THEME 02
Trauma and Stressor Related Disorderss
Acute and Posttraumatic Stress Disorders
The presence of psychological distress which usually follows the exposure to such a traumatic or
stressful event typically manifests as symptoms of anhedonia (loss of experiencing pleasure),
dysphoria (a state of feeling sad, unwell or unhappy), externalising angry and aggressive symptoms,
or dissoclative symptoms, in addition to the typical presence of anxiety- and fear-based symptoms.
This combination of anxiety, dissociative, depressive, aggressive, angry, and fear based symptoms
has therefore baffled clinicians for many years, and stress and trauma related disorders were thus
relegated to a wide spectrum of different DSM categories. This heterogeneous group of symptoms
has also been recognised in the Adjustment Disorders, Reactive Attachment Disorder and Disinhibited
Social Engagement Disorder. In the case of Reactive Attachment Disorder and Disinhibited Social
Engagement Disorder, social neglect was found to be the common etiological foundation for traumatic
experiences in children below the age of 5. Social neglect of children can lead to either internalising,
depressive, withdrawn behaviour, as depicted in Reactive Attachment Disorder, or Disinhiblting and
Externalising behaviour, as depicted in Disinhibited Social Engagement Disorder.
DSM-5 dlagnostic criteria for Acute Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the
following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing in person the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of
actual or threatened death of a family member or friend, the event(s) must have been violent or
accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)
B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion,
negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic
event(s) occurred:
Intruslon Symptoms
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic events.
Note: In children repetitive play may occur in which themes or aspects of the traumatic event(s) are
expressed.
2. Recurrent distressing dreams in which the content and/or effect of the dream are related to the
traumatic event(s).
Note: In chlldren, there may be frightening dreams without recognizable content.
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic
event(s) were recurring.
Note: In chlldren, trauma-specific re-enactment may occur in play.
4. Intense or prolonged psychological distress or marked physiological reactions in response to
internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Negatlve Mood
5. Persistent inability to experience positive emotions.
Dissociative Symptoms
6. An altered sense of reality of one's surroundings or oneself.
7. Inability to remember an important aspect of the traumatic event(s) typically due to dissociative
amnesia and not to other factors such as head injury, alcohol, or drugs).
Avoldance Symptoms
8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the
traumatic event(s).
Trauma and Stressor Related Disorderss
Acute and Posttraumatic Stress Disorders
The presence of psychological distress which usually follows the exposure to such a traumatic or
stressful event typically manifests as symptoms of anhedonia (loss of experiencing pleasure),
dysphoria (a state of feeling sad, unwell or unhappy), externalising angry and aggressive symptoms,
or dissoclative symptoms, in addition to the typical presence of anxiety- and fear-based symptoms.
This combination of anxiety, dissociative, depressive, aggressive, angry, and fear based symptoms
has therefore baffled clinicians for many years, and stress and trauma related disorders were thus
relegated to a wide spectrum of different DSM categories. This heterogeneous group of symptoms
has also been recognised in the Adjustment Disorders, Reactive Attachment Disorder and Disinhibited
Social Engagement Disorder. In the case of Reactive Attachment Disorder and Disinhibited Social
Engagement Disorder, social neglect was found to be the common etiological foundation for traumatic
experiences in children below the age of 5. Social neglect of children can lead to either internalising,
depressive, withdrawn behaviour, as depicted in Reactive Attachment Disorder, or Disinhiblting and
Externalising behaviour, as depicted in Disinhibited Social Engagement Disorder.
DSM-5 dlagnostic criteria for Acute Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the
following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing in person the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of
actual or threatened death of a family member or friend, the event(s) must have been violent or
accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)
B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion,
negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic
event(s) occurred:
Intruslon Symptoms
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic events.
Note: In children repetitive play may occur in which themes or aspects of the traumatic event(s) are
expressed.
2. Recurrent distressing dreams in which the content and/or effect of the dream are related to the
traumatic event(s).
Note: In chlldren, there may be frightening dreams without recognizable content.
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic
event(s) were recurring.
Note: In chlldren, trauma-specific re-enactment may occur in play.
4. Intense or prolonged psychological distress or marked physiological reactions in response to
internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Negatlve Mood
5. Persistent inability to experience positive emotions.
Dissociative Symptoms
6. An altered sense of reality of one's surroundings or oneself.
7. Inability to remember an important aspect of the traumatic event(s) typically due to dissociative
amnesia and not to other factors such as head injury, alcohol, or drugs).
Avoldance Symptoms
8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the
traumatic event(s).
