Trauma and Stress issues

Trauma and stress issues are characterised by emotional and behavioural changes in response to some type of traumatic or stressful event. This category of disorders exists within the spectrum of anxiety disorders and obsessive-compulsive disorders.

Post-traumatic stress disorder (PTSD) 

Post-traumatic stress disorder (PTSD) is a trauma-specific psychiatric disorder. It is an experience that may occur following a subjective experience of trauma whereby a person’s life is threatened in some way. Some examples include combat, witnessing atrocities, natural disasters, violent attacks, and other events where safety and integrity is compromised to a point of perceived fatality.

The main presentation of PTSD is avoidance, such as avoiding the stimulus where the trauma occurs; re-experiencing the event via intrusive thoughts or nightmares; and hypervigilance, such as feeling on edge and quick to react. In making a diagnosis of PTSD, duration, intensity, frequency of symptoms as well as functional impairment are integral.

Treatment depends on the severity of symptoms and how soon they occur after the traumatic event. Treatment may include psychological therapies, such as CBT or a novel form of therapy called Eye-Movement Desensitisation and Reprocessing (EMDR), medication, and self-care. NICE guidelines recommend first line treatment for PTSD as trauma-focused CBT (tf-CBT).

Acute stress disorder

Acute stress disorder is a response to a traumatic experience that typically occurs within one month of a traumatic event. It lasts at least 3 days and can continue for a month. A key feature is exposure to actual or threatened death, serious injury, or sexual violation. There can be associated intrusive distressing memories or dreams of the event, dissociation, low mood, avoidance, hypervigilance, and poor sleep. CBT is recommended as first line treatment for acute stress disorder, and in some instances with short term medication can be useful.

Adjustment disorder

Adjustment disorder differs from acute stress disorder in that the identified stressor can date back to 3 months in the past. The presence of the disorder itself can last up to 6 months. It is characterised by distress that is out of proportion to the severity or intensity of the stressor. This distress then impairs social or occupational functioning. Some common examples of stressors include the ending of a relationship, work difficulties, illness, or natural disasters. Adjustment disorder should be self-limited, although some people find intervention from a counsellor or clinical psychologist to be helpful.