Trauma- and stressor-related disorders (TSRDs) are mental health conditions in which exposure to a triggering event is explicitly part of the diagnostic criteria. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5,1 contains five specific disorders in this category: posttraumatic stress disorder (PTSD), acute stress disorder (ASD), reactive attachment disorder (RAD), disinhibited social engagement disorder (DSED), and adjustment disorder (AD). Additionally, persistent complex bereavement disorder (PCBD) was added to the DSM-5 as a condition for further study and is conceptualized as a TSRD, given that it would be diagnosed after a triggering event, the death of someone with whom the individual had a close relationship.
The purpose of this chapter is to review the public health literature on TSRDs. We begin by summarizing the empirical research on the prevalence and predictors of TSRDs. The vast majority of this literature has focused on the epidemiology of potentially traumatic events (PTEs) and PTSD and, as such comprise the bulk of our review. Subsequently, we review the literature on public health practices to decrease exposure to traumatic events and stressors, as well as to prevent and mitigate TSRDs. We conclude by making suggestions for future research and practice based on our review.
PTEs are defined in the DSM-5 as experiences involving actual or threatened death, serious injury, or sexual violence.1 PTEs can involve direct experiences of the event, witnessing the event occurring to someone else, learning that a relative or close friend was exposed to the event, or being exposed to aversive details of the event, typically through duties.1 Along with PTE exposure, the diagnosis of PTSD requires at least one intrusion symptom (e.g., distressing dreams, dissociative reactions), one avoidance symptom (e.g., avoidance of trauma-related memories or situations), two symptoms indicating negative alterations of cognition and mood (e.g., inability to remember important parts of the event, feelings of detachment from others), and two arousal symptoms (e.g., hypervigilance, sleep disturbances). These symptoms must be present for at least 1 month and be associated with significant distress or impairment, and cannot be due to the effects of a substance or other medical condition. Slightly different criteria are applied for children age 6 and younger.1
Several changes were made to the DSM-5 diagnostic criteria for PTSD from prior versions of the DSM. Many of these changes center on how PTEs are defined. Whereas in the DSM-III and DSM-III-R, PTEs were defined as events occurring “outside the range of human experience,” in the DSM-IV and DSM-IV-R they were described as involving “actual or threatened death or serious injury, or threat to the physical integrity of self or others” (criterion A1), as well as an emotional response of “fear, helplessness, or horror” (criterion A2). DSM-5 retained criterion A1, but dropped criterion A2. Further changes included the addition of the negative ...