Trauma and Stressor

Related Disorders
PSY 321 Abnormal Psychology

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Learning Outcomes
• Distinguish normal stress and chronic stress.
• Explain the essential features of trauma and stressor related disorders.
• Explain the etiology of trauma and stressor related disorders.
• Suggest treatments for trauma and stressor related disorders.

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Stress
• Stress – a psychological condition when we experience or perceive challenges to
our wellbeing as exceeding our coping resources and abilities
• Stressor – external demands that create stress
• Can be either negative (eg: taking exam) or positive situations (eg: wedding)
• Coping strategy – effort to deal with stress

Stressor Stress Coping strategy

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Stress
Normal stress reaction
• Hypothalamic-pituitary-adrenal (HPA) axis
• CRH: corticotropin-releasing hormone
• ACTH: adrenocorticotropic hormone
• Cortisol
• Prepares the body for fight or flight
• Suppresses immune system, prioritizing
escaping rather than healing
• Our body has a negative feedback mechanism
to dampen the HPA axis

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 GAS Model
(Selye, 1950)

Sanghamitra Gupta, HELP University (Psych) 6

Stress
Characteristics of stressors
Severity How closely it affects our lives
Stressors that involve more important A person who is more closely involved in
aspects of one’s life tend to be highly the traumatic situation tends to intensify
stressful for most people the stress

Chronicity Degree of predictability

The longer the stressor operates, the Unpredictable events are likely to cause
more severe its effect more severe stress

Timing Degree of perceived controllability

Experiencing stressors all at the same Uncontrollable stressors are more
time vs over an extended period of time stressful
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Stress
Resilience - the process and outcome of successfully adapting to difficult or
challenging life experiences
• Being a positive person helps one to adjust better in responding to stressors.
• Having more negative affect is associated with lower resilience.

Crisis – refers to times when a stressful situation exceeds the adaptive capacities of
a person. It overwhelms a person’s ability to cope
Chronic stress: a stressful period that goes on for too long, eventually wearing out
the immune system and making one susceptible to developing illnesses.

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Chronic Stress
Effect on the body
Musculoskeletal system Respiratory system
• Headache, chronic muscle tension, • Exacerbate asthma
musculoskeletal pain • Hyperventilation
Cardiovascular system Nervous system
• Hypertension, heart attack or • Wear-and-tear on the body due to
stroke continuous activation of nervous system
Gastrointestinal system
Reproductive system
• Gut discomfort
• Decline in sexual desire • Diarrhea or constipation
• Reduced ability to conceive • Swelling of stomach lining
• Irregular menstrual cycles

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 Adjustment disorder

PTSD
Stress and Trauma
Related Disorders Acute stress disorder

Prolonged Grief disorder

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Adjustment Disorder
A. The development of emotional or behavioral symptoms in response to an identifiable
stressor/s occurring within 3 months of the onset of the stressor(s).
B. These symptoms or behaviors are clinically significant, as evidenced by one or both of
the following
1. Marked distress that is out of proportion to the severity or intensity of the stressor
taking into account the external context and the cultural factors that might influence
symptom severity and presentation.
2. Significant impairment in social, occupational, or other important areas of
functioning.
C. The stress-related disturbance does not meet criteria for another mental disorder and is
not merely an exacerbation of a pre-existing mental disorder
D. The symptoms do not represent normal bereavement.
E. Once the stressor or its consequences have terminated, the symptoms do not persist for
more than an additional 6 months.
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Adjustment Disorder

Potential stressors:
• Single event • Continuous
• Relationship break-up • Persistent painful illness/
• Multiple events disability
• Marital problems • Crime-ridden neighbourhood
• Recurrent events • Specific developmental event
• Seasonal business crises • Primary school
• Preparing to get married
• Pregnant with first kid
• Post-retirement
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Case example

• Jack, a 28-yr-old male, unemployed, started experiencing excessive

emotional distress after his long-term romantic relationship ended 1
month ago. He complained of chronic headache, anger outbursts,
crying spells, lack of motivation and inability to fall asleep.

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Posttraumatic Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violence 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, the event(s) must have been
violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic
event(s), (e.g., first responders, collecting human remains; police officers
repeatedly exposed to details of child abuse).

