Trauma and Stressor Related Disorder DSM (all except PTSD)

Question 1

social neglect (absence of adequate caregiving during childhood) is a requirement in diagnosis of which disorders

Answer 1

reactive attachment disorder

disinhibited social engagement disorder

Question 2

what distinguished reactive attachment disorder and disinhibited social engagement disorder

Answer 2

share common etiology (social neglect), differ in manifestation of distress

RAD–> internalizing disorder with depressive symptoms and withdrawn behaviour

DSED–> marked by disinhibition and externalizing behaviour

Question 3

what is the “consistent pattern” of behaviour that characterizes criterion A of reactive attachment disorder

Answer 3

inhibited, emotionally withdrawn behaviour toward adult caregivers

there is a pattern of “markedly disturbed and developmentally inappropriate attachment behaviours”

Question 4

criterion A for reactive attachment disorder

Answer 4

a consistent pattern of INHIBITED, emotionally WITHDRAWN behaviour towards adult caregivers manifested by BOTH of the following:

1. child rarely or minimally SEEKS comfort when distressed
2. child rarely or minimally RESPONDS to comfort when distressed

Question 5

criterion B for reactive attachment disorder

Answer 5

a 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

Question 6

criterion C for reactive attachment disorder

Answer 6

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 (i.e frequent changes in foster care)
3. rearing in UNUSUAL SETTINGS that severely limit opportunities to form selective attachments (i.e institutions with high child-to-caregiver ratio)

Question 7

criterion D for reactive attachment disorder

Answer 7

the care in criterion C is presumed to be responsible for the disturbed behaviour in criterion A (i.e disturbance in criterion A began after the lack of adequate care in criterion C)

Question 8

criterion E for reactive attachment disorder

Answer 8

criteria not met for autism spectrum disorder

Question 9

criterion F for reactive attachment disorder

Answer 9

disturbance is evident BEFORE age 5 years

Question 10

criterion G for reactive attachment disorder

Answer 10

child has developmental age of at least 9 months

Question 11

what specifiers exist for reactive attachment disorder

Answer 11

1. “persistent”–> present for more than 12 months
2. severity

Question 12

describe what would be considered “severe” reactive attachment disorder

Answer 12

when a child exhibits ALL the symptoms of the disorder, with each symptom manifesting at relatively high levels

Question 13

reactive attachment disorder symptoms must be present before what age

Answer 13

5

Question 14

developmental age of a child must be above what age to diagnose reactive attachment disorder

Answer 14

at least 9 months

Question 15

how do summarize the criteria for reactive attachment disorder

Answer 15

a–> must have both, around seeking and responding to comfort

B–> social and emotional disturbances associated (must have 2)

C–> pattern of etiological neglect (must have experienced at least 1)

cant have ASD diagnosis

Question 16

what is the essential feature of reactive attachment disorder

Answer 16

absent or grossly underdeveloped attachment between the child and putative caregiving adults

Question 17

are children with reactive attachment disorder believed to have the capacity to form selective attachments

Answer 17

yes

however, because of limited opportunities during early development, they fail to show the behavioural manifestations of selective attachments

Question 18

reactive attachment disorder often occurs with what other features

Answer 18

developmental delays–> especially cognition and language (due to severe neglect)

may have stereotypies

may have other signs of severe neglect ie malnutrition

Question 19

how prevalent is reactive attachment disorder even in populations of severely neglected children

Answer 19

less than 10% of such children

*thus considered relatively rare though actual prevalence is unknown

Question 20

does reactive attachment disorder occur in older children

Answer 20

per DSM it is “unclear” if it occurs in children older than 5 and thus the dx should be made with caution in kids older than 5–> unclear how this presentation would differ in older kids compared to younger

Question 21

name risk factors for reactive attachment disorder

Answer 21

social neglect is both a requirement or dx and the only known risk factor

Question 22

name a factor that determines prognosis of reactive attachment disorder

Answer 22

quality of the caregiving environment following serious neglect

**the majority of severely neglected kids do not develop the disorder

Question 23

ddx reactive attachment disorder

Answer 23

autism spectrum disorder

intellectual disability

depressive disorders

Question 24

list some of the features that overlap between reactive attachment disorder and autism

Answer 24

both may show:
dampened expression of positive emotions

cognitive and language delays

impairments in social reciprocity

stereotypies

Question 25

how do you distinguish between reactive attachment disorder and autism spectrum disorder

Answer 25

1. differential histories of neglect (+RAD) 2. presence of restricted interests or ritualized behaviours (+ASD) 3. specific deficit in social communication (+ASD) 4. specific deficit in selective attachment behaviours (+RAD)

