Trauma- and Stressor-Related Disorders p. 265

Question 1

What is the explicit Dx criterion for Trauma-and stressor-related disorders?

Answer 1

Trauma- and Stressor-Related disorders have the explicit Dx criterion of exposure to a traumatic or stressful event.

Question 2

What are the disorders of the Trauma- and Stressor-Related category?

Answer 2

Disorders under the Trauma- and Stressor-Related categories include:

1. Reactive Attachment Disorder
2. Disinhibited Social Engagement Disorder
3. Posttraumatic Stress Disorder (PTSD)
4. Acute Stress Disorder
5. Adjustment Disorders
6. Other Specified Trauma- and Stressor-Related Disorder
7. Unspecified Trauma- and Stressor-Related Disorder

Question 3

What are the common symptoms of Trauma- and Stressor-Related Disorders?

Answer 3

Common symptoms of Trauma- and Stressor-Related Disorders may include:

1. Psychological Distress that is Anxiety or Fear based
2. Anhedonic (lack of joy or excitement from an activity that would normally elicit such feeling) and dysphoric (a state of unease, anxiety, and misery) symptoms.
3. Externalized anger and aggressiveness
4. Dissociative symptoms

Question 4

Give Criterion A & B for Reactive Attachment Disorder

Answer 4

Criterion A & B for Reactive Attachment Disorder:
A. A consistent pattern of inhibited, emotionally w/drawn behavior toward adult caregivers, manifested by: The child rarely or minimally (1) seeks or (2) responds to comfort when distressed.
B. 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 5

Give Criterion C for Reactive Attachment Disorder

Answer 5

Criterion C for Reactive Attachment Disorder:
C. The 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 (eg: foster care)
3. Rearing in unusual settings that severely limited opportunities to form selective attachments (institutions w/high child-caregiver ratios)

Question 6

Give Criterion D thru G & Specifiers for Reactive Attachment Disorder:

Answer 6

Criterion D thru G for Reactive Attachment Disorder & Specifiers:
D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A.
E. The criteria are not met for autism spectrum disorder
F. The disturbance is evident before age 5 years
G. The child has a developmental age of at least 9 months.
Specify if: Persistent: The disorder has been present for more than 12 months
Specify current severity: Reactive attachment disorder is specified as SEVERE when a child exhibits all symptoms of the disorder, w/each symptom manifesting at relatively high levels.

Question 7

Age of Onset of Reactive Attachment Disorder and Symptoms

Answer 7

Age of onset for Reactive Attachment Disorder:
A Dx should not be made in children who are developmentally unable to form selective attachments. For this reason, the child must have a developmental age of 9 months.
Symptoms include:
1. Markedly disturbed and developmentally inappropriate attachment Bxs
2. Child rarely or minimally turns preferentially to an attachment figure for comfort, support, protection, and nurturance.
3. The essential feature is absent or grossly underdeveloped attachment between the child and caregiving adults.
4. Do not repsond more than minimally to comforting efforts of caregivers.
5. Show diminished or absent expression of positive emotions
6. Emotion regulation capacity is compromised and they display episodes of negative emotions of fear, sadness, or irritability

Question 8

Causes of Reactive Attachment Disorder

Answer 8

Causes of Reactive Attachment Disorder:
Serious social neglect is the only known risk factor for this disorder. Significantly impairs young children’s abilities to relate interpersonally to adults or peers and is associated w/functional impairment across many domains of early childhood.

Question 9

Differential Dx of Reactive Attachment Disorder

Answer 9

Differential Dx of Reactive Attachment Disorder:

1. Autism Spectrum Disorder
2. Intellectual disability (intellectual developmental disorder)