Trauma and Stress-Related Disorders

Traumatic events have permeated our lives throughout history and across the globe, inflicting profound losses on individuals, families, and communities during warfare, armed conflict, natural disasters, and relational violence. Although many survivors of these events harness their resilience and cope without long-term negative mental health effects, others experience a range of physical and mental health conditions, including trauma- and stress-related disorders. With an emphasis placed on adult trauma survivors, the conditions of posttraumatic stress disorder, acute stress disorder, adjustment disorders, complex trauma, and other stress-related conditions have been explored within a social context. Starting with a historical context, the following topics were addressed. The typologies of trauma were introduced including the definitions of Type I trauma—a single discrete event including natural catastrophes; Type II trauma—chronic and repetitive traumatic physical, sexual, and/or emotional abuse; and Type IIII—severe and multiple abusive events with multiple perpetrators. Historical and intergenerational trauma reflect a collective of complex traumatic events throughout generations that resonate in subsequent generations in terms of ungrieved losses and survivor guilt, among other psychosocial issues. Cultural and racial trauma include chronic verbal and/or physical assaults that involve racialized bigotry. Combat trauma involves a combination of deployment stressors that have affected servicemembers in distinct ways with “signature injuries” associated with different wartime conflicts. The next section addresses the current typology of the Diagnostic and Statistical Manual of Mental Disorders—V, noting the changes in diagnostic criteria, in particular related to the diagnosis of posttraumatic stress disorder (PTSD). Mental health responses to trauma vary a great deal based on a balance of risk and protective factors, often revealing noteworthy resilience and the absence of negative aftereffects. The neurobiological effects of trauma are addressed along with mental health conditions or disorders (e.g., acute stress response, PTSD, complex trauma, and anxiety disorders). Specific phase-oriented and multimodality treatment interventions are reviewed that focus specifically on the mental health conditions presented. These approaches are research-informed, culturally responsive, and theoretically grounded Finally, the responses experienced by clinicians who work with traumatized clients are outlined along with recommendations for ways to minimize the effects of secondary, or vicarious, traumatization. Clinical vignettes based on case composites have been utilized to illustrate central points.