Trauma symptoms and diagnoses

The currently used international classification of diseases (ICD-10) in Finland has two diagnoses directly related to psychological traumatization. These are acute stress reaction and post-traumatic stress disorder. The introduction of the new version of the disease classification (ICD-11) is being prepared in Finland during the years 2023–2026. In the future version, a new diagnosis will be included, Complex post-traumatic stress disorder (cPTSD). Acute stress reaction, on the other hand, will be left out of the disease classification. In addition to these psychiatric disorders, being psychologically traumatized also exposes you to several other psychological and physical symptoms and difficulties. Long-term chronic traumatization, in particular, has a variety of consequences that impair the quality of life.

Acute stress reaction (ASR)

An acute stress reaction (ASR) is a transient condition that develops rapidly, often within minutes, following severe physical or mental stress. 

The symptoms are typically multiple and change quickly. Individual vulnerability and, on the other hand, coping ability have a significant impact on the emergence of an acute stress reaction and its severity. The first symptom is often a "dazed" feeling, narrowing of the field of consciousness and narrowing of attention, as well as difficulty and confusion in perception. This condition is often followed by either a psychological withdrawal from the situation, sometimes all the way to dissociative shutdown state, or agitation and hyperactivity. Panic anxiety symptoms also occur frequently. The condition may be accompanied by partial or complete amnesia regarding the events. 

The symptoms of an acute stress reaction usually disappear in a few hours or days. The most important thing in supporting a person in a shocking situation and alleviating an acute stress reaction is to calm the situation and increase the feeling of security, concrete help in practical matters, treatment of possible physical injuries and enabling rest. Structuring the events to clarify them reduces the anxiety they arouse, but in the acute phase it is still best to refrain from taking the conversation too much in the direction of the distressing feelings evoked by the trauma. It may even increase the risk of later developing post-traumatic stress disorder. 

In the new version of the disease classification (ICD-11) to be introduced in the coming years, acute stress reaction has been completely removed from the list of diseases. However, dissociative or bodily symptoms resulting from the activation of the autonomic nervous system that appear in connection with a very distressing experience can be a sign that the symptoms are prolonged and developing into post-traumatic stress disorder (PTSD). If the symptoms of an acute stress reaction last more than a month, this is usually the case.

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder occurs after a delayed or prolonged stressful event (either short-term or long-term) that would cause intense anxiety for anyone. 

Traumatic experiences are pushed into the rotating memories, momentary strong flashbacks or nightmares. Typically, experiencing the trauma in various forms combines with emotional "numbness," withdrawal from relationships, inability to experience pleasure, and avoidance of activities and places reminiscent of the trauma. 

Signs of traumatization are also unnessessary activation of defense functions. The reaction of active defense are the freezing that prepares for the action, and the action itself: fight or flight. The emergence of these action impulses leads to an overstimulated state of the body and mind, which can be seen e.g. as a mental state of shock, fear or aggression. Physically, trauma is often experienced as tension, sleep problems, tremors, and overactivation manifesting as difficulty relaxing. On an emotional level, trauma includes often experiences of insecurity, helplessness and guilt, and on the other hand, anger and rage. 

In addition to active defensiveness, being traumatized can also lead to passive defensiveness and protective functions: hypoactivity and paralysis in order to keep the unbearable parts of the experience out of consciousness. The event remains unconnected as part of one's own life history and identity. Dissociative symptoms include the feeling of detachment, the absence of emotional reactions, little awareness of the environment, experiencing oneself or one's environment as a strange, and the inability to remember any events related to the trauma. Sometimes, post-traumatic stress disorder can continue chronically for many years and cause complex post-traumatic disorder. Psychological traumatization may also lead to dissociative symptoms that extend to the identity structure, such as dissociative identity disorder.

Complex Post-Traumatic Stress Disorder (cPTSD)

Complex Post-Traumatic Stress Disorder (cPTSD) develops as a result of long-term, repeated or chronic trauma. It is often related to long-term violence, abuse or neglect that happened in childhood, but it can also arise as a result of trauma experienced in adulthood. This condition differs from post-traumatic stress disorder (PTSD) in its symptom picture in that it includes many additional symptoms and manifestations. It is often accompanied by disturbed self-esteem and self-identity, long-term difficulty in regulating emotions, difficulties in relationships and building trust, problems related to body image, and symptoms of somatization and dissociation. 

Many forms of traumatic stress disorder are also often associated with long-term and continuous trauma memories pushing into consciousness and re-experiencing the trauma. Often, the symptom picture is also accompanied by strong anxiety or panic symptoms, sleep disturbances, nightmares, fear and constant vigilance for no reason. 

In addition, there may be cognitive difficulties, especially in concentration, memory and decision-making. A diverse range of symptoms can significantly affect an individual's quality of life. It can cause long-term suffering and difficulties in social relationships, work life and daily activities. In the treatment of complex post-traumatic stress disorder, it is often essential to provide trauma psychotherapy and multiprofessional support so that the individual can deal with their traumatic experiences, learn coping strategies and strengthen self-regulation skills.

© 2023 Manu Vesterinen