Trauma- and Stressor-Related Disorders Flashcards
Reactive Attachment Disorder Diagnostic Criteria
A. A consistent pattern of inhibited, emotionally withdrawn behaviour towards adult caregives, manifested by both:
1. The child rarely or minimally seeks comfort when distressed.
2. The child rarely or minimally responds to comfort when distressed.
B. A persistent social and emotional disturbance characterized by ≥2 of the following:
1. Minimal social/emotional responsiveness to others.
2. Limited positve affect
3. Episodes of unexplained irritability, sadness, or fearfulness in nonthreatening interactions with adult caregivers.
C. The child has experienced a pattern of extremes of insufficient cares as evidenced by ≥1 of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation or affection met by adult caregivers.
2. Repeated changes of primary caregivers the limit opportunitites to form stable attachments.
3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., in institutions with high child-to-caregiver ratios)
D. C is presumed to be responsible for A
E. Criteria for ASD not met
F. Evident before age 5
G. Child is ≥9 months old
Specify if:
* Persistent: Disorder has been present for > 12 months
Specify current severity: classified as sever is child exhibits all symptoms, all at high levels
Differentiation of Reactive Attachment Disorder from ASD
- Can be differentiated based on differential histories of neglect
- ASD includes presence of restricted interests and repetitive behaviours (although rocking/flapping can be seen in both diagnoses)
- Only ASD involves selective impairment in social communicative behaviours (i.e., deliberate communication to influence others), whereas RAD will involve cognitive communication commensurate with general intellectual functioning
- ASD children regularly show developmentally normative attachment behaviour
Differentiation of Reactive Attachment Disorder from intellectual developmental disorder
- Children with IDD show social/emotional skills commensurate with their cognitive skills
- IDD does not come with the marked reduction in positive affect that RAD does
- IDD does is not characterized with difficulties forming selective attachments
Differentiation of Reactive Attachment Disorder from depressive disorders
- Children with depressive disorders tend not to show difficulties with attachment
Disinhibited Social Engagement Disorder Diagnostic Criteria
A. A pattern of behaviour in which a child actively approaches and interacts with unfamiliar adults and exhibits ≥2 of the following:
1. Reduced or absent reticence in approach/interacting with the adults
2. Overly familar verbal/physical behaviour (that is not consistent with cultural/age-appropriate social boundaries)
3. Diminished or absent checking back with adult caregiver before venturing away, even in unfamiliar settings
4. Willingness to go off with an unfamiliar adult with minimal/no hesitation
B. Above symptoms not limited to impulsivity (i.e., in ADHD) but include social disinhibition
C. The child has experienced a pattern of extremes of insufficient care as evidenced by ≥1 of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation or affection met by adult caregivers.
2. Repeated changes of primary caregivers the limit opportunitites to form stable attachments.
3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., in institutions with high child-to-caregiver ratios)
D. C is presumed to be responsible for A
E. Child is ≥9 months old
Specify if:
* Persistent
Specify current severity
Differentiation of Disinhibited Social Engagement Disorder from ADHD
Children with DSED do not show the attentional/hyperactive difficulties that children with ADHD show.
Posttraumatic Stress Disorder Diagnostic Criteria (In Individuals Age ≤6)
A. Exposure to actual or threatened death, serious injury, secual violence in ≥1 of the following ways:
1. Direct experience
2. Witnessing as it occurred to others, especially primary caregivers
3. Learning that it occurred to a parent or caregiver figure
B. Presence if ≥1 of the following intrusion symptoms, following from the trauma:
1. Recurrent, involuntary, and intrusive distressing memories of the event (may be expressed as play reenactment)
2. Recurrent distressing dreams in which the content and/or affect of the dream relates to the event (may be unclear whether content relates to the event)
3. Dissociative reactions (e.g., flashbacks) in which the person feels or acts as if the event is recurring
4. Intense prolonged psychological distress at exposure to internal/external cues that resemble/symbolize an aspect of the event.
5. Marked physiological reactions to internal/external cues that symbolize/resemble an aspect of the event.
C. ≥1 of the following, respesenting persistent avoidance of reminders or alterations in cognitions/mood
* Persistent avoidance of reminders:
1. Avoidance or efforts to avoid distressing memories, thoughts, feelings about or closely associated with the event
2. Avoidance of efforts to avoid external reminders of the event
* Negative alterations in cognitions:
3. Substantially increased frequency of negative emotional states
4. Markedly diminished interest or participation in significant activities, including constricted play
5. Socially withdrawn behaviour
6. Persistent reduction in expressed positive emotoins
D. Marked alterations in arousal/reactivity, as evidenced by ≥2 of the following:
1. Irritable behaviour and angry outburts (with little/no provocation)
2. Hypervigilance
3. Exaggerated startle response
4. Problems with concentration
5. Sleep disturbances
E. Duration of B-E is ≥1 month
F. Causes clinically significant distress/functional impairment
G. Not attributable to substances/medication/medical condition.
PTSD Sepcifiers
- With dissociative symptoms: Individual experiences either or both of the following:
1. Depersonalization
2. Derealization - With delayed expression: Full diagnostic criteria not met until ≥6 months after the event
Posttraumatic Stress Disorder Diagnostic Criteria (In Individuals Age >6)
A. Exposure to actual or threatened death, serious injury, secual violence in ≥1 of the following ways:
1. Direct experience
2. Witnessing as it occurred to others
3. Learning that it occurred to a close family member or friend. In these cases, even must have been violent or accidental
4. Experiencing extreme/repeated exposure to aversive details of the even (e.g., first responders collecting human remains; police officers who work on child abuse cases; Note: Not through media, unless it is work related)
B. Presence if ≥1 of the following intrusion symptoms, following from the trauma:
1. Recurrent, involuntary, and intrusive distressing memories of the event
2. Recurrent distressing dreams in which the content and/or affect of the dream relates to the event
3. Dissociative reactions (e.g., flashbacks) in which the person feels or acts as if the event is recurring
4. Intense prolonged psychological distress at exposure to internal/external cues that resemble/symbolize an aspect of the event.
