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Trauma- Stressor

Trauma and Stressor Related Disorders

QuestionAnswer
Reactive Attachment Disorder Reactive attachment disorder of infancy or early childhood is characterized by a pattern of markedly disturbed and developmentally inappropriate attachment behaviors, in which a child rarely or minimally turns preferentially to an attachment figure for comfort, support, protection, and nurturance. The essential feature is absent or grossly underdeveloped attachment between the child and putative caregiving adults.
Reactive Attachment Disorder (Criterion A) A. Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by the following: 1. The child rarely or minimally seeks comfort when distressed 2. The child rarely or minimally responds to comfort when distressed.
Reactive Attachment Disorder (Criterion B) B. Persistent social and emotional disturbance characterized by at least two of the following: 1. minimal social and emotional responsiveness to others 2. Limited positive affect 3. Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.
Reactive Attachment Disorder (Criterion C) C. The child experienced a pattern of extremes of insufficient care by at least one of the following: 1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. 2. Repeated changes of primary caregivers that limit opportunities to form stable attachments. 3. Rearing in unusual settings that severally limit opportunities to form selective attachments.
Reactive Attachment Disorder (Criterion D-G) D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A. E. Criteria are not met for autism spectrum disorder F. The disturbance is evident before age 5 G. The child is has at least 9 month of developmental age
Reactive Attachment Disorder (Specifiers) Persistent- present for more than 12 months Severe- All symptoms present of the disorder and are expressed at relatively high levels
Disinhibited Social Engagement Disorder The essential feature of disinhibited social engagement disorder is a pattern of behavior that involves culturally inappropriate, overly familiar behavior with relative strangers. This overly familiar behavior violates the social boundaries of the culture. A diagnosis of disinhibited social engagement disorder should not be made before children are developmentally able to form selective attachments. For this reason, the child must have a developmental age of at least 9 months.
Disinhibited Social Engagement Disorder (Criterion A) A. Child actively approaches and interacts with unfamiliar adults and exhibits two of the following: 1. Reduced or absent reticence in approaching and interacting with unfamiliar adults. 2. Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries) 3. Diminished or absent checking back with adult caregiver in unfamiliar settings. 4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.
Disinhibited Social Engagement Disorder (Criterion B) B. The behaviors in Criterion A are not limited to impulsivity (as in ADHD) but include socially disinhibited behavior.
Disinhibited Social Engagement Disorder (Criterion C: 1-2) C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following: 1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. 2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
Disinhibited Social Engagement Disorder (Criterion C: 3 & D & E) 3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios). D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C). E. The child has a developmental age of at least 9 months.
Disinhibited Social Engagement Disorder (Specifier) Persistent: The disorder has been present for more than 12 months. Disinhibited social engagement disorder is specified as severe when the child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.
Posttraumatic Stress Disorder The essential feature of posttraumatic stress disorder (PTSD) is the development of characteristic symptoms following exposure to one or more traumatic events. Emotional re- actions to the traumatic event
Posttraumatic Stress Disorder (Criterion A: 1-2) A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: 1. Directly experiencing the traumatic event(s). 2. Witnessing, in person, the event(s)as it occurred to others.
Posttraumatic Stress Disorder (Criterion A: 3-4) 3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. 4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
Posttraumatic Stress Disorder (Criterion B: 1-2) B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
Posttraumatic Stress Disorder (Criterion B: 3-5) 3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). 5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Posttraumatic Stress Disorder (Criterion C: 1-2) C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following: 1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). 2. Avoidance of or efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Posttraumatic Stress Disorder (Criterion D: 1-2) D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs) 2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
Posttraumatic Stress Disorder (Criterion D: 3-7) 3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. 4. Persistent negative emotional state (e.g.,fear, horror, anger, guilt, or shame). 5. Markedly diminished interest or participation in significant activities. 6. Feelings of detachment or estrangement from others. 7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
Posttraumatic Stress Disorder (Criterion E: 1-2) E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 1. Irritable behavior and angry outbursts (with little or no provocation) typically ex- pressed as verbal or physical aggression toward people or objects. 2. Reckless or self-destructive behavior.
Posttraumatic Stress Disorder (Criterion E: 3-6) 3. Hypervigilance. 4. Exaggerated startle response. 5. Problems with concentration. 6. Sleep disturbance (e.g.,difficulty falling or staying asleep or restless sleep).
