L3

Trauma and Stressor-Related Disorders

• Include disorders where a traumatic or stressful event is a diagnostic criterion
• Reactive Attachment Disorder (RAD), Disinhibited Social Engagement Disorder (DSED), Posttraumatic stress disorder (PTSD), Acute stress disorder, and Adjustment disorders are included.

DSM-IV vs. DSM-5

• PTSD is now categorized under Trauma and Stressor-Related Disorders, not Anxiety Disorders
• Many trauma survivors exhibit symptoms other than anxiety or fear
• These symptoms can include anhedonia, dysphoria, externalizing anger, aggression, and dissociation

Reactive Attachment Disorder (RAD)

• An internalizing disorder, with depressive symptoms and withdrawn behavior.
• RAD has been reclassified from DSM-IV, with two subtypes (inhibited, disinhibited), to two distinct disorders in DSM-5
• Inhibited phenotype (more withdrawn and emotionally withdrawn).
• Disinhibited phenotype (more social and indiscriminately engaging with adults).
• Social neglect during childhood is a required diagnostic element
• Prevalence is less than 10%
• Symptoms appear between 9 months and 5 years of age

Diagnostic Criteria for RAD

• A. Consistent pattern of inhibited, emotionally withdrawn behavior toward adults
  • Rarely seeks comfort when distressed
  • Rarely responds to comfort when distressed
• B. Persistent social and emotional disturbance
  • Minimal social and emotional responsiveness to others.
  • Limited positive affect.
  • Unexplained irritability, sadness, or fearfulness during interactions with adults
• C. Experienced a pattern of insufficient care (at least one of):
  • Social neglect or deprivation
  • Repeated caregiver changes
  • Unusual caregiving environments

Diagnostic Criteria for Disinhibited Social Engagement Disorder (DSED)

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

  • Reduced or absent reticence in approaching and interacting with unfamiliar adults
  • Overly familiar verbal or physical behavior (not consistent with age-appropriate social boundaries)
  • Diminished or absent checking back with adult caregivers after venturing away, especially in unfamiliar situations

• Willingness to go off with an unfamiliar adult with minimal or no hesitation

• Behaviors not limited to impulsivity but are socially disinhibited

• Child has experienced a pattern of insufficient care due to: Social neglect or deprivation, repeated caregiver changes, or unusual caregiving environments.

• Behavioral age of 9 months or older

Posttraumatic Stress Disorder (PTSD)

• Exposure to actual or threatened death, serious injury, or sexual violence
• Symptoms (intrusion, avoidance, negative mood and cognitions, altered arousal, and reactivity) present for more than one month
• Distinct symptoms in children younger than 6 years old

Acute Stress Disorder

• A brief disorder (3 days-1 month), following a traumatic event.
• Diagnostic criteria, similar to PTSD but are characterized by duration (3 days-1 month) and fewer symptoms required.

Adjustment Disorders

• Emotional or behavioral symptoms in response to a stressor occurring within 3 months of the stressor
• Symptoms are clinically significant, causing impairment in social, occupational or other areas of functioning