Posttraumatic despair is apparent in all of the common disorders that follow traumatization—depression, anxiety disorders, acute and posttraumatic stress disorders (ASD & PTSD), and substance abuse disorder—but it is greatest in depression and PTSD. The term despair denotes hopelessness, the sense that an unbearable situation cannot be improved. Despair worsens as a posttraumatic disorder becomes chronic. Feelings of despair are provoked by cognitive, relational, and emotional factors that cause functional impairments. The combined impact of these impairments is a major blow to the self of the survivor. The individual feels he or she is damaged and despairs of being able to feel whole again.