Trauma and Stressor Related Disorders

 

Learn more about the symptoms of Posttramatic Stress Disorder (PTSD), Acute Stress Disorder, Adjustment Disorder, Reactive Attachment Disorder, and Disinhibited Social Engagement Disorder.  The most common treatments for these disorder are psychotherapy and antidepressants


Posttraumatic Stress Disorder (PTSD)

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

  1. Directly experiencing the traumatic event.
  2. Witnessing, in person, the event as it occurred to others.
  3. Learning that the traumatic event occurred to a close family member or friend.  In cases of actual or threatened death of a family member or friend, the event must have been accidental or violent.
  4. Experiencing repeated or extreme exposure to details of the traumatic event (examples include first responders or police officers repeatedly exposed to details of child abuse). This does not include exposure through media, such as TV, movies or pictures.

B. Presence of one or more of the following intrusion symptoms associated with the traumatic events, beginning after the traumatic event occurred:

  1. Recurrent, involuntary, intrusive, distressing memories of the traumatic event.  (In children older than six years, repetitive play may occur in which themes or aspects of the traumatic event are expressed).
  2. Recurrent, distressing dreams in which the emotions of the dream are related to the traumatic event. (In children, there may be frightening dreams).
  3. Dissociative reactions (such as flashbacks) in which the individual feels or acts as if the traumatic event was recurring. (In children, trauma related 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 traumatic event.
  5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occurred, as evidenced by one or both of the following:

  1. Avoidance of or efforts to avoid distressing memories, feelings or thoughts about the traumatic event.
  2. Avoidance of or efforts to avoid external reminders (people, places, things, situations, conversations, activities) that arouse distressing memories, feelings or thoughts about the traumatic event.

D. Negative alterations in thoughts and mood associated with the traumatic event, beginning or worsening after the traumatic event occurred as evidenced by two or more of the following:

  1. Inability to remember an important aspect of the traumatic events (typically due to dissociative amnesia).
  2. Persistent and exaggerated negative beliefs or expectations about oneself, others or the world. (some examples include: “The world is dangerous,” “No one can be trusted,” and “I am permanently ruined.”).
  3. Persistent, distorted thoughts about the cause or consequences of the traumatic event that lead the individual to blame himself/herself or others.
  4. Persistent negative emotional state (such as anger, guilt, shame, fear, or horror).
  5. Significantly decreased interest or participation in significant activities.
  6. Feelings of estrangement or detachment from others.
  7. Persistent inability to experience positive emotions (such as happiness, satisfaction or loving feelings).

E. Significant alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event, as evidenced by two or more of the following:

  1. Irritable behavior and angry outbursts 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 with concentration.
  6. Difficulty falling or staying asleep or restless sleep.

F.  The disturbance last more than one month.

G. The disturbance causes clinically significant distress or impairment in social, work, or other important areas of functioning.

H.  The disturbance is not caused by another substance or medical condition.

Acute Stress Disorder

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

  1. Directly experiencing the traumatic event.
  2. Witnessing, in person, the event as it occurred to others.
  3. Learning that the traumatic event occurred to a close family member or friend.  In cases of actual or threatened death of a family member or friend, the event must have been accidental or violent.
  4. Experiencing repeated or extreme exposure to details of the traumatic event (examples include first responders or police officers repeatedly exposed to details of child abuse). This does not include exposure through media, such as TV, movies or pictures.

B. Presence of nine or more of the following intrusion symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning after the traumatic event occurred:

  1. Recurrent, involuntary, intrusive, distressing memories of the traumatic event.  (In children older than six years, repetitive play may occur in which themes or aspects of the traumatic event are expressed).
  2. Recurrent, distressing dreams in which the emotions of the dream are related to the traumatic event. (In children, there may be frightening dreams).
  3. Dissociative reactions (such as flashbacks) in which the individual feels or acts as if the traumatic event was recurring. (In children, trauma related 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 traumatic event.
  5. Efforts to avoid distressing memories, feelings or thoughts about the traumatic event.
  6. Efforts to avoid external reminders (people, places, things, situations, conversations, activities) that arouse distressing memories, feelings or thoughts about the traumatic event.
  7. Irritable behavior and angry outbursts typically expressed as verbal or physical aggression toward people or objects.
  8. Hypervigilance.
  9. Exaggerated startle response.
  10. Problems with concentration.
  11. Difficulty falling or staying asleep or restless sleep.
  12. Persistent inability to experience positive emotions (such as happiness, satisfaction or loving feelings).
  13. Inability to remember an important aspect of the traumatic events (typically due to dissociative amnesia).
  14. An altered sense of the reality of one’s surroundings or oneself (such as seeing oneself from another’s perspective, being in a daze, or time slowing).

C. The disturbance is three days to one month after trauma exposure.

D. The disturbance causes clinically significant distress or impairment in social, work, or other important areas of functioning.

E. The disturbance is not caused by another substance or medical condition.

Adjustment Disorder

A. The development of emotional or behavioral symptoms in response to an identifiable stressor occurring within three months of the onset of the stressor.

B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following:

  1. Significant distress that is out of proportion to the intensity of the stressor.
  2. Significant impairment in social, work, or other important ares of functioning.

C. The stress related disturbance does not meet the criteria for another mental disorder.

D. The symptoms do not represent normal grief and mourning.

E. Once the stressor or its consequences have ended, the symptoms do not persist for more than an additional six months.

Reactive Attachment Disorder

A. A consistent pattern of inhibited, emotionally withdraw behavior toward adult caregivers, as evidenced by both of the following:

  1. The child minimally or rarely seeks comfort when distressed.
  2.  The child minimally or rarely 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 emotional expressions.
  3. Episodes of unexplained sadness, irritability, or fearfulness that are evident even during nonthreatening interactions with 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, affection and stimulation met by caregiving adults.
  2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (such as frequent changes in foster care).
  3. Growing up in unusual settings that severely limit opportunties to form selective attachments (such as residential facilities with high child-to-caregiver ratios).

D. The care in Criterion C is believed to be responsible for the disturbed behavior in Criterion A.

E.  The disturbance is not due to autism spectrum disorder.

F.  The disturbance is present before age five years.

G. The child has a development age of at least nine months. 

Disinhibited Social Engagement Disorder

A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:

  1. A reduced or lack of reservation in approaching and interacting with unfamiliar adults.
  2. Overly familiar verbal or physical behavior.
  3. Reduced or absent checking back with adult caregivers after venturing away.
  4. Willingness to go off with an unfamiliar adult with little 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 one of the following:

  1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, affection and stimulation met by caregiving adults.
  2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (such as frequent changes in foster care).
  3. Growing up in unusual settings that severely limit opportunities to form selective attachments (such as residential facilities with high child-to-caregiver ratios).

D. The care in Criterion C is believed to be responsible for the disturbed behavior in Criterion A

E. The child has a development age of at least nine months.

 

The above criteria are adapted from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).