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Trauma- and stress-related disorders: Pathology review

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Questions

USMLE® Step 1 style questions USMLE

0 of 3 complete

A 23-year-old woman comes to her primary care physician to evaluate recurrent nightmares. The patient was sexually assaulted two weeks ago, and since that time, reports recurrent nightmares surrounding the event. She states, “Ever since the incident, I can’t return to campus. The thought of being back at school after what happened is unbearable.” The patient avoids thinking about the incident and feels depressed, irritable, and distracted throughout the day. The patient has not had any suicidal ideation or thoughts. The patient has no past medical history. Which of the following is the most likely diagnosis?  

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Content Reviewers

Antonella Melani, MD

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.

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. 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.

Summary

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 negligence 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 selective norepinephrine reuptake inhibitors (SNRIs).

Sources

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