acute and post-traumatic stress disorders

Textbook:

Sue, D., Sue, D. W., Sue, D., & Sue, S. (2014). Essentials of understanding abnormal behavior (2nd ed.). Belmont, CA: Wadsworth Cengage Learning.

 

 

Chapter 5

5-1aAdjustment Disorders

An  adjustment disorder  (AD) occurs when someone has difficulty coping with or adjusting to a specific life stressor—the reactions to the stressor are disproportionate to the severity or intensity of the event or situation.

Common stressors such as interpersonal or family problems, divorce, academic failure, harassment or bullying, loss of a job, or financial problems may lead to an AD. When do these common stressors cause diagnosable AD? According to DSM-5, the following is necessary for a diagnosis of AD (APA, 2013):

1. Exposure to an identifiable stressor that results in the onset of significant emotional or behavioral symptoms that occur within 3 months of the event.

2. Emotional distress and behavioral symptoms that are out of proportion to the severity of the stressor and result in significant impairment in social, academic, or work-related functioning, or other life activities.

3. These symptoms last no longer than 6 months after the stressor or consequences of the stressor have ended.

Adjustment disorders often involve mood or behavioral changes, including symptoms of anxiety or depression. It is not always easy to distinguish between normal adaptive stress, adjustment disorders, and depressive and anxiety disorders.

The main differentiating factor is that a specific stressor precedes the symptoms seen in AD and that the person experiences an unusually intense reaction to the stressor.

To increase diagnostic accuracy and to rule our preexisting mental health conditions, clinicians also consider a person’s emotional functioning prior to encountering the stressor (Kangas, 2013).

We have limited data on the prevalence of AD in the general population. However, it is a common diagnosis among people seeking help from medical or mental health professionals.

The prevalence in that population ranges from 7 to 28 percent (P. Casey, 2009; Mitchell et al., 2011; Pelkonen, Marttunen, Henriksson, & Lönnqvist, 2007).

AD is particularly common among those who have received a worrisome medical diagnosis; for example, up to one-third of those diagnosed with cancer meet the criteria for an AD diagnosis.

As you will see in the next section, in contrast to an AD diagnosis that involves exposure to stressors that range in their level of severity, other trauma-related disorders (acute and post-traumatic stress disorders) require the presence of certain traumatic stressors (see Table 5.1).

Table 5.1 Trauma- and Stressor-Related Disorders

 

Disorders Chart
Disorder	DSM-5 Criteria	Prevalence	Gender and Cultural Factors	Course
Adjustment Disorder	· Exposure to stressors of any type or severity · Symptoms begin within 3 months of exposure to the stressor · Lasts less than 6 months after termination of the stressor or consequences from the stressor	· Prevalence unknown in general population · From 7–28% in medical and psychiatric samples	· More common in women and those with disadvantaged life circumstances	· Most adults recover · Adolescents may be at risk for other disorders
Acute Stress Disorder	· Direct or indirect exposure to a traumatic stressor involving actual or threatened death, serious injury, or sexual violence · Nine or more symptoms involving · intrusive memories · avoidance of reminders of event · negative thoughts or emotions · heightened arousal · dissociation or inability to remember details · Disturbance persists from 3 days to 1 month after exposure to trauma	· Up to 20% for most traumatic events; higher rates for those involving interpersonal situations · Varies according to the type, intensity, and personal meaning of the traumatic stressor	· More prevalent in women, possibly due to more interpersonal trauma · Symptoms may vary cross-culturally	· Over half will later receive a PTSD diagnosis; the remainder will remit within 30 days
Post-traumatic Stress Disorder	· Direct or indirect exposure to a traumatic stressor involving actual or threatened death, serious injury, or sexual violence · One or two symptoms involving each of the following: · intrusive memories · avoidance of reminders of the event · negative thoughts or emotions · heightened arousal and hypervigilance · Symptoms are present for at least 1 month	· Lifetime prevalence for U.S. adults is about 8.7%; 12-month prevalence is 3.5% · Varies according to the traumatic stressor and population involved; higher rates for rape, military combat, and emergency responders	· Twice as prevalent in women · Female adolescents have higher prevalence (6.6%) compared to males (1.6%) · Low prevalence in Asian Americans · Higher prevalence in Latinos and African Americans · Symptoms may vary cross-culturally	· Symptoms fluctuate · Over 50% recover within the first 3 months; for a minority, PTSD is a chronic condition