Trauma disorders are specific mental health conditions that arise from traumatic experiences, although not all traumas result in such situations. It's important to recognise that the perception of trauma is subjective, as it depends on personal backgrounds and experiences. However, certain traumas, such as violence, neglect, abuse, loss of a loved one, witnessing abuse or violence, torture, accidents, and natural disasters, are directly linked to the development of mental health conditions. Traumatic experiences can affect individuals of all ages, and the severity of their impact varies.
If you've experienced trauma and find yourself grappling with its lingering effects, remember that you can take your first step towards healing by seeking professional help. Experts are dedicated to providing empathetic support and evidence-based treatments, helping you navigate through the challenges of trauma and regain control over your well-being.
The impact of trauma varies for each individual, and in some cases, it can lead to the development of a mental health condition. Trauma disorders are specific mental health conditions that arise from traumatic experiences, although not all traumatic experiences result in a mental health condition.
The perception of trauma is subjective, as it depends on personal backgrounds and experiences. It's crucial not to dismiss someone's mental health condition based on what may or may not traumatise you. However, certain traumas have been identified to directly correlate with the development of mental health conditions, including violence, neglect, abuse, loss of a loved one, witnessing abuse or violence, torture, accidents, and natural disasters. These traumas can affect individuals of all ages, and their severity varies.
Traumatic disorders, if left undiagnosed and unmanaged, can have a significant impact on our lives. Trauma can have a more profound emotional impact than we realise, with dissociation and numbness often clouding our awareness of its effects.
These disorders may present similarly to other psychiatric conditions like depression and anxiety, but the presence of a trigger event is necessary for diagnosis. Understanding the nature and timing of the triggering event, as well as the severity of symptoms, is essential.
Treatment typically involves psychotherapy and medication. In the past, trauma-related disorders were often misdiagnosed as anxiety disorders, but it has since been recognised that they primarily manifest through symptoms such as anhedonia, dysphoria, dissociation, and the externalisation of anger and aggression. While anxiety or fear may still be present in individuals with trauma-related disorders, they are not the primary symptoms.
Each trauma disorder presents distinct symptoms and diagnostic criteria according to the DSM-5. However, these related conditions share several common symptoms and characteristic signs, including:
While most mental illnesses lack a single cause, trauma disorders can often be attributed to one or more traumatic experiences. Not everyone who undergoes trauma will develop trauma disorder, as individuals' responses can vary. However, having a trauma disorder increases the risk of co-occurring mental illnesses and substance use disorders.
Individuals may turn to drugs or alcohol to self-medicate and escape negative feelings, leading to substance abuse problems. Additionally, trauma disorders can have serious consequences across various aspects of life, such as damaged relationships, work or school difficulties, financial problems, isolation, insomnia, impulsive behaviour-related injuries, and legal issues.
Childhood experiences, including exposure to physical or emotional violence, abuse, or neglect, can contribute to trauma and stress or-related disorders. Witnessing parental abuse or experiencing parental divorce or loss are examples of stressors affecting children. Traumatic events like terrorist attacks or sexual assault also contribute to trauma and stress-related disorders.
Understanding these symptoms and categories helps to identify and diagnose trauma and stressor-related disorders accurately.
Trauma disorder can be triggered by many events in an individual's life. It's essential to understand these causes in order to actually treat and manage patients. Some of the causes are
Exposure to Violence: Trauma disorders may arise after being exposed to violence, either when one experiences or witnesses an attack or war.
Accidents: Such ones that may result from car accidents that may lead to trauma.
Natural disasters: Experiencing natural disasters like earthquakes or floods causes traumatic stress.
Loss of a Loved One: Trauma disorders may derive from having experienced severe loss due to the immediate death of a loved one.
Childhood Abuse: Physical, emotional, or sexual abuse during childhood is a highly influential risk factor.
Neglect: Chronic neglect or lack of support in childhood would render the person at risk for chronic trauma symptoms.
Medical Trauma: Such things as life-threatening medical conditions or invasive procedures would be psychological trauma triggers.
Sudden Changes: Major life shifts such as divorce or even loss of employment can also trigger trauma responses.
The study of trauma-related disorders has focused extensively on combat experiences and physical/sexual assault. Combat-related trauma symptoms trace back to World War I when soldiers returned with "shell shock." However, significant progress in identifying and treating war-related psychological difficulties occurred after the Vietnam War.
Posttraumatic stress disorder (PTSD) is characterised by physiological, psychological, and emotional symptoms following exposure to trauma. Individuals must have been exposed to situations involving death, sexual violence, or severe injury. Examples include witnessing trauma, learning about traumatic events happening to loved ones, directly experiencing trauma, or being repeatedly exposed to aversive events.
Acute stress disorder is similar to PTSD, but symptoms must be present from 3 days to 1 month. If symptoms persist beyond one month, the individual meets the criteria for PTSD.
