Overview of mental health disorders following trauma exposure

Exposure to a traumatic event commonly results in psychological distress. Events that pose an actual or perceived threat to the life or physical safety of the person, or others around them, can be traumatic; examples include war, physical or sexual assault, kidnap, terrorist attacks, torture, natural disasters and severe motor vehicle accidents. A miscarriage, ectopic pregnancy, or difficult childbirth or pregnancy can also be traumatic, especially in people with a history of sexual trauma.

Psychological symptoms of distress usually settle in the days to weeks following the traumatic event but a minority of people have persisting symptoms and develop acute stress disorder or posttraumatic stress disorder (PTSD).

Acute stress disorder is characterised by significant distress or functional impairment after a traumatic event. Symptoms last for more than 2 days but less than 1 month and, in most people, spontaneously remit. Intrusion (persistent re-experience of the traumatic event), marked dissociation, avoidance and heightened arousal are common.

PTSD is characterised by intrusion, persistent avoidance of stimuli associated with the traumatic event, negative thoughts or feelings, and marked alterations in reactivity and arousal (eg irritability, aggression, difficulty concentrating). Symptoms last for more than 1 month. A diagnosis of delayed-expression PTSD is made if symptoms first occur more than 6 months after exposure.

Suspected acute stress disorder or PTSD in a child should be evaluated using a developmentally informed approach. Symptoms in children may include withdrawal, disruptive behaviours, inattention, nightmares, or repeated play with themes or re-enactment of the traumatic event. Symptoms in children 6 years or younger can also include regressive behaviours, excessive tantrums, crying, clinginess or immobility. The impact of a traumatic event on a child can be influenced by their caregiver’s reaction to the trauma and ability to provide support.

People with acute stress disorder or PTSD commonly have comorbid problem substance use, or major depression; these comorbidities require treatment. Somatic complaints may also be experienced.

People with PTSD associated with childbirth or pregnancy may avoid their infants, which can cause problems with emotional regulation in the infant. PTSD related to childbirth or pregnancy may also lead to avoidance of sexual activity and a fear of further childbearing (tocophobia).

For treatment considerations for females of childbearing potential, including advice on contraception, preconception planning and psychotropic use, see here.

For considerations in managing anxiety disorders such as acute stress disorder and PTSD in the perinatal period, see here or for considerations in partners, see here.