Psychiatry: disorder groups
Trauma- and stress-related disorders
Trauma- and stress-related disorders, including PTSD, complex PTSD, prolonged grief disorder and adjustment disorder, follow frightening or very stressful events. Psychiatrists assess them and treat them with trauma-focused therapies and medication.
Depth by stage, Pre-U → Consultant (details)
What is it?
After a traumatic event such as a road accident, assault, violence, disaster or war, most people recover naturally. Some develop post-traumatic stress disorder: they relive the event in nightmares or flashbacks, avoid reminders and feel constantly on guard. Complex PTSD, recognised in ICD-11, adds long-lasting problems with emotions, self-worth and relationships, often after prolonged or repeated trauma such as childhood abuse.
Other conditions in this group include adjustment disorder (a strong reaction to a life change that is out of proportion or lasts longer than expected), prolonged grief disorder (grief that remains intense and disabling well beyond cultural norms) and, in children, attachment disorders after severe neglect.
Malaysia has regular floods and road traffic crashes, and many patients carry histories of domestic violence or childhood adversity, so trauma-informed care is part of everyday psychiatry.
Why does a psychiatrist need it?
Trauma underlies many presentations in psychiatry, from depression and substance misuse to self-harm and personality difficulties. Psychiatrists must ask about trauma safely, avoid re-traumatising patients, choose evidence-based therapy such as trauma-focused CBT or EMDR, and provide medico-legal reports after accidents or assaults.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalAwareLearns the stress response and normal grief in behavioural science.
- ClinicalUnderstandsRecognises PTSD symptoms and knows the difference between normal and complicated grief.
- HousemanshipAwareRecognises acute stress reactions in casualty and trauma wards and provides basic support.
- Medical officerUnderstandsScreens for trauma, gives psychological first aid and refers for specialist therapy.
- Psych traineeMasters / TeachesDiagnoses the full group, plans trauma-focused treatment and writes reports; examined in Part II and MRCPsych.
- Specialist / consultantMasters / TeachesLeads complex trauma care, disaster mental health responses and expert reports.
What are the key topics?
Conditions
- Post-traumatic stress disorder (PTSD)
- Complex PTSD (ICD-11)
- Prolonged grief disorder (ICD-11 and DSM-5-TR)
- Adjustment disorder
- Acute stress reaction (ICD-11 treats this as a normal response, not a disorder) / acute stress disorder (DSM-5-TR)
- Reactive attachment disorder and disinhibited social engagement disorder in children
Clinical features
- Re-experiencing: flashbacks, nightmares, intrusive memories
- Avoidance of reminders and emotional numbing
- Hyperarousal: startle, sleep problems, irritability, poor concentration
- Disturbances in self-organisation in complex PTSD
- Common comorbidity with depression, substance use and self-harm
Causes and risk factors
- Type, severity and duration of trauma; interpersonal violence carries higher risk
- Previous trauma, prior mental illness, low social support
- Fear-conditioning and memory processing models
- Neurobiology: amygdala, hippocampus, prefrontal cortex, HPA axis
Assessment and treatment
- Trauma-informed interviewing; scales such as PCL-5 and the International Trauma Questionnaire
- Psychological first aid after disasters; avoiding routine single-session debriefing
- Trauma-focused CBT and EMDR as first-line therapies
- Medication: SSRIs, venlafaxine; prazosin for nightmares in some guidelines
- Grief interventions; adjustment disorder support and problem-solving
- Safety planning in domestic violence; links with social welfare and police where appropriate
How is it learned and assessed?
- Behavioural science and undergraduate psychiatry teaching
- Emergency and liaison work as MO and trainee
- MMed Part II; MRCPsych Paper B (evidence on treatments) and CASC (e.g. PTSD history)
Typical textbooks and resources
- Shorter Oxford Textbook of Psychiatry — Oxford University Press
- The Body Keeps the Score — Bessel van der Kolk; popular overview (read critically)
- NICE guideline on post-traumatic stress disorder — NICE (UK)
- WHO psychological first aid guidance — World Health Organization
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Does everyone who goes through trauma get PTSD?
No. Most people recover with time and support. PTSD develops in a minority, and the risk is higher after interpersonal violence, repeated trauma or when support is lacking.
What is complex PTSD?
A condition in ICD-11 that includes the core PTSD symptoms plus long-standing problems controlling emotions, a deeply negative view of oneself and difficulty in relationships. It often follows prolonged or repeated trauma.