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Trauma-Related Issues

Acute Stress Disorder

What is it?

Acute stress disorder is a specific mental health condition that causes significant psychological distress which can occur immediately after experiencing or witnessing a traumatic event. It differs from PTSD as it is a temporary condition, starting at least 3 days after the event and lasting up to a month. However, if not recognised or treated, it can lead to PTSD. In fact, if symptoms persist after one month after the event, it is cause to assess for PTSD.

Symptoms

   Symptoms fall under five broad categories:

  1. Intrusion symptoms.These include flashbacks, memories, or dreams of the traumatic event that occur as persistent unwanted experiences.
  2. Negative mood.This includes sadness, low mood, negative thoughts, and/or distress that can impact functioning in work, socially, or personally.
  3. Dissociative symptoms.These can include feeling numb, inability to remember certain parts of the event, an altered sense of reality, or a lack of awareness of the surroundings.
  4. Avoidance symptoms.After a traumatic event, individuals often purposely avoid thoughts, feelings, people, places, or other stimuli associated with the traumatic event.
  5. Arousal/Anxiety symptoms.These can include constant tension, irritability, difficulty sitting still, easily startled, sleep issues, and concentration difficulties.
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Causes and Risk Factors

All individuals process and react differently to traumatic experiences – an event that may not trigger Acute Stress Disorder for one individual may still trigger it for another individual. This disorder does appear to be more common in females, and those who have a prior history of experiencing trauma, PTSD or other psychiatric disorders. Specific events that may trigger Acute Stress Disorder, include: receiving a terminal diagnosis, the death of a loved one, the threat of death or serious injury, natural disasters, motor vehicle accidents, sexual assault, domestic violence, or surviving a traumatic brain injury.

Treatment

Acute Stress Disorder is a short-term condition with a good prognosis for recovery; in fact, lots of individuals improve on their own without treatment. However, for others, timely diagnosis and treatment may be important (and even crucial to prevent development of PTSD). 

Treatment may include stress management techniques, CBT, or any other form of therapy that allows for adequate processing of the event in order to prevent development of PTSD.

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Posttraumatic Stress Disorder

What is it?

Post Traumatic Stress Disorder is a psychological disorder that can develop as a result of experiencing a life-threatening, shocking, or dangerous event. It is natural to feel afraid during and after a traumatic situation, resulting in various split-second changes in the body aimed at responding to danger and to help avoid danger in the future. Nearly everyone will experience a range of reactions after a traumatic experience, yet people can often recover from those symptoms naturally.

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Those who continue to experience problems from such an event may develop PTSD. People who have PTSD may feel stressed or frightened even when they are no longer in danger. Anyone can develop PTSD at any age, which includes war veterans as well as survivors of physical and sexual assault, abuse, car accidents, disasters, terror attacks, or other serious events. However, not everyone with PTSD has necessarily been through a dangerous event; PTSD can also be caused by experiences such as the sudden or unexpected death of a loved one.

Symptoms

Symptoms usually begin within three months of the traumatic incident, but may begin later, as with “delayed onset”. For symptoms to be considered PTSD, they must last more than a month and be severe enough to interfere with functioning in relationships or work. The course of the illness varies from person to person. Some people recover within six months, while others have symptoms that last much longer. In some people, the condition becomes chronic (ongoing).

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  • Intrusive thoughts, nightmares, or flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders
  • Trauma-related thoughts or feelings
  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
 
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect/difficulty experiencing positive emotions
  • Decreased interest in activities
  • Feeling isolated
  • Irritability or aggression
  • Risky or destructive behavior
  • Hypervigilance (over reacting to perceived threat)
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping

How Common is PTSD?

Approximately two-thirds of the Australian population will experience events that are potentially traumatic (“potentially” is used here to reflect the subjective element in what is perceived as traumatic). Around 12% of Australians will experience PTSD in their life-time. Specifically, 4.4% of people experience PTSD within the first 12 months after a traumatic event and 7.2% experience PTSD over their lifetime. Rates are higher after specific traumas; interpersonal trauma such as rape and torture leading to lifetime prevalence rates as high as 50% 

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Causes and Risk Factors

PTSD commonly develops after exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. This can occur in a number of ways, including through direct exposure, witnessing the trauma, learning that a relative or close friend was exposed to a trauma, or indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics).

Anyone can develop PTSD following one of these traumatic events, but people are at greater risk if the event involved deliberate harm such as physical or sexual assault or they have had repeated traumatic experiences such as childhood sexual abuse or living in a war zone. Apart from the event itself, risk factors for developing PTSD include a past history of trauma or previous mental health problems, as well as ongoing stressful life events after the trauma and an absence of social supports.

Treatment

Psychological treatment has been shown to be very effective in dealing with PTSD and reducing symptoms back to normal functioning. Various forms of Cognitive-Behavioural Therapy (CBT) have been shown to be effective in treating PTSD – these include Cognitive Processing Therapy (CPT), Cognitive Therapy for PTSD (CT-PTSD), and Prolonged Exposure (PE). Sometimes a broader version of CBT is used that combines elements of each. Eye Movement Desensitization and Reprocessing (EMDR) has also been shown to be an effective treatment for PTSD.

Complex - PTSD

What is it?

Complex post-traumatic stress disorder (C-PTSD) is a psychological disorder thought to occur as a result of repetitive, prolonged trauma involving harm or abandonment by a caregiver or other interpersonal relationships with an uneven power dynamic. Complex PTSD is associated with sexual, emotional or physical abuse or neglect in childhood, issues of attachment with primary caregivers, violence from an intimate partner, victims of kidnapping and hostage situations, slavery, prisoners of war, bullying, concentration camp survivors, and defectors of cults or cult-like organisations.

Symptoms

Complex PTSD is a disorder that requires PTSD symptoms as described above, but also includes additional features that reflect the problems that ongoing trauma can cause. Six clusters of symptoms have been suggested to occur with C-PTSD.

Symptoms
  1. alterations in regulation of affect and impulses (heightened emotional reactivity, violent outbursts, reckless or self-destructive behavior, a tendency towards experiencing prolonged dissociative states when under stress, emotional numbing)
  2. alterations in attention or consciousness;
  3. alterations in self-perception (persistent beliefs about oneself as diminished, defeated or worthless accompanied by deep and pervasive feelings of shame or guilt)
  4. alterations in relations with others (persistent difficulties in sustaining relationships due to a tendency to either avoid, ridicule or have little interest in relationships).
  5. somatisation (experiencing the psychological distress in the form of physical symptoms)
  6. alterations in systems of meaning.

Causes and Risk Factors

Individuals who experience complex trauma such as maltreatment, prolonged family or community violence, torture or exploitation (especially in early childhood or during adolescence) are at risk not only for PTSD but also C-PTSD. In particular, early childhood abuse of any kind which is ongoing/continuous, in combination with a past history of trauma or other psychological issues, and ongoing stressors in daily life increase risk of developing C-PTSD.

Treatment

Complex trauma means complex reactions and this leads to complex treatments. Hence, Complex Post Traumatic Stress Disorder treatment requires a multi-modal approach. It has been suggested that treatment for C-PTSD should differ from treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. These problems include emotional dysregulation, dissociation, and interpersonal problems. 

Multiple treatments have been suggested for C-PTSD, such as Dialectical Behaviour Therapy (DBT), Cognitive-Behavioural Therapy (CBT), Schema-Focused Therapy, Interpersonal Psychotherapy (IPT), or Psychodynamic therapy; and often a combination approach is required.