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Acute Stress Disorder

Acute stress disorder occurs in reaction to a traumatic event, just as PTSD does, and the symptoms are similar. However, the symptoms occur between three days and one month after the event. People with acute stress disorder may relive the trauma, have flashbacks or nightmares and may feel numb or detached from themselves.  These symptoms cause major distress and problems in their daily lives. About half of people with acute stress disorder go on to have PTSD.

An estimated 13 to 21 percent of survivors of car accidents develop acute stress disorder and between 20 and 50 percent of survivors of assault, rape or mass shootings develop it.

Psychotherapy, including cognitive behavior therapy can help control symptoms and help prevent them from getting worse and developing into PTSD.  Medication, such as SSRI antidepressants can help ease the symptoms.

Adjustment disorder

Adjustment disorder occurs in response to a stressful life event (or events). The emotional or behavioral symptoms a person experiences in response to the stressor are generally more severe or more intense than what would be reasonably expected for the type of event that occurred.

Symptoms can include feeling tense, sad or hopeless; withdrawing from other people; acting defiantly or showing impulsive behavior; or physical manifestations like tremors, palpitations, and headaches. The symptoms cause significant distress or problems functioning in important areas of someone’s life, for example, at work, school or in social interactions. Symptoms of adjustment disorders begin within three months of a stressful event and last no longer than six months after the stressor or its consequences have ended.

The stressor may be a single event (such as a romantic breakup), or there may be more than one event with a cumulative effect. Stressors may be recurring or continuous (such as an ongoing painful illness with increasing disability). Stressors may affect a single individual, an entire family, or a larger group or community (for example, in the case of a natural disaster).

An estimated 5% to 20% of individuals in outpatient mental health treatment have a principal diagnosis of adjustment disorder. A recent study found that more than 15% of adults with cancer had adjustment disorder. It is typically treated with psychotherapy.     

Disinhibited social engagement disorder

Disinhibited social engagement disorder occurs in children who have experienced severe social neglect or deprivation before the age of 2. Similar to reactive attachment disorder, it can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments.

Disinhibited social engagement disorder involves a child engaging in overly familiar or culturally inappropriate behavior with unfamiliar adults. For example, the child may be willing to go off with an unfamiliar adult with minimal or no hesitation. These behaviors cause problems in the child’s ability to relate to adults and peers. Moving the child to a normal caregiving environment improves the symptoms. However, even after placement in a positive environment, some children continue to have symptoms through adolescence. Developmental delays, especially cognitive and language delays, may co-occur along with the disorder.

The prevalence of disinhibited social engagement disorder is unknown, but it is thought to be rare. Most severely neglected children do not develop the disorder. Treatment involves the child and family working with a therapist to strengthen their relationship.   

Reactive attachment disorder

Reactive attachment disorder occurs in children who have experienced severe social neglect or deprivation during their first years of life. It can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments.

Children with reactive attachment disorder are emotionally withdrawn from their adult caregivers. They rarely turn to caregivers for comfort, support or protection or do not respond to comforting when they are distressed. During routine interactions with caregivers, they show little positive emotion and may show unexplained fear or sadness. The problems appear before age 5. Developmental delays, especially cognitive and language delays, often occur along with the disorder.

Reactive attachment disorder is uncommon, even in severely neglected children. Treatment involves the child and family working with a therapist to strengthen their relationship.

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury.

PTSD has been known by many names in the past, such as “shell shock” during the years of World War I and “combat fatigue” after World War II, but PTSD does not just happen to combat veterans. PTSD can occur in all people, of any ethnicity, nationality or culture, and at any age. PTSD affects approximately 3.5 percent of U.S. adults every year, and an estimated one in 11 people will be diagnosed with PTSD in their lifetime. Women are twice as likely as men to have PTSD. Three ethnic groups – U.S. Latinos, African Americans, and American Indians – are disproportionately affected and have higher rates of PTSD than non-Latino whites.

People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.

A diagnosis of PTSD requires exposure to an upsetting traumatic event. However, the exposure could be indirect rather than first hand. For example, PTSD could occur in an individual learning about the violent death of a close family or friend. It can also occur as a result of repeated exposure to horrible details of trauma such as police officers exposed to details of child abuse cases.

