Trauma - Emotional and Psychological

Definition

Trauma refers to the psychological or physiological response of an individual to a deeply distressing or disturbing event. Such experiences can have long-term effects on both physical and mental health. Trauma typically results in emotional disturbance due to the recollection of a painful incident and often leads to a disrupted sense of safety and security.

As a result, the DSM-5 classifies trauma and stress-related disorders together due to their shared etiology. Individuals experiencing trauma may persistently relive the event and remain in a heightened state of psychological distress

What are the Types of Trauma?

A. Reactive Attachment Disorder:

This disorder is characterized by a consistent pattern of emotionally withdrawn behavior in young children towards their primary caregivers. It typically develops due to a lack of adequate caregiving and can only be diagnosed if symptoms persist for over 12 months.

Diagnosis:

  • A noticeable pattern of emotionally inhibited behavior, where the child seldom seeks or responds to comfort when distressed.
  • Ongoing emotional disturbances reflected in at least two of the following:
  • Persistent irritability or fearfulness inconsistent with normal interactions
  • Limited expression of positive emotions
  • Decreased responsiveness to social interactions
  • The child has experienced insufficient care, evidenced by one or more of the following:
  • Frequent changes in primary caregivers
  • Neglect or denial of basic emotional needs
  • Rearing in socially unusual environments that hinder the development of selective attachments
  • Symptoms must appear before the age of five, and the child must have a developmental age of at least nine months
  • The behavior is not better explained by autism spectrum disorder

B. Disinhibited Social Engagement Disorder:

This disorder involves a pattern of overly familiar or socially inappropriate behavior toward strangers, often resulting from early neglect or a lack of stable attachment relationships. Diagnosis is considered if symptoms are present for more than 12 months.

Diagnosis:

  • Display of at least two of the following behaviors:
  • Inappropriate familiarity in verbal or physical interactions with unfamiliar adults
  • Reduced tendency to check back with caregivers in unfamiliar situations
  • Little hesitation in engaging with strangers or leaving with them
  • Absence of social caution or restraint in new interactions
  • These behaviors are not solely due to impulsivity but reflect broader issues with social boundaries
  • The child must have a developmental age of at least nine months
  • Evidence of insufficient care is required, such as:
  • Repeated changes in caregiving figures
  • Emotional or physical neglect
  • Rearing in settings that inhibit the formation of stable attachments
  • The lack of appropriate care is presumed to be the cause of the disinhibited behavior

C. Post-Traumatic Stress Disorder (PTSD):

PTSD arises after exposure to a traumatic event and is marked by prolonged psychological and physiological distress. It includes symptoms such as flashbacks, intrusive thoughts, avoidance behaviors, and emotional numbing. Read the diagnosis outlined by DSM-5 on PTSD.

D. Adjustment Disorders:

These disorders occur in response to a recent identifiable stressor, with symptoms typically developing within three months of the event. The condition generally resolves within six months of the stressor’s end, although it can last longer depending on whether the condition is acute or chronic. Adjustment disorders are often diagnosed when the individual’s response to a life event—such as the loss of a loved one—exceeds typical expectations of grief.

Diagnosis:

  • Emotional or behavioral symptoms develop within three months of encountering a stressor
  • Symptoms are not better accounted for by another mental disorder or an exacerbation of an existing condition
  • The response is not part of a normal grief process and does not meet the criteria for prolonged grief disorder
  • Clinical significance is indicated by one or both of the following:
  • Marked difficulty in functioning in social, academic, or occupational areas
  • Distress that is excessive in intensity or duration compared to the nature of the stressor
  • Symptoms do not continue for more than six months once the stressor is removed

E. Prolonged Grief Disorder:

This disorder involves an extended and intense grief reaction following the death of a loved one. Individuals experience persistent yearning and frequent thoughts about the deceased, often accompanied by emotional pain, identity disturbances, and feelings of meaninglessness. There is also a heightened risk of suicidal thoughts.

Diagnosis:

  • The individual has lost a close person at least 12 months prior (six months for children and adolescents)
  • Symptoms of prolonged grief are marked by both:
    • Persistent preoccupation with the deceased
    • Intense longing for the person who has died
  • The symptoms impair functioning in key areas of life
  • The grief response is not aligned with cultural or religious norms
  • The symptoms are not better explained by another mental health condition
  • At least three of the following are present:
  • Difficulty accepting the death
  • Intense loneliness
  • Emotional numbness
  • Sense of life being meaningless
  • Loss of a sense of identity
  • Deep emotional pain
  • Trouble returning to daily routines
  • Avoidance of reminders related to the loss

F. Acute Stress Disorder (ASD):

ASD is a trauma-related condition characterized by symptoms that occur between three days and one month following exposure to a traumatic event. Individuals may experience dissociation, intrusive thoughts, emotional numbness, and difficulty processing the event. This condition is observed more frequently in females due to higher rates of trauma exposure.

Diagnosis:

A. Exposure to a traumatic event through one or more of the following:

  • Directly experiencing the trauma
  • Witnessing the trauma
  • Learning of trauma experienced by a close family member or friend
  • Repeated or intense exposure to trauma-related details (e.g., emergency personnel)

B. Presence of at least nine symptoms from the following categories:

  • Intrusive memories, distressing dreams, or flashbacks
  • Difficulty experiencing positive emotions
  • Detachment from self or surroundings, memory gaps
  • Avoidance of trauma-related thoughts, feelings, or reminders
  • Sleep disturbances, irritability, hypervigilance, trouble concentrating, exaggerated startle response

C. Symptoms last for a minimum of three days and do not exceed one month

D. Symptoms significantly impair daily functioning

E. The symptoms are not attributable to medication, substance use, or another mental disorder

Causes

  • Traumatic experiences such as physical, emotional, or sexual abuse
  • Chronic exposure to violence, including in home environments
  • Childhood neglect or household dysfunction
  • Invasive or painful medical procedures without adequate pain relief
  • Witnessing or experiencing natural disasters like floods, earthquakes, or fires

Signs and Symptoms:

  • Recurrent, intrusive thoughts or memories of the trauma
  • Avoidance of situations or cues that trigger recollections
  • Nightmares or flashbacks
  • Heightened alertness or hypervigilance
  • Problems with concentration
  • Emotional numbness
  • Increased irritability
  • Sleep-related difficulties
  • Sense of being constantly on edge
  • Loss of interest in previously enjoyable activities
  • Somatic symptoms such as headaches or stomach aches

Treatment:

Therapeutic Interventions:

  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): This form of therapy is designed to help individuals, particularly children and adolescents, process traumatic experiences and the negative thoughts associated with them. It equips clients with practical coping strategies and promotes healthier emotional expression and communication in response to trauma.
  • Written Expression Therapy: This technique involves clients writing about their traumatic experiences, with a focus on identifying the emotions and behaviors linked to the event. The process aids in confronting distressing memories and helps develop constructive responses to trauma-related thoughts.

Coping Strategies: Self-managed practices can also aid in recovery, including:

  • Engaging in regular physical activity
  • Maintaining a balanced and healthy diet
  • Allocating time for self-care and hobbies
  • Reducing or eliminating caffeine and substance use
  • Adopting a consistent sleep routine
  • Seeking social support through trusted relationships

Conclusion: While trauma can have lasting psychological effects, it is important to know that healing is possible. By accessing timely resources, you can restore emotional well-being.

Related Resources: If you are experiencing the lasting effects of trauma, access these resources to guide you through your journey of recovery: 

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