Trauma and Stressor Related Disorders

Question 1

Reactive Attachment Disorder

Answer 1

A. Consistent patter of inhibited, emotionally withdrawn behavior toward adult caregiver, manifested by both:

• child rarely or minimally seeks comfort when distressed
• child “” responds to comfort when distressed

B. A persistant social and emotional disturbance characterized by at least two

1. minimal social and emotional responsiveness
2. limited postive affect
3. episodes of unexplained irritability, sadness or fearfulness that are evident even during nonthreatening interactions with adult caregivers.

C. The child has experienced a pattern of extremes of insufficient care as evidence 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
3. rearing in usual settings that severely limit opportunites to form selective attachments

D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A.

E. Criteria for autsim spectrum disorder not met

F. The disturbance is evident before the age of 5 years.

G. The child has developmnental age of at least 9 months

Question 2

Reactive Attachment Disorder Specifers:

Answer 2

Specify If:

• Persistent: present for 12+ months
• Current severity: a case is severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels

Question 3

Disinhibited Social Engagement Disorder

Answer 3

A. A pattern of behavior in which a child actively approaches an dinteracts with unfamiliar adults and exhibits at least two:

1. Reduced or absent reticence (not revealing one’s thoughts or feelings) in approaching and interacting with unfamiliar adults
2. overly familar verbal or physical beahavior (that is not consistent with culturally or age appropriate boundaries)
3. Diminished or absent checking back with adult caregiver after vetnuring away, even in unfamiliar settings
4. Willingness to go off with an unfamiliar adult with minimal or hesitation

B. Crieterion A behaviors are not limtted to impulsivity (or ADHD) but includ social disinihited behavior

C. Child has experienced a pattern of extremes of insufficent care as evidenced by at least oneof 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
3. rearing in usual settings that severely limit opportunites to form selective attachments

D. Criterion C is presumed to be responsible for the disturbed behavior in Criterion A began following the pathogenic care in Criterion C

E. The child has a developmental age of at least 9 months

Question 4

Disinhitibed Social Engagement Disorder Specifers:

Answer 4

• Persistent: present for 12+ months
• Current severity: a case is severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels

Question 5

Posttraumatic Stress Disorder

Answer 5

• apply to adults, adolescents, and children older than 6 years.

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) ways:

1. Directly experiencing the traumatic events
2. Witnessing, in person, the events as i occurred to others.
3. Learning that the traumatic events occured to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the events must have been violent or accidental.
4. Experiencing repeated ore extreme exposure to aversive details of the traumatic events

B. Presence of one (or more) of the following intrusion symptoms associated with traumatic events, beginning after the traumatic events occurred

1. Recurrent, involuntary, and intrusive distressing memories of the traumatic events
2. Recurrent distressing dreams in which the content and or affect of the dream are related to traumatic event
3. Dissociative actions (flashblacks) in which the individual feels or acts as if the traumatic events were recurring.
4. Intense or prolonged psychological distress at exposure to internal or external cues that sympolize ore resemble an aspect of the traumatic events
5. marked physiological reactions to internal or external cues that symobolize or resemeble an spect of the traumatic event

C. Persistent avoidance of stilmuli associated with the traumatic event, beginning after the traumatic event occured as evidenced by one or both of the following:

1. Avoidance of or effors to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events.
2. Avoidance of or efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic events.

D. Negative alterations in cognitions and mood associated with the traumatic events, beginning or worsening after the traumatic events occurred, as evidenced by two or more of the following:

1. Inability to remember an important aspect of the traumatic events (due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs)
2. Persistent and exaggerated negative beliefs or expectations about oneself, others or the world
3. Persistent, distorted cognitions about the cause or consequences of the traumatic events that lead the indivudal to blame himself or others
4. Persistent negavitve emotional state
5. Markedly diminished interest or parcipation in significant activities
6. Feelings of detachment or estrangement from others
7. Persistent inablilty to experience positive emotions

E. Marked alterations in arousal and reactivity with the traumatic events beginning or worsening after the traumatic events occurred, as evidenced by two or more of the following:

1. Irritable behavior and angry outbursts typically expressed as verbal or physical aggression toward people or objects
2. Reckless or self-destructive behavior
3. Hyper-vigilance
4. Exaggerated startle response
5. Problems with concentration
6. Sleep disturbance

F. Duration of the disturbance is more than 1 month
G. The disturbance causes clinically significant distress or impairment in social occupational or other important areas of functioning
H. the disturbance is not attributable to the physiological effects of a substance or another medical conditions

Question 6

PSTD specifers

Answer 6

With dissociative symptoms: the individual’s symptoms meet the critera for pstd and in in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:

1. depersonalizatioin: persistent or recureent experiences of feeling detached from and as if one were an outside observer of one’s mental processes or body
2. Derealization: persistent or recurrent experiences of unreality of surroundings (the world around the individual is experienced as unreal like, dreamlike, distant and distorted)
   * This subtype, the dissociative symptoms must not be attributable to the physiological effects of a or other medical condition

With delay expression: full criteria not met until at least 6 months after the event