• Symptoms and DiagnosisSymptoms and DiagnosisSymptoms of PTSD fall into four categories. Specific symptoms can vary in severity.
  1. Intrusion: Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.
  2. Avoidance: Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.
  3. Alterations in cognition and mood: Inability to remember important aspects of the traumatic evet, negative thoughts and feelings leading to ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); distorted thoughts about the cause or consequences of the event leading to wrongly blaming self or other; ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; feeling detached or estranged from others; or being unable to exprience positive emotions (a void of happiness or satisfation).
  4. Alterations in arousal and reactivity: Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being overly watchful of one’s surroundings in a suspecting way; being easily startled; or having problems concentrating or sleeping.Many people who are exposed to a traumatic event experience symptoms similar to those described above in the days following the event. For a person to be diagnosed with PTSD, however, symptoms must last for more than a month and must cause significant distress or problems n the ndividual’s daily functioning. Many individuals develop symptoms within three months of the trauma, but symptoms may appear later and often persist for months and sometimes years. PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems.(See information on Acute Stress Disorder below.)

May the world be kind to you,
and may your own thoughts be gentle upon yourself.
– Jonathan Lockwood Huie

Our Joy comes from living our own lives simply –
never from demanding that others live simply –
or from ever making any demands whatsoever upon others.
– Jonathan Lockwood Huie

Whatever you do, do with kindness.
Whatever you say, say with kindness.
Wherever you go, radiate kindness.
– Jonathan Lockwood Huie

Anger can feel overwhelming when it suddenly “erupts.” Here are some expert tips to tame your rage, get rid of regret, and prevent ruined relationships.

1 Set Boundaries.

This is a nuanced skill, according to Brock Schludecker, PsyD, of Columbus, Ohio. But it’s important for “protecting one’s time and space and autonomy in a way that doesn’t set oneself up to feel taken advantage of, exploited or used.” Each of which is a feeling that can trigger anger. Schludecker suggests tackling this skill and discussing the specifics with your therapist.

#2 Track Down Your Triggers.

An important step to tamping down on “anger attacks” is to identify the source. When you’re in a place that’s calm and private, take some time to reflect and record. Ask yourself questions like the following: What kinds of interactions consistently leave you angry? Are there “little things” that tend to build up until you feel like you’re about to lose your cool? If so, what are they? Does your anger crop up during certain moods or seasons or parts of your routine? and so on. Write down your answers so you can dig a little deeper.

#3 Get to the Roots of Your Rage.

After you’ve reflected and recorded your answers to the trigger-tracking questions, look for patterns within your responses. Are they associated with certain emotional states, such as feelings of rejection, criticism, or abandonment? Are they connected to, or limited to, certain mood episodes or times of year? Finding the roots of your triggers can help you reduce future regrets.

4 Find a Relaxation Guide.

Look for guided imagery programs on Spotify or YouTube that will help lower your heart rate and regulate breathing when feeling in a heightened state. “There are scripts you can follow that will say, ‘Tense this muscle first,’ or they’ll walk you through visualizing a forest or beach scene,’” says music therapist Meegan Hussain. “They help change that narrative in the mind from rumination and agitation—that negative space—into something positive.”

#5 Schedule Ways to De-Stress.

“Few of us have to do everything we think we have to do,” notes psychiatrist Ben Christenson, MD. He advises placing a higher priority on restorative activities like reading a book, going for a walk or watching a movie while balancing non-negotiable responsibilities.

#6 Put Your Feet Down.

Shaley Hoogendoorn, who co-hosts a vlog/podcast called “This is Bipolar,” tries to release her rage in a healthy way by taking off her shoes and socks—preferably outside—and focusing on the ground beneath her. “Sometimes I close my eyes and tell myself, ‘You’re safe. You’re grounded. There’s an emotion behind this, and it’s not going to last forever.’”

Be Proactive, Not Reactive.

After you’ve gotten to the roots of your anger response and found a way to de-stress, it’s important to become proactive rather than reactive, says Michael Pipich, LMFT, a psychotherapist in Denver and author of Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder. He also suggests asking yourself these questions: What do I want to tell the people I care about so that they don’t trigger me? What would be the right thing for me to hear if they’re worried that I’m going into a manic episode? How can they be supportive of me—and how can I be supportive of them? “And then,” he says, “take the cooler moments, not the heated moments, to talk about these things with loved ones.”

From bipolar support groups forum. Jan support