The consequences of traumatic stress

The consequences of traumatic stress

Part of being human is experiencing trauma. Although people have always been interested in the
effects of trauma on an individual, and have expressed that interest through art and literature, the
scientific study of these consequence didnt come into place until the latter part of this century.
Throughout history, people have been exposed to terrible events. Most of them, however, were
able to survive these events without developing psychiatric disorders. Some people have been
able to adapt to these terrible events with flexibility and creativity. Others, however, were not
capable of doing so, and have become fixated on the trauma and gone on to lead traumatized
and traumatizing existences. (Van der Kolk, B., et al., 2007) Although people naturally should
have the capacity to survive and adapt, traumatic experiences can alter peoples psychological,
biological and social equilibrium to such a degree, that the memory of one particular event
comes to taint all other experiences, spoiling appreciation of the present. (Van der Kolk, B., et
al., 2007)
1. What is stress?
The first general definition of stress was given in 1936 by Hans Selye the father of stress:
Stress is the nonspecific response of the body to any demand.
Stress may be perceived in a different way by different people under different conditions. This is
the reason why, according to George Fink, the working definition of stress is: a condition in
which an individual is aroused by an uncontrollable aversive challenge. (2007) Stress leads to a
feeling of fear and anxiety. Depending on the circumstances, the fear response can be either fight
or flight. The magnitude of the stress and its physiological consequences are influenced by the
individuals perception of their ability to cope with the stressor. (Fink, G., 2007)
2. What is trauma?
The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, defines trauma as a
direct personal experience of an event that involves actual or threatened death or serious injury,
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The consequences of traumatic stress

or other threat to ones physical integrity; or witnessing an event that involves death, injury, or a
threat to the physical integrity of another person; or learning about unexpected or violent death,
serious harm, or threat of death or injury experienced by a family member or other close
associate. (DSM-IV, 1994) Trauma causes the person to feel intense fear, helplessness, or horror
(or in children, the response involves disorganized or agitated behavior). (DSM-IV, 1994)
However, since there is still an ongoing debate about whether an event has to satisfy the current
diagnostic definitions of trauma in order to be, in fact, traumatic, dr. John Briere gives a
different definition, stating that an event is traumatic if it is extremely upsetting and at least
temporarily overwhelms the individuals internal resources, taking into account the fact that
some people who experience major threats to psychological integrity can suffer as much as
those traumatized by physical injury or life threat, and can respond equally well () to traumafocused therapies. (Briere, J., 2006) The major types of trauma are: natural disasters, mass
interpersonal violence, large-scale transportation accidents, house or other domestic fires, motor
vehicle accidents, rape and sexual assault, stranger physical assault, partner battery, torture, war,
child abuse, emergency worker exposure to trauma. (Briere, J., 2006)
3. What is the outcome of trauma?
As mentioned before, traumatic experiences can alter peoples psychological, biological and
social equilibrium to a varied intensity, depending on the individuals unique response. At the
higher level of this spectrum of intensity is mental illness.
The 4th edition of the Diagnostic and Statistical Manual of Mental Disorders classifies PostTraumatic Stress Disorder and Acute Stress Disorder - the two most known disorders caused by
traumatic stress - under Anxiety Disorders. However, in the 5th edition of the D.S.M., this chapter
of Anxiety Disorders was split into three different groups, based on recent research done and
growing scientific evidence from neuroimaging, genetic and family studies. The evidence found
by this research shows that these 3 groups represent somewhat independent and distinct
disorders, each characterized by its own specific heritability, risk factors, course, and treatment
response. These are: Anxiety Disorders (characterized by excessive fear and anxiety), Obsessive
Compulsive Disorders (characterized by obsessive thinking and repetitive behaviors) and

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The consequences of traumatic stress

Trauma-and-Stress-Related Disorders (characterized by the presumption of them following
exposure to actual or threatened death, serious injury or sexual violence).
The latter group of disorders encompasses two childhood stress-related disorders: Reactive
Attachment Disorder and Disinhibited Social Engagement Disorder, the two well-known
disorders: Post-Traumatic Stress Disorder and Acute Stress Disorder, and also Adjustment
Disorders. These disorders are the only ones found in the D.S.M.5 that are defined in terms of
their presumed etiology. (Comer, 2013)
4. Reactive Attachment Disorder and Disinhibited Social Engagement Disorder
Reactive Attachment Disorder and Disinhibited Social Engagement Disorder are the two stressrelated disorders that represent childhood. Both of them are characterized by severely disturbed
and developmentally inappropriate patterns of attachment to primary care-givers which are
believed to be directly related to neglect, abuse, insufficient care, separation, or other
emotionally harmful rearing conditions during infancy or early childhood.
5. Post-Traumatic Stress Disorder and Acute Stress Disorder
The essential feature of Post-Traumatic Stress Disorder and Acute Stress Disorder is the
development of the psychological symptoms after the exposure to severe stress or a traumatic
event. The 5th edition of the D.S.M. states that, in order to correctly diagnose these 2 disorders,
the stress must have been exposed to actual or threatened death, serious injury or sexual violence
in one or more of the following ways:

Directly experienced the traumatic event

Personally witnessing the events
Learning of the trauma occurring to a close family or friend
Experiencing repeated or extreme exposure to aversive or traumatic events (policemen,
repeatedly exposed to evidence of child abuse, etc.)

