Module 5 – Part 2 – 2 Trauma and stress reactions

2.1 Acute stress reaction F 43.0

  1. Sudden occurrence
  2. Experiences of helplessness
  3. Grief, fear, rage, despair
  4. Overreaction or social withdrawal

An acute stress disorder is a short manageable stress reaction, which occurs primarily through the release of adrenaline and noradrenaline in the adrenal medulla, easing out after a few days. This kind of stress reaction does not lead to damages in the organism (for example: McEwen and Sapolsky, 1995; Huether, 1996; Greenberg, Carr, and Summers, 2002). If the reactions on the trauma have not faded away after 24 hours or maximal 3 days, additional stabilizing support measures are required.


2.2 Post-traumatic stress disorders F 43.1

A delayed occurrence of PTSD is possible between several weeks and up to 6 months after the incidence!


  • Cognitive: blackouts, concentration difficulties
  • Mental: repeatedly reliving of the traumatic situation! Memories, nightmares, fear, powerlessness
  • Physical: sweating, diarrhoea, stomach pain, headache, circulatory disturbances
  • Affected persons flee from painful memory
  • Affectivity is negatively affected


When the exposure to stress is continuous, both the noradrenaline axis and the adrenal cortex, where cortisol is produced in the brain, are stimulated. This continuous exposure to stress and the continuous elevated release of stress hormones leads the individual to perceive their life as subjectively uncontrollable. Furthermore, this kind of stress leads to pronounced symptoms that require a medical/psychotherapeutic treatment. Unattended, a permanent personality change can occur.


2.3 Personality change due to extreme stress F 62.0


  • Permanently increased tension can weaken the
  • Organism and may lead to invalidity
  • Chronic depressive conditions, chronic states of panic or anxiety
  • Risk for addictive behaviour: alcohol, medications, etc.
  • Permanent sick leave up to early retirement


2.4        How to deal with reactions on particular incidences

This sub-chapter is based on Stiftung Mayday, adapted by the author. []

Reactions after particular incidences, like described earlier, occur in about 20% of affected individuals and in most cases immediately after the incidence. However, such reactions can also occur with a delay of several hours, days or weeks; symptoms can occur individually or cumulatively.
First and foremost, all possible reactions are normal and healthy.

Usually, when they occur, one needs a recovery phase of a few days at most.

The spectrum of these possible reactions can be classified into four categories:

1) Emotional:

  • fear; feelings of guilt; helplessness; feeling of insecurity; anxiety
  • dejection, flash backs, returning memories
  • rage (-outbursts); strong feelings of sadness; panic attacks; increased irritability
  • depressive mood states; lack of emotion; feelings of lability

2) Behaviour specific:

  • Hectic, restlessness and insomnia; increased consumption of stimulants
  • Hypersensitivity; evasive behaviour; social withdrawal; changed linguistic picture
  • Changed use of language; changes in the social environment; emotional outbursts
  • Uncontrollable movements; risk seeking behaviour

3) Physical:

  • Nausea; loss of appetite; insomnia; muscular pains; increased heart heat
  • Respiratory problems; sweating; dizziness, feeling of faintness; numbness
  • Fatigue; visual impairment; vomiting; shivering; muscular tension; headache
  • Increased fluid intake; high blood pressure; hyperventilation; symptoms of shock

4) Cognitive (mental):

  • Lack of concentration and poor memory; disorientation regarding time, space and/or persons; excessive/ reduced readiness to react;
  • General mental confusion
  • Nightmares; distrust; difficulties with decision making
  • Increased/ reduced perception of the surrounding; decreased attentiveness

If the described reactions have not significantly improved after 4 weeks at the most, the reactions have to be understood as symptoms and professional help is imperative.