Psychiatry
Stress-Related Disorders
Stress-related disorders for MBBS and NEET-PG: acute stress reaction, PTSD and adjustment disorder, trauma-focused CBT, EMDR and SSRIs, mapped to NMC codes PS9.
MedNext Academy | 3 min read
Stress-Related Disorders
Stress-related disorders for MBBS and NEET-PG: acute stress reaction, PTSD and adjustment disorder, trauma-focused CBT, EMDR and SSRIs, mapped to NMC codes PS9.
This chapter covers the disorders that arise as a reaction to stress and trauma: acute stress reaction, post-traumatic stress disorder and adjustment disorder. It sets out their features and time course, the distinction from a normal reaction, and the trauma-focused psychological therapies and drug treatments that lead management.
High-yield: Stress-Related Disorders
- Stress-related disorders arise as a direct response to an exceptionally threatening event or a significant life change.
- Acute stress reaction begins within minutes to hours of a severe stressor and typically settles within a few days.
- Post-traumatic stress disorder follows an exceptionally threatening event and lasts beyond a month.
- The core features of post-traumatic stress disorder are re-experiencing through flashbacks and nightmares, avoidance of reminders, hyperarousal, and negative changes in mood and cognition.
- Symptoms of post-traumatic stress disorder usually begin within six months of the trauma.
- Adjustment disorder is an emotional or behavioural reaction to an identifiable life stressor that is out of proportion or impairs functioning.
- Trauma-focused cognitive behavioural therapy is the first-line treatment for post-traumatic stress disorder.
- Eye movement desensitisation and reprocessing is an effective psychological therapy for post-traumatic stress disorder.
- Selective serotonin reuptake inhibitors are the first-line drug treatment when medication is needed for post-traumatic stress disorder.
- Benzodiazepines are avoided in post-traumatic stress disorder because they do not treat the core symptoms and carry a dependence risk.
- Debriefing immediately after trauma is not recommended as it may worsen outcomes.
- Grief is a normal reaction to loss, while a prolonged or complicated grief reaction may need specific treatment.
- Social support, early psychological first aid and treating comorbid depression improve recovery from stress-related disorders.
- Distinguishing a normal stress reaction from a disorder rests on the severity, duration and functional impact of the symptoms.
Stress-related disorders compared
- **Acute stress reaction:** Onset within minutes to hours; settles within days.
- **Post-traumatic stress disorder:** Re-experiencing, avoidance, hyperarousal lasting beyond a month.
- **Adjustment disorder:** Disproportionate reaction to an identifiable life stressor.
- **Treatment:** Trauma-focused CBT and EMDR first-line; SSRIs when medication needed.
NMC competencies in this chapter
- **PS9.1:** Magnitude and aetiology of stress-related disorders
- **PS9.2:** Clinical features of stress-related disorders
- **PS9.3:** Indications and interpretation of investigations
- **PS9.4:** Treatment of stress-related disorders including behavioural methods
- **PS9.5:** Family education and specialist referral
- **PS9.6:** Pharmacological basis and side effects of therapies
- **PS9.7:** Distinguishing normal reactions from disorders
Frequently Asked Questions
What is the difference between acute stress reaction and PTSD?
An acute stress reaction begins within minutes to hours of a severe stressor and settles within days, while post-traumatic stress disorder lasts beyond a month with re-experiencing, avoidance and hyperarousal.
What is the first-line treatment for PTSD?
Trauma-focused cognitive behavioural therapy and eye movement desensitisation and reprocessing are first-line, with selective serotonin reuptake inhibitors used when medication is needed.
Why are benzodiazepines avoided in PTSD?
Benzodiazepines do not treat the core re-experiencing and avoidance symptoms of post-traumatic stress disorder and carry a risk of dependence, so they are avoided.
Is early debriefing after trauma helpful?
No. Single-session debriefing immediately after trauma is not recommended because it may interfere with natural recovery and can worsen outcomes.
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