Trauma & Stressor Related Disorders Flashcards
Reactive Attachment Disorder
A: Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifest by both of the following:
1. The child rarely or minimally seeks comfort when distressed
2. The child rarely or minimally responds to comfort when distressed
B: A persistent social & emotional disturbance characterized by at least 2 of the following:
1. Minimal social & emotional responsiveness to others
2. Limited positive affect
3. Episodes of unexplained irritability, sadness or fearfulness that are evident even during nonthreatening interaction w/ adult caregivers
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 & affection met by caregiving adults
2. Repeated changes of primary caregivers that limit opportunities to form stable attachments
3. Rearing in unusual settings that severely limit opportunities to form selective attachments (institutions w/ high child to care giver ratios)
D. The care in Criterion C is presumed to be responsible for the disturbed behaviors in Criteria A (disturbances in Criteria A began after the lack of adequate care in Criteria C)
E. Criteria is not met ASD
F: Disturbance is evident before age of 5
G: The child has a developmental age of at least 9 mos
Specify If: Disorder has been present for more than 12 mos
Specify Current Severity: severe when a child exhibits all sx at high levels
Disinhibited Social Engagement Disorder
A: Pattern of behavior in which a child actively approaches & interacts w/ unfamiliar adults & exhibits at least two of the following:
1. Reduced or absent reticence (unwillingness) in approaching & interacting with unfamiliar adults
2. Overly familiar verbal or physical behaviors
3. Diminished or absent checking back w/ adult caregiver after venturing away, even in unfamiliar settings
4. Willingness to go off w/ an unfamiliar adult w/ minimal or no hesitation
B: The behaviors in Criterion A are not limited to impulsivity but include socially disinhibited behavior
C: The child has experienced a pattern of extremes of insufficient care as evidenced by at least 1 of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation & affection met by caregiving adults
2. Repeated changes of primary caregivers that limit opportunities to form stable attachments
3. Rearing in unusual settings that severely limit opportunities to for selective attachments
D: The care in Criteria C is presumed to be responsible for the disturbed behavior in Criteria A
E: The child has a developmental age of at least 9 mos
Specify If: Persistent- the disorder has been present for more than 12 mos
Specify current severity: Severe when the child exhibits all sx with each sx manifesting at high levels
PTSD (6 years old-adulthood)
A: Exposure to actual or threatened death, serious injury or sexual violence in 1 or more way:
1. Directly experiencing the traumatic event (s)
2. Witnessing, in person, the event (s) as it occurred to others
3. Learning that the traumatic events occurred to a close family member or friends. In cases of actual or threatened death of family or friend that event must have been violent or accidental
4. Experiencing repeated or extreme exposure to aversive details of the traumatic events (first responders). DOES NOT apply to exposure through media, tv, movies or pictures unless work related
B: Presence of 1 or more of the following instruisve sx
PTSD (6 years old-adulthood) Criteria A
A: Exposure to actual or threatened death, serious injury or sexual violence in 1 or more way:
1. Directly experiencing the traumatic event (s)
2. Witnessing, in person, the event (s) as it occurred to others
3. Learning that the traumatic events occurred to a close family member or friends. In cases of actual or threatened death of family or friend that event must have been violent or accidental
4. Experiencing repeated or extreme exposure to aversive details of the traumatic events (first responders). DOES NOT apply to exposure through media, tv, movies or pictures unless work related
PTSD (6 years old-adulthood) Criteria B & C
B. Presence of 1 or more of the following intrusion sx associated with the traumatic events:
1. Recurrent, involuntary and intrusive distressing memories of the traumatic events
Note: In children older than 6 yrs old, repetitive play may occur in which themes or aspects of the event are expressed
