Trauma- & Stressor-Related Disorders: Signs, Symptoms, and Treatment

What Are Trauma-Related Disorders?

The Diagnostic and Statistical Manual of Mental Disorders (5^th edition) (DSM-5) defines trauma- and stressor-related disorders as mental disorders in which a traumatic event or chronic stress are specifically listed as a diagnostic criterion.² Several disorders (e.g., posttraumatic stress disorder, acute stress disorder, prolonged grief disorder) are recognized in this category, despite having a wide variety of symptoms.²

Symptoms of Trauma Disorders

Symptoms of trauma disorders fall into several categories that can be expressed in a multitude of ways depending on the person’s age, personality, and other life circumstances. People exposed to stressful or traumatic events may exhibit symptoms that are well understood as anxiety- or fear-based.² However, other types of symptoms that are grouped into stressor- and trauma-based disorders may include:²

• Anhedonic and dysphoric symptoms. Anhedonia is the loss of the ability to experience pleasure from experiences that were previously positive. For example, a food lover may no longer enjoy eating. Dysphoria is a having a mental state that is generally discontent and makes a person feel agitated.³
• Externalizing angry and aggressive symptoms.
• Dissociative symptoms (i.e., disconnection from self or reality).

People with trauma- or stressor-based disorders may experience one or a combination of the above symptomatic categories, with or without the presence of anxiety or fear-based symptoms. These types of symptoms may occur in people without a pathological trauma-related disorder (e.g., experiencing dysphoria when grieving the death of a loved one); however they would be experienced to a lesser degree.²

Types of Stressor- & Trauma-Related Disorders

Stressor- and trauma-related disorders include:²

• Posttraumatic stress disorder (PTSD), which may manifest differently from person to person and can occur after any form of trauma. Symptoms may vary from extreme fear and anxiety-based symptoms during flashbacks of traumatic events, while others may predominantly struggle with more negative or dysphoric mood states. Symptoms can also occur without flashbacks and may appear as constant feelings of stress, increased reactivity, or dissociation.
• Acute stress disorder, which may occur immediately following a traumatic event(s) and symptoms typically lasts from 3 days to 1 month. A person may have some form of re-experiencing the traumatic event and have ongoing anxiety or reactivity as if the event were truly recurring over and again.
• Adjustment disorders, which consist of a collection of emotional or behavioral symptoms that occur after a person experiences an identifiable stressor. It could be a single event, recurrent stressors, or ongoing stress such as living in a crime-ridden neighborhood. The intensity of these symptoms are considered out of proportion to what was experienced or the symptoms cause significant impairment in someone’s social life, career, or other important areas of functioning.
• Prolonged grief disorders, which can be diagnosed when the symptoms of grief that follow the death of a loved one or another grievous event exceed the usual length of time or severity for symptoms. One such disorder is called persistent complex bereavement disorder.
• Other specified trauma- and stressor-related disorder, which can be diagnosed when a person is experiencing some constellation of trauma- or stressor-related disorder symptoms but does not meet the full criteria for diagnosis with other known disorders This diagnosis may appear in emergency room settings when there is insufficient information available to make a specific diagnosis.

Trauma- and stress-related disorders diagnosed only in children include:²

• Reactive attachment disorder. Infants and young children affected by reactive attachment disorder do not, or rarely, seek comfort from their attachment figures due to a lack of opportunity to develop attachment relationships. This can result in long-term difficulty with emotional regulation and unexplained episodes of strong negative emotional displays.
• Disinhibited social engagement disorder.  Disinhibited social engagement disorder can be diagnosed at any age above 9 months, when children are able to form attachments. People with this disorder behave in overly familiar, culturally inappropriate ways toward relative strangers.

Risk Factors of Trauma Disorders

Certain people may have risk or prognostic factors that predispose them to extreme emotional responses to traumatic events.

