Mental Health and Trauma

traumaWhile half of the population is exposed to at least one traumatic event over the course of life, relatively few of those people endure lasting psychiatric sequelae.[1] Trauma occurs in many different contexts. Bombings, mass shootings, wars, and man-made and natural disasters all affect large numbers of people.1 Other forms of trauma are private experiences, such as childhood maltreatment, sexual and physical assault, witnessing a violent death, and surviving a life-threatening accident or illness.1 When psychological problems develop, people relive the pain and raw memories that are associated with the extreme stress brought on by trauma.1

Mental health correlates of trauma include post-traumatic stress disorder (PTSD), anxiety disorder, mood disorder, and substance use disorders.1 Comorbidity is often the rule, and separating symptoms of PTSD from anxiety, mood, and somatoform disorders can be challenging.1

There are populations that need extra attention by clinicians after trauma exposure.1 In reference to the elderly, the American Association of Geriatric Psychiatry states that the absence of family and other support systems may be the most critical factor for adverse outcomes.1 Therefore, it is important for clinicians to explore life trauma in the elderly, as their emotional salience allows them to remember traumatic events quite well, even if cognitive impairment is present.1

Although studies of PTSD in children are lacking, the research that has been conducted suggests that children who are exposed to trauma may have higher rates of PTSD than adults.1 However, it is often overlooked in children as it presents differently, with disorganized behavior, reenactment of trauma themes in play, and vague dreams.1

Addictive disorders are also associated with trauma, especially childhood sexual abuse.1 Approximately half of those with PTSD have a comorbid substance use disorder, and one-fourth of adults in substance abuse treatment have a diagnosis of PTSD.1 The subpopulation that suffers from comorbid conditions often misuse alcohol, cocaine, cannabis, and opioids.1 With the combined disorders, there is a worse prognosis than if the person suffered from each disorder alone.1 PTSD symptoms increase the risk of relapse and the severity of drug use.1 Treatment for comorbid disorders must address both disorders at the same time to improve the outcome for both.1

Physical health is also influenced by PTSD, as the stressful life events increase the risk of illness, such as tuberculosis, anxiety, and depression.1 Recent studies also state that trauma causes change in the hypothalamic-pituitary-adrenal axis after trauma exposure, as well as alterations to the immune system.1 It can also cause changes in cytokines and T cells, which can increase susceptibility to infection and trigger inflammatory conditions.1 PTSD is also predictive of arthritis, respiratory problems, hypertension, lupus, GI problems, and kidney or liver disease.1

Traumatized patients depend on psychiatrists to uncover their emotional pain and to understand its effects on the body and mind.1 They also depend on psychiatrists to recognize and draw on their unique strengths and vulnerabilities as recovery is promoted.1 Talk therapy combined with pharmacotherapies lead to positive outcomes for the trauma survivor.1

[1] Tucker, P., Aggarwal, R., & Foote, E. (2013, May 3). Introduction: Mental Health Correlates of Trauma. Psychiatric Times. Retrieved November 19, 2013, from http://www.psychiatrictimes.com/trauma-and-violence/introduction-mental-health-correlates-trauma/page/0/1

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