Trauma Disorder

Trauma disorders are specific mental health conditions that arise from traumatic experiences, although not all traumas result in such conditions. It's important to recognize that the perception of trauma is subjective, as it depends on personal backgrounds and experiences. However, certain traumas, such as violence, neglect, abuse, loss of a loved one, witnessing abuse or violence, torture, accidents, and natural disasters, have been found to be directly linked to the development of mental health conditions. Traumatic experiences can affect individuals of all ages, and the severity of their impact varies. 

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  • Re-experiencing the trauma through flashbacks, intrusive thoughts, and nightmares.
  • Avoidance of trauma reminders.
  • Feelings of depression, hopelessness, and overwhelming anxiety.
  • Loss of interest in activities and withdrawal from social interactions.

  • Traumatic experiences
  • Childhood experiences
  • exposure to physical or emotional violence
  • abuse or neglect

  • Psychotherapy
  • Exposure Therapy
  • Cognitive Behavioral Therapy (CBT)
  • Eye Movement Desensitization and Reprocessing (EMDR)

  • Psychiatry
  • Psychology
  • Therapy

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Trauma Disorder

What is Trauma Disorder?

The impact of trauma varies for each individual, and in some cases, it can lead to the development of a mental health condition. Trauma disorders are specific mental health conditions that arise from traumatic experiences, although not all traumatic experiences result in a mental health condition. 

The perception of trauma is subjective, as it depends on personal backgrounds and experiences. It's crucial not to dismiss someone's mental health condition based on what may or may not traumatize you. However, certain traumas have been identified to directly correlate with the development of mental health conditions, including violence, neglect, abuse, loss of a loved one, witnessing abuse or violence, torture, accidents, and natural disasters. These traumas can affect individuals of all ages and severity varies among individuals. 

Traumatic disorders, if left undiagnosed and unmanaged, can have a significant impact on our lives. Trauma can have a deeper emotional impact than we realize, with dissociation and numbness often clouding our awareness of its effects. 

These disorders may present similarly to other psychiatric conditions like depression and anxiety, but the presence of a trigger event is necessary for diagnosis. Understanding the nature and timing of the triggering event, as well as the severity of symptoms, is essential. 

Treatment typically involves psychotherapy and medication. In the past, trauma-related disorders were often misdiagnosed as anxiety disorders, but it has since been recognized that they primarily manifest through symptoms such as anhedonia, dysphoria, dissociation, and externalization of anger and aggression. While anxiety or fear may still be present in individuals with trauma-related disorders, they are not the primary symptoms. As a result, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has dedicated a specific chapter to trauma and stressor-related disorders.

Trauma Disorder Symptoms:

Each trauma disorder presents distinct symptoms and diagnostic criteria according to the DSM-5. However, these related conditions share several common symptoms and characteristic signs, including:

  1. Re-experiencing the trauma through flashbacks, intrusive thoughts, and nightmares.
  2. Avoidance of trauma reminders.
  3. Feelings of depression, hopelessness, and overwhelming anxiety.
  4. Loss of interest in activities and withdrawal from social interactions.
  5. Emotional numbness and an inability to experience pleasure.
  6. Sleep disturbances and appetite changes.
  7. Outbursts of anger or violence.
  8. Difficulty concentrating, thinking, and forming relationships.
  9. Heightened startle response and constant edginess.
  10. Impulsive behaviors.
  11. Suicidal thoughts and behaviors.

While most mental illnesses lack a single cause, trauma disorders can often be attributed to one or more traumatic experiences. Not everyone who undergoes trauma will develop a trauma disorder, as individuals' responses can vary. However, having a trauma disorder increases the risk of co-occurring mental illnesses and substance use disorders.

Individuals may turn to drugs or alcohol to self-medicate and escape negative feelings, leading to substance abuse problems. Additionally, trauma disorders can have serious consequences across various aspects of life, such as damaged relationships, work or school difficulties, financial problems, isolation, insomnia, impulsive behavior-related injuries, and legal issues.

Childhood experiences, including exposure to physical or emotional violence, abuse, or neglect, can contribute to trauma and stressor-related disorders. Witnessing parental abuse or experiencing parental divorce or loss are examples of stressors affecting children. Traumatic events like terrorist attacks or sexual assault also contribute to trauma and stress-related disorders. 

The characteristic symptoms of trauma and stressor-related disorders fall into four broad categories:

  1. Intrusion symptoms: Recurrent distressing memories, thoughts, and dreams of the traumatic event, as well as flashbacks.
  2. Avoidance symptoms: Efforts to avoid trauma-related triggers, both internal and external, becoming a central focus of the individual's life.
  3. Negative alterations: Problems with memory, mood alterations such as depression, fear, guilt, shame, and feelings of isolation.
  4. Hyper-arousal symptoms: Hypervigilance, irritability, anger outbursts, self-destructive behavior, concentration difficulties, and sleep disturbances.