In order to avoid over-diagnosing these diseases, the D.S.M. 5 specifies some characteristics of
the traumatic event that make it not suitable for the diagnosis:

Exposure occurring through electronic media, TV, or pictures

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The consequences of traumatic stress

Learning that person has a life-threatening or debilitating but not traumatic disease (such as
cancer)

The specific symptoms associated with the traumatic events are:

Re-experiencing the traumatic event (intrusive memories, distressing dreams, flashbacks,

dissociative reactions, distress when exposed to stimuli that resemble or symbolize some

aspects of the traumatic event)

Avoidance of stimuli associated with traumatic events (people, places, situations,

conversations, memories, etc.)

Negative changes in cognition and moods (amnesia for important details of traumatic events,

detachment, anhedonia, persistent negative mood)

Changes in arousal and reactivity (hyper vigilance, sleep problems, exaggerated startle
response, concentration problems) (Comer, 2013)

The differences between Post-Traumatic Stress Disorder and Acute Stress Disorder are, most of
all, time-related. Acute Stress Disorder is characterized by the fact that symptoms must begin
within 4 weeks of the traumatic event, and they must last less than 4 weeks. In the case of PostTraumatic Stress Disorder, symptoms persist longer than 4 weeks and they may appear within
hours, days, months or years of the trauma.
Other differences between the two diseases are prognosis-related. It is a well-known fact that the
prognosis of Acute Stress Disorder is much better than the one of Post-Traumatic Stress
Disorder. In the case of the first, the recovery rate is about 90% of individuals meeting criteria
for the diagnosis. The latter, as mentioned before, has a worse prognostic, with the recovery rate
of only 50% within 6 months. Also, about 30% of patients will still report significant symptoms
6 years post-trauma. (Comer, 2013)
There are some risk factors that make certain traumatic events result in disease. These factors
could be:

Temperamental and psychological: prior history of mental health problems or substance

abuse, neuroticism, negative appraisal, inappropriate coping strategies

Environmental:

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The consequences of traumatic stress

o Trauma related: severity of the trauma, perceived life threat, interpersonal injury,
amount of violence
o Personal: poverty, low education, family dysfunction, previous history of trauma,

adverse life events, low social support

Genetic and physiological: being a female, ethnic background, younger age at the trauma (for
adults), increased reactivity as reflected by acoustic startle response

Regarding the treatment of these mental illnesses, there is a variety of options available. First of
all, it is recommended that the person at risk follows immediate therapy and emotional support,
in order to prevent the development of a full-blown P.T.S.D. Other than that, there are a lot of
various therapeutic techniques utilized, depending on the type of trauma, individual
characteristics and coping skills. These include: medication, behavioral exposure techniques
like flooding or trauma desensitization, meditation, eye movement therapy, group therapy and
family therapy.
6. Adjustment Disorders
Adjustment Disorders, the last stress-related disorders included in the D.S.M.5, involve
maladaptive behaviors in response to identifiable common psycho-social stressors, such as
marital difficulties, separation or divorce, finances, work or illness, or related to major life events
such as marriage, first employment or retirement. The characteristic symptoms of Adjustment
Disorders occur within a 3-month period of the onset of the stressor and resolve within 6 months
of its termination. (Comer, 2013)
7. Conclusion
Successful treatment of stress-related disorders includes a process of integration which allows
the trauma to become a part of normal memory, and no longer interfere with an individuals
normal life. (http://psychcentral.com)

8. References:
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The consequences of traumatic stress

American Psychiatric Association (1994). Diagnostic and statistical manual of

mental disorders (4th ed.). Washington, DC: Author.

American Psychiatric Association (2000). Diagnostic and statistical manual of

mental disorders (4th ed.,text rev.). Washington, DC: Author.

American Psychiatric Association. (2014). Diagnostic and statistical manual of

mental disorders (5th ed.).Washington, DC: Author.

Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk
factors for posttraumatic stress disorder in trauma-exposed adults. Journal of

consulting and clinical psychology, 68(5), 748.

Briere, John, (2006) Dissociative Symptoms and Trauma Exposure: Specificity,
Affect Dysregulation, and Posttraumatic Stress. Journal of Nervous & Mental

Disease: February 2006 - Volume 194 - Issue 2 - pp 78-82

Comer, J. R., (2013) Abnormal Psychology Worth Publishers, New York
Fink, G. (2007) Encyclopedia of Stress (Second Edition) - Elsevier Inc.
Margolies, L. (2013). Understanding the Effects of Trauma: Post-traumatic Stress

Disorder (PTSD). Psych Central

Van der Kolk, B. A., McFarlane, A. C., Weisaeth, L. (2007) Traumatic stress. The
Effects of Overwhelming Experience on Mind, Body and Society The Guilford

Press
http://psychcentral.com/lib/understanding-the-effects-of-trauma-post-traumaticstress-disorder-ptsd/

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Stress Idea, research and experience