Trauma- and Stressor-Related Disorders

  1. Post-traumatic stress disorder (PTSD)

It is a mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

The first DSM-5criterion has 4 components, they are as follows:

Directly experiencing the traumatic event(s)

Witnessing, in person, the event(s) as it occurred to others

Learning that the traumatic event(s) occurred to a close family member or friend

Experiencing repeated or extreme exposure to aversive details of the traumatic event(s); this does not apply to exposure through media such as television, movies, or pictures


The second criterion involves the persistent re-experiencing of the event in 1 of several ways:

Thoughts or perception



Illusions or hallucinations

Dissociative flashback episodes

Intense psychological distress or reactivity to cues that symbolize some aspect of the event

Unlike adults, children re-experience the event through repetitive play rather than through perception.

The third criterion involves avoidance of stimuli that are associated with the trauma and numbing of general responsiveness, as determined by the presence of 1 or both of the following:

Avoidance of thoughts, feelings, or conversations associated with the event

Avoidance of people, places, or activities that may trigger recollections of the event


The fourth criterion is 2 or more of the following symptoms of negative alterations in cognitions and mood associated with the traumatic event(s):

Inability to remember an important aspect of the event(s)

Persistent and exaggerated negative beliefs about oneself, others, or the world

Persistent, distorted cognitions about the cause or consequences of the event(s)

Persistent negative emotional state

Markedly diminished interest or participation in significant activities

Feelings of detachment or estrangement from others

Persistent inability to experience positive emotions


The fifth criterion is marked alterations in arousal and reactivity, as evidenced by 2 or more of the following:

Irritable behavior and angry outbursts

Reckless or self-destructive behavior


Exaggerated startle response

Concentration problems

Sleep disturbance

The remaining 3 criteria are as follows:

The duration of symptoms is more than 1 month;

The disturbance causes clinically significant distress or impairment in functioning;

The disturbance is not attributable to the physiological effects of a substance or other medical condition.

Case Example:

Jenny worked as a night shift supervisor in a factory which is 25 kilometers driving from her home. Three months ago, on her way to work Jenny got into a car accident that did not involve any other cars. It was a summer night with clear sky. Yet, Jenny’s car landed on a ditch of a highway and turned upside down. Since the accident, Jenny was unable to drive at all. Even when her husband or children are driving, she refuses to ride with them if they are taking any highways instead of the city roads. Jenny has developed an interrupted sleeping pattern. She has nightmares almost every night. Every time when either the radio or a television station is broadcasting news about car accidents, Jenny will immediately switch to a different channel.


  1. Reactive attachment disorder

This disorder is the result of social neglect or other circumstances that limit a young child’s opportunity to form selective attachments with adult caregivers. There are two subtypes.


Reactive attachment disorder (RAD)

The specific DSM-5 diagnostic criteria for RAD are as follows:

A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers;

A persistent social and emotional disturbance;

A pattern of extremes of insufficient care.

The care described in the third criterion is presumed to be responsible for the disturbed behavior described in the first criterion.

The disturbance is evident before age 5 years;

The child has a developmental age of at least 9 months.

Case Example:

Tom, six years old, comes across as a child who is very independent. In reality, it is not the case. Tom was raised by her parents who both believed picking up their son every time he cried would spoil him. For this reason, Tom was often left crying by himself until he got tired and felt asleep.

The parenting style Tom’s parents adopted to raise him in early years left Tom with the belief that he cannot dependent on anyone except on himself. Tom often has difficulty calming down when stressed, and he will not look for comfort from his parents when he is upset. Tom may seem to have little to no emotions whenever he is being left in the care of others or when he is being picked up by his parents. Tom often appears to be unhappy, irritable, or sad while having normal activities with other children. When he is being left alone, he seems to be fine.


Disinhibited social engagement disorder (DSED)

The specific DSM-5 diagnostic criteria for DSED are as follows:

A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults in an impulsive, incautious, and overfamiliar way;

The behaviors described in the first criterion are not limited to impulsivity but also include socially disinhibited behavior;

A pattern of extremes of insufficient care.

The care described in the third criterion is presumed to be responsible for the disturbed behavior described in the first criterion.

The child has a developmental age of at least 9 months.

Case Example:

Susan does not appear fearful when meeting someone for the first time. In fact, she is often overly friendly, and she will walk up to strangers to talk or even hug them. When she is left in the children-play area to play, she will allow strangers to pick her up, or give her toys to play with. When she is put in a situation with total strangers who approach her, Susan will respond to them spontaneously without checking with her parents first. She has had gone twice with someone she does not know outside the children-play area.

With both RAD and DSED, if the disorder has been present for longer than 12 months, it is specified as persistent; if the child exhibits all the symptoms of RAD or DSED, with each symptom manifesting at relatively high levels, the disorder is further specified as severe.


DISCLAIMER: Description of each of the mental issue is intended for a quick reference only. You are advised not to use it for self-diagnosis. If you have concerns about your mental health conditions, you are advised to seek medical advice from your family doctor or from a psychiatrist. If you already have a confirmed diagnosis of a mental health issue and you are considering counselling as an alternative treatment, you are encouraged not to stop taking medications without discussing and consulting with your family doctor or psychiatrist. Please also mention to your medical professionals about seeking counselling if you can.