Understanding these symptoms and categories helps to identify and diagnose trauma and stressor-related disorders accurately.

Types of Trauma Disorder:

The study of trauma-related disorders has focused extensively on combat experiences and physical/sexual assault. Combat-related trauma symptoms trace back to World War I, where soldiers returned with "shell shock." However, significant progress in identifying and treating war-related psychological difficulties occurred after the Vietnam War.

Post-Traumatic Stress Disorder (PTSD):

Posttraumatic stress disorder (PTSD) is characterized by physiological, psychological, and emotional symptoms following exposure to trauma. Individuals must have been exposed to situations involving death, sexual violence, or serious injury. Examples include witnessing trauma, learning about traumatic events happening to loved ones, directly experiencing trauma, or being repeatedly exposed to aversive events. 

Acute stress disorder is similar to PTSD, but symptoms must be present from 3 days to 1 month. If symptoms persist beyond one month, the individual meets the criteria for PTSD. 

Adjustment Disorders:

Adjustment disorders develop in response to identifiable stressors and involve emotional or behavioral symptoms. Symptoms must occur within three months of the stressful event and not persist beyond six months. 

Unlike PTSD and acute stress disorder, adjustment disorder does not have specific symptom criteria. Symptoms must relate to the stressor and impair functioning disproportionately. Classification modifiers include depressed mood, anxiety, mixed anxiety and depressed mood, disturbance of conduct, mixed disturbance of emotions and conduct, or unspecified, depending on the individual's symptoms.

Disinhibited Social Engagement Disorder:

Disinhibited Social Engagement Disorder (DSED) is observed in children who display overly familiar behavior with strangers, lacking fear or caution. DSED can result from social neglect, frequent changes in caregivers, or limited ability to form attachments. 

Reactive Attachment Disorder:

Reactive Attachment Disorder (RAD) occurs in children aged 9 months to 5 years and is characterized by emotionally withdrawn behavior toward adult caregivers. RAD stems from a pattern of insufficient care or neglect, affecting attachment formation.

Prolonged Grief Disorder:

Prolonged Grief Disorder, formerly known as persistent complex bereavement disorder, is characterized by intense longing, preoccupation with thoughts or memories of the deceased at least 12 months after their death. Symptoms include feelings of personal loss, disbelief, emotional numbness, meaninglessness, loneliness, impaired social engagement, intense emotional pain, and avoidance of reminders. Individuals with prolonged grief disorder may hold maladaptive cognitions, experience guilt, negative life views, engage in harmful health behaviors, and exhibit anger, restlessness, blame, and sleep disturbances.

Unspecified Trauma and Stressor Related Disorder:

An unspecified trauma and stressor-related disorder diagnosis is used when there is inadequate information for a specific diagnosis. It encompasses symptoms associated with trauma-related disorders that cause distress and impairment but do not meet full diagnostic criteria.

Diagnosis and Treatment

Determining the prevalence of the trauma-related disorders can be difficult because they are triggered by exposure to a specific traumatic or stressful event. RAD and disinhibited social engagement disorder are thought to be rare in the general population affecting less than 1% of children under the age of five.

Successful treatment of the trauma-related disorders usually requires both medication and some form of psychotherapy.

While trauma disorders cause a lot of distress and impairment, they can be treated and managed. Because the symptoms can be severe and patients can be at risk of causing themselves harm, treatment in a residential setting is one of the most effective ways to address a trauma disorder. There, the patient can be treated with a variety of therapies, including cognitive behavioral therapy, which helps change negative patterns of thoughts and behaviors.

Exposure therapy can also be used to help patients become desensitized to traumatic memories and to learn and practice healthy coping strategies. This is especially useful for people who experience flashbacks or nightmares. Guided eye movements through eye movement desensitization and reprocessing have been shown to help patients process trauma and react more calmly to memories of the event.

The experience of trauma can be devastating and when the normal response to it extends beyond the usual timeframe or is severe, there may be an underlying trauma disorder. 

Fortunately, dedicated treatment has been shown to be effective in managing the symptoms by learning and using healthy coping strategies, changing negative thoughts and behaviors, and relying on loved ones and others for support.


Several treatments can help people with trauma to cope with their symptoms and improve their quality of life.


Two forms of trauma-focused cognitive-behavior therapy (TF-CBT) have been shown to be effective in treating the trauma-related disorders. Prolonged exposure therapy is an effective variant of CBT that treats both anxiety and trauma-related disorders. Therapists create a safe environment to “expose” the patient to the thing(s) they fear and avoid. The exposure to the feared objects, activities, or situations in a safe environment helps reduce fear and decrease avoidance.

