Trauma and stress Flashcards by Amy Collins

main characteristic of reactive attachment disorder

consistent, inhibited emotional withdrawal toward caregivers manifested by
-rarely/minimally seeks comfort
-rarely/minimally responds to comfort

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social/emotional disturbance criteria for reactive attachment disorder, of which you must have 2

-minimal social/emotional responsiveness to others
-limited positive affect
-episodes of unexplained irritability, sadness, or fearfulness during nonthreatening interactions with caregivers

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manifestations of patterns of extreme insufficiency of care for reactive attachment disorder of which you must have 1

-social neglect/deprivation (consistently not having basic emotional needs met)
-repeated changes in caregivers
-raised in a setting with minimal opportunity to form attachments with caregivers

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other criteria for reactive attachment disorder

-criteria not met for autism
-disturbance before age 5
-developmental age of at least 9 months
-insufficient care presumed cause of disturbed behavior

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what constitutes persistent and severe reactive attachment disorder

persistent - present for at least 12 months
severe - all symptoms at high levels

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risk factor for reactive attachment disorder

serious social neglect is a requirement and only known risk factor

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functional consequences of reactive attachment disorder

significantly impair child’s ability to relate to others and associated with impairment across many domains of

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symptoms comorbid with reactive attachment disorder

cognitive/language delays
stereotypies
malnutrition

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disinhibited social engagement disorder

child inappropriately interacts with strangers as if they are familiar with

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criteria for manifestations of inappropriate interactions with adults in disinhibited social engagement disorder, of which you must have 2

-no restraint when interacting with unfamiliar adults
-overly familiar verbal/physical behavior
-not checking back with caregivers after wandering away
-willingness to go with unfamiliar adult without hesitation

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types of insufficient care that can lead to disinhibited social engagement disorder

social neglect/deprivation
repeated changes in caregivers
raised with little opportunity to form attachments

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other criteria for disinhibited social engagement disorder

-behaviors nor limited to impulsivity
-lack of care presumed to cause behavior disturbance
-developmental age of at least 9 months
-specify is persistent or severe

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associated features of disinhibited social engagement disorder

-may have developmental/language delays
-may have malnutrition
-s/s persist once neglect no longer present

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diagnostic criteria for PTSD in patients older than 6

-exposure to actual/threatened death, serious injury, or sexual violence
-1 or more intrusion symptoms associated with traumatic event
-persistent avoidance of stimuli associated w/ trauma
-negative alterations in mood/cognitions
-marked alteration in arousal/reactivity associated with trauma

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how can the traumatic exposure occur in PTSD in patients over 6, of which there must be at least 1

-directly experiencing
-witnessing event in person
-learning event happened to a family member/close friend
-experiencing repeated exposure to traumatic details

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what are the 5 intrusion symptoms associated with traumatic event in PTSD (of which you must have at least 1)

-recurrent, involuntary, intrusive memories
-recurring distressing dreams
-dissociative reactions
-intense psychological distress r/t internal/external cues of trauma
-marked physiological reactions to internal/external cues of trauma

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how many negative alterations in cognitions/mood are required for dx of PTSD

at least 2

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evidence of persistent avoidance of stimuli associated with trauma required for PTSD dx (must have at least 1)

-avoidance of memories, thoughts, feelings associated w/ event
-avoidance of external reminders of the event

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7 negative alterations in cognitions/mood require for PTSD dx (need at least 2)

-unable to remember important aspects of event
-negative beliefs about one’s self, other, or the world
-self-blame for the event
-persistent negative emotional state
-loss of interest/participation in significant activities
-feeling detached from others
-inability to experience positive emotions

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how many alterations in arousal/reactivity are required for PTSD dx

at least 2

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6 types of alterations in arousal/reactivity associated with traumatic event

-irritable behavior/angry outbursts
-reckless/self-destructive behavior
-hypervigilance
-exaggerated startle response
-concentration problems
-sleep disturbance

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how long must sx be present for dx of PTSD

at least 1 month

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how many persistent avoidance/negative alteration in cognition/mood criteria must be met for dx of PTSD in children under 6

at least 1

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types of persistent avoidance in patients under 6

