CHAPTER 5

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Disorders of Trauma and Stress

During the horror of combat, soldiers often become highly anxious and depressed, confused and disoriented, even physically ill. Moreover, for many, like Latrell, these and related reactions to extraordinary stress or trauma continue well beyond the combat experience itself.

Of course, it is not just combat soldiers who are affected by stress. Nor does stress have to rise to the level of combat trauma to have a profound effect on psychological and physical functioning. Stress comes in all sizes and shapes, and we are all greatly affected by it.

We feel some degree of stress whenever we are faced with demands or opportunities that require us to change in some manner. The state of stress has two components: a stressor, the event that creates the demands, and a stress response, the person’s reactions to the demands. The stressors of life may include annoying everyday hassles, such as rush-hour traffic; turning-point events, such as college graduation or marriage; long-term problems, such as poverty or poor health; or traumatic events, such as major accidents, assaults, tornadoes, or military combat. Our response to such stressors is influenced by the way we judge both the events and our capacity to react to them in an effective way (Biron & Link, 2014; Lazarus & Folkman, 1984). People who sense that they have the ability and the resources to cope are more likely to take stressors in stride and to respond well.

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When we view a stressor as threatening, a natural reaction is arousal and a sense of fear—a response frequently discussed in Chapter 4. As you saw in that chapter, fear is actually a package of responses that are physical, emotional, and cognitive. Physically, we perspire, our breathing quickens, our muscles tense, and our heart beats faster. Turning pale, developing goose bumps, and feeling nauseated are other physical reactions. Emotional responses to extreme threats include horror, dread, and even panic, while in the cognitive realm fear can disturb our ability to concentrate and remember and may distort our view of the world. We may, for example, remember things incorrectly or exaggerate the harm that actually threatens us.

Stress reactions, and the sense of fear they produce, are often at play in psychological disorders. People who experience a large number of stressful events are particularly vulnerable to the onset of the anxiety disorders that you read about in Chapter 4. Similarly, increases in stress have been linked to the onset of depression, schizophrenia, sexual dysfunctioning, and other psychological problems.

Extraordinary stress and trauma play an even more central role in certain psychological disorders. In these disorders, the reactions to stress become severe and debilitating, linger for a long period of time, and may make it impossible for the individual to live a normal life. Under the heading “Trauma- and Stressor-Related Disorders,” DSM-5 lists several disorders in which trauma and extraordinary stress trigger a wide range of stress symptoms, including heightened arousal, anxiety and mood problems, memory and orientation difficulties, and behavioral disturbances. Two of these disorders, acute stress disorder and posttraumatic stress disorder, are discussed in this chapter. In addition, DSM-5 lists the “dissociative disorders,” a group of disorders also triggered by traumatic events, in which the primary symptoms are severe memory and orientation problems. These disorders—dissociative amnesia, dissociative identity disorder (multiple personality disorder), and depersonalization-derealization disorder—are also examined in this chapter.

To fully understand these various stress-related disorders, it is important to appreciate the precise nature of stress and how the brain and body typically react to stress. Thus let’s first discuss stress and arousal, then move on to discussions of acute and posttraumatic stress disorders and the dissociative disorders.

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