Trauma- and Stressor-Related Disorders in Late Life

Chapter

Abstract

Posttraumatic stress disorder (PTSD) is a 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 symptoms (persistent pathological avoidance, intrusions, and negative alterations of cognition, emotions, and arousal) or 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 HPA 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 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, it has its own category. This chapter will review 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 will also be discussed.

Keywords

Trauma Adverse childhood experiences Trigger PTSD Stress Intimate partner violence Abuse War Nightmare Dissociation Amygdala HPA axis Emotional regulation Veteran Epigenetics DNA methylation CBT Exposure therapy Trauma informed Self-efficacy 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral SciencesUniversity of California Davis Medical CenterSacramentoUSA
  2. 2.Psychiatry & Behavioral SciencesUniversity of California, DavisDavisUSA

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