This post and others discussing specific mental disorders will reference the Diagnostic and Statistical Manuel of Psychiatry and Psychology, Edition Five (DSM-5). Apologies to my international readers, I’m just not familiar enough with the ICD to use it as a reference.

Trauma and Stress Related Disorders

1. Post Traumatic Stress Disorder (PTSD)
2. Acute Stress disorder
3. Reactive Attachment Disorder
4. Disinhibited Social Engagement Disorder
5. Adjustment Disorder

PTSD is the best known of the trauma and stress related disorders. In the US it is widely associated with military personnel and the psychological damage of military service. However Trauma and Stress Related Disorders, including PTSD, can be caused by any type of trauma. Car accidents, abuse, natural disasters, and high-stress jobs such as working in an ER or fire department are only a few of the possible causes of trauma and stress related disorders.

PTSD and Acute Stress Disorder are can be caused by trauma that has happened in the past or long term ongoing traumas.

Reactive Attachment Disorder and Disinhibited Social Engagement Disorder are childhood disorders. From what I can find they result from trauma related to loss of caregivers or damage to a child’s ability to connect with their caregivers. While these disorders develop in childhood, they don’t magically disappear when people become adults. Residual effects can cause difficulty with social interaction or forming attachments to loved ones.

Adjustment Disorder is a (relative) mild disorder caused by ongoing life stress. These stresses don’t need to reach the level of trauma. Anything from a family illness, to job instability, to loss of a relationship, can cause adjustment disorder. An important facet of adjustment disorder is that it is not an ongoing psychological condition. As soon as the stressor causing adjustment disorder is removed, the disorder will go away on its own.

Symptoms of Trauma and Stress Related Disorders

Symptoms vary a great deal, and everyone’s experience of trauma and stress related disorders will be different. However most symptoms fall into a few general categories:

1. Re-experiencing the event—flashbacks are the best known form of this. Literally reliving the event or events that caused the trauma. However it can also take the form of dreams, obsessive thoughts, or disturbing memories popping up out of no where. One note about flashbacks: most people assume flashbacks are either visual (seeing the event again) or full-sensory (experiencing it with all your senses). However flashbacks can take other forms. A person may suddenly feel their abusers hands on them, reliving the physical feeling of the abuse. Of hear screaming or other sounds associated with the trauma.
2. Heightened arousal—Arousal in the psychological sense is not the sexual arousal we usually associate with the word. In fact, arousal in psychology is a lot closer to what laypeople call the “fight-flight-freeze” response. In a state of arousal, everything is more intense. Arousal can lead to everything from aggressiveness to impulsiveness. It often causes hyper-vigilance and sleep disorders.
3. Avoidance—someone with a trauma or stress related disorder will often go out of their way to avoid anything that reminds them of or is associated with the trauma or stress.
4. Negative thoughts, mood, or feelings—this can take a lot of forms, from negative thoughts about yourself, to negative thoughts about the whole world. At base it is a distorted perception caused by the trauma or stress. Someone with adjustment disorder related to job loss might think that there is no point in trying to find a job. Obviously they just aren’t worth hiring. An abuse survivor will often expert other people to act like their abuser did. Etc. Memory loss from the trauma is also associated with this symptom.

Treatments for Trauma and Stress Related Disorders

Medication

There are no medications specifically for trauma and stress related disorders. Unlike many mental illnesses, with these disorders there is a very clear, non-biological cause. Effective treatment needs to address the experience and associated feelings.

That said, medication is sometimes used in association with other treatment. Anti-depressants, anti-anxiety meds, and sleeping medications are sometimes used to treat the symptoms, especially with PTSD. These medications can help a person with a trauma or stress related disorder to continue with as close to normal life as possible while they heal.

Therapy

Cognitive behavioral therapy (CBT) is often cited as the most effective treatment for trauma and stress related disorders. Exposure therapy—gradually exposing yourself to the trauma and things that remind you of the trauma in a safe place—is often used and can be very effective. Even more than other forms of therapy, exposure therapy requires the right therapist. You NEED to feel safe and secure in order for exposure therapy to work. Support groups for survivors of various traumas often include unofficial exposure therapy, as people discuss their own experiences with others who they know will understand.

Eye movement desensitization and reprocessing (EMDR) is a relatively new approach to trauma therapy. Ever notice it’s easier to talk about hard stuff if you have something to distract you? A lot of people like to have “something in their hands” when discussing emotionally difficult topics. This is because having something benign to focus on helps distance our emotional reaction. EMDR uses this tendency to help trauma survivors face and deal with their trauma without the extremes of emotional reaction. There is still a lot of speculation about how and why it works. It does seem to allow trauma survivors to better cope with their trauma, reducing symptoms and speeding healing.

Alternative Treatments

I don’t know of any alternative treatments that I would trust which are specifically for trauma and stress related disorders. That said, herbal calmatives may help reduce arousal symptoms, meditation can also be helpful in dealing with negative thoughts and gaining space from strong emotions, and I personally have found that Massage Therapy can be a huge help in healing from trauma associated with sexual abuse.

When Trauma and Stress Related Disorders and Polyamory Collide

Some problems that come with trauma and stress related disorders are obvious. I’ve had flashbacks, and I’ve held loved ones while they relived the worst experiences of their life. I honestly can’t tell you which is worse.

Other problems are both more subtle, and more frustrating.

Someone whose trauma or stress was related to betrayal, abuse within a relationship, abandonment, and similar issues will find themselves triggered by many things that are a normal part of polyamorous relationships. And constantly waiting for your current partners to abuse you/betray you/abandon you like the people who caused your trauma never does good things for a relationship. In a poly relationship, your poly partners spending time with someone else—or even just the expectation of them spending time with someone else—can definitely be triggers.

Worse, the combination of psychological arousal and negative thoughts can come across as anything from a jealous rage to a guilt trip to gaslighting. (Remember—distorted perspective. Someone with a trauma or stress related disorder literally doesn’t see the world the way it really is.) And while the person lost in their trauma doesn’t intend or even realize that this is how they are acting, the people around them can still be hurt by it.

Let me note that this level of problem is not universal with trauma and stress related disorders. Please do not assume everyone with a trauma or stress related disorder will be affected this way. This is the most damaging effect trauma and stress related disorders can have on relationships—that does NOT make it the most common.

Other types of trauma can cause other types of problems. Trauma from a car accident may make riding in a car difficult to impossible—which interferes with going on dates, poly meet ups, or just picking a visiting partner up from the hospital.

For partners who don’t understand the impact trauma and stress related disorders can cause, refusing to do something that seems simple to them can cause other problems. “Why do I always need to come visit you. It’s just a short drive!”

Because of my specific trauma, I used to get flashbacks eating certain foods. The consistency and texture of food is a big meal to me, which many people have never understood or accepted. Being invited over to dinner was a mine field. I would struggle to navigate trying to be polite, trying to avoid conversation ending-explanations, and trying not to trigger myself. So as awesome as it might sound for a poly partner to offer to put together a picnic for us…

And of course, having a panic attack, flash back, or other trauma related freak-out as your partner is walking out the door to go on a date—no matter what the trigger or cause—is not only disruptive to your own relationship, but to your partner’s relationships as well.

Part II on ways to manage PTSD and other Trauma and Stress Related disorders.

This post is part of the Polyamory and Mental Illness blog series.