Acute and Chronic Mental Health Trauma

Excerpt

The word "trauma" derives from the Greek word for "wound" or "hurt." Mental health or psychological trauma has since become more broadly defined as an experience that is subjectively perceived as painful or distressing and results in acute or chronic mental and physical impairment or dysfunction. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), defines a traumatic event as the exposure to "death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence." Trauma may be experienced either through direct involvement or by witnessing or learning of such an event happening to others and is often accompanied by a sense of shock, helplessness, or loss of control.

Trauma can be categorized and described across myriad factors, and one such categorization is acute versus chronic forms of trauma. These can include the sudden loss of a loved one, physical abuse, sexual predation, natural disasters, or exposure to war and violence, among many others. Causes of trauma are thus ubiquitous and a nearly universal human experience. Traumas can occur throughout the lifespan; current data suggest that childhood trauma leads to worse outcomes than trauma experienced in adulthood.

Trauma is typically described as either an acute or chronic process. The acute trauma response or acute stress reaction is characterized by a short-lived sympathetic response to a real or perceived threat that typically results in a "fight or flight" response. If this response does not resolve or the perceived threats remain ongoing, this initial acute response can progress to a chronic trauma response. This chronic response is often associated with significant impairment and comorbidity.

Like acute stress reactions, chronic stress reactions can occur in response to a single traumatic event or following multiple stressors. Chronic trauma usually presents with aberrant behavioral and physiological processes, outlined in the DSM-5 as the following symptom clusters: (1) hyperarousal states, (2) avoidance behaviors, (3) intrusive trauma-associated memories, and (4) altered cognitions and moods. These symptoms can occur in both Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD), which are further distinguished by the duration of the symptoms following a traumatic event, where ASD lasts less than a month, and PTSD lasts greater than a month, respectively.

In addition to acute and chronic trauma, complex trauma includes repeated trauma exposure that can be severe and prolonged, resulting from the perversion or loss of a significant relationship. While repeated trauma exposures may occur in adulthood, this typically occurs in childhood or adolescence and is often perpetrated by adult caregivers or other authority figures who were previously perceived as trustworthy or protective. Such trauma tends to be characterized by the real or perceived impossibility of escape; this sense of feeling trapped and a loss of safety leads to trauma responses such as hypervigilance and persistent negative mood. Complex posttraumatic stress disorder (CPTSD) includes the symptoms of PTSD accompanied by dysfunction in self-concept, affect regulation, and relationships.