• One of the major changes in the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013) was the inclusion of a new group of disorders called Trauma and Stressor-Related Disorders.
• This involved the re-classification and modification of several existing disorders that were previously classified elsewhere in the manual.
• This change in classification reflected a change in our understanding about the impact of unhealed trauma and unmanaged stress on human behavior.
• Disorders included in this category are
• Reactive Attachment Disorder
• Disinhibited Social Engagement Disorder
• Acute Stress Disorder
• Posttraumatic Stress Disorder
• Adjustment Disorders
• Unclassified and Unspecified Trauma Disorders

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Different configurations of these symptoms form specific diagnoses within the classification of Trauma and Stressor-Related Disorders, but generally include:

• Intrusive Symptoms - People experiencing these intrusive symptoms describe it as though they are right back there, reliving and re-experiencing the trauma all over again. These are called intrusive symptoms because they are unwanted, unbidden, and therefore, involuntary.
• Distressing Images, Thoughts, Memories - A distressing memory, image or thought is something that you can't get out of your head related to trauma or stress. These may occur spontaneously, or they may be cued/triggered.
• Flashbacks, Dissociative Reactions - A flashback, while certainly intrusive, is also dissociative, which means there is a brief or extended period where time and reality are suspended.
• Distressing Dreams and Nightmares - For some survivors of trauma, nightmares occurred nightly, while for others, the nightmares are less frequent and unpredictable.
• Intense or Prolonged Psychological Distress - Exposure to reminders or cues associated with a traumatizing experience can trigger symptoms of severe psychological distress such as depression, panic attacks, and even hallucinations.
• Physiological Distress or Body Memory - The physiological, or body, response to trauma can include gastrointestinal pain, chest pain, light-headedness, tingling sensations, shortness of breath, and unspecified muscle pain.
• Avoidance Symptoms - Avoidance symptoms represent an effort to withdraw from certain situations that bring about body-level distress of trauma-related symptoms.
• Negative Thoughts and Feelings - Since unhealed wounds can affect our mood states, it make sense to pay attention to unhelpful thinking patterns, and to explore our feelings about ourselves and the world around us.
• Arousal and Reactivity Symptoms - This category of symptoms has also been called heightened arousal and includes behaviors like jumpiness, sleep disturbances, irritability and/or aggressive behavior, problems with concentration, and reckless or self-destructive behaviors.

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In trying to understand the impact of unhealed trauma on the human brain, it\'s helpful to have a basic understanding of the brain.

A simple model of the human brain is to envision it as three separate brains (the triune brain); each with its own separate functions and sense of time. These parts are:

• R-complex brain or brainstem - The base of the brain contains the cerebellum, and it directly connects to the spinal cord. This part is responsible for functions like reflexive behaviors, muscle control, balance, breathing, heartbeat, feeding/digestion, and reproduction.
• The limbic brain - This area is the center of emotion and learning. This part also includes the amygdala, which scans for any threat or danger, and sends out a signal to other parts of the brain when a threat is perceived.
• The cerebral brain or neocortex - this part is responsible for things that make us distinctly human: logic; reasoning skills; analysis and problem-solving; speech and verbal understanding; meaning-making; willpower; and, wisdom.

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• The simplest framework for healing trauma dates back to the late 1800s and includes 3 stages - Stabilization, Identification and Relapse prevention.
• One great misconception about trauma counseling is that once trauma is processed or cleared, then it's gone. A healthier and more accurate approach is to view trauma as something that can be healed, but not cured. A cure implies you either have a disease or disorder, or you do not. Healing implies various degrees of adaptation and adjustment that occur over time.
• If trauma seems like it might be a factor in your healing journey, finding a trauma-informed therapist is key.
• Trauma recovery looks different for each survivor. It is largely dependent upon each person's recovery goals.
• Cognitive therapies focus on modifying those dysfunctional thoughts so that feelings and behaviors improve.
• Mindfulness teaches people to live in a state of acceptance with a keen awareness of the present moment, and recognizes that thoughts are just that - merely thoughts. They don't represent any truth or reality.
• Many approaches for healing trauma incorporate an element of exposure therapy.
• Eye Movement Desensitization and Reprocessing (EMDR) is currently one of the most researched therapies for PTSD, and it now appears on the SAMHSA registry of evidence-based practices.
• Body, Movement & Expressive Arts Therapies - Because unhealed trauma wreaks havoc on the body, it makes perfect sense to include the body in the healing process.
• Medications - Before you agree to take a medication, be sure you have specifically mentioned to the provider your trauma background. Many symptoms of trauma and stressor-related disorders look like symptoms of other disorders. Without properly considering your trauma background, your provider may prescribe medications that are not helpful, and may even make things worse.

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