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic events
Note: In children, there may be frightening dreams w/o recognizable content
3. Dissociative reactions (flashbacks) in which the individual feels or acts as if the events were recurring.
Note: In children, trauma-specific reenactment may occur in play
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the events
5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the events
C. Persistent avoidance of stimuli associated w/ the traumatic events, as evidenced by one or both of the following:
1. Avoidance of or efforts to avoid distressing memories, thoughts or feelings about or closely associated w/ the events
2. Avoidance of or efforts to avoid external reminders (people, places, conversations, etc) that arouse distressing memories, thoughts or feelings about or closely associated w/ traumatic events
PTSD (6 years old-adulthood) Criteria D & E
D. Negative alterations in cognitions & mood associated w/ the events beginning or worsening after the events as evidenced by 2 or more of the following:
1. Inability to remember an important aspect of the events
2. Persistent & exaggerated negative beliefs or expectations about oneself, others or the world (“I AM BAD, No one can be trusted, etc)
3. Persistent, distorted cognitions about the cause or consequences of the events that lead the individual to blame themselves or others
4. Persistent negative emotional state
5. Markedly diminished interest or participation in significant activities
6. Feelings of detached or estrangement of others
7. Persistent inability to experience positive emotions
E. Marked alterations in arousal & reactivity associated w/ the event beginning or worsening after the events, evident by 2 or more of the following:
1. Irritable behavior & angry outbursts (w/ little or no provocation) typically expressed as verbal or physical aggression toward people or objects
2. Reckless or self-destructive behavior
3. Hypervigilance
4.Exaggerated startle response
5. Problems w/ concentration
6. Sleep disturbance
PTSD (6 years old-adulthood) Criteria F-H
F. Duration of the disturbance (Criteria B-E) is more than 1 month
G. The disturbance causes clinically significant distress or impairment
H. The disturbance is not attributable to effects of a substance or another medical condition
PTSD: Specify If
With dissociative sx:
Depersonalization- persistent or recurrent experiences of feeling detached, as if one were an outside observer
Derealization-persistent or recurrent experiences of unreality of surroundings
With delayed expression: if full dx criteria isn’t met at least 6 mos after the event
PTSD (for children 6 years or younger) Criteria A & B
Specifiers are the same
A. In children 6 & younger, exposure to actual or threatened death, serious injury, or sexual violence in 1 or more of the following ways:
1. Directly experiencing the traumatic event
2. Witnessing, in person, the events as it occurred to others, especially primary caregivers
Note: Witnessing does not include events that are witnessed only in electronic media, tv, movies or pictures
3. Learning that the traumatic events occurred to a parent or caregiving figure
B. Presence of 1 or more of the following intrusion sx associated w/ the event:
1. Recurrent, involuntary & intrusive distressing memories of the events
Note: Spontaneous & intrusive memories may not necessarily appear distressing & may be expressed as play reenactment
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the events
Note: It may not be possible to ascertain that the frightening content is related to the event
3. Dissociative reactions (flashbacks) in which the child feels or acts as if the events were recurring . Trauma specific reenactment may occur in play
4, Intense of prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the event
5. Marked physiological reactions to reminders of the event
C. One or more of the following sx, representing either persistent avoidance of stimuli or negative alterations in cognitions & mood must be present:
Persistent Avoidance of Stimuli:
1. Avoidance of or efforts to avoid activities, places or physical reminders that arouse recollections of the events
2. Avoidance of or efforts to avoid people, conversations or interpersonal situations that arouse recollections of the events
Negative Alterations in Cognitions:
3. Increased frequency of negative emotional states
4. Markedly diminished interest or participation in significant activities, including constriction of play
5. Socially withdrawn behavior
6. Persistent reduction in expression of positive emotions
PTSD (for children 6 years or younger) Criteria D-G
D. Alterations in arousal & reactivity:
1. Irritable behavior & angry outbursts
2. Hypervigilance
3. Exaggerated startle response
4. Problems w/ concentration
5. Sleep disturbance
E. The durations is at least 1 month
F. Disturbance causes significant distress
G. The disturbance is not due to effects of a substance or medical condition`
Acute Stress Disorder Criteria A
A. Exposure to actual or threatened death, serious injury or sexual violation in 1 or more of the following ways:
1. Directly experiencing traumatic events
2. Witnessing, in person, the event as it occurred to others
3. Learning that the events occurred to a close family member or friend
Note: In the case of death of a family member or friend thar event must be violent or accidental
4. Experiencing repeated or extreme exposure to aversive details of the events
Note: does not apply to to electronics
Acute Stress Disorder Criteria B
B. Presence of 9 or more of the following sx from any of the five categories of 1) Intrusion 2) Negative Mood 3)Dissociation 4) Avoidance 5) Arousal:
Intrusion Sx:
1. Recurrent, involuntary & intrusive distressing memories of the events. Note: In children repetitive play may occur in which themes or aspects of the events are expressed
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the events . Note: In children, there may be frightening dreams w/o recognizable content
3. Dissociative reactions in which the individual feels or acts as if the events were recurring. Note: In children, trauma specific reenactment may occur in play
4. Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the event
Negative Mood:
5. Persistent inability to experience positive emotions
Dissociative Sx:
6. An altered sense of the reality of one’s surroundings or oneself
7. Inability to remember an important aspect of the event
Avoidance Sx:
8. Efforts to avoid distressing memories, thoughts or feelings about or related to the event
9. Efforts to avoid external reminders that arouse distressing memories, thoughts or feelings
Arousal Sx:
10. Sleep disturbance
11. Irritable behavior & angry outbursts
12. Hypervigilance
13. Problems w/ concentration
14. Exaggerated startle response
Acute Stress Disorder Criteria C-E
C. Duration of the disturbance is 3 days -1 month after trauma exposure. Note: Sx typically begin immediately after the trauma, but persistence for at least 3 days & up to a month is needed to meet disorder criteria
D. The disturbance cause significant distress or impairment
E. The disturbance is not due to physiological effects of a substance or another medical condition
Adjustment Disorder
A: The development of emotional or behavioral sx in response to an identifiable stressors occurring within 3 mos of the onset of the stressors
B. These sx or behaviors are clinically significant, evident by 1 or more of the following:
1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context & cultural factors that might influence sx severity & presentation
2. Significant impairment in important areas of functioning
C: The stress-related disturbance does not meet criteria for another mental disorder & isn’t an exacerbation of a pre-existing mental disorder
D: Sx do not represent normal bereavement
E: Once the stressor or its consequences have terminated, the sx do not persist for more than an additional 6 mos
Adjustment Disorder: Specify Whether
With depressed mood
With anxiety
With mixed anxiety & depressed mood
With disturbance of conduct
With mixed disturbance of emotions & conduct
Unspecified
