Trauma & Stressor Related Disorders

Question 1

Reactive Attachment Disorder

Answer 1

Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by:

• rarely or minimally seeking comfort when distressed
• rarely or minimally responds to comfort when distressed

Persistent social and emotional disturbance characterized by at least two of the following:

• minimal social and emotional responsiveness to others
• limited positive affect
• episodes of unexplainable irritability, sadness, or fearfulness evident even during non threatening interactions with adult caregivers

Experienced patterns of extreme insufficient care as evidenced by at least one of the following:

• social neglect and deprivation in the form of persistent lack of basic emotional needs for comfort, stimulation, and affection met by caregivers
• repeated changes of primary caregivers that limit opportunities to form stable attachments
• rearing in unusual settings that severely limit opportunities to form selective attachments

Onset of disturbance evident before 5 years old (but development of at least 9 months)

Question 2

Disinhibited Social Engagement Disorder

Answer 2

Pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least 2 of the following:

• reduced or absent reservation in approaching and interacting with unfamiliar adult
• overly familiar verbal or physical behavior
• diminished or absent “checking back” with caregiver after venturing away in unfamiliar settings
• willingness to go off with unfamiliar adult with minimal or no hesitation

Socially disinhibited behavior should be considered in line with impulsivity if identified

Experience of pattern of extreme insufficient care

Must have developmental age of at least 9 months

Question 3

Posttraumatic Stress Disorder

[6 years and older]

Answer 3

Exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways:

• directly experiencing traumatic event(s)
• witnessing, in person, event as it occurred to others
• learning that a traumatic event occurred to a close family or friend
• experiencing repeated or extreme exposure to aversive details of traumatic events

Presence of one or more of the following intrusion symptoms:

• recurrent, involuntary, and intrusive distressing memories
• recurrent distressing dreams
• dissociative reactions (i.e. flashbacks)
• intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble aspects of trauma
• marked physiological reactions

Persistent avoidance of stimuli associated with trauma evidenced by one or both of the following:

• avoidance of or efforts to avoid distressing memories, thoughts, or feelings
• avoidance of or efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings

Negative alterations in cognitions and mood evidenced by:

• inability to remember an important aspect of the traumatic event (ex. Dissociative amnesia)
• persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
• persistent, distorted cognitions about the cause or consequences of trauma that leads to blame of self or others
• persistent negative emotional state
• diminished interest in significant activities
• feelings of detachment or estrangement from others
• persistent inability to experience positive emotions

Alterations in arousal and reactivity:

• irritable behavior and angry outbursts
• reckless or self-destructive behavior
• hypervigilance
• exaggerated startled response
• problems with concentration
• sleep disturbances

Duration is more than one month

Question 4

Acute Stress Disorder

Answer 4

Development of PTSD characterized symptoms lasting from 3 days to 1 month

Question 5

Adjustment Disorder

Answer 5

Development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of stressor

• marked distress that is out of proportion to the severity or intensity of the stressor
• significant impairment to functioning

Symptoms do not represent normal bereavement

Symptoms do not persist for more than 6 months AFTER termination of stressor and consequences