In cognitive processing therapy (CPT) the therapist seeks to help the client gain an understanding of the traumatic event and take control of distressing thoughts and feelings associated with it. CPT explores how the traumatic event has affected your life and skills needed to challenge maladaptive thoughts related to the trauma.

Exposure Therapy

While exposure therapy is predominately used in anxiety disorders, it has also shown great success in treating PTSD-related symptoms as it helps individuals extinguish fears associated with the traumatic event. There are several different types of exposure techniques—imaginal, in vivo, and flooding are among the most common types (Cahill, Rothbaum, Resick, & Follette, 2009).

In imaginal exposure, the individual mentally re-creates specific details of the traumatic event. The patient is then asked to repeatedly discuss the event in increasing detail, providing more information regarding their thoughts and feelings at each step of the event. During in vivo exposure, the individual is reminded of the traumatic event through the use of videos, images, or other tangible objects related to the traumatic event that induces a heightened arousal response. While the patient is re-experiencing cognitions, emotions, and physiological symptoms related to the traumatic experience, they are encouraged to utilize positive coping strategies, such as relaxation techniques, to reduce their overall level of anxiety.

Imaginal exposure and in vivo exposure are generally done in a gradual process, with imaginal exposure beginning with fewer details of the event, and slowly gaining information over time. In vivo starts with images or videos that elicit lower levels of anxiety, and then the patient slowly works their way up a fear hierarchy, until they are able to be exposed to the most distressing images. Another type of exposure therapy, flooding, involves disregard for the fear hierarchy, presenting the most distressing memories or images at the beginning of treatment. While some argue that this is a more effective method, it is also the most distressing and places patients at risk for dropping out of treatment (Resick, Monson, & Rizvi, 2008).

 Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy has been proven to be an effective form of treatment for trauma/stress-related disorders. It is believed that this type of treatment is effective in reducing trauma-related symptoms due to its ability to identify and challenge the negative cognitions surrounding the traumatic event, and replace them with positive, more adaptive cognitions.

Trauma-focused cognitive-behavioral therapy (TF-CBT) is an adaptation of CBT that utilizes both CBT techniques and trauma-sensitive principles to address the trauma-related symptoms. According to the Child Welfare Information Gateway (CWIG; 2012), TF-CBT can be summarized via the acronym PRACTICE:

  • P: Psycho-education about the traumatic event. This includes discussion about the event itself, as well as typical emotional and/or behavioral responses to the event.
  • R: Relaxation Training. Teaching the patient how to engage in various types of relaxation techniques such as deep breathing and progressive muscle relaxation.
  • A: Affect. Discussing ways for the patient to effectively express their emotions/fears related to the traumatic event.
  • C: Correcting negative or maladaptive thoughts.
  • T: Trauma Narrative. This involves having the patient relive the traumatic event (verbally or written), including as many specific details as possible.
  • I: In vivo exposure (see above).
  • C: Co-joint family session. This provides the patient with strong social support and a sense of security. It also allows family members to learn about the treatment so that they are able to assist the patient if necessary.
  • E: Enhancing Security. Patients are encouraged to practice the coping strategies they learn in TF-CBT to prepare for when they experience these triggers out in the real world, as well as any future challenges that may come their way.

Eye Movement Desensitization and Reprocessing (EMDR)

In the late 1980s, psychologist Francine Shapiro found that by focusing her eyes on the waving leaves during her daily walk, her troubling thoughts resolved on their own. From this observation, she concluded that lateral eye movements facilitate the cognitive processing of traumatic thoughts (Shapiro, 1989).

While EMDR has evolved somewhat since Shapiro’s first claims, the basic components of EMDR consist of lateral eye movement induced by the therapist moving their index finger back and forth, approximately 35 cm from the client’s face, as well as components of cognitive-behavioral therapy and exposure therapy. The following 8-step approach is the standard treatment approach of EMDR (Shapiro & Maxfield, 2002):

  • Patient History and Treatment Planning – Identify trauma symptoms and potential barriers to treatment.
  • Preparation – Psychoeducation of trauma and treatment.
  • Assessment – Careful and detailed evaluation of the traumatic event. Patient identifies images, cognitions, and emotions related to the traumatic event, as well as trauma-related physiological symptoms.
  • Desensitization and Reprocessing – Holding the trauma image, cognition, and emotion in mind, while simultaneously assessing their physiological symptoms, the patient must track the clinician’s finger movement for approximately 20 seconds. At this time, the patient must “blank it out” and let go of the memory.
  • Installation of Positive Cognitions – Once the negative image, cognition, and emotions are reduced, the patient must hold onto a positive image or thought while again tracking the clinician’s finger movement for approximately 20 seconds.
  • Body Scan – Patient must identify any lingering bodily sensations while again tracking the clinician’s fingers for a third time to discard any remaining trauma symptoms.
  • Closure – Patient is provided with positive coping strategies and relaxation techniques to assist with any recurrent cognitions or emotions related to the traumatic experience.
  • Reevaluation – Clinician assesses if treatment goals were met. If not, schedule another treatment session and identify remaining symptoms.

