Trauma- and Stressor-Related Disorders

Question 1

Acute Stress Disorder

Answer 1

DSM-5

1. Stressor criterion: explicit as to whether qualifying traumatic events were experienced directly, witnessed, or experienced indirectly.
2. Subjective reaction to the traumatic event (fear, hopelessness, or horror) has been removed.
3. Previous DSM IV: acute posttraumatic reactions are very heterogeneous and emphasis on dissociative symptoms has been too restrictive.
4. meet criteria: 9 of 14 listed symptoms in categories: intrusion, negative mood, dissociation, avoidance, and arousal.
5. The disturbance in an acute stress disorder must last for a minimum of 3 days and a maximum of 4 weeks, and must occur within 4 weeks of the traumatic event.
6. dissociative symptoms (numbing, emotional detachment, derealization, dissociative amnesia)
7. persistent reexperiencing of the trauma
8. marked avoidance of stiumuli that cause recollection of the trauma
9. marked anxiety or increased arousal.

Question 2

Adjustment Disorders

Answer 2

DSM-5

• reconceptualized as a heterogeneous array of stress-response syndromes that occur after exposure to a distressing (traumatic or nontraumatic) event,
• rather than as a residual category for individual who exhibit clinically significant distress w/o meeting criteria for a more discrete disorder.
• Subtypes marked by depressed mood, anxious symptoms, or distrubances in conduct are the same.
• onset of symptoms must be w/in 3 months of the stressor
• evidence of impairment in social, occupational or academic functioning and/or distress that is in excess of what would be expected given the nature of the stressor.
• symptoms usually remit w/in 6 months after termination of the stressor, but may be longer if the stressor is chronic or has enduring consequences.

1. Adjustment disorders are reconceptualized in the DSM-5 as a stress-response syndrome. This takes them out of their residual, catch-all category and places them into a conceptual framework that these disorders represent a simple response to some type of life stress (whether traumatic or not).

Question 3

Posttraumatic Stress Disorder

Answer 3

DSM 5

Stressor criterion (A):

1. more explicit with regard to how an individual expereinced ‘traumatic’ events

Subjective Reaction Criteria (A2): removed

Now 4 symptom clusters w/Avoidance/Numbing is divided into two distinct clusters

1. avoidance and persistent negative alterations in cognitions and mood
2. Mood: persistent negative emotional states
3. Arousal/Reactivity: irritable or aggressive behavior and reckless or self-destructive behavior
4. diagnostic thresholds have been lowered for children and adolescents
5. separate criteria for children age 6 years or younger w/the disorder.

Re-experiencing the event — For example, spontaneous memories of the traumatic event, recurrent dreams related to it, flashbacks or other intense or prolonged psychological distress.

Heightened arousal — For example, aggressive, reckless or self-destructive behavior, sleep disturbances, hyper-
vigilance or related problems.

Avoidance — For example, distressing memories, thoughts, feelings or external reminders of the event.

Negative thoughts and mood or feelings — For example, feelings may vary from a persistent and distorted sense of
blame of self or others, to estrangement from others or markedly diminished interest in activities, to an inability to remember key aspects of the event.

PTSD Preschool Subtype

DSM-5 will include the addition of two new subtypes. The first is called PTSD Preschool Subtype, which is used to diagnose PTSD in children younger than 6 years. Post-traumatic stress disorder is also now developmentally sensitive, meaning that diagnostic thresholds have been lowered for children and adolescents.

PTSD Dissociative Subtype

The second new PTSD subtype is called PTSD Dissociative Subtype. It is chosen when PTSD is seen with prominent dissociative symptoms. These dissociative symptoms can be either experiences of feeling detached from one’s own mind or body, or experiences in which the world seems unreal, dreamlike or distorted.

Question 4

PTSD cont…

Answer 4

1. Acute (duration of symptoms less than 3 months)
2. Chronic (duration of symptoms 3 or more months)
3. Delayed Onset (symptoms is at least 6 months after the stressor).

Treatment

1. comprehensive CBT approach that incorporates exposure, cognitive restructuring, anxiety management.
2. SSRI may be helpful
3. single-session psychological debriefing (PD) has been criticized: not useful and may exacerbate symptoms
4. EMDR: benefits due to exposure and other nonspecific factors rather than to eye movements.
5. prognosis for PTSD is usually worse when symptoms have a delayed onset.

Question 5

Reactive Attachment Disorder

Answer 5

DSM-5

markedly distrubed and developmentally inappropriate social relatedness in most settings that begins prior to age 5.

subtypes are now distinct disorders

1. Reactive Attachment Disorder
   
   1. dampened positive affect
   2. closely resembles internalizing dx
   3. it is equivalent to a lack of or incompletely formed preferred attachments to caregiving adults.
2. Disinhibited Social Engagement Disorder
   
   1. resembles ADHD,
   2. may occur in children who do not necessarily lack attachments and may have established or even secure attachemnts.
3. both are the result of social neglect or other situations that limit a young child’s opportunity to form selective attachments.