Getting a Handle on Trauma and Stress

The concepts of trauma and stress have been prominent in the field of abnormal psychology since its earliest days. Dating back to Sigmund Freud, for example, psychodynamic theorists have proposed that most forms of psychopathology—from depression to schizophrenia—begin with traumatic losses or events. Even theorists from the other clinical models agree that people under stress are particularly vulnerable to psychological disorders of various kinds, including anxiety disorders, depressive disorders, eating disorders, substance use disorders, and sexual dysfunctions.

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But why and how do trauma and stress translate into psychopathology? That question has, in fact, eluded clinical theorists and researchers—until recent times. In part because of the identification and study of acute and posttraumatic stress disorders, researchers now better understand the relationship between trauma, stress, and psychological dysfunction—viewing it as a complex interaction of many variables, including biological and genetic factors, personality traits, childhood experiences, social support, multicultural factors, and environmental events. Similarly, clinicians are now developing more effective treatment programs for people with acute and posttraumatic stress disorders—programs that combine biological, behavioral, cognitive, family, and social interventions.

Insights and treatments for the dissociative disorders, the other group of trauma-triggered disorders discussed in this chapter, have not moved as quickly. Although these disorders were among the field’s earliest identified problems, the clinical field stopped paying much attention to them during the latter part of the twentieth century, with some clinicians even questioning the legitimacy of the diagnoses. However, the field’s focus on dissociative disorders has surged during the past two decades—partly because of intense clinical interest in stress reactions and partly because of the growing effort to understand physically rooted memory disorders such as Alzheimer’s disease. Researchers have begun to appreciate that dissociative disorders may be more common than clinical theorists had previously recognized. In fact, there is growing evidence that the disorders may be rooted in processes that are already well known from other areas of study, such as state-dependent learning and self-hypnosis.

Amidst the rapid developments in the realms of trauma and stress lies a cautionary tale. When problems are studied heavily, it is common for the public, as well as some researchers and clinicians, to draw conclusions that may be too bold. For example, many people—perhaps too many—are now receiving diagnoses of posttraumatic stress disorder, partly because the symptoms of PTSD are many and because PTSD has received so much attention (Holowka et al., 2014; Wakefield & Horwitz, 2010). Similarly, some of today’s clinicians worry that the resurging interest in dissociative disorders may be creating a false impression of their prevalence. We shall see such potential problems again when we look at other forms of pathology that are currently receiving great focus, such as bipolar disorder among children and attention deficit/hyperactivity disorder. The line between enlightenment and overenthusiasm is often thin.