Question 26

do kids with reactive attachment disorder show deficits in social communicative functioning

Answer 26

no--> its generally comparable to their overall intellectual level

Question 27

how do you distinguish reactive attachment disorder from intellectual disability

Answer 27

kids with ID would not show the profound reduction in positive affect and emotion regulation difficulties seen in reactive attachment disorder kids with ID (if have intellectual age of 7-9 months) should still show selective attachments regardless of chronological age

Question 28

list conditions associated with neglect

Answer 28

cognitive delays language delays stereotypies

Question 29

criterion A for disinhibited social engagement disorder

Answer 29

a pattern of behaviour in which a child ACTIVELY APPROACHES and interacts with UNFAMILIAR ADULTS and exhibits at least TWO of the following: 1. reduced or absent reticence in approaching and interacting with unfamiliar adults 2. overly familiar verbal or physical behaviour (that is not consistent with culturally sanctioned or with age-appropriate social boundaries) 3. diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings 4. willingness to go off with an unfamiliar adult with minimal or no hesitation

Question 30

criterion B for disinhibited social engagement disorder

Answer 30

behaviours in criterion A are not limited to impulsivity (i.e in ADHD) but include socially DISINHIBITED behaviour

Question 31

criterion C for disinhibited social engagement disorder

Answer 31

child has experiences 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 (i.e frequent changes in foster care) 3. rearing in UNUSUAL SETTINGS that severely limit opportunities to form selective attachments (i.e institutions with high child-to-caregiver ratio)

Question 32

criterion D for disinhibited social engagement disorder

Answer 32

the care in criterion C is presumed to be responsible for the disturbed behaviour in criterion A

Question 33

criterion E for disinhibited social engagement disorder

Answer 33

child has developmental age of at least 9 months

Question 34

what are the specifiers available for disinhibited social engagement disorder

Answer 34

1. persistent (at least 12 months) 2. severity (severe if have all symptoms of disorder to relatively high levels)

Question 35

describe the essential feature of disinhibited social engagement disorder

Answer 35

pattern of behaviour that involves culturally INappropriate, OVERLY FAMILIAR behaviour with relative strangers --> violates social boundaries of the culture

Question 36

at what age are children able to start forming selective attachments

Answer 36

9 months

Question 37

do kids with disinhibited social engagement disorder always have signs of disordered attachment

Answer 37

no--> condition can present in children who show no signs of disordered attachment may be seen in children with a history of neglect who lack attachments or whose attachments to caregivers range from disturbed to secure

Question 38

what is the prevalence of disinhibited social engagement disorder in HIGH RISK populations (those who have been severely neglected and subsequently placed in foster care or raised in institutions)

Answer 38

about 20% *rarely seen in other settings

Question 39

neglect beginning after what age is UNLIKELY to result in disinhibited social engagement disorder

Answer 39

age 2 "there is no evidence that neglect beginning after age 2 years is associated with manifestations of the disorder"

Question 40

what is the course of disinhibited social engagement disorder

Answer 40

if neglect occurs early and signs of the disorder appear, clinical featuers of the disorder appear to be moderately STABLE over time (particularly if neglect persists)

Question 41

how does the presentation of disinhibited social engagement disorder shift r from toddlerhood to preschool years? from preschool to middle childhood?

Answer 41

toddler--> indiscriminate social behaviour, lack of reticence with unfamiliar adults preschool--> attention seeking behaviours; verbal and social intrusiveness most prominent middle childhood--> verbal and physical overfamiliarity as well as INAUTHENTIC expressions of emotions (particularly with adults) peer relationships are most affected in adolescence --> both indiscriminate behaviour and conflicts apparent, extends from mostly towards adults to peers as well (disorder not described in adults)

Question 42

what are risk factors for disinhibited social engagement disorder

Answer 42

serious social neglect is both diagnostic requirement and also only known risk factor --> specifically neglect before the age of 2 majority of neglected children do not develop this however has not been described in kids experiencing neglect only after age 2

Question 43

does the quality of the caregiving environment following serious neglect affect prognosis in disinhibited social engagement disorder

Answer 43

somewhat, but only MODESTLY--> in many cases, the disorder PERSISTS (at least through adolescence) even in children whose caregiving environments are markedly improved

Question 44

ddx disinhibited social engagement disorder

Answer 44

ADHD (overlap in terms of some social impulsivity)

Question 45

criterion A for acute stress disorder

Answer 45

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 2. witnessing in person the event as it occurs to others 3. learning that the event occurred to a close family member or close friend (must have been violent or accidental) 4. experiencing repeated or extreme exposure to aversive details of the traumatic events

