In the United States, the majority of clinical helping professions (e.g., psychology, psychiatry, counseling, social work, and marriage and family), use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe and diagnose mental, emotional, and relational difficulties. The DSM is published by the American Psychiatric Association. The fifth and most recent edition was published in 2013, and is commonly called DSM-5. The DSM may be considered a living document. It constantly evolves and undergoes revisions as new research changes our understanding of mental and emotional disorders. Therefore, it should not be surprising that the newest edition has many such changes.
The DSM uses a classification system that groups individual diagnoses into clusters of similar disorders. Post-traumatic stress disorder (PTSD) was first introduced in 1980 and was included in the group of disorders known as Anxiety Disorders. One of the major changes in the newest edition, (DSM-5, 2013) was the inclusion of a new group of disorders called Trauma and Stressor-Related Disorders. This involved the re-classification and modification of several existing disorders that were previously classified elsewhere in the manual. For example, as mentioned, PTSD was originally classified with Anxiety Disorders. While PTSD and other stressor-related disorders have anxious features associated with those disorders, the re-classification highlights the important role of stress and trauma in the formation and treatment of these disorders. This change in classification reflected a change in our understanding about the impact of unhealed trauma and unmanaged stress on human behavior.
The new chapter of Trauma and Stressor-Related Disorders contains the following diagnoses:
- Reactive Attachment Disorder
- Disinhibited Social Engagement Disorder
- Acute Stress Disorder
- Posttraumatic Stress Disorder
- Adjustment Disorders
- Unclassified and Unspecified Trauma Disorders
As mentioned, diagnoses within each classification share common symptomology. Different configurations of these symptoms form specific diagnoses within that classification. In the next section, we will describe the common signs and symptoms that result from trauma, stress, and adverse life experiences (e.g., abuse). We will also consider how trauma, stress, and adverse life experiences impact other mental health diagnoses such depressive or mood disorders, anxiety disorders, or personality disorders, even though these are separately classified.
It should be noted that the experience of trauma, stress, or abuse does not automatically mean that problems will ensue, or that you will develop a "disorder" of any kind. In the framework of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a disorder generally refers to a cluster of symptoms that interfere with a person's ability to function well in one or more areas of their life (e.g., social or occupational impairment). For instance, the symptoms may make it difficult for someone to form or maintain meaningful social relationships with others (social impairment). In many situations, symptoms may cause problems at school, or may interfere with someone's ability to get and keep a job (occupational impairment). In other words, symptoms alone do not determine the presence of a disorder. For instance, I have a niece who is terrified of the dentist. She has all the symptoms of a phobic disorder, including full-blown panic attacks. However, her dental phobia does not in any way affect her functioning. She still goes to the dentist regularly so her phobic symptoms do not affect her health or other functioning. Thus, she does not meet the criteria for a phobic disorder.
Many people get hung up on the word disorder because it seems to suggest something is inherently wrong with them. If you are one of these people, try not to become overly concerned with the word "disorder," or the words that form diagnostic labels. Clinicians use diagnostic labels as a form of descriptive shorthand that rapidly communicates a set of symptoms. Used outside this context, these labels can take on a meaning that was never intended. Likewise, if the word symptom is too charged for you, you can think of symptoms as challenges that indicate the need for a more adaptive response. Once a more adaptive response is developed and applied, life functioning improves as strength and resilience are revealed.
In this next section we describe the symptoms that characterize the group (or class) of disorders called Trauma and Stressor-Related Disorders. During this discussion, we will highlight the different ways these symptoms manifest in both children and adults. Later we will discuss specific disorders within this class.