Trauma & Stressor-

Related Disorders
 Characterized by disorders which
develop after exposure to an
extremely stressful or traumatic
event
 Different from the anxiety
disorders since it is not only limited
to fear and anxiety---- prominent
in these disorders are feelings of
anhedonia or dysphoria,
externalizing angry/aggressive
symptoms, and dissociative
episodes
Trauma and stressor related
disorders…
 Reactive Attachment Disorder
 Disinhibited Social Engagement Disorder
 Posttraumatic Stress Disorder
 Acute Stress Disorder
 Adjustment Disorder
 Other Specified Trauma and Stressor-Related
Disorder
 Unspecified Trauma and Stressor- Related Disorder
 Some examples of traumatic
events...
 Witnessing actual or threatened death
 Actual or threatened serious injury
 Actual or threatened sexual violation
 Natural disasters
 Accidents
 Sudden unexpected violent death
 War
 Some common treatments...
 Cognitive-Behavioral Therapy based techniques (i.e. Cognitive
therapy)

 Exposure Therapy (i.e. Prolonged exposure)

 Eye-Movement Desensitization and Reprocessing

 Stress Inoculation Training

Post-Traumatic Stress Disorder
and
Acute Stress Disorder
 Intrusive memories Avoidance Neg. alteration in Alterations in
(1 or more) (1 or both) cog and mood (2 arousal/reactivity
or more) (2 or more)
 Recurrent,  Inability to  Irritable behavior and
 Applies to children, adolescents
involuntary, and aspect
remember adults angry
older than
outbursts
distressing  Avoiding associated of traumatic event (verbal/physical aggress
6yrs.
memories memories, thoughts or  Neg.beliefs/expect
towards object or people)
feelings ations about self,
 Dreams with others or world
related content  Distorted cognition  Reckless/self-destructive
 Exposure
and affect to Avoidance
traumatic event about
of external in either
cause of or these
behavior ways:
 Diss. reaction as if
event
Directis
experience,
re-
witnessing
reminders that trigger
memories, thoughts or
the
consequence event
leading to self-
in person,
 Hypervigilance
learning
occuring that an accidental
feelings or violent
blame or event
blame on happened to
others
a friend or family member,
 Intense,

Repeated
Persistent neg.
exposure
 Exagg, startleto
response
prolonged distress
when aversive
exposed to details of the traumatic event.
emotional state
 Diminished interest  Problems w/
cues(I & E) which or participation in
symbolize the concentration
activities
event  Detachment or
 Phyiological estrangement  Sleep Disturbance
reactions to cues  Inability to exp.
positive emotions
 Duration is more than 1 month
 Causes sig. distress or impairment in areas of
functioning
 Not attributable to substance or medical
condition

Specify whether/if:
withdissociative symptoms
(depersonalization/derealization)
with delayed expression (full criteria not met until
atleast 6months)
 Changes in criteria for Children 6
years and younger...
 Criterion A: Witnessing in person as it occured to others
especially primary caregivers.
 Criterion B: (1) Memories may not necessarily appear distressing--
- play reenactment is common
(2) May be hard to ascertain that frightening content
is related to traumatic event
 Criterion C (combination of C & D in adults; 1 or more):
Avoidance is typically focused on E reminders (1) activities,
places, physical reminders, (2) people, conversations,
interpersonal situations. Has restrictions in play and reduced
expression of positive emotions.
 Criterion D absence of self-destructive behavior
 How is Acute Stress Disorder
different?
 Presence of 9 or more symptoms from any of the 5
categories: Intrusion, negative mood, dissociation,
avoidance and arousal.

 Duration is 3 days to 1 month (symptoms typically begin

immediately after trauma but persistence for 3-1mo. is
needed)
Adjustment Disorder
 Development of emotional or behavioral symptoms in
response to identifiable stressor (s) occuring w/in 3mos.
of onset to 6 months (chronic if more than 6 mos.)

 Clinically significant as evidenced by:

 Marked distress that is out or proportion to severity
or intensity of stressor
 Sig. impairment in areas of functioning

 Does not meet criteria for another mental d/o or

an exacerbation of d/o
 Symptoms do not represent normal bereavement
 Once stressor terminates, symptoms do not persist
for more than additional 6 mos.
Adjustment disorders are different
based on...
 Timing: may be diagnosed immediately and persist up to
6 