As you can see from above, only steps 4-6 are specific to EMDR; the remaining treatment is essentially a combination of exposure therapy and cognitive-behavioral techniques. Because of the high overlap between treatment techniques, there have been quite a few studies comparing the treatment efficacy of EMDR to TF-CBT and exposure therapy. While research initially failed to identify a superior treatment, often citing EMDR and TF-CBT as equally efficacious in treating PTSD symptoms (Seidler & Wagner, 2006), more recent studies have found that EMDR may be superior to that of TF-CBT, particularly in psycho-oncology patients). While meta-analytic studies continue to debate which treatment is the most effective in treating PTSD symptoms, the World Health Organization’s (2013) publication on the Guidelines for the Management of Conditions Specifically Related to Stress, identified TF-CBT and EMDR as the only recommended treatment for individuals with PTSD.

Somatic therapies

Some therapists use somatic or body-based techniques to help the mind and the body process trauma. 

A review of the literature in the Psychotherapy and Counseling Journal of Australia found that body-based therapies could help a range of people. These therapies include:

  • Somatic experiencing: This approach involves a therapist helping a person to relive traumatic memories in a safe space.
  • Sensorimotor psychotherapy: This type of therapy combines psychotherapy with body-based techniques to turn traumatic memories into sources of strength.
  • Acupoint stimulation: This involves a practitioner applying pressure to specific points on the body, which induces a state of relaxation.
  • Touch therapies: Other touch therapies include Reiki, healing touch, and therapeutic touch therapy.


While psychopharmacological interventions have been shown to provide some relief, particularly to veterans with PTSD, most clinicians agree that resolution of symptoms cannot be accomplished without implementing exposure and/or cognitive techniques that target the physiological and maladjusted thoughts maintaining the trauma symptoms. With that said, clinicians agree that psychopharmacology interventions are an effective second line of treatment, particularly when psychotherapy alone does not produce relief from symptoms.

Among the most common types of medications used to treat PTSD symptoms are selective serotonin reuptake inhibitors. SSRIs work by increasing the amount of serotonin available to neurotransmitters. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are also recommended as second-line treatments. Their effectiveness is most often observed in individuals who report co-occurring major depressive disorder symptoms, as well as those who do not respond to SSRIs. Unfortunately, due to the effective CBT and EMDR treatment options, research on psychopharmacological interventions has been limited. Future studies exploring other medication options are needed to determine if there are alternative medication options for stress/trauma disorder patients.

Coping with Trauma Disorders:

Practicing self-care can help individuals to cope with the emotional, psychological, and physical symptoms of trauma. 


Trauma can activate the body’s fight-or-flight response. Exercise may help mitigate some of these effects. Research Suggests that aerobic exercise may be an effective therapy for people with PTSD.

Individuals can aim to exercise for at least 30 minutes a day on most days of the week.


Mindful breathing and other mindfulness-based exercises can ground people in the present, which can stop them from reliving the traumatic event.

Studies suggest that mindfulness-based treatments are a promising intervention for PTSD, whether alone or in conjunction with other treatments.

Connection with others

Withdrawal from others is a common symptom of trauma. However, connecting with friends and family is important. 

According to the Anxiety and Depression Association of America, staying in contact with people can help to prevent trauma from becoming PTSD.

It is not necessary to talk about the trauma with other people if it is too difficult. Simply engaging with others can improve mood and well-being. Some people feel a benefit from disclosing the trauma with people they trust.

A balanced lifestyle

A person with trauma may find it difficult to relax or to sleep well. However, sleep, relaxation, and diet all play a role in mental health. If possible, a person should try to:

  • sleep for 7–9 hours a night
  • eat a balanced diet
  • avoid alcohol and drugs
  • relieve stress with mindful or enjoyable activities


If necessary, people can ask for support from others. This includes talking to trusted loved ones or joining a support group for trauma survivors.

When to seek help

People who experience persistent or severe symptoms of trauma should seek help from a mental health professional. It is especially important to seek help if the trauma symptoms interfere with daily functioning or relationships with others.

Even those with mild symptoms can feel better once they talk to someone.

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