Trauma- and Stressor-Related Disorders

Posttraumatic stress disorder (PTSD) is an often disabling psychiatric condition of great public health significance, and older adults are not spared. It can develop after a traumatic experience at any point in life. As we can imagine, difficult experiences are the norm. Trauma is ubiquitous and affects the whole person, but some people go through life with such stressful experiences that they have a sustained impact, which can go unrecognized for many decades. Once the usual coping mechanisms fail, a complex cluster of PTSD symptoms (persistent pathological avoidance, intrusions, and negative alterations of cognition, emotions, and arousal) and other commingled full-spectrum psychiatric disorders may develop. Those manifestations are mediated by disturbances in various systems governing cognitive, affective, and physiological responses to stress (e.g., the limbic system, the hypothalamic-pituitary-adrenal axis). Traumatic stress triggers a cascade of physiological catastrophes that impact various major systems in the body. Comorbidities and the overlap with other disorders are very frequent. A new onset of PTSD symptoms may occur in old age, even when the trauma was remote. PTSD, which consists of changes in circadian rhythms, mood regulation, perception, cognition, and behavior, is no longer considered an anxiety disorder, and since the publication of the DSM-5 and subsequent DSM-5-TR, it has its own category. This chapter reviews the foundational concepts of trauma, its different types (natural versus interpersonal, including adverse childhood experiences), the general manifestations, and specific symptoms in old age. Treatment approaches that are evidence based and trauma informed are also discussed.