Adjustment disorders develop in response to identifiable stressors and involve emotional or behavioural symptoms. Symptoms must occur within three months of the stressful event and not persist beyond six months.
Unlike PTSD and acute stress disorder, adjustment disorder does not have specific symptom criteria. Symptoms must relate to the stressor and impair functioning disproportionately. Classification modifiers include depressed mood, anxiety, mixed anxiety, and depressed mood, disturbance of conduct, mixed disturbance of emotions and conduct, or unspecified, depending on the individual's symptoms.
Disinhibited Social Engagement Disorder (DSED) is observed in children who display overly familiar behaviour with strangers, lacking fear or caution. DSED can result from social neglect, frequent changes in caregivers, or limited ability to form attachments.
Reactive Attachment Disorder (RAD) occurs in children aged 9 months to 5 years and is characterised by emotionally withdrawn behaviour toward adult caregivers. RAD stems from a pattern of insufficient care or neglect, affecting attachment formation.
Prolonged Grief Disorder, formerly known as persistent complex bereavement disorder, is characterised by intense longing and preoccupation with thoughts or memories of the deceased at least 12 months after their death. Symptoms include feelings of personal loss, disbelief, emotional numbness, meaninglessness, loneliness, impaired social engagement, intense emotional pain, and avoidance of reminders. Individuals with prolonged grief disorder may hold maladaptive cognitions, experience guilt and negative life views, engage in harmful health behaviours, and exhibit anger, restlessness, blame, and sleep disturbances.
An unspecified trauma and stressor-related disorder diagnosis is used when there is inadequate information for a specific diagnosis. It encompasses symptoms associated with trauma-related disorders that cause distress and impairment but do not meet full diagnostic criteria.
Determining the prevalence of trauma-related disorders can be difficult because they are triggered by exposure to a specific traumatic or stressful event. RAD and disinhibited social engagement disorders are thought to be rare in the general population, affecting less than 1% of children under the age of five.
Successful treatment of trauma-related disorders usually requires both medication and some form of psychotherapy.
While trauma disorders cause massive distress in the suffering patient and interfere with routine life, they are treatable and can be managed. The severity of symptoms and high risk for suicide attempts often require residential treatment for patients. There, they are offered various therapies, including CBT, which allows a modification in their negative thoughts and behaviour.
The prime therapy provided here is exposure therapy, which will help the patient desensitise themselves with traumatic memory and thus help in developing more functional coping mechanisms. It works pretty perfectly well for people suffering from flashbacks or nightmares. The other widely practised technique here is eye movement desensitisation and reprocessing, which involves guided eye movements to help a patient deal with traumatic events and respond to memories in a calmer and more controlled way.
An overwhelming trauma and an emotional response extending or becoming worse than it should be is a sign of a trauma disorder. Fortunately, there are practical treatment options to help patients cope with the symptoms by facilitating changes in maladaptive patterns of thought, replacing unhealthy coping mechanisms with more health-conducive alternatives, and engaging loved ones in the healing process.
There have been many treatments that were considered effective in enabling patients diagnosed with trauma to live better lives.
Some approaches have indeed been shown to be very effective, like trauma-focused cognitive-behavioural therapy (TF-CBT), which currently utilises short-term therapies' most effective: prolonged exposure therapy. This therapy involves being exposed to the feared object, situation, or activity in a controlled environment until they progressively give way to reduced anxiety and avoidance.
Another form of CBT is cognitive processing therapy or CPT. The therapy helps patients to understand how the traumatic event shapes their lives and equips them with appropriate coping skills that help to combat negative thoughts about the traumatic experience. Through understanding the impact of the trauma, CPT enables the person to take charge of uncomfortable feelings.
Exposure therapy is one of the most frequently used treatments for anxiety disorders; it has also been successfully applied to trauma-related illnesses. Techniques available to patients for the gradual confrontation of traumatic memories are imaginal and in vivo exposure.
Imaginal exposure involves mental recreation by the patient concerning certain aspects of the event and frequent discussion of their thoughts and feelings. In vivo exposure involves actual reminders such as video or images that provoke a response, using relaxation techniques to reduce the anxiety that the patients experience regarding these reminders.
It is a gradual process, building their confidence to tackle more distressing memories over time. Another form of exposure is known as Flooding, where all the most distressing memories are presented from the very beginning. It can be effective, but patients are more likely to leave treatment than if they experienced it as a gradual process.
Cognitive Behavioural Therapy has been proven to be an effective form of treatment for trauma/stress-related disorders. It is believed that this type of treatment is effective in reducing trauma-related symptoms due to its ability to identify and challenge the negative cognitions surrounding the traumatic event and replace them with positive, more adaptive cognitions.