Question 7

PTSD in children younger than 6

Answer 7

Children 6 yeas or younger, exposure to actual or threatened death, serious injury or sexual violence in 1 ore more of the following ways:

1. directly experiecning the traumatic events
2. witnessing, in person, the events as it occurred to others, especially primary care givers
3. Learning that the trauma occcurent to parent or caregiver

B. Presence of one or more of the following intrusion symptoms associated with the traumatic events, beginning after the traumatic evens occured:

1. recurrent, involuntary and intrusive distressing memories
   - spontaneous and intrusive memories may not necessarily appear distressing
2. Recurrent distressing dreams in which the content and or affect of the dream are related to the traumatic event
   - it may not be possible to ascertain that the frightening content is related of the traumatic event
3. Dissociative reactions in which the child feels or acts as if the traumatic events were recurring
4. Intense prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an respect of the traumatic evens

C. One or more present beginning after the event, or worsening after event
Persisstent Avoidance of Stimuli
1. Avoidance of or efforts to avoid activities, places, or physical reminders that arouse recollections of the traumatic events
2. avoidance of or efforts to avoid people, conversations or interpersonal situations that arouse recollections of trauamtic events

Negative alterations in cognitions

3. substantially increased frequency of negative emotional states
4. markedly diminished interest or participation in significant activities
5. Socially withdrawn behavior
6. Persistent reduction in expression of positive emotions

D. Alterations in arousal and reactivity with the traumatic events beginning or worsening after the traumatic events occurred, as evidenced by two or more of the following:

1. Irritable behavior and angry outbursts (with little to no provoction)
2. Hyper-vigilance
3. Exaggerated startle response
4. Problems with concentration
5. Sleep disturbance

E. Duration of the disturbance is more than 1 month
F. The disturbance causes clinically significant distress or impairment in social occupational or other important areas of functioning
G. the disturbance is not attributable to the physiological effects of a substance or another medical conditions

Question 8

PTSD for Children specifers:

Answer 8

With dissociative symptoms: the individual’s symptoms meet the critera for pstd and in in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:

1. depersonalizatioin: persistent or recureent experiences of feeling detached from and as if one were an outside observer of one’s mental processes or body
2. Derealization: persistent or recurrent experiences of unreality of surroundings (the world around the individual is experienced as unreal like, dreamlike, distant and distorted)
   * This subtype, the dissociative symptoms must not be attributable to the physiological effects of a or other medical condition

With delay expression: full criteria not met until at least 6 months after the event

Question 9

Acute Stress Disorder

Answer 9

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) ways:

1. Directly experiencing the traumatic events
2. Witnessing, in person, the events as i occurred to others.
3. Learning that the traumatic events occured to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the events must have been violent or accidental.
4. Experiencing repeated ore extreme exposure to aversive details of the traumatic events

B. Presence of 9 (or more) of any of the five categories:
Intrusion, negative mood, dissociation, avoidance and arousal, beginning or worsening after traumautic event
Intrusive Symptoms
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic events
2. Recurrent distressing dreams in which the content and or affect of the dream are related to traumatic event
3. Dissociative reactions (flashblacks) in which the individual feels or acts as if the traumatic events were recurring.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize ore resemble an aspect of the traumatic events

Negative Moods
5. Persistent inability to experience positive emotions

Dissociative Symptoms

6. An altered sense of the reality of one’s surroundings or oneself from another’s perspective, being in a daze, time slowing
7. inablity to remember an important aspect of the traumatic event

Avoidance Symptoms

8. Efforts to avoid distressing memories, thoughts or feelings about or closely associated with traumatic events
9. Efforts to avoid external reminders that arouse distressing memories, thoughts or feelings about or closely associated with the traumatic event

Arousal Symptoms

10. Irritable behavior and angry outbursts typically expressed as verbal or physical aggression toward people or objects
11. Hyper-vigilance
12. Exaggerated startle response
13. Problems with concentration
14. Sleep disturbance

C. Duration of the disturbance is 3 days to 1 month after trauma exposure
*symptoms show up immediately but must last for 3 days - 1 month to meet criteria

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

E. the disturbance is not attributable to the physiological effects of a substance or another medical conditions

Question 10

Adjustment Disorders

Answer 10

A. Development of emotional or behaviroal symptoms in response to an identifiable stressor occuringn with 3 months of the onset of stressors
B. Symptoms are clincally signficant 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 contect and the cultural factors that might influence symptom severity and presentation
2. Signicant impairment in functioning

C. stress related disturbance does not meet criteria for another mental disorder

D. Symptoms do not represent normal bereavement

E. Once stress has terminated, symptoms do not persist for 6 months

Question 11

Adjustment Disorder Specifers

Answer 11

1. with depressed mood :low mood, tearfulness, or feelings of hopelessness are predominant
   2.With anxiety: nervousness, worry, seperation anxiety
   3.with mixed anxiety and dpressed mood: a combination of depression and anxiety
2. with disturbance of conduct:
   with mixed dusturbance of emtion and conduct: both 5.emotional symtpoms and disturbance of conduct
   unspecified