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Survivors’ immediate reactions in the aftermath of trauma are quite complicated and are affected by their own experiences, the accessibility of natural supports and healers, their coping and life skills and those of immediate family, and the responses of the larger community in which they live. This chapter explores the role of culture in defining mental illness, particularly PTSD, and ends by addressing co-occurring mental and substance-related disorders. It also addresses common disorders associated with traumatic stress. This chapter discusses psychological symptoms not represented in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5 American Psychiatric Association, 2013a), and responses associated with trauma that either fall below the threshold of mental disorders or reflect resilience. It highlights common short- and long-term responses to traumatic experiences in the context of individuals who may seek behavioral health services. This chapter begins with an overview of common responses, emphasizing that traumatic stress reactions are normal reactions to abnormal circumstances. How an event affects an individual depends on many factors, including characteristics of the individual, the type and characteristics of the event(s), developmental processes, the meaning of the trauma, and sociocultural factors. The impact of trauma can be subtle, insidious, or outright destructive. Some individuals may clearly display criteria associated with posttraumatic stress disorder (PTSD), but many more individuals will exhibit resilient responses or brief subclinical symptoms or consequences that fall outside of diagnostic criteria. Trauma, including one-time, multiple, or long-lasting repetitive events, affects everyone differently.

This chapter examines common experiences survivors may encounter immediately following or long after a traumatic experience. Providers need to understand how trauma can affect treatment presentation, engagement, and the outcome of behavioral health services. Trauma-informed care (TIC) involves a broad understanding of traumatic stress reactions and common responses to trauma.

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