For example, factors that may increase the likelihood of developing posttraumatic stress disorder (PTSD) include:²

• Pre-traumatic factors. These may include temperamental elements such as childhood emotional problems, prior mental disorders (e.g., anxiety, depression, obsessive-compulsive disorder), common personality traits such as a negative emotional response such as mild neuroticism. Environmental factors like low socioeconomic status, exposure to prior trauma, childhood adversity, experiencing racial or ethnic discrimination, and more. Research suggests that PTSD is heritable, indicating that genetics and epigenetics play a role.
• Peritraumatic factors. This may include the severity of the trauma, the perceived threat to the patient’s life, injuries experienced, witnessing atrocities, dissociation or panic during the event, and more.
• Posttraumatic factors, such as unhealthy coping methods following the traumatic event, negative assessments, or the development of acute stress disorder. Environmental factors like upsetting reminders, additional adversity, high levels of daily stress, and more also increase likelihood of PTSD.

Factors that can reduce the likelihood of suffering from PTSD include:⁴

• Peer-support groups of help from friends.
• Accepting one’s actions in response to a traumatic event
• Healthy coping strategies for dealing with a traumatic event.
• Preparing oneself to respond to distressing events.

What Is the Connection Between Trauma, Stress, and Substance Use Disorders?

Experiences such as violence, neglect, abuse, or chronic stress have been shown to increase a person’s vulnerability to substance use and the subsequent development of a substance use disorder.¹

For example:¹

• People with a history of physical childhood abuse have a 74% greater risk of developing a substance use disorder.
• People that endured sexual abuse during childhood have a 73% greater risk of developing a substance use disorder.
• Nearly 1 out of 5 Veterans with PTSD also have a co-occurring substance use disorder.⁷

Experts have identified a few theories that may explain the connection between trauma and addiction.¹

For one, trauma and chronic stress can cause adaptations in particular brain regions that may lead to addiction. Trauma or chronic stress is known to cause brain changes in the reward, motivation, and learning circuits of the brain that influence both brain functioning and a person’s behaviors that increase their risk of addiction.¹ Trauma experienced in early childhood, as the brain is still developing, is associated with an even greater risk of substance use disorder development.¹

Additionally, a person who is or has experienced chronic stress or trauma may use alcohol or other substances as an unhealthy coping mechanism.¹ As symptoms of their trauma-related disorder worsen or persist, they may increase their usage, thereby further increasing their risk of substance use disorder.¹

Does Trauma Always Lead to Developing a Substance Use Disorder?

No, having a traumatic experience does not always lead to the development of a substance use disorder or addiction.⁵ Trauma or chronic stress does not directly cause substance use disorder but can increase the likelihood someone will develop one.⁵

There is no one reason why some people get addicted to drugs or alcohol while others don’t. Some people may also be more susceptible than others to addiction due to certain factors such as genetic vulnerabilities, epigenetic influence (the effect of one’s environment on their gene expression), or substance use at an early age. The more of these risk factors one has, the more vulnerable they are to develop an addiction.⁶

Treatment for Trauma- & Stressor-Related Disorders and Co-Occurring Addiction

If you or a loved one are struggling with a trauma- or stressor-related disorder alongside addiction, help is available. Many patients benefit from undergoing simultaneous treatment for addiction and co-occurring disorders rather than focusing on one disorder at a time.¹ Co-occurring trauma disorder treatment may include:⁷

• Cognitive-behavioral therapy.
• Exposure therapy.
• Cognitive processing therapy.
• Medications.
• Support groups.

Levels of care for addiction treatment with co-occurring disorders could include:⁸

• Detox or withdrawal management, to stabilize the patient through the withdrawal process.
• Inpatient or residential treatment, in which the patient lives at the facility and benefits from 24/7 care, structured treatment schedules, and medical supervision.
• Outpatient care, in which the patient lives at home and visits the facility several times per week. Length and frequency of sessions depends on the program and the patient’s needs.

The combination of different interventions is individualized for each person in recovery. American Addiction Centers (AAC) admissions navigators can answer your questions about treatment and help you get set up with an assessment team to begin your journey to recovery.