Question 46

criterion B for acute stress disorder

Answer 46

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 occured (see next cards)

Question 47

what are the "intrusion" symptoms in acute stress disorder

Answer 47

recurrent, involuntary, distressing memories of the event recurrent distressing dreams in which content and/or affect of the dream are related to the event(s) dissociative reactions in whcih person feels or acts as if the traumatic events were recurring intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues

Question 48

what is the duration/time criteria for acute stress disorder (criterion C)

Answer 48

3 days to 1 month after trauma exposure sx typically begin immediately after the trauma but then persist

Question 49

what is a factor that affects prevalence of acute stress disorder

Answer 49

the type of trauma experienced i.e acute stress disorder is seen in less than 20% of cases of trauma that does not involve interpersonal assault, 13-20% of MVAs, 14% of mild TBI, 19% of assault, 10% severe burn higher rates (20-50%) are reported following interpersonal traumatic events including assault, rape, witnessing mass shooting

Question 50

what % of people who go on to develop PTSD initially present with acute stress disorder

Answer 50

about half

Question 51

which gender is more at risk for developing acute stress disorder

Answer 51

females

Question 52

what is a physiological risk factor for developing acute stress disorder

Answer 52

elevated reactivity, as reflected by acoustic startle response, prior to trauma exposure

Question 53

list temperamental risk factors for acute stress disorder

Answer 53

prior mental disorder high levels of neuroticism greater preceived severity of the traumatic event avoidant coping style catastrophic appraisal of the traumatic experience

Question 54

ddx acute stress disorder

Answer 54

adjustment disorders panic disorders dissociative disorders PTSD OCD psychotic disorders TBI

Question 55

criterion A for adjustment disorders

Answer 55

the development of EMOTIONAL or BEHAVIOURAL symptoms in response to an identifiable stressor occurring WITHIN 3 months of the onset of the stressor

Question 56

criterion B for adjustment disorders

Answer 56

these symptoms or behaviours 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

Question 57

criterion C for adjustment disorder

Answer 57

the stress related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder

Question 58

criterion D for adjustment disorder

Answer 58

the symptoms do not represent normal bereavement

Question 59

criterion E for adjustment disorder

Answer 59

once the stressor or its consequences have terminated, the symptoms do not persist for more than SIX months

Question 60

list the specifiers available for adjustment disorder

Answer 60

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 + acute (less than 6 months) vs persistent (chronic) (lasting more than 6 months)

Question 61

what is the essential feature of adjustment disorder

Answer 61

the presence of emotional or behavioural symptoms in response to an identifiable stressor

Question 62

does the stressor in adjustment disorder have to be one single event

Answer 62

no, can be multiple stressors i.e marital problems and marked business difficulties can also be recurrent or continuous (i.e living in a crime ridden neighborhood, persistent painful illness etc)

Question 63

does adjustment disorder increase risk of SI/SAs

Answer 63

yes--> associated with increased risk of suicide attempts and completed suicide

Question 64

what is the prevalence of adjustment disorders in those in outpatient mental health treatment

Answer 64

5-20% (with adjustment disorder as a principal diagnosis)

Question 65

how common are adjustment disorders in hospital psychiatric consultation settings

Answer 65

the MOST COMMON diagnosis frequently reaches 50%

Question 66

what is a risk factor for adjustment disorder

Answer 66

those from disadvantaged life circumstances may be at increased risk of stressors and thus at increased risk of adjustment disorder

Question 67

ddx adjustment disorder

Answer 67

MDD PTSD acute stress disorder personality disorders psychological factors affecting other medical conditions normative stress reactions

Question 68

list examples that may fall under the "other specified" designation of trauma and stressor related disorders

Answer 68

1. adjustment like disorder 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 4. other cultural syndromes 5. persistent complex bereavement disorder

Question 69

what is persistent complex bereavement disorder

Answer 69

an example of "other specified trauma and stressor related disorders" characterized by severe and persistent grief and mourning reactions

Question 70

what is the treatment for reactive attachment disorder

Answer 70

main tx is PSYCHOSOCIAL + ensure a stable caregiving environment with stable attachment figures

Question 71

what is the treatment for disinhibited social engagement disorder

Answer 71

main tx is PSYCHOSOCIAL + ensure a stable caregiving environment and to LIMIT CONTACT with non-caregiving adults

Question 72

what treatments have been investigated to manage adjustment disorder

Answer 72

psychotherapy including CBT and brief supportive therapy