Trauma- and Stressor-Related Disorders

*(DSM-5 Classification)*

A group of psychiatric conditions triggered by exposure to traumatic or stressful events, characterized by dysregulated emotional/behavioral responses.

DSM-5 Disorders in This Category

1. Reactive Attachment Disorder (RAD)

  • Cause: Severe neglect/deprivation in early childhood (<5 years).
  • Symptoms:
    • Emotionally withdrawn (minimal seeking of comfort).
    • Limited positive affect + unexplained irritability/sadness.

2. Disinhibited Social Engagement Disorder (DSED)

  • Cause: Similar to RAD but with different behavioral profile.
  • Symptoms:
    • Overly familiar with strangers (no social boundaries).
    • Lack of checking back with caregivers in unfamiliar settings.

3. Posttraumatic Stress Disorder (PTSD)

  • Trigger: Direct/threatened exposure to death, serious injury, or violence.
  • Symptoms (4 Clusters):
    • Intrusion: Flashbacks, nightmares.
    • Avoidance: Of trauma-related stimuli.
    • Negative Cognitions/Mood: Amnesia, guilt, detachment.
    • Arousal: Hypervigilance, startle response.
  • Subtypes:
    • Preschool: For children <6 years.
    • Dissociative: With prominent depersonalization/derealization.
    • Delayed Expression: Symptoms emerge ≥6 months post-trauma.

4. Acute Stress Disorder (ASD)

  • Duration: 3 days to 1 month post-trauma.
  • Key Feature: Dissociative symptoms (numbing, reduced awareness).
  • Risk: Predicts later PTSD development.

5. Adjustment Disorders

  • Trigger: Identifiable stressor (e.g., divorce, job loss).
  • Symptoms: Emotional/behavioral reactions disproportionate to stressor.
  • Subtypes: With anxiety, depression, or conduct disturbance.

6. Other Specified/Unspecified Trauma Disorders

  • Includes conditions like:
    • Prolonged Grief Disorder (persistent bereavement-related distress).
    • Complex PTSD (proposed for chronic trauma; not in DSM-5 but in ICD-11).

Shared Neurobiological Features

  • Amygdala Hyperactivity: Enhanced fear response.
  • Prefrontal Cortex Hypoactivity: Poor emotional regulation.
  • HPA Axis Dysregulation: Abnormal cortisol levels.

Assessment Tools

  • PTSD Checklist (PCL-5)
  • Childhood Trauma Questionnaire (CTQ)
  • Structured Clinical Interviews (e.g., CAPS-5)

Treatment Approaches

1. Psychotherapy

  • Trauma-Focused CBT (TF-CBT): Gold standard for PTSD (exposure + cognitive restructuring).
  • EMDR: Eye movement desensitization for trauma memories.
  • Attachment Therapy: For RAD/DSED (rebuilding caregiver-child bond).

2. Pharmacotherapy

  • SSRIs (Sertraline, Paroxetine): FDA-approved for PTSD.
  • Prazosin: For trauma-related nightmares.
  • Short-term Benzodiazepines: Avoid in PTSD (risk of worsening symptoms).

3. Emerging Treatments

  • MDMA-Assisted Therapy: For severe PTSD (in clinical trials).
  • Neurofeedback: To regulate hyperarousal.

Differential Diagnosis

ConditionDistinguishing Features
Anxiety DisordersNo required trauma history.
Borderline PDSelf-harm/identity disturbance (vs. PTSD’s focus on trauma).
Psychotic DisordersReality testing intact in PTSD.

Cultural Considerations

  • Expressions of distress: Somatic symptoms common in some cultures.
  • Stigma: May prevent help-seeking (e.g., military, assault survivors).

Prognosis

  • PTSD: 50% recover within 3 months; chronic cases often need long-term care.
  • RAD/DSED: Early intervention critical for attachment repair.

Resource: National Center for PTSD