose an adjustment disorder, these symptoms must develop within 3 months of a known event, and disappear within 6 months after the event has been resolved.
If symptoms persist for more than 6 months, it is diagnosed as generalized anxiety disorder.Now, when it comes to treating trauma and stress-related disorders, there are three main approaches: psychotherapy, lifestyle changes, and medication.

Treatment4:55–6:18

Milder forms of anxiety usually do not require medication. Instead, they can be managed by psychotherapy, including cognitive-behavioral therapy or CBT for short.
This is a type of talk therapy that primarily focuses on teaching the individual strategies to address and cope with negative beliefs, assumptions, or emotions associated with their trauma.
In addition, individuals may benefit from lifestyle changes like having a regular sleep schedule and a healthy diet, as well as meditation, deep-breathing exercises, physical activity, and yoga.If these treatment approaches fail, there are several medications that can help improve symptoms.
Now, first-line medications typically include selective serotonin reuptake inhibitors or SSRIs, such as fluoxetine, paroxetine, sertraline, citalopram, escitalopram, and fluvoxamine; as well as selective norepinephrine reuptake inhibitors or SNRIs, such as venlafaxine, duloxetine and desvenlafaxine.
In addition, prazosin, an alpha-1 blocker, may help with nightmares. Bear in mind that the exception is acute stress disorder, for which there aren’t any indications for medication.All right, as a quick recap.

Review6:18–7:30

Both PTSD and acute stress disorder can occur in individuals who have either directly experienced or witnessed one or prolonged traumatic events, or heard about a traumatic event that involved a close family member or friend.
Symptoms include recurrent, involuntary, and intrusive memories associated with nightmares or flashbacks; as well as intense psychological distress or physical reactions; hypervigilance or hyperarousal; avoidance behavior; and negative alterations in thinking or mood.
What sets PTSD apart from acute stress disorder is that in PTSD, the symptoms must last for more than one month, while in acute stress disorder, they should last at least three days but less than 1 month following the traumatic event.
In adjustment disorders there are emotional or behavioral symptoms that develop within 3 months of a stressful or life-changing event and resolve within 6 months.
Treatment of trauma and stress-related disorders typically includes cognitive behavioral therapy and lifestyle changes. If these treatment options fail, individuals can be treated with medications, such as SSRIs, SNRIs, and less commonly prazosin.

Summary7:30–8:02

Okay, back to our case. Amelia is a 31 year old female that has been experiencing sleep disturbances due to vivid nightmares.
A very important clue here is that her symptoms began four months ago, after witnessing an armed bank robbery. In addition, since then, Amelia has been displaying avoidance behavior related to crowded places that remind her of the traumatic event.
This, along with her hyperarousal symptoms, such as jumping at sudden or loud noises like a phone ringing, make this a pretty straightforward case of post-
Trauma- and stress-related disorders: Video | Osmosis