Trauma

Question 1

• child interacts with unfamiliar adults
in ≥2 of the following
• reduced reticence interacts with
unfamiliar adults
• overly familiar verbal/physical
behavior
• diminished checking back with
adult caregiver
• willingness to go off with unfamiliar
adult without hesitation
• not limited to impulsivity (as in
ADHD)
• extremes of insufficient care as
evidenced by 1 of the following:
• Social neglect and lack of basic
emotional needs, repeated changes
of primary caregivers, rearing in
unusual settings
• Developmental age of at least 9
months
• Specify: Persistent (if >1 year) and/or
Severe (all symptoms at high levels)

Answer 1

Disinhibited Social
Engagement Disorder

Question 2

• Inhibited, emotionally withdrawn
behavior toward adult caregivers
including both: child rarely seeks
comfort AND doesn’t respond to
comfort when distressed
• Persistent social/emotional
disturbance including at least 2 of the
following
1. Minimal social/emotional
responsiveness, limited positive
affect, or episodes of unexplained
irritability/sadness/fearfulness
even during non-threatening
interactions with caregivers
2. Pattern of extremes of insufficient
care evidence by one of the following:
3. Social neglect and lack of basic
emotional needs, repeated changes
of primary caregivers, rearing in
unusual settings
• Not autism
• Evidence before 5 years old,
developmental age of at least 9
months
• Specify: Persistent (if >1 year) and/or
Severe (all symptoms at high levels)

Answer 2

Reactive Attachment
Disorder

Question 3

• Disturbance is ≥1 1 month

• Criterion A: Exposure to actual or
threatened death, injury, or sex
violence in ≥1 of the following ways:

1. Directly experiencing
2. Witnessing
3. Learning a violent or accidental
   event occurred to a close family
   member/friend
4. Repeated exposure to aversive
   details of traumatic events

• Presence of ≥1 of the following:
1. Recurrent, involuntary/intrusive
memories (in kids repetitive play)

2. Recurrent dreams
3. Dissociative reactions
4. Intense/prolonged distress at
   exposure to cues that symbolize or
   resemble the event
5. Physiological reactions to cues
6. Persistent avoidance of stimuli
   associated evidenced by: avoidance of
   associations with the trauma AND/OR
   avoidance to avoid external reminds
   that arouse memories
7. Negative alterations in cognition and
   mood as evidenced by 2 of the
   following:

a. Can’t remember important aspects
of event
b. Persistent negative beliefs about
oneself, others, or the world
c. Persistent distorted cognitions
about event leading individuals to
blame themselves
d. Persistent negative emotional state
e. Decreased interest in activities
f. Feelings of detachment from others
g. Inability to experience positive
emotions

• Alterations in arousal (2 of the
following):

1. Anger outbursts with aggression
   towards people or objects
2. Self-destructive reckless behavior
3. Hypervigilance
4. Exaggerated startle response
5. Difficulty concentrating
6. Sleep disturbance
   • Specify whether: with dissociative
   symptoms
   a. depersonalization
   b. derealization
   • Specify if: with delayed expression (if
   ≥6 months after event)

Answer 3

PTSD

Question 4

• Symptoms after trauma, persisting 3 days to 1
month
• Criterion A of PTSD
• Presence of ≥9 symptoms
• Intrusion Symptoms
▪ Recurrent intrusive distressing memories (in
kids repetitive play)
▪ Recurrent distressing dreams
▪ Dissociative reactions (flashbacks)
▪ Intense psychological distress with
physiological responses to cues of event
• Negative Mood
▪ Inability to experience positive emotions
• Dissociative
▪ Altered sense of reality
▪ Inability to remember aspects of event
• Avoidance
▪ Efforts to avoid distressing memories,
thoughts, or feelings about event
• Arousal
▪ Sleep disturbance
▪ Irritable behavior and angry outbursts
▪ Hypervigilance
▪ Problems with Concentration
▪ Exaggerated startle response

Answer 4

Acute Stress Disorder

Question 5

• Emotional/behavioral symptoms within 3
months of onset of identifiable stressor, and once
stressor stops symptoms don’t persistent >6 mo
• Distress out of proportion to severity of stressor
OR significant impairment in function
• Doesn’t meet criteria for another mental
disorder, and doesn’t represent normal
bereavement
• Specifiers:
1. With depressed mood
2. With anxiety
3. With mixed anxiety and depressed mood
4. With disturbance of conduct
5. With mixed disturbance of emotions and
conduct
6. Unspecified

Answer 5

Adjustment Disorder

Question 6

• Trauma / Stressor disorder causing significant
distress and you don’t want to communicate
the reason

Answer 6

Unspecified Trauma and StressorRelated Disorder

Question 7

• Trauma / Stressor disorder causing significant
distress and you want to communicate the
reason

Answer 7

Other Specified Trauma and
Stressor-Related Disorder