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 If intrusive, why are
Posttraumatic Stress Disorder they not
compulsions?

B. Presence of one (or more) of the following intrusion symptoms associated with
the traumatic event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic
event(s).
2. Recurrent distressing dreams in which the content and/or affect of the dream are
related to the traumatic event(s).
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the
traumatic event(s) were recurring.
4. Intense or prolonged psychological distress at exposure to internal or external cues
that resemble an aspect of the traumatic event(s).
5. Marked physiologic reactions to internal or external cues that resemble an aspect
of the traumatic event(s). Intrusion
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Posttraumatic Stress Disorder
C. Persistent avoidance of stimuli associated with the traumatic event(s),
beginning after the event(s) occurred, as evidenced by one or both of the
following:
1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings
about or closely associated with the traumatic event(s).
2. Avoidance of or efforts to avoid external reminders that arouse distressing
memories, thoughts, or feelings about or closely associated with the traumatic
event(s).

Avoidance

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Posttraumatic Stress Disorder
D. Negative alterations in cognitions and mood associated with the traumatic
event(s), beginning or worsening after the event(s) occurred, as evidenced by
two (or more) of the following:
1. Inability to remember an important aspect of the traumatic event(s).
2. Persistent and exaggerated negative beliefs or expectations about oneself,
others, or the world.
3. Persistent, distorted cognitions about the cause or consequences of the
traumatic event(s) that lead the individual to blame him/herself or others
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities. Negative
6. Feeling of detachment or estrangement from others. cognition
7. Persistent inability to experience positive emotions. and mood
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Posttraumatic Stress Disorder
E. Marked alterations in arousal and reactivity associated with the traumatic
event(s), beginning or worsening after the event(s) occurred, as evidenced by
two (or more) of the following:
1. Irritable behavior and angry outbursts typically expressed as verbal or physical
aggression toward people or objects.
2. Self-destructive or reckless behavior
3. Hypervigilance Altered
4. Exaggerated startle response arousal and
reactivity
5. Problems in concentration
6. Sleep disturbance

F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. 19

Posttraumatic Stress Disorder
G. The disturbance causes clinically significant distress or impairment in important
areas of functioning.
H. The disturbance is not attributable to the physiological effects of a substance or
another medical condition.
Specify if: With dissociative symptoms.
In addition to meeting criteria for diagnosis, an individual experiences high levels of
either of the following in reaction to trauma-related stimuli:
1. Depersonalization 2. Derealization

Specify if: With delayed expression.

Full diagnosis is not met until at least six months after the trauma(s), although
onset of symptoms may occur immediately. 20
Posttraumatic Stress Disorder

Exposure

Dissociation Intrusion

PTSD
Altered
arousal/reac Avoidance
tivity

Negative
Cognition &
Mood

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Acute Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violence 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, the event(s) must have been
violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic
event(s), (e.g., first responders, collecting human remains; police officers
repeatedly exposed to details of child abuse).

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Acute Stress Disorder
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:
Intrusion symptoms
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
2. Recurrent distressing dreams in which the content and/or affect of the dream are
related to the traumatic event(s).
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the
traumatic event(s) were recurring.
4. Intense or prolonged psychological distress or marked physiological reactions in
response to internal or external cues that resemble an aspect of the traumatic
event(s).
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Acute Stress Disorder
B. Presence of nine (or more) of the following symptoms …… :
Negative mood
5. Persistent inability to experience positive emotions.
Dissociative symptoms
6. An altered sense of the reality of one’s surroundings or oneself.
7. Inability to remember an important aspect of the traumatic event(s).
Avoidance symptoms
8. Efforts to avoid distressing memories, thoughts, or feelings about or closely
associated with the traumatic event(s).
9. Efforts to avoid external reminders that arouse distressing memories, thoughts,
or feelings about or closely associated with the traumatic event(s).
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Acute Stress Disorder
B. Presence of nine (or more) of the following symptoms …… :
Arousal symptoms
10. Sleep disturbance
11. Irritable behavior and angry outbursts, typically expressed as verbal or physical
aggression toward people or objects.
12. Hypervigilance
13. Problems in concentration
14. Exaggerated startle response

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Acute Stress Disorder
C. Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after
trauma exposure.
D. The disturbance causes clinically significant distress or impairment in important
areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance or
another medical condition.

