6 General adult psychiatry6.1 Psychiatric disorders in adulthood
6.1.5 Disorders associated with stress
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Stressor and syndrome
A stressful event on its own does not mean a disorder is present. The diagnosis depends on the pattern of symptoms, how long they last, and the distress and impairment they cause, judged in the person's cultural context.
ICD-11 groups post-traumatic stress disorder (PTSD), complex PTSD, adjustment disorder and prolonged grief disorder as disorders specifically associated with stress.
Acute stress reaction is different. ICD-11 uses this term for a transient response to extreme stress, and places it outside the mental-disorder grouping.
Disorder | Defining pattern |
|---|---|
PTSD | Re-experiencing the trauma as if it is happening now, avoidance, and an ongoing sense of current threat |
Complex PTSD | PTSD plus lasting problems regulating emotion, a negative view of oneself, and difficulties in relationships |
Adjustment disorder | Preoccupation with an identifiable stressor and failure to adapt to it, causing impairment |
Prolonged grief disorder | Persistent yearning for, or preoccupation with, the person who died, with intense emotional pain and impaired function beyond what the culture expects |
PTSD and complex PTSD
Re-experiencing means the event feels as if it is happening again, in the present, as in flashbacks or trauma-related nightmares. Simply remembering an unpleasant event is not enough.
Avoidance can be of internal memories or of external reminders.
Sense of current threat may show as hypervigilance (constantly watching for danger) or an exaggerated startle response.
Complex PTSD commonly follows prolonged or repeated trauma that was difficult to escape. A trauma history alone does not establish the diagnosis.
In assessment, ask about dissociation, depression, substance use, suicide risk and current safety, including whether the person is still exposed to violence or exploitation.
Adjustment and grief
Adjustment disorder is a maladaptive response to an identifiable stressor that another disorder does not explain better. In ICD-11, symptoms usually begin within a month of the stressor. They tend to resolve within six months after it ends, unless the stressor persists.
Grief becomes prolonged grief disorder only when it lasts beyond the response expected in the person's culture. ICD-11 requires at least six months since the bereavement, with significant impairment.
A label that sounds less severe does not mean low risk. Suicide risk can be substantial.
Management
Immediate care: attend to safety, practical needs, social support and any treatable comorbidity. Do not insist on a detailed account of the trauma before the person is ready.
Trauma-focused cognitive behavioural therapy and eye movement desensitisation and reprocessing are established treatments for PTSD. Choose between them through assessment and shared decision-making.
Routine single-session psychological debriefing is not recommended to prevent PTSD.
People with complex needs may need more time to build trust. Housing, safety, emotional regulation or substance use may need attention alongside trauma treatment.
Adjustment and grief: care focuses on the stressor, coping, relationships and day-to-day function. Treat any coexisting depressive or other disorder when present.