5. Marked physiological reactions to internal/external cues that symbolize/resemble an aspect of the event.
C. Persistent avoidance of stimuli associated with the event, as evidenced by ≥1 of the following:
1. Avoidance or efforts to avoid distressing memoriees, thoughts, feelings about or closely associated with the event
2. Avoidance of efforts to avoid external reminders of the event
D. Negative alterations in cognitions and mood associated with the event, as evidenced by ≥2 of the following:
1. Inability to remember an important aspect of the event (not better explained by e.g., head injury, substances)
2. Persistent and exaggerated negative beliefs about self, others, or the world
3. Persistent, disotrted cogntions about the cause/consequences of the event, leading to inappropriate blame of self or others
4. Persistent negative emotional states (e.g., fear, horror, anger, guilt, shame)
5. Marked diminished pleasure/participation in significant activities
6. Feelings of detachment or estrangement from others
7. Persistent inability to experience positive emotions (e.g., happiness, satisfaction, love)
E. Marked alterations in arousal/reactivity, as evidenced by ≥2 of the following:
1. Irritable behaviour and angry outburts (with little/no provocation)
2. Reckless/self-destructive behaviour
3. Hypervigilance
4. Exaggerated startle response
5. Problems with concentration
6. Sleep disturbances
F. Duration of B-E is ≥1 month
G. Causes clinically significant distress/functional impairment
H. Not attributable to substances/medication/medical condition.
Differentiation of PTSD from Adjustment Disorders
- In adjustment, the stressors can be of any severity
- If Criterion A is met, but others for PTSD are not, adjustment disorder may be appropriate, or if Criterion A is not met, but the rest of the PTSD symptom pattern does
Differentiation of PTSD from Acute Stress Disorder
Based on duration: 3 days-1 month for acute stress disorder, >1 month for PTSD
Acute Stress Disorder Diagnostic Criteria
A. Exposure to actual or threatened death, serious injury, secual violence in ≥1 of the following ways:
1. Direct experience
2. Witnessing as it occurred to others
3. Learning that it occurred to a close family member or friend. In these cases, even must have been violent or accidental
4. Experiencing extreme/repeated exposure to aversive details of the even (e.g., first responders collecting human remains; police officers who work on child abuse cases; Note: Not through media, unless it is work related)
B. Presence of ≥9 of the following from any 5 categories of intrusion, negative mood, dissociation, avoidance, and aroual
* Intrusion Symptoms
1. Recurrent/involuntary/intrusive memories of the event
2. Recurrent distressing dreams in which content/affect relate to the event
3. Dissociative reactions in which the individual feels like the event is recurring
4. Intense/prolonges psychological distress or marked physiological reactions to internal/external cures of the event.
* Negative Mood
1. Persistent inability to experience positive emotions
* Dissociative symptoms
1. Altered sense of reality
2. Inability to remember important aspects of the event
* Avoidance
1. Efforts to avoid distressing memories/thoughts/feelings of the event
2. Efforts to avoid external reminds of the event
* Arousal symptoms
1. Sleep disturbance
2. Irritable behaviour and angry outbursts
3. Hypervigilance
4. Problems with concentrattion
5. Exaggerated startle response
C. Duration is 3 days - 1 month after trauma exposure
D. Causes clinically significant distress/functional impairment
E. Not attributable to substances/medication/other medical condition or brief psychotic disorder
Adjustment Disorders Diagnostic Criteria
A. The development of emotional/behavioural symptoms in response to an identifiable stressor(s), occurring within 3 months of the onset of the stressor(s).
B. Symptoms or behaviours are clinically significant, as evidenced by ≥1 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 cultural factors that might influence symptom severity and presentation.
2. Significant functional impairment
C. Does not meet criteria for another mental disorder/is not an exacerbation of an existing mental disorder
D. Not explained by normal bereavement or prolonged grief disorder
E. Once the stressor/its consequences have terminate, symptoms do not persist longer than an additional 6 months
Adjustment Disorder Specifiers
Presentation:
* With depressed mood: low mood, tearfulness, feelings of hopelessness predominate
* With anxiety: Nervousness, worry, jitteriness, separation anxiety predominate
* With mixed anxiety and mood
* With disturbance of conduct
* With mixed disturbance of emotions and conuct: Mood symptoms and conduct disturbance are present
* Unpsecified: Maladaptive reactions cannot cleanly be classified
Course:
* Acute: Symptoms persist for <6 months
* Persistent (chronic): Symptoms persist ≥6 months (in total; symptoms cannot, by definition persist 6 months after stressor termination and still be adjustment disorder)
Differentiation of Adjustment Disorder and MDD
Both diagnoses cannot be given, if MDD criteria are met, then MDD wins out.
