Trauma and Stressor-Related Disorders

Post-Traumatic Stress Disorder and Acute Stress Disorder

Stress disorders result from exposure to actual or threatened death, serious injury, or sexual violation in one of the following ways:

• Direct experience
• Repeated exposure (first responders)
• Witnessing the event
• Learning of violent or accidental traumatic event involving a close family member or friend

Exposure may lead to re-experiencing of symptoms in the form of nightmares or flashbacks. Women > men. Symptoms include:

• Phobic avoidance
• Hypervigilance
• Increased startle reflex
• Mood instability
• Sleep disturbances
• Dissociative symptoms

Treatment is exposure therapy and SSRIs.

	Post-Traumatic Stress Disorder	Acute Stress Disorder
Onset	Anytime	>3 days but <1 month
Duration	≥1 month	<1 month

Adjustment Disorder

Adjustment disorder is a maladaptive response to an identifiable stressor causing distress in functioning.

• Symptoms must occur within 3 months of stressor
• Symptoms cannot last >6 months in duration

Treatment is supportive psychotherapy.

Recall Question

1. A 28-year-old woman presents to the physician for routine examination. She states that for the past 2–3 weeks she has been less able to concentrate at work, is easily distracted, has increased energy, has been sleeping only 3 hours/night, and has had multiple sexual partners. What other findings would be consistent with the most likely diagnosis?

   1. Slow, telegraphic speech
   2. Rapid, tangential speech
   3. Depressed mood
   4. Self-injurious behavior
   5. Recurrent food binges

Answer: B