# Trauma- and stressor-related disorders

The DSM-5 chapter built around an external event: no traumatic or stressful event, no diagnosis. A CTEVT PSC curriculum topic (trauma, PFA, IASC).

## Post-Traumatic Stress Disorder (PTSD)

After exposure to death, serious injury, or sexual violence: one month or more of intrusion, avoidance, negative mood, and hyperarousal.

**In plain words:** After a terrible event, the mind keeps replaying it, avoids reminders, turns dark, and stays on high alert for more than a month.

**First, the reassurance:** most people who live through a terrible event do not develop PTSD. Fear, poor sleep, jumpiness and replaying the event in the first weeks are the mind's normal response. PTSD is the name for when this does not settle after a month and takes over daily life.

DSM-5 Criteria (adults)

1. **Exposure** to actual or threatened death, serious injury, or sexual violence: directly · witnessing · learning it happened to a close one (violent/accidental) · repeated exposure to aversive details (first responders). *Media exposure alone does not count unless work-related.*
2. ≥1 **intrusion** symptom (see cluster B below).
3. ≥1 **avoidance** symptom (cluster C).
4. ≥2 **negative alterations in cognitions and mood** (cluster D).
5. ≥2 **arousal and reactivity** changes (cluster E).
6. Duration of B–E more than **1 month**.
7. Clinically significant distress or impairment.
8. Not attributable to a substance or medical condition.

### B · Intrusion

- need at least 1 of 5 Intrusive memories
- Trauma nightmares
- Flashbacks
- Distress at reminders
- Physiological reactions to cues

### C · Avoidance

- need at least 1 of 2 Avoiding memories, thoughts, feelings
- Avoiding external reminders (people, places, activities)

### D · Negative cognition & mood

- need at least 2 of 7 Can't recall key parts
- Negative beliefs ("world is dangerous")
- Distorted self/other blame
- Persistent fear, anger, shame
- Diminished interest
- Detachment from others
- Can't feel positive emotions

### E · Arousal & reactivity

- need at least 2 of 6 Irritability, anger outbursts
- Reckless, self-destructive behaviour
- Hypervigilance
- Exaggerated startle
- Poor concentration
- Sleep disturbance
Specifiers: with dissociative symptoms (depersonalisation/derealisation) · with delayed expression (full criteria only after 6 months). **Acute Stress Disorder** (308.3/F43.0) is a closely related picture (9 or more of 14 symptoms) lasting 3 days to 1 month; **Adjustment Disorder** (F43.2x) is distress out of proportion to a non-traumatic stressor, within 3 months of it.

International

First systematised after the Vietnam war ("shell shock", "war neurosis" before that); today the heaviest burdens are in conflict zones and among refugees and survivors of sexual violence. Most people exposed to trauma do *not* develop PTSD: resilience is the norm; risk rises with dose, proximity, and interpersonal violence.

Nepal

Three national layers: the 1996–2006 conflict (disappearances, torture survivors), the 2015 earthquakes, and yearly floods and landslides; plus trafficking survivors and returned migrant workers. Post-earthquake research (e.g., TPO Nepal studies) found distress often expressed through the heart-mind: fear idioms like "man aatteko", "saato gaeko" (the spirit has fled). PFA's Look-Listen-Link, not debriefing, is the evidence-based first response; most acute reactions settle without a disorder label. The National Mental Health Survey 2020 put post-traumatic stress disorder under 0.2% (its confidence interval reaches 0.2), a rounding floor rather than an absence. See [Nepal in numbers](https://manoatlas.com/data.md).

The window of tolerance (Siegel). A survivor is not "overreacting"; their window has been narrowed. Grounding (5-4-3-2-1, feet on the floor, cold water on the face) does not solve the trauma; it brings the person back inside the window, where talking becomes possible.

## Generational (intergenerational) trauma

Trauma's effects can pass from one generation to the next. The pain may not have started with you, but healing can start with you.

**How it transmits, through five channels:**

1. **Biology and the stress response:** long stress changes the body's alarm systems, and those settings shape how children react
2. **Learned behaviour:** children absorb parents' anger, fear, love, and problem-solving styles
3. **Silence and secrecy:** hidden painful events still leak their emotional weight into the next generation
4. **Relationship patterns:** insecure attachment, emotional distance, and low trust repeat across generations
5. **Survival behaviours:** pleasing everyone, taking all responsibility, suppressing feelings
These once kept a family alive; later they become the problem itself.

**Understanding is not blaming.** The point is never to accuse the older generation; it is to recognise the inherited pain, behaviours, and beliefs, and then choose consciously what to carry forward: love, compassion, healthy patterns, truth, connection, hope.

Awareness is the first step; change is a decision. Paths that help: counselling and therapy, writing and expression, breathing and meditation practice, support groups and community, self-care, and honest conversation inside the family. Some negative cycles can end with you.

Nepal

Three Nepali examples of trauma that travels through families: the 1996 to 2006 conflict, whose survivors' children grew up with unspoken disappearances and fear; caste-based humiliation carried across generations as shame and guardedness; and long labour-migration separations.

Family silence is common and culturally understandable; the counselor's craft is opening space for the story without forcing it.

**A worked example:** A 28-year-old named Tara, whose father disappeared during the conflict, avoids crowded markets and startles at loud sounds. Her counselor explains that her avoidance and hypervigilance are the mind's protective response, not weakness, and that the window of tolerance diagram shows how grounding can widen her capacity before any trauma-focused work begins.

A skill to try · two minutes

**5-4-3-2-1 grounding.** Feet flat on the floor. Name 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell, 1 you can taste. This walks the mind back from then to now, back inside the window of tolerance above. Cold water on the face works the same way.

A coping skill, not a treatment: it supports care, it does not replace it.

Key points

1. PTSD needs an actual traumatic event and four symptom groups (re-experiencing, avoidance, negative mood, arousal) for more than a month.
2. Most people recover on their own with safety, support and time; only some develop PTSD.
3. Trauma can travel through families; understanding it is not blaming, and the cycle can end with one person.
Learn more

Pick one, not all: these are chosen to be light, not exhaustive.

Video · 5 min[The psychology of PTSD (TED-Ed)](https://www.youtube.com/watch?v=b_n9qegR7C4): The four symptom clusters, animated.

Book chapter**The Body Keeps the Score (van der Kolk): ch. 1**: How trauma lives in the body; read slowly, it is heavy.

Article[Nepali concepts of psychological trauma (Kohrt & Hruschka)](https://link.springer.com/article/10.1007/s11013-010-9170-2): THE paper on saato, man, dimaag and trauma in Nepal.


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*Source: https://manoatlas.com/trauma · Licence: CC BY-NC-SA 4.0. Mano Atlas is an educational resource, not a diagnostic tool.*