Trauma and Stressor Related Disorders
I wrote this reflection for my problem identification class at the University of Rochester. The professor asked us to reflect on a particular reading, the reading for this reflection the chapter on Trauma and Stressor Related Disorders in the DSM-5. I have included my reflection below.
Trauma and Stressor Related Disorders
I continued my reading of the DSM this week, in the DSM-5-TR, with the chapter on Trauma and Stressor Related Disorders. My impression of the chapter was that it separated these disorders into two main types: attachment-related and lifespan-related disorders. For attachment-related disorders, trauma and stress affect the individual during childhood when attachments are forming. In this case, exposure to trauma and stress appears more chronic and ongoing instead of a single event. These attachment-related disorders included Reactive Attachment Disorder (RAD), where the child becomes very inhibited and withdrawn to adults, and Disinhibited Social Engagement Disorder (DSED), where the child actively approaches adults in an overly familiar way without regard for their safety.
The second category I see is lifespan-related. These seem to apply more frequently to a single event of trauma and stress. While these lifespan disorders may impact attachment, I presume the DSM offers these diagnoses to recognize an individual's symptoms related to the event and impairments at the individual level, not so much developmentally or from an attachment perspective. The different kinds of disorders I see as lifespan-related are Post Traumatic Stress Disorder (PTSD), Acute Stress Disorder (ASD), Adjustment Disorder (AD), and Prolonged Grief Disorder (PGD).
The attachment-related RAD and DSED may come about due to extreme neglect or deprivation of the child; this could take the form of a lack of emotional or physical comfort from caregivers or frequent changes in caregivers, such as in environments of orphanages. PTSD comes about by exposure to trauma. The DSM defines trauma as exposure to actual or threatened death, injury, or sexual violence. PTSD can come about either by directly experiencing an event, witnessing an event, or learning about an event, such as from a friend or in the course of work. Symptoms may emerge immediately or months or years after the event. A key feature of PTSD is recurring, involuntary, and intrusive memories of the event, sometimes called flashbacks. The individual with PTSD may persistently make efforts to avoid stimuli that remind them about the event, and the individual with PTSD may experience negative symptoms such as painful thoughts, emotions, withdrawal, anger, hypervigilance, or concentration or sleep problems due to the event or reminders of it. Symptoms of PTSD must be present for at least one month.
ASD appears to be a milder version of PTSD, with similar symptoms, a key difference being that individuals diagnosed with ASD should present symptoms from 3 days to 1 month after the event and should last for no longer than 1 month. If ASD does last for longer than 1 month, then a diagnosis may shift to PTSD. AD appears to be a milder version again of both PTSD and ASD. In AD, the event that causes symptoms is less severe; it may be moving to a new city, losing a job, or getting divorced, for example. AD symptoms must develop within 3 months of the stressful event and typically do not last longer than 6 months after the event. Finally, PGD refers to symptoms of excessive grief that persist for 12 months after the loss of a loved one.
My initial reactions were very positive reading this section. Trauma and Stressor-related disorders seemed to be very different from all other disorders in the DSM in that they are related to an external event instead of only within the individual. Relating a diagnosis to an external event, to me, is a big change because it opens the door to considering mental illness as something that the environment causes (e.g., the traumatic event), not something that the person with the mental illness caused. Trauma and stressor-related diagnosis give us a sociocultural perspective of mental illness. Through the act of diagnosing someone with a trauma and stressor-related disorder, we are admitting that a particular event or chronic series of events caused an individual's issues. Therefore, a trauma and stressor diagnosis shifts the locus of blame to the external world rather than leaving it within the individual's biology or psychology; this is a huge and positive change for me.
Furthermore, after reading this, I reflected on previous class discussions about dimensional measurements of mental illness instead of categorical ones. We talked about HiTOP as an effort to do this, as well as the P-factor (or psychopathology factor), which attempts to consider all mental illness as simply a response to trauma. I very much appreciate this view; it aligns with my personal experiences and how I synthesize the knowledge I obtain through readings and my work. My personal experience is that I experienced trauma in childhood, and while I believe I recovered from it and am now in a mentally healthy position, society and millions of others are still being exposed to trauma each day. By increasing the dialogue around trauma, we can decrease the stigma associated with it. We can also unify disparate camps of pain under one umbrella: that of trauma. The people who experienced systemic poverty, racism, or sexism and the people who experienced abuse, substance use, or war today may adopt different ends of the political spectrum in an attempt to have their own experiences represented. Suppose we can consider all forms of pain like this as trauma. In that case, we can unify efforts and heal divisions to work together to recognize and ameliorate everyone's trauma instead of a divided partisan approach.
It is not a perfect solution because if all pain has its roots in trauma, then are we making things so generic that it is harder to solve? Also, how do we measure trauma where there are so many diverse kinds of it? I am not sure of these answers, but I think it is important that we try to find ways to unify humanity's pain under a single umbrella of trauma. I hope that in my practice, I can do this, and if I meet someone with experiences I cannot relate to personally, which I gather will happen frequently, I will still be able to relate to them through my understanding of trauma in general.
