Disorders Specifically Associated with Stress: PTSD, Complex PTSD, Prolonged Grief Disorder, Acute Stress Reaction, Adjustment Disorder
The International Classification of Diseases and Diagnostic and Statistical Manual of Mental Disorders, published by the World Health Organization and American Psychiatric Association, respectively, identify multiple psychiatric disorders specifically associated with stress, namely, posttraumatic stress disorder (PTSD), acute stress reaction, and adjustment disorder. Though their etiological criteria vary, a common feature of each disorder is that these conditions may develop following highly stressful experiences that result in clinically significant symptoms, associated distress, and functional impairment. Biopsychosocial research over the past several decades has helped to identify several vulnerability and maintenance factors, such as genetic factors, neurobiological factors, psychophysiological factors, cognitive factors, behavioral factors, and sociocultural factors. Similarly, basic and intervention research studies have converged to yield somatic (pharmacotherapy) and behavioral (psychotherapy) treatments that act on these purported vulnerability and maintenance factors with varying levels of efficacy and tolerability. In this chapter, each disorder is defined and their epidemiology, etiology and pathophysiology, assessment issues, comorbidities, course, differential diagnosis, and developmental and cultural considerations are summarized. Then, the overall goals of treatment are reviewed and specific treatment approaches and factors influencing treatment response are discussed. Each section concludes with an illustrative, hypothetical clinical vignette. It is hoped that this chapter informs readers with little or substantial prior familiarity with stress-related disorders alike and helps the field improve its understanding, assessment, and treatment of PTSD, acute stress disorder, and adjustment disorder.
