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Trauma- and stressor-related disorders: Clinical
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A 25-year-old single white man comes to the emergency department after having what he describes as a "mental breakdown." His past medical history is significant for generalized anxiety disorder for which he is prescribed a selective serotonin re-uptake inhibitor. He is a third-year graduate student studying chemistry, and his anxiety is centered on school performance. Recently he has struggled at school, which has led him to feel down over the past few weeks. He started to sleep more, put on 10 pounds in the past 2 months and began smoking marijuana daily. He has been hearing voices and reports that he cannot “take it anymore”. He admits that he attempted suicide via overdose three weeks prior. He would not contract for safety and is admitted to the psychiatric unit. Which of the following most likely places the patient at the greatest risk for a successful suicide attempt?
Everyone experiences trauma at some point in their lives, and most of the time, with support from loved ones - people are able to recover.
But in individuals with trauma and stressor-related disorders like post-traumatic stress disorder, these experiences lead to symptoms like flashbacks and nightmares, hypervigilance, and aggressiveness - all of which can profoundly impact their life in a negative way.
Trauma and stressor-related disorders are thought to be caused by a combination of genetics, biological factors, and environmental factors.
The genetic link is based on the fact that those with a family history of mental issues tend to develop the disorders more frequently.
Biological factors include high levels of stress hormones like adrenaline and cortisol, even in the absence of stressful situations.
Environmental factors include things like family neglect in early childhood or jobs with high trauma exposure like being a fire-fighter or soldier. That’s because repeated trauma increases the risk of trauma and stressor-related conditions.
Trauma can be thought of as an overwhelming amount of stress that exceeds one’s ability to cope or process the emotions involved with that experience.
A traumatic event can involve one or repeated experiences over time.
For example, the experiences include things like serious road accidents, poverty, neglect in early childhood, military combat, and sexual abuse.
Psychological distress following a traumatic event most commonly causes anhedonia or lost interest in activities that were once enjoyable and a decreased ability to feel pleasure, dysphoria or a profound state of unease or dissatisfaction, externalized anger or aggression, and dissociative symptoms such as detachment from reality or self.
Most individuals develop depression, anxiety, and have problems with substance abuse which is often a way to self-medicate symptoms.
For diagnosis, the symptoms should cause distress and prevent individuals from functioning properly in all areas of life, including at school, work, and in social situations.
According to DSM-5, the group includes seven conditions: posttraumatic stress disorder or PTSD, acute stress disorder, adjustment disorders, reactive attachment disorder, disinhibited social engagement disorder, and the last two are other specified and unspecified trauma and stressor-related disorder - diagnoses which are reserved for symptoms that don't fit any of the main sleep disorders.
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