Posttraumatic Stress Disorder (Criterion F, G & H) F. Duration of the disturbance (Criteria B, C, D, andE) is more than1month. G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
Posttraumatic Stress Disorder (Specifier: Dissociate) With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and the individual experiences persistent or recurrent symptoms of either of the following: 1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body. 2. Derealization: Persistent or recurrent experiences of unreality of surroundings .
Posttraumatic Stress Disorder (Specifier: Expression) With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
Posttraumatic Stress Disorder for Children 6 Years and Younger The essential feature of posttraumatic stress disorder (PTSD) is the development of characteristic symptoms following exposure to one or more traumatic events. Emotional re- actions to the traumatic event
Posttraumatic Stress Disorder for Children 6 Years and Younger (Criterion A: 1-3) A. In children 6 years and younger, exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: 1. Directly experiencing the traumatic event(s). 2. Witnessing, in person, the event(s) as it occurred to others, especially primary caregivers. Note: Witnessing does not include events that are witnessed only in electronic media, television, movies, or pictures. 3. Learning that the traumatic event(s) occurred to a parent or caregiving figure.
Posttraumatic Stress Disorder for Children 6 Years and Younger (Criterion B: 1-2) B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). May be expressed as play re-enactiment. 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). May not be able to ascertain content of fright.
Posttraumatic Stress Disorder for Children 6 Years and Younger (Criterion B: 3-5) 3. Dissociative reactions (e.g., flashbacks) in which the child feels or acts as if the traumatic event(s) were recurring. Such trauma-specific reenactment may occur in play. 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). 5. Marked physiological reactions to reminders of the traumatic event(s).
Posttraumatic Stress Disorder for Children 6 Years and Younger (Criterion C) C. One (or more) of the following symptoms, representing either persistent avoidance of stimuli associated with the traumatic event(s) or negative alterations in cognitions and mood associated with the traumatic event(s), must be present, beginning after the event(s) or worsening after the event(s):
Posttraumatic Stress Disorder for Children 6 Years and Younger (Criterion C: 1-2) (Persistent Avoidance) Persistent Avoidance of Stimuli 1. Avoidance of or efforts to avoid activities, places, or physical reminders that arouse recollections of the traumatic event(s). 2. Avoidance of or efforts to avoid people, conversations, or interpersonal situations that arouse recollections of the traumatic event(s).
Posttraumatic Stress Disorder for Children 6 Years and Younger (Criterion C: 3-6) (Negative Alterations in Cognitions) Negative Alterations in Cognitions 3. Substantially increased frequency of negative emotional states (e.g., fear, guilt, sadness, shame, confusion). 4. Markedly diminished interest or participation in significant activities, including constriction of play. 5. Socially withdrawn behavior. 6. Persistent reduction in expression of positive emotions.
Posttraumatic Stress Disorder for Children 6 Years and Younger (Criterion D: 1) D. Alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 1. Irritable behavior and angry outbursts (with little or no provocation) typically ex- pressed as verbal or physical aggression toward people or objects (including extreme temper tantrums).
Posttraumatic Stress Disorder for Children 6 Years and Younger (Criterion D: 2-5) 2. Hypervigilance. 3. Exaggerated startle response. 4. Problems with concentration. 5. Sleep disturbance(e.g., difficulty falling or staying asleep or restless sleep).
Posttraumatic Stress Disorder for Children 6 Years and Younger (Criterion E, F & G) E. The duration of the disturbance is more than 1 month. F. The disturbance causes clinically significant distress or impairment in relationships with parents, siblings, peers, or other caregivers or with school behavior. G. The disturbance is not attributable to the physiological effects of a substance (e.g., medication or alcohol) or another medical condition.
Posttraumatic Stress Disorder for Children 6 Years and Younger (Specifier: Dissociate) With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and the individual experiences persistent or recurrent symptoms of either of the following: 1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body. 2. Derealization: Persistent or recurrent experiences of unreality of surroundings .
Posttraumatic Stress Disorder for Children 6 Years and (Specifier: Expression) With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
Acute Stress Disorder The essential feature of acute stress disorder is the development of characteristic symptoms lasting from 3 days to 1 month following exposure to one or more traumatic events. Traumatic events that are experienced directly include, but are not limited to, exposure to war as a combatant or civilian, threatened or actual violent personal assault natural or human- made disaster and severe accident .