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Prolonged Grief Disorder
A. The death, at least 12 months ago, of a person who was close to the bereaved
individual.
B. Since the death, the development of a persistent grief response characterized
by one or both of the following symptoms, which have been present most days
to a clinically significant degree. In addition, the symptom(s) have occurred
nearly every day for at least the last month:
1. Intense yearning/longing for the deceased person
2. Preoccupation with thoughts or memories of the deceased person

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Prolonged Grief Disorder
C. Since the death, at least 3 of the following symptoms have been present most days to a
clinically significant degree. In addition, the symptoms have occurred nearly every day
for at least the last month:
1. Identity disruption (e.g., feeling as though part of oneself has died) since the death
2. Marked sense of disbelief about the death
3. Avoidance of reminders that the person is dead (in children and adolescents, efforts
to avoid reminders)
4. Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death
5. Difficulty reintegrating into one’s relationships and activities after the death (e.g.,
problems engaging with friends, hobbies)
6. Emotional numbness (absence or marked reduction of emotional experience) as a
result of the death
7. Feeling that life is meaningless as a result of the death
8. Intense loneliness as a result of the death. 28
Prolonged Grief Disorder
D. The disturbance causes clinically significant distress or impairment in social,
occupational, or important areas of functioning.
E. The duration and severity of the bereavement reaction clearly exceeds
expected social, cultural or religious norms for the individual’s culture and
context.
F. The symptoms are not better explained by major depressive disorder, PTSD, or
another mental disorder, or attributable to the physiological effects of a
substance (e.g., medication, alcohol) or another medical condition.

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Grief and Culture
• In Bali, Indonesia, mourning is brief and tearfulness is discouraged. If family members do cry,
tears must not fall on the body as this is thought to give the person a bad place in heaven. To cry
for too long is thought to invoke malevolent spirits and encumber the dead person’s soul with
unhappiness.

• In Egypt, tearfully grieving after seven years would still be seen as healthy and normal – whereas
in the US this would be considered a disorder.

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Etiology of Trauma and Stressor Related
Disorders
Biological perspective
• Female
• High-risk (s/s) genotype of the serotonin-transporter gene
• If they were exposed to trauma and low social support

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Etiology of Trauma and Stressor Related
Disorders
Psychological perspective
• Low level of social support
• High level of neuroticism
• Having depression, anxiety, and substance abuse
• Cognitive distortions
• Poorer cognitive ability to process the traumatic experience

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Etiology of Trauma and Stressor Related
Disorders
Sociocultural perspective
• Nature of the trauma
• Human intent kind of trauma is more likely to cause PTSD
• rape vs accidents
• Nature of job at risk for experiencing trauma
• Firefighter vs librarian
• Minority
• Absence of family support
• Lower socioeconomic status, lower education

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Treatments
Stress inoculation training
• Prepare people to tolerate an anticipated threat by guided self-dialogue and
other coping strategies
• Preventative approach
Psychological first aid
• A humane, supportive response to an individual who is suffering and who
may need support (WHO, 2011)
• Prepare, look, listen, link
Psychological debriefing
• Provide emotional support and encourage people to talk about their
experience during the crisis
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Treatments
Trauma focused Cognitive-behavioral therapy (TF-CBT)
• Prolonged exposure
• Vividly recalling the traumatic event over and over until there is a decrease
in emotional responses
• Also involve exposure to feared stimuli either in vivo or in imagination
Eye Movement Desensitization and Reprocessing (EMDR) therapy
• Focus on the trauma memory while simultaneously experiencing bilateral
stimulation. The “bilateral stimulation” by-passes the area of the brain that has
become stuck due to the trauma.
Psychiatric Medication
• Antidepressant showed modest benefit

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Source: https://www.apa.org/ptsd-guideline/treatments/index
Treatments
• Complicated grief therapy (Mauro et al., 2022; Wetherell, 2012)
• Facilitate the grieving process to help clients come to term with the death
• Through loss- and restoration-focused techniques
• Reconnecting clients to their daily life
• Imaginal revisiting

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384444/pdf/DialoguesClinNeurosci-14-159.pdf
https://onlinelibrary.wiley.com/doi/epdf/10.1002/wps.20991
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