Trauma- and Stressor-Related Disorders
Trauma- and stressor-related disorders while varied in their manifestations, are unified by a central theme: they emerge as a direct consequence of an individual’s exposure to traumatic or profoundly stressful situations. Such events, whether they be sudden tragedies or prolonged adversities, can profoundly shape an individual’s psychological response.
This chapter delves deep into these disorders, aiming to provide psychology residents with a comprehensive understanding that bridges theoretical knowledge with clinical application. Through this exploration, we aim to equip readers with the tools necessary to diagnose, manage, and empathize with those affected, while also preparing them for the rigors of the In-service exam and ABPN Psychiatry Boards exam.
Bereavement, Grief, and Mourning
Bereavement
- The experience of losing someone significant, most commonly from death
- Normal bereavement is a common experience that involves a range of emotions, such as sadness, guilt, anger, and disbelief. For most people, the grieving process gradually subsides over time, within 6-12 months
- Strong social support has the largest protective effect against psychological distress following the loss of a spouse
- Finding meaning in the loss correlates with improved adjustment outcomes
- Childhood manifestations:
- Age-typical separation anxiety and heightened concern for surviving parent’s health
- Regression in developmental milestones (e.g., bowel/bladder control)
- Perceptual experiences of the deceased (seeing/feeling presence)
- Belief that the deceased is watching over them
- For preschool children experiencing loss, conflict or trauma, the presence of supportive and nurturing caregivers, specifically parental functioning, is the most important protective factor from trauma-related disorders
- Parents who can provide a sense of safety, comfort, and security to their children during and after trauma can significantly reduce their child’s distress and promote positive adaptation
Remember
Many school-aged children are old enough to understand that death is irreversible and permanent. When children develop this understanding, it can lead to anxiety about their health as well as the health and safety of loved ones.
Grief
- The natural emotional response that follows bereavement, encompassing thoughts, feelings, behaviors, and physiological responses. Can also occur with non-bereavement losses such as job loss or divorce.
- It’s important to consider cross-cultural grief practices when considering if a patient’s grief is normal or pathologic
Mourning
- The adaptive process through which individuals adjust to a loss and assimilate their grief
- Key components of successful mourning:
- Accepting finality and full impact of loss
- Renegotiating relationship with the deceased
- Rebuilding capacity for positive experiences
- Reconstructing a meaningful future despite absence
- Providers should encourage the development of new activities and relationships to offset loss
Prolonged Grief Disorder
- Persistent and pervasive grief responses characterized by longing for the deceased and/or preoccupation with thoughts and memories of the deceased
- These symptoms persist for an atypically long period beyond expected norms and cause significant impairment in functioning
- Risk factors:
- Ambivalent relationship with the deceased
- Multiple concurrent losses
- Pre-existing low self-esteem or insecurity
- History of recurrent major depression
- History of substance/alcohol use disorder
- Major depressive disorder is the most common comorbid condition associated with prolonged grief disorder, occurring in approximately 55% of cases.
- Post-traumatic stress disorder is the second most common.
Learned Helplessness and Trauma Responses
- Learned helplessness is a psychological phenomenon that occurs when an individual experiences a lack of control over repeated adverse events or situations, leading them to believe that they are unable to change or influence the outcomes
- This perception can cause the individual to stop trying to improve their circumstances or avoid similar situations in the future, even when the opportunity for change is present
- In trauma survivors, it can manifest as a sense of powerlessness, decreased motivation, passivity, and difficulty recognizing or acting upon opportunities to improve their situation.
- This concept was first proposed by psychologists Martin Seligman and Steven Maier in the 1960s after conducting experiments with animals
- They observed that animals repeatedly exposed to aversive stimuli they could not escape or avoid eventually became passive and did not attempt to escape, even when presented with a chance to do so
Reactive Attachment Disorder (RAD)
- Characterized by children with emotionally withdrawn behavior toward caregivers with minimal social/emotional responsiveness
- Typically diagnosed during the preschool period (ages 3-5)
- Associated with a history of insufficient care, such as:
- Social neglect or deprivation
- Repeated changes of primary caregivers
- Rearing in settings that severely limit opportunities to form selective attachments (i.e. frequent foster care placements, understaffed orphanages)
- Treatment:
- Provide a stable and nurturing environment, which may involve foster care or adoption
- Parent-child interaction therapy to strengthen attachment bonds
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