Trauma and Stress-Related Disorders
It has long been understood that exposure to a traumatic event, particularly combat, causes some individuals to display abnormal thoughts and behaviors that we today refer to as a mental illness.
The trauma- and stressor-related disorders are serious psychological reactions that develop in some individuals following exposure to a traumatic or stressful event such as childhood neglect, childhood physical/sexual abuse, combat, physical assault, sexual assault, natural disaster, an accident or torture.
Characteristic symptoms of all other trauma- and stressor-related disorders can be placed into four broad categories:
Intrusion symptoms include recurrent, involuntary and distressing memories, thoughts, and dreams of the traumatic event. The individual may also experience flashbacks, a dissociative experience in which they feel or act as if the traumatic event is reoccurring.
Avoidance symptoms are efforts to avoid internal (memories, thoughts, feelings) and/or external (people, places, situations) reminders of the traumatic event. Preoccupation with avoiding trauma-related feelings and stimuli can become a central focus of the individual’s life.
Negative alterations in cognition and mood include problems remembering important aspects of the traumatic event, depression, fear, guilt, shame, and feelings of isolation from others.
Hyper-arousal symptoms include being jumpy and easily startled, irritability, angry outbursts, self-destructive behavior, problems concentrating, and diffculty sleeping.
Types of Trauma and Stress-Related Disorders
REACTIVE ATTACHMENT DISORDER (RAD)
Reactive Attachment Disorder is characterized by serious problems in emotional attachment to others. These children rarely seek comfort when distressed and are minimally emotionally responsive to others. RAD results from a pattern of insufficient caregiving or emotional neglect that limits an infant’s opportunities to form stable attachments.
DISINHIBITED SOCIAL ENGAGEMENT DISORDER
Disinhibited Social Engagement Disorder is characterized by a pattern of behavior that involves culturally inappropriate, overly familiar behavior with unfamiliar adults and strangers. This disorder results from a pattern of insuffcient caregiving or emotional neglect that limits an infant’s opportunities to form stable attachments.
POST-TRAUMATIC STRESS DISORDER (PTSD)
Post-Traumatic Stress Disorder is characterized by significant psychological distress lasting more than a month following exposure to a traumatic or stressful event. Symptoms from all of the categories discussed above must be present.
ACUTE STRESS DISORDER
Acute Stress Disorder is similar to PTSD but the duration of the psychological distress last only three days to one month following exposure to a traumatic or stressful event.
Adjustment Disorders are characterized by the development of emotional or behavioral symptoms in response to an identifiable stressor (e.g., problems at work, going off to college). Adjustment disorder symptoms must occur within three months of the stressful event. Symptoms do not persist more than six months.
Prevalence and Age of Onset
Determining the prevalence of the trauma-related disorders can be difficult because they are triggered by exposure to a specific traumatic or stressful event. RAD and disinhibited social engagement disorder are thought to be rare in the general population affecting less than 1% of children under the age of five.
The lifetime prevalence of PTSD in the United States is estimated to be 8.7% of the population. PTSD occurs more commonly in women than men and can occur at any age. The prevalence of acute stress disorder varies according to the traumatic event.
Adjustment disorders are the least severe and the most common of disorders. The prevalence of adjustment disorders varies widely. Research estimates that 2.9% of primary care patients meet criteria for an adjustment disorder while 5-20% of outpatient mental health clients have been found to meet criteria.
Treatments & Support
Successful treatment of the trauma-related disorders usually requires both medication and some form of psychotherapy.
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI’S)
These antidepressant medications block the neurotransmitter serotonin (5-HT) from being reabsorbed into the brain cells. Currently only the SSRIs Zoloft (sertraline) and Paxil (paroxetine) are approved by the Food and Drug Administration for the treatment of PTSD.
Two forms of trauma-focused cognitive-behavior therapy (TF-CBT) have been shown to be effective in treating the trauma-related disorders. Prolonged exposure therapy is an effective variant of CBT that treats both anxiety and trauma-related disorders. Therapist create a safe environment to “expose” the patient to the thing(s) they fear and avoid. The exposure to the feared objects, activities, or situations in a safe environment helps reduce fear and decrease avoidance.
In cognitive processing therapy (CPT) the therapist seeks to help the client gain an understanding of the traumatic event and take control of distressing thoughts and feelings associated with it. CPT explores how the traumatic event has affected your life and skills needed to challenge maladaptive thoughts related to the trauma.
A Spiritual Perspective
The Scriptures teach five significant principles about trauma and suffering:
- God is present and in control of our suffering
- God is good and cares for us
- Suffering is an opportunity to grow closer to God
- Jesus understands our suffering
- Our identity—who we are—is not defined by traumatic events or
suffering but is grounded in Christ.
First, God is present and in control of our suffering. We often feel the furthest from God in times of great suffering and pain. From our limited human perspective, pain and suffering seem contrary to our idea of a sovereign God. Suffering should not cause us to question God’s sovereignty. God is sovereign, despite our circumstances. He created all things, and He controls all things. God is in control of our circumstances.
Second, God loves us, and that love is evident in our redemptive history. He is patient and gracious. God is indeed good, and He longs to be in an ever-deepening relationship with us. In James 1:2, we are told to “consider it all joy” when we go through difficult times. We must understand that trials or difficult times in our lives are opportunities God allows so we will recognize our need for complete dependence on Him (John 15:5).
The third truth we are called to recognize is that through our trials and suffering we have an opportunity to draw closer to God. During the easy times we often become self-reliant, forgetting our need for God. It is in the hard times, when our faith is tested, that we recognize our need for complete dependency on Him. James tells us that persevering through the difficult times develops a mature and complete faith (James 1:4). Suffering is a necessary process of progress. Draw near to Him during difficult times and submit to the Holy Spirit within us; he draws near to us, and the intimacy of our relationship grows (Galatians 4:6).
A fourth truth is that we do not worship an unapproachable God. We worship a God who knows what it is to be human. Jesus knows what it is to suffer. Just think about Jesus’ life for a moment. He didn’t experience just one traumatic event during His time on earth—His whole life was full of suffering. We can take great comfort in the fact that God can relate to us on our level; He understands what it is to suffer.
Finally, our identity is grounded in Christ. God does not see you as a victim. He sees you as His child. We sit at the right hand of the Father! We have His righteousness! We must not allow tragedy or circumstances to define who we are or how we live. We have His very life within us, and we must choose to live out of that truth.