What is stress?
Stressors can be considered in terms of their severity, duration, timing, personal meaning, predictability, and controllability.
There’s no single definition of stress — it can be physical, psychological, or both.
Working definition: stress occurs when coping resources are insufficient to meet an actual or perceived challenge.
Stress isn’t always in the event itself — it depends on how the person interprets it, though some life events are widely seen as stressful or traumatic.
How does stress effect health-
- high stress increases susceptibility to illness
- Stress may alter the immune system, increase the risk of heart disease and is linked to premature ageing
How do you manage stress
Manage physical health: regular check-ups, medication, healthy habits.
Build coping skills: use CBT, emotional expression, relaxation, or meditation.
Strengthen social supports: reduce isolation and address social disadvantage
What stress disorders (psychopathologies) can result from stress
- Reactive attachment disorder
- Disinhibited social engagement disorder
- Acute stress disorder
- Posttraumatic stress disorder
- Adjustment disorder
- Prolonged grief disorder
[(PGD) added in DSM-5-TR
What is prolonged grief disorder and why is it significant
DSM-5-TR added this diagnosis under trauma- and stressor-related disorders.
Not a mood disorder (bereavement was in DSM-IV).
Distinguished from normal grief by its severity, intensity, and duration.
Debate continues over duration of how long grief ‘should’ last. The DSM said 12 months ICD said 6 months.
Grouped with trauma disorders since antidepressants may not help; trauma-informed therapy preferred.
Key point: Grief is individual; diagnosing Prolonged Grief Disorder (PGD) requires attention to social and cultural context.
What is the critical view of including ‘Prolonged Grief Disorder’ in the DSM
It was criticised as it
- pathologizes ‘normal’ grief
the threshold is too low, leading to over-diagnosis and medication.
It sets an arbitrary time limit on grief, despite no universal standard.
It ignores context — such as relationship type, circumstances of death, culture, and support systems.
No field testing means weak empirical support for PGD as a valid diagnosis.
Cacciatore & Francis (2022): say adding PGD “creates a problem rather than solving one” and suggest using Adjustment Disorder instead.
what is Adjustment Disorder
diagnosis used when stressful events (like divorce or job loss) overwhelm coping ability and cause noticeable emotional or behavioural symptoms, but not as severe as in PTSD or ASD. The specific symptoms are described using a specifier with the diagnosis. –> cant adjust to change
Symptoms start within three months of a stressful event and are caused by it.
They usually fade once the stressor ends or over time; if they last over six months, another diagnosis may apply.
The person shows significant distress or impairment that is greater than expected for the situatio
History of PTSD
– “Maladaptive” reactions to trauma have long been of interest to the military: “shell shock”, “combat neurosis”.
–Vietnam War prompted much interest in PTSD, highlighting a delayed reaction to combat.
-Remains a significant issue for veterans.
-Changed from a “military disorder” to one that could affect civilians via exposure to non- combat events
What is traumatic stress?
Defined in the DSM-5 as:
an event that involves actual or threatened death, serious injury, or sexual violence to self, or witnessing others experience trauma, learning that loved ones have been traumatized, or repeatedly being exposed to details
of trauma
How did the DSM-5 change PTSD from DSM- 4
DSM-5 changes to PTSD aimed to narrow the definition of traumatic stress so fewer people would meet the criteria.
A study comparing DSM-IV vs DSM-5 found mixed results — only some measures showed fewer diagnoses under DSM-5.
Overall, the changes were seen as positive, slightly raising the diagnostic threshold and focusing on more accurate cases.
As before, both the event and an individual’s meaning, context, and coping resources remain central when assessing traumatic stress, ASD, and PTSD
After traumatic stress exposure, the defining
symptoms for both acute and posttraumatic
stress disorder include
1.Intrusive re-experiencing
2.Avoidance of reminders
3.Increased arousal or reactivity
4.Negative mood or thoughts
5.Dissociative symptoms
What is intrustive re-experiencing
- Repeated, distressing memories (1), or dreams (2)
*Intrusive flashbacks (dissociative reactions) (3) - Psychological (4) or physiological (5) distress or
from event-related cue
To get diagnosed with PTSD, how many symptoms from the intrusive re-experiencing cluster do you need
5 possible symptoms in this cluster, 1 or more to meet criterion
What is avoidance
- Avoids (or tries to avoid) internal reminders (e.g.,
thoughts, feelings) - Avoids (or tries to avoid) external reminders (e.g.,
people, places, or activities etc)
To get diagnosed with PTSD, how many symptoms from the avoidance cluster do you need
2 possible symptoms in this cluster, 1 or more to meet criterion
What is negative mood or thought
- Anhedonia
*Negative emotions (e.g. fear, anger, guilt)
*Self blame
*Negative world view
To get diagnosed with PTSD, how many symptoms from the negative mood/thought cluster do you need
There are 7 possible symptoms (4 shown),
2 or more to meet criterion
What is arousal/reactivity
- Hypervigilance
*Irritability / angry outburst
*Exaggerated startle response - Sleep disturbance (e.g., can’t get to or stay asleep)
To get diagnosed with PTSD, how many symptoms from the arousal/reactivity cluster do you need
6 possible symptoms (3 shown), 2 or more to
meet criterion. These features are why PTSD used
to be an anxiety disorder PTSD: 7 possible symptoms
(4 shown), 2 or more to meet criterion
how do dissociative features differ in ASD compared to PTSD
In ASD, dissociative features are listed
separately (as a symptom cluster); In PTSD they are
subsumed within other clusters and can be added as
specifiers
What is dissociation?
Depersonlisation
Loss of sense of self, a feeling of disconnection or
detachment from one’s body and mental processes.
Feeling as if one is in a dream
derealisation
Experiencing distortion or detachment from reality. The
outside world (one’s surroundings) do not seem be
stable or palpable or real
Overview of dignostic criteria and cluster categories in PTSD
Exposure to “trauma” (defined by DSM-5)
*Intrusion (1/5)
*Avoidance (1/2)
*Negative mood/thoughts (2/7)
*Arousal or reactivity (2/6)
*Symptoms lasting more than 1 month
*Causing Distress
*Not due to substance or medical condition
In PTSD, the experience may create a pathological memory that does not abate over time. It intrudes and interrupt cognitive and other functions and involve extreme emotions, fitting for experience, but now displaced because the immediate danger is gone
Overview of dignostic criteria and cluster categories in ASD
*Exposure to “trauma” (as defined by DSM-5)
*Intrusion
*Avoidance
* Dissociative thoughts
* Negative mood/thoughts
*Arousal or reactivity
*9 symptoms from any cluster
*Sx lasting 3 days to 1 month
*Causing Distress
*Not due to substance or medical condition
Does ASD predict PTSD
- Over 80% of people with ASD have PTSD six months later; BUT, not everyone with ASD will get PTSD.
- PTSD can develop in the absence of ASD but this is relatively unusual. 4% to 13% of people will not have ASD, but will have PTSD in later months or years.