Trauma-focused cognitive-behavioural therapy (TF-CBT) is an adaptation of CBT that utilises both CBT techniques and trauma-sensitive principles to address trauma-related symptoms. According to the Child Welfare Information Gateway (CWIG; 2012), TF-CBT can be summarised via the acronym PRACTICE:
In the late 1980s, psychologist Francine Shapiro found that by focusing her eyes on the waving leaves during her daily walk, her troubling thoughts resolved on their own. From this observation, she concluded that lateral eye movements facilitate the cognitive processing of traumatic thoughts (Shapiro, 1989).
While EMDR has evolved somewhat since Shapiro’s first claims, the basic components of EMDR consist of lateral eye movement induced by the therapist moving their index finger back and forth, approximately 35 cm from the client’s face, as well as components of cognitive-behavioural therapy and exposure therapy, the following 8-step approach is the standard treatment approach of EMDR (Shapiro & Maxfield, 2002):
As you can see from above, only steps 4-6 are specific to EMDR; the remaining treatment is essentially a combination of exposure therapy and cognitive-behavioural techniques. Because of the high overlap between treatment techniques, there have been quite a few studies comparing the treatment efficacy of EMDR to TF-CBT and exposure therapy.
While research initially failed to identify a superior treatment, often citing EMDR and TF-CBT as equally efficacious in treating PTSD symptoms (Seidler & Wagner, 2006), more recent studies have found that EMDR may be superior to that of TF-CBT, particularly in psycho-oncology patients).
While meta-analytic studies continue to debate which treatment is the most effective in treating PTSD symptoms, the World Health Organization’s (2013) publication on the Guidelines for the Management of Conditions Specifically Related to Stress identified TF-CBT and EMDR as the only recommended treatment for individuals with PTSD.
Some therapists are using body-based techniques, where the mind and body process trauma together. Studies published in the Psychotherapy and Counselling Journal of Australia pointed out that these therapies can be especially useful for many different types of people. Some of them are:
Somatic Experiencing: This therapy takes patients through traumatic memory in a protected and controlled environment.
Sensorimotor Psychotherapy: This therapy alters the perception of traumatic memories by incorporating traditions of psychotherapy into body-based methods.
Acupoint Stimulation: This method applies pressure to specific points on the body through a therapist in order to reduce stress and enhance relaxation.
Touch Therapies: Reiki, healing touch, and therapeutic touch therapies attempt to create emotional as well as physical wellness.
While psychopharmacological interventions have been shown to provide some relief, particularly to veterans with PTSD, most clinicians agree that resolution of symptoms cannot be accomplished without implementing exposure and/or cognitive techniques that target the physiological and maladjusted thoughts maintaining the trauma symptoms. With that said, clinicians agree that psychopharmacology interventions are an effective second line of treatment, particularly when psychotherapy alone does not produce relief from symptoms.
Among the most common types of medications used to treat PTSD symptoms are selective serotonin reuptake inhibitors. SSRIs work by increasing the amount of serotonin available to neurotransmitters. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are also recommended as second-line treatments.
Their effectiveness is most often observed in individuals who report co-occurring major depressive disorder symptoms, as well as those who do not respond to SSRIs. Unfortunately, due to the effective CBT and EMDR treatment options, research on psychopharmacological interventions has been limited. Future studies exploring other medication options are needed to determine if there are alternative medication options for stress/trauma disorder patients.
Coping with Trauma Disorders: An individual will discover that self-care plays a critical role in the management of the emotional, mental, and physical impact of trauma. Some ways to do this are through the following:
Exercise: Trauma is a stimulus for the fight-or-flight response, but regular physical exercise neutralises this effect. Research now suggests that aerobic exercise may be the most effective for patients with PTSD. Exercises lasting at least 30 minutes most days can really make a difference.
Mindfulness: Grounding techniques like mindful breathing can allow people to live more in the present, stopping and preventing them from being taken over by past traumas. Results suggest that mindfulness-based interventions may be helpful with most patients with PTSD, such as when used alone or in combination with other therapies.
Connecting with Others: Trauma can also include withdrawal, but staying connected to family and friends is what creates a safety network. According to the Anxiety and Depression Association of America, staying connected to other people can indeed reduce the risk that trauma will evolve into PTSD. Even when hard to talk about, just being around loved ones can help lift the mood and support healing.
Balanced lifestyle: Traumatic experiences tend to disrupt sleep and relaxation. However, these lifestyle habits can help:
These are essential steps one takes towards acquiring recovered mental and physical health.
Seeking Support: Reaching out to trusted people or forming support groups with other survivors of trauma is an excellent resource to recover with.
When the symptoms of trauma begin to interfere with daily life, seek a professional. Even minor symptoms can be positively impacted by talking to someone. The sooner that treatment occurs, the more successful it will be in the long run.
Mindtalk, part of the renowned Cadabam’s network, is a leading provider of mental health services, delivering cutting-edge, evidence-based therapy. With a commitment to personalised, modern care, Mindtalk combines the latest psychological research and advanced technology to offer holistic mental health support. Their approach creates a safe, nurturing space for clients to experience meaningful growth and healing.