Acute Stress Disorder (Criterion A: 1-2) A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways: 1. Directly experiencing the traumatic event(s). 2. Witnessing, in person, the event(s)as it occurred to others.
Acute Stress Disorder (Criterion A: 3-4) 3. Learning that the event(s) occurred to a close family member or close friend. Note: In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. 4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s). Note: This does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
Acute Stress Disorder (Criterion B) B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:
Acute Stress Disorder (Criterion B: 1-2) (Intrusion Symptoms) Intrusion Symptoms 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed. 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s). Note: In children, there may be frightening dreams without recognizable content.
Acute Stress Disorder (Criterion B: 3-4) (Intrusion Symptoms) 3. Dissociative reactions in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play. 4. Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Acute Stress Disorder (Criterion B: 5) (Negative Mood) Negative Mood 5. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
Acute Stress Disorder (Criterion B: 6-7) (Dissociate Symptoms) Dissociative Symptoms 6. An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a daze, time slowing). 7. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
Acute Stress Disorder (Criterion B: 8-9) (Avoidance Symptoms) Avoidance Symptoms 8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). 9. Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Acute Stress Disorder (Criterion B: 10-14) (Arousal Symptoms) Arousal Symptoms 10. Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep). 11. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects. 12. Hypervigilance. 13. Problems with concentration. 14. Exaggerated startle response.
Acute Stress Disorder (Criterion C) C. Duration of the disturbance(symptoms in Criterion B) is 3 days to 1 month after trauma exposure. Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria.
Acute Stress Disorder (Criterion D & E) D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not attributable to the physiological effects of a substance (e.g., medication or alcohol) or another medical condition (e.g., mild traumatic brain injury) and is not better explained by brief psychotic disorder.
Adjustment Disorders The presence of emotional or behavioral symptoms in response to an identifiable stressor is the essential feature of adjustment disorders . The stressor may be a single event , or there may be multiple stressors (e.g., marked business difficulties and marital problems). Stressors may be recurrent (e.g., associated with seasonal business crises, unfulfilling sexual relationships) or continuous (e.g., a persistent painful illness with increasing disability, living in a crime-ridden neighborhood)
Adjustment Disorders (Criterion A) A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
Adjustment Disorders (Criterion B 1-2) B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following: 1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation. 2. Significant impairment in social, occupational, or other important areas of functioning.
Adjustment Disorders (Criterion C, D & E) C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder. D. The symptoms do not represent normal bereavement. E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.
Adjustment Disorders (Specifiers) 309.0 (F43.21) With depressed mood: Low mood, tearfulness, or feelings of hopelessness are predominant. 309.24 (F43.22) With anxiety: Nervousness, worry, jitteriness, or separation anxiety is predominant. 309.28 (F43.23) With mixed anxiety and depressed mood: A combination of depression and anxiety is predominant.
Adjustment Disorders (Specifiers) 309.3 (F43.24) With disturbance of conduct: Disturbance of conduct is predominant. 309.4 (F43.25) With mixed disturbance of emotions and conduct: Both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant. 309.9 (F43.20) Unspecified: For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.
Other Specified Trauma- and Stressor-Related Disorder Applies to symptoms characteristic of a trauma- and stressor-related disorder that cause clinically significant distress or impairment areas of functioning do not meet the full criteria in the trauma- and stressor-related disorders. The other specified trauma- and stressor-related disorder category is used when the clinician chooses a specific reason does not meet the criteria for the disorder.
Other Specified Trauma- and Stressor-Related Disorder (Specifier) 1. Adjustment-like disorders with delayed onset of symptoms that occur more than 3 months after the stressor. 2. Adjustment-like disorders with prolonged duration of more than 6 months without prolonged duration of stressor. 3. Ataque de nervios
Other Specified Trauma- and Stressor-Related Disorder (Specifier) 4. Other cultural syndromes 5. Persistent complex bereavement disorder :This disorder is characterized by severe and persistent grief and mourning reactions.
Unspecified Trauma- and Stressor-Related Disorder Symptoms characteristic of a trauma- and stressor-related disorder that cause clinically significant distress or impairment in areas of functioning do not meet the full criteria for any of the disorders in the trauma- and stressor-related disorders diagnostic class. This category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met and includes presentations in which there is insufficient information to make a more specific diagnosis.
Created by: amdressler