Reference
Guide | Reference

25  Trauma-Related Experiences

25.1 Summary

  • Experiences of intrusion, hyperarousal, avoidance, or shutdown tied to past or ongoing threat.

25.2 Patient-Language Phrases

  • “I keep reliving it.”
  • “I feel on edge, like something bad is about to happen.”
  • “I go numb or shut down.”
  • “I avoid anything that reminds me of it.”

25.3 Core Features

  • Intrusions (memories, flashbacks, nightmares).
  • Hypervigilance and exaggerated startle.
  • Avoidance and emotional numbing.
  • Dissociation or fragmentation under stress.

25.4 Boundary Markers

  • What it is: threat-linked responses that persist beyond the event.
  • What it is not: expected short-term stress reactions to acute events.

25.5 Variants / Spectrum

  • Intrusion-dominant (re-experiencing).
  • Hyperarousal-dominant (vigilance, irritability).
  • Dissociative/shutdown-dominant.
  • Grief-trauma overlap or moral injury.

25.6 Severity Anchors (0-4)

  • 0: No trauma-linked symptoms.
  • 1: Mild, intermittent, manageable.
  • 2: Moderate, recurrent, impacts function.
  • 3: Severe, persistent, with avoidance or dissociation.
  • 4: Extreme, disabling or unsafe.

25.7 Time-Course Patterns

  • Acute post-event reactions.
  • Chronic persistence with triggers.
  • Fluctuations with stress or reminders.

25.8 Functional Impact

  • Work/school: concentration issues, avoidance.
  • Relationships: withdrawal, mistrust, conflict.
  • Self-care: sleep disruption, hyperarousal.

25.9 Common Mimics / Differential

  • Anxiety threat responses without trauma linkage.
  • Obsessional intrusions without trauma context.
  • Mood dysregulation with agitation.

25.10 Medical / Substance Rule-Outs

  • Sleep deprivation or substance effects.
  • Neurologic contributors to dissociation-like states.

25.11 Developmental Expression

  • Childhood: behavioral regression, play reenactment.
  • Adolescence: risk-taking, emotional volatility, shutdown.
  • Late life: reactivation around losses or medical events.

25.12 Cultural / Context Notes

  • Trauma meaning varies by culture and community narratives.
  • Ongoing threat changes interpretation and management.

25.13 Measurement Prompts

  • Brief trauma symptom checklist.
  • Trigger and avoidance tracking.

25.15 Documentation Snippet (1-2 lines)

  • “Reports trauma-linked intrusions and avoidance with hyperarousal; Trauma/Stress 3; chronic course.”