Reference
Guide | Reference

37  Trauma and Stress Response

37.1 Summary

  • A dimensional construct describing persistent threat responses, intrusions, and dysregulation following adverse or traumatic events.

37.2 Core Construct

  • Trauma-linked reactivity that persists beyond immediate threat and alters functioning.

37.3 Subdimensions

  • Intrusion and re-experiencing.
  • Avoidance and numbing.
  • Hyperarousal and vigilance.
  • Dissociation or shutdown.

37.4 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.

37.5 Time-Course Patterns

  • Acute post-event response.
  • Chronic persistence with triggers.
  • Fluctuating with stress load or reminders.

37.6 Functional Impact

  • Work/school: concentration or attendance impairment.
  • Relationships: mistrust, withdrawal, conflict.
  • Self-care: sleep disruption, hyperarousal.

37.7 Developmental Expression

  • Childhood: regression, reenactment, externalizing behavior.
  • Adolescence: risk-taking, withdrawal, dissociation.
  • Late life: reactivation with losses or illness.

37.8 Cultural / Context Notes

  • Trauma meaning is shaped by culture and community narratives.
  • Ongoing threat changes symptom interpretation and need for safety planning.

37.9 Differential and Rule-Outs

  • Anxiety threat responses without trauma linkage.
  • Obsessional intrusions.
  • Substance effects or withdrawal.
  • Sleep disorders and medical contributors.

37.10 Measurement Prompts

  • Brief trauma symptom checklist.
  • Avoidance and trigger tracking.

37.11 Treatment-Relevant Correlates (non-prescriptive)

  • High avoidance often predicts functional restriction.
  • Ongoing threat suggests prioritizing safety stabilization.

37.13 Documentation Snippet (1-2 lines)

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