Trauma or Stressor DSM-5-TR

Question 1

What are the diagnostic criteria for ASD?
Acute stress disorder

Answer 1

Symptoms from traumatic situations must have a negative impact on clients’ functioning/ROSE

9 or more symptoms from the following 5 categories must be present.

Arousal
Avoidance
Dissociative
Intrusion
Negative mood

Duration: Diagnosed after day 3 lasts 1 day put to 1 month

Longer than 1 month –> likely PTSD

Question 2

Name the Arousal Symptoms in ASD/PTSD

Answer 2

Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep).

Irritable behaviour and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.

Hypervigilance.

Problems with concentration.

Exaggerated startle response.

Question 3

Name Dissociative Symptoms in ASD/PTSD

Answer 3

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).

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).

Question 4

What are the intrusion symptoms in ASD/PTSD?

Answer 4

Intrusion Symptoms

Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).

Recurrent distressing dreams in which the content and/or effect of the dream are related to the event(s).

Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.

Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

Question 5

What assessment tools are used for Acute Stress Disorder?

Answer 5

Acute Stress Disorder interview

Brief trauma questionnaire

IES-R Impact of event scale - (PTSD)

TSI-2 Trauma symptom Inventory (PTSD)

Question 6

What are the most common treatments for ASD?

Answer 6

CBT

Anxiety management

Supportive counseling

Exposure therapy

Question 7

What are the differentials for ASD?

Answer 7

Adjustment disorder

Dissociative disorder

Neurocognitive disorder

Psychotic disorder

PTSD

Question 8

What are the differences between Adjustment disorder and ASD?

Answer 8

ASD is typically more severe in relation to a traumatic event. The intrusive symptoms in ASD are more debilitating. Events in adjustment disorder are NOT life-threatening whereas in ASD they ARE.

With Adjustment disorder, symptoms can appear anytime within 3 months. After the stressor is gone, symptoms should reside in 6 months.

Question 9

Dx of Adjustment Disorder

Answer 9

After an event, the patient/client exhibits more distress than usual. Marked emotional and behavioral changes within 3 months of onset.

Extreme distress, depressed mood, anxiety

Results in problems in functioning ROSE

NOT due to grieving, medical, or other diagnosis

Once stressor is over, symptoms should not last longer than 6 months

Question 10

What are the subtypes of Adjustment Disorder?

Answer 10

With depressed mood

With anxiety

With mixed anxiety and depressed mood

With disturbance of conduct

With mixed disturbance of emotions and conduct

Unspecified.

Question 11

Assessments for Adjustment disorder?

Answer 11

SCID-5 - structured clinical interview for DSM-5

ADS - adjustment disorder scales

IES-R Impact of event scale revised

ADNM Adjustment disorder new module

MMPI-2

Question 12

Treatments for AD?

Answer 12

CBT

Narrative Therapy

Interpersonal social rythm

Question 13

Differentials for Adjustment Disorder?

Answer 13

Major Depressive Disorder

PTSD

Personality Disorder

Other medical condition

Normative stress reactions

(The biggest indicator in differentials is severity and time, if symptoms last longer 6months w/o stressor, it is likely something else)

Question 14

There has been a traumatic event in client’s life.
No intrusive symptoms
No avoidant behavior
No negative symptoms or exaggerated reactions

But they are withdrawn. They did suffer neglect in the past (especially at a young age)

What could be a diagnosis?

Answer 14

Reactive attachment disorder
(if withdrawn)

OR

if the client has overly loose boundaries

Disinhibited social engagement disorder

Question 15

If there has been trauma but no sings of ASD or PTSD. But there are psychotic symptoms lasting less than a month?

Answer 15

Brief psychotic disorder

Question 16

What can happen in trauma is the forgetting of important or personal information. If no other symptoms or mood disturbances are present what might this be in accordance with Dx?

Answer 16

Dissociative amnesia.

Question 17

Differential for PTSD?

Answer 17

Acute stress disorder (Time)

Adjustment disorder (Time + Severity)

Anxiety disorders (not associated with traumatic events)

Major depressive disorder (does not include avoidance or intrusive symptoms of PTSD)

OCD

Personality disorders (will be relevant irrespective of trauma)

Psychotic disorders