TRAUMA- AND STRESSOR-RELATED DISORDERS

Question 1

Potentially traumatic event

Answer 1

Read through in one note.

Question 2

ACUTE STRESS DISORDER

Answer 2

A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or
more) of the following ways:
I. Directly experiencing the traumatic event(s) _

2. witnessing in person the event(s) as it occurred to Others.
3. Learning the 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 human remains, police officers repeatedly exposed to details Of child abuse).
   Note: This does not apply to exposure through electronic media, television, movies- or pictures, unless this exposure is work-related.

B. Presence of nine (or more) of 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:

Intrusion Symptoms
I. Recurrent, *voluntary, and intrusive memories of the traumatic event(s). 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.
3. Dissociative reactions (e_g, flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring (Such reactions may occur 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 traumatic event(s).

Negative Mood
5. Persistent inability to experience positive emotions (e.g., inability to experience
satisfaction or loving feelings).

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).

Avoidance Symptoms
8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the event(s).

9. Efforts to avoid external reminders places, conversations. activities,
   jects, situations) that arouse distressing memories, thoughts, or feelings about or
   Closely associated with the traumatic event(s).

Arousal Symptoms
10. Sleep disturbance (eg., difficulty falling or staying asleep, restless s%),

Il. Irritable behavior and angry outbursts (with little or no typically expressed as verbal or physical toward people or objects

12. Hypervigilance.
13. problems with concentration
14. Exaggerated startle responce.

C _ Duration of (symptoms in Criterion B) is 3 days to I month after
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.

D. The disturbance causes clinically significant distress impairment in social or occupational Or Other important areas of functioning.

E. disturbance is not attributable to the 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.

Question 3

POSTTRAUMATIC STRESS DISORDER (AGES 7 AND UP) pt 1

Answer 3

Posttraumatic Stress Disorder

Note: The following criteria apply to adults, adolescents, and children older than 6 years.
For children 6 years and younger, see corresponding criteria below.
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.
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).
Note: Criterion A4 does not apply to exposure through electronic media, television,
movies, or pictures, unless this exposure is work related.
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).
Note: In children older than 6 years, 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 traumatic event(s).
Note: In children, there may be frightening dreams without recognizable content.
3. Dissociative reactions (e.g., flashbacks) 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 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 re-
semble an aspect of the traumatic event(s).
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).
Avoidance of or efforts to avoid external reminders (people, places, conversations,
activities, objects, situations) that arouse distressing memories, thoughts, or feel-
ings about or closely associated with the traumatic event(s).
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 animportant aspect ofthe traumatic event(s) (typically due to dis-
sociative amnesia and not to other factors such as head injury, alcohol, or drugs).

2. Persisistand and exaggerated negative
   beliefs or expectations about oneself, others,
   or the world (e.g., “I am bad,” “Noone can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
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).

E. Marked alterationsin arousal and reactivity associated with the traumatic event(s), beginning or worseining after the tramatic events occured Evidenced by two or more) of the following:
1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1month.
G. The disturbance causes Clinically significant distress or impairmet in social, ocupational, or other important areas of functioning.
H. The disturnacne is not attributable to the physiological effects of a substance (medication, alcohol) or another medical condition.

Specify whether:
With dissociative symptoms: The individual’s symptoms meet the criteria for post-traumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistant or reccurent 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 (e.g.,
   feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
2. Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant,
   or distorted).

Note: To use this subtype, the dissociative symptoms must not be attributable to the physilogicical effects of a substance
(e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Specify if:
With delayed expression: If the full diagnostic criteria are not met until at least 6 months
after the event (although the onset and expression ofsome symptoms may be immediate).

Question 4

POSTTRAUMATIC STRESS DISORDER (AGE 6) (Diamond-Kid Only) pt 1

Answer 4

Posttraumatic Stress Disorder for Children 6Years andYounger
A. In children 6 years andyounger, 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, inperson, the event(s) as itoccurred to others, especially primary caregivers.
Posttraumatic Stress Disorder
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.

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic events beginning
after the traumatic events ocuured
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
Note: Spontaneous and intrusive memories may not necessarily appear distressing and may be expressed as play reenactment.
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
Note: It may not be possible to ascertain that the frightening content is related to the traumatic event.
3. Dissociative reactions (e.g., flashbacks) in which the child 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.) 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 ofthe traumatic event(s).
5. Marked physiological reactions to reminders of the traumatic event(s).
C. One (or more) of the following symptoms, representing either persistent avoidance of stimuli associated with the traumatic event(s) or negative alterations incognitions and
mood associated with the traumatic event(s), must be present, beginning after the event(s) or worsening after the event(s):
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).

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.
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 expressed as verbal or physical aggression toward people or objects (including extreme temper tantrums).
2. Hypervigilance.
3. Exaggerated startle response.
4. Problems with concentration.
5. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
E. The duration ofthe disturbance is morethan 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 disurbance is not attributable to physiological effects of a substance medication or alcohol) or another medical condition.

Specify whether:
With dissociative symptoms: The individual’s symptoms meet the criteria for post-traumatic stress disorder, and the individual experiences persistent or recurrent symp-
toms of either of the following:
1. Depersonalization: Persistent or recurrent experiences offeeling detached from, and as if one were an outside observer of,one’s mental processes or body (e.g.,
feeling as though onewere in a dream; feeling a sense ofunreality of self or body or of time moving slowly).
2. Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant,
or distorted).

Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts) or another medical condition (e.g., complex partial seizures).

Specify if:
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).

Question 5

ADJUSTMENT DISORDER

Answer 5

Adjustment Disorders
A. The development ofemotional orbehavioral symptoms in response to an identifiable stressor(s) occurring within 3 months ofthe onset of the stressor(s).

B. These symptoms orbehaviors are clinically significant, as evidenced by oneorboth 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, orother important areas offunctioning.

C. The stress-related disturbance does not meet thecriteria 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.

Specify whether:
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.

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 ofconduct are predominant.

309.9 (F43.20) Unspecified: For maladaptive reactions thatare not classifiable as one of the specific subtypes of adjustment disorder.