-avoiding activities, places, reminders of trauma
-avoiding people, conversations, interpersonal situations that remind of trauma

negative alterations in cognition/emotional in patients under 6

-increased frequency of negative emotional states -dimininshed interest/participation in significant activities -socially withdrawn behavior -persistent reduction in positive emotion expression

how many alterations in arousal/reactivity are required for PTSD dx in patients under 6

at least 2

PTSD-qualifying alterations in arousal/mood in patients under 6

-irritable behavior/angry outbursts -hypervigilance -exaggerated startle response -concentration problems -sleep disturbance

when do PTSD sx typically begin

within 3 months of traumatic event

what is often initial dx of PTSD

acute stress disorder until sx have been present for 1 month

PTSD presentation in non-western cultures

less avoidance and more somatic complaints

Which gender is PTSD more prevalent in

females

dx if PTSD criteria is met other than severity of stressor

adjustment disorder

duration of acute stress disorder

3 days - 1 month following traumatic event

what if criteria for PTSD and MDD is met

give both dx

what if criteria is met for PTSD and a dissociative disorder

dx is PTSD w/ dissociative features

what are common PTSD comorbidities in children

ODD and separation anxiety

diagnostic criteria for acute stress disorder

-same exposure as PTSD -9 symptoms out of any of the 5 categories -3 days - 1 month

symptoms categories for the 9 symptoms required for acute stress disorder dx

intrusive symptoms negative mood dissociative symptoms avoidance symptoms arousal symptoms

intrusive symptoms r/t acute stress disorder

-recurrent, involuntary, intrusive thoughts about event -recurrent distressing dreams r/t event -dissociative reactions (flashbacks) -intense psychological distress/physiological reaction to internal/external cues r/t trauma

negative mood symptom r/t acute stress disorder

persistent inability to experience positive emotions

dissociative symptoms associated with acute stress disorder

-altered sense of reality about oneself or surroundings -inability to remember aspects of event

avoidance symptoms associated with acute stress disorder

avoids memories of event avoid external reminders of event

arousal symptoms associated with acute stress disorder

-sleep disturbance -irritable behavior/angry outbursts -hypervigilance -concentration problems -exaggerated startle response

common presentations of acute stress disorder in children

-reexperience trauma through repetitive play -may become preoccupied with reminders of trauma -may have excessively bright affect nightmares may not be r/t trauma

what differentiates panic attacks from panic disorder from those in acute stress disorder

in panic disorder there is also worry about having panic attacks

diagnostic criteria for adjustment disorder

-emotional/behavioral responses to a stressor -does not meet criteria for another mental disorder -is not an exacerbation of another mental disorder

when do emotional/behavioral symptoms emerge in response to stressor in adjustment disorder

within 3 months of stressor onset

what determines if symptoms in adjustment disorder are clinically significant

-distress is out of proportion to severity of stressore -there is significant impairment in functioning

how long can symptoms last after removal of stressor in adjustment disorder

no more than 6 months

6 specifiers for adjustment disorder

-with depressed mood -with anxiety -w/ mixed anxiety/depressed mood -with conduct disturbance -with mixed disturbance of emotions/conduct -unspecified

duration of acute and persistent adjustment disorder

acute: less than 6 months persistent: longer than 6 months

when can symptoms in adjustment disorder last longer than 6 months

if it is a chronic stressor

what if criteria is met for adjustment disorder and MDD

only MDD. Cannot have both dx

what differentiates normative stress reaction from adjustment disorder

adjustment disorder if distress is out of proportion w/ stressor or when stressor is before functional impairment

diagnostic criteria for prolonged grief disorder

-death at least 12 months ago -grief response present nearly every day for last month -3 out of 8 symptoms present

what are the 2 ways grief response is characterized after death in prolonged grief disorder

-intense yearning/longing for deceased -preoccupation w/ thoughts/memories of deceased

what are the 8 symptoms that qualify for prolonged grief disorder (must have at least 3)

-identity disruption -marked disbelief about death -avoidance of reminders person is dead -intense emotional pain -difficulty reintegrating into relationships/activities -emotional numbness -feeling that life is meaningless -intense lonliness

most common comorbidities with prolonged grief disorder

MDD, PTSD, substance use