DSM V:

Posttraumatic Stress Disorder

• Exposure to actual or threatened death, serious injury, or sexual violence through:
• direct experience of the trauma,
• witnessing in person the event,
• learning that a traumatic event occurred to a close family member or friend, and/or
• experiencing repeated or extreme exposure to aversive details of the event
• For weeks or months, clients:
• Experience intrusion symptoms including:
• recurrent, involuntary distressing memories,
• recurrent distressing dreams,
• dissociative reactions (flashbacks) of the event,
• intense of prolonged psychological distress at exposure to cues, and/or
• marked physiological reactions to internal or external

cues

PTSD Cont.

• Duration of disturbance is more than 1 month and causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
• Not attributable to the physiological effects of a substance or other medical condition

Specify if…

with delayed expression- symptoms sufficient for diagnosis didn't accumulate until at least 6 months after the event

with dissociative symptoms:

depersonalization- indicates feelings of detachment from patient's own mind or body

derealization- to the patient, the surroundings seem distant, distorted, dreamlike, or unreal

PTSD Cont.

• Take steps to avoid the stimuli associated with the event including:
• avoidance of memories, thoughts, or feelings about or associated with the traumatic event, and/or
• avoidance of external reminders that arouse distressing memories, thoughts, or feelings about or associated with the event
• Develop 2 or more negative alterations in cognition and mood including:
• inability to remember an important aspect of the event,
• persistent and exaggerated negative beliefs or expectations about oneself, others, or the world,
• loss of interest in important activities,
• feeling detached from others, and/or
• become numb and feel unable to love or experience joy
• Experience symptoms of hyperarousal:
• irritability
• hypervigilance
• trouble concentrating
• sleep disturbance
• reckless or self-destructive behavior

Disinhibited Social Engagement Disorder

Acute Stress Disorder

• Child is unreserved in interactions with unfamiliar adults due

to poor child care

• Shown through at least 2 of the following:
• Reduced or absent shyness with unfamiliar adults
• Overly familiar verbal or physical behavior
• Willingness to go off with minimal or no hesitation
• Diminished or absent checking back with caregiver
• Demographics- Child has to have developmental age of at least 9 months
• Differential Diagnosis- does not meet criteria for autism, intellectual disability, ADHD

Specify if:

Persistent- present for more than 12 months, Sever- child exhibits all symptoms of the disorder on relatively high levels

• Criteria embodies the same elements required for PTSD, but the number and duration of symptoms are different
• Must have nine or more of symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal
• Duration is 3 days to 1 month after trauma exposure
• Also causes clinically significant distress and is not attributable to the physiological effects of a substance or medical condition and is not better explained by brief psychotic disorder

Overview

• Reactive Attachment Disorder
• Disinhibited Social Engagement Disorder
• Posttraumatic Stress Disorder
• Acute Stress Disorder
• Attachment Disorders
• Other and Unspecified Trauma- and Stressor-Related Disorders

PTSD, Child PTSD, & ASD

Reactive Attachment Disorder

DSM V:

Trauma- and Stressor-Related Disorders

• Child shows patterns of inhibited, emotionally withdrawn behavior toward adult caregivers and rarely seeks comfort or responds to comfort when distressed
• Due to poor child care (abuse, neglect, insufficient caregiving, or caregiving changed too frequently)
• Children will habitually show little emotional or social response and may experience periods of unprovoked irritability or sadness
• Demographics- The disturbance is evident before the age of 5, has developmental age of at least 9 months,
• Differential Diagnosis- the criteria is not met for autism, depressive disorders, intellectual disability

Drew Lomax

Practicum

Howard University

Specify if:

Persistent: The disorder has been present for more than 12 months.

Severe: when a child exhibits all symptoms of the disorder at relatively high levels.

Adjustment Disorders

Thank you!

Matching Game!

• The development of emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor
• Marked by distress that is out of proportion to the intensity of the stressor and/or significant impairment in social, occupational, or other important areas of functioning
• Does not meet the criteria for another disorder and does not represent normal bereavement
• The symptoms do not last more than 6 months past the termination of the stressor

Julia, an exceptionally radiant child, was adopted by the Jones, a loving couple. However, the mother begins to notice that Julia does not cling to her, look her in the eye, or tolerate being held. She doesn't reach for her mother's hand, let her mother read to her or play with her mother. The mother describes her as "kind of manic" and restless when restrained in a crib or stroller. Julia never relaxes into a tender embrace and is always controlling and difficult.

• RAD
• Disinhibited Social Engagement Disorder
• PTSD
• Adjustment Disorder

Specify if:

Acute- lasted less than 6 months, or

Persistent (or chronic)- more than 6 months of symptoms, but not more than 6 months after end of stressor

Other Specified Trauma- and Stressor-Related Disorder

Unspecified Trauma- and Stressor-Related Disorder

Specify whether:

309.0 (F43.21) With depressed mood: Low mood, tearfulness, or feelings of hope­lessness are predominant.

309.24 (F43.22) With anxiety: Nervousness, worry, jitteriness, or separation anxiety is predominant.

309.28 (F43.23) With mixed anxiety and depressed mood: A combination of de­pression and anxiety is predominant.

309.3(F43.24)With disturbance of conduct: Disturbance of conduct is predominant.

309.4 (F43.25) With mixed disturbance of emotions and conduct: Both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant.

309.9 (F43.20) Unspecified: For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.

· Also does not meet the full criteria but is used when the clinician chooses not to specify the reason that the criteria is not met and there is insufficient information to make a more specific diagnosis

· Symptom characteristics cause clinically significant distress or impairment in social, occupational, or other important areas of functioning but do not meet the full criteria for any of the trauma and stressor-related disorders

· Used when the clinician chooses to communicate the specific reason that the presentation does not meet the criteria