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Trauma and Stressor Related Disorders
A traumatic event is a ‘very frightening or distressing event that may result in psychological wound or injury – a difficulty coping or functioning normally following a particular event’ (Australian Psychological Society, 2014). Many young people will face a major traumatic event in their lives. According to the Australian Institute of Family Studies (2012), most young people will recover and won’t have long-term negative outcomes from traumatic events, but young people exposed to traumatic events are at a greater risk of experiencing a trauma and stressor related disorder, anxiety and depression.
Types of Trauma and stressor-related disorders
Reactive attachment disorder and Disinhibited social engagement disorder
Children can experience reactive attachment disorder or disinhibited social engagement disorder from experiencing social neglect (extremely inadequate care from their caregivers), such as:
- Having primary caregivers who persistently fail to meet their basic emotional needs for comfort, stimulation and affection
- Having experienced repeated changes in their primary caregivers (e.g., experiencing frequent changes in foster care) which limits their ability to form stable attachments
- Having experienced a caregiving environment with limited opportunities to form selective attachments (e.g., in an institution with high child-to-caregiver ratios)
When children with reactive attachment disorder are distressed, they rarely seek comfort, support, protection or nurturance and they rarely respond to comfort, support, protection or nurturance from caregivers. They usually don’t show positive emotions with their caregivers. They often have problems with their emotional regulation and may have unexplained outbursts of anger, fear, sadness or irritability.
Children with disinhibited social engagement disorder inappropriately approach and behave in an overly familiar way with people they do not know. These children often do not check back in with their caregivers after they have ventured away and are willing to go off with unfamiliar adults.
Posttraumatic stress disorder and Acute stress disorder
Children can experience posttraumatic stress disorder or acute stress disorder from having personally experienced or witnessed a range of threatened or actual events, such as:
- Serious injury or accident
- Sudden, catastrophic, medical events (e.g., anaphylactic shock)
- Natural disasters
- Man-made disasters
- Physical violence
- Domestic violence
- Sexual violence
Posttraumatic stress disorder is a very complex disorder that affects people differently. Essentially, young people feel greatly distressed when they regularly re-experience the trauma they experienced via intrusive memories, dreams or flashbacks. Younger children may re-experience the trauma through play that directly or symbolically relates to the trauma. They avoid reminders of the traumatic event, which may be observed as restricting play, avoiding new situations or restricting pursuing developmentally appropriate activities. Young people with posttraumatic stress disorder may be hyper-vigilant, angry/irritable/quick-tempered, have trouble sleeping, have problems concentrating and/or be easily startled.
Acute stress disorder shares some common symptoms with posttraumatic stress disorder, such as: regular, intrusive memories, dreams or flashbacks that cause great distress, avoiding reminders of the traumatic event and having arousal symptoms (hyper-vigilant, problems concentrating, problems sleeping, being easily startled and/or having a negative mood. Children with acute stress disorder may have frightening dreams without content directly related to the trauma, re-experience the trauma through play, have significant separation anxiety, have a range of emotional expressions and be preoccupied with the trauma. In acute stress disorder, the symptoms must occur within one month of the traumatic event and last for three days to one month.
Children can experience an adjustment disorder from having experienced stress as a result of a specific event, regular event(s) or a continuous event, such as:
- Starting school
- Changing schools
- Having problems in school
- Moving house
- Parents’ separation/divorce
- Family conflict
- Having relationship problems
- Experiencing changes to their bodies and to their sexual identity during adolescence
- Unexpected catastrophes
- Living in an unsafe neighbourhood
- Persistent illness
- Death of a loved one
Young people who develop emotional symptoms (depressed or anxious mood) or behavioural symptoms (disturbance of conduct) as a result of a stressful event may have an adjustment disorder. To be diagnosed with an adjustment disorder, the emotional and behavioural symptoms must be out of proportion to the severity of the stressful event and/or negatively impact a young person's daily functioning. In an adjustment disorder, the symptoms must occur within three months of the event and not persist longer than six months after the stressful event or its consequences have finished.
Related concerns for young people with Trauma and stressor-related disorders
It is common for young people with a trauma and stressor-related disorder to have more than one trauma and stressor-related disorder. They also may experience a range of other concerns, including: anxiety, separation anxiety disorder, depression, attention-deficit hyperactivity disorder, oppositional defiant disorder, cognitive delays, language delays, social concerns, poor self-esteem, or sleeping problems.
Outcomes for young people with Trauma and stressor-related disorders
Reactive attachment disorder and disinhibited social engagement disorder greatly impact young people’s abilities to relate to and develop relationships with their peers and with adults. Posttraumatic stress disorder, acute stress disorder and adjustment disorder can impact a young person’s ability to function at home, at school and socially with their peers. The impacts of trauma and stressor-related disorders will persist into adulthood if left untreated. With appropriate intervention most children with trauma and stressor-related disorders can develop skills that challenge their thinking so that they see the world differently and can improve their daily functioning.
Assessment of Trauma and stressor-related disorders
During your first session we meet with you and your child to conduct a clinical interview to determine if your child has a trauma and stressor-related disorder and to identify any other underlying behavioural, emotional or educational concerns your child may have. Finally, we develop a personalised, evidence-based treatment plan to help your child and your family.
Treatment of Trauma and stressor-related disorders
The aim of our treatment is to reduce the negative impact the traumatic or stressful event is having on your child’s thoughts, feelings and behaviours and to improve your child’s daily functioning. We accomplish this by helping you to understand your child’s thoughts, feelings, and needs, and by providing your child and family with strategies and skills that challenge your child’s thoughts, feelings and behaviours while ensuring that their underlying needs are met.
We use evidence-based, cognitive behavioural therapy to treat trauma and stressor-related disorders. We use a range of cognitive behavioural therapy techniques, depending upon your individual child’s needs, such as:
- Exposure therapy (the core of our treatment plan for young people with posttraumatic stress disorder, acute stress disorder and adjustment disorders)
- Emotion regulation training
- Problem skills training
- Anxiety group programs
We may also use the following evidence-based therapy techniques:
- Resilience group programs
- Social skills groups
For more detailed information on what to expect in your sessions with us, please visit our Appointments page.
If your child has experienced a traumatic/stressful event and is having difficulty coping, please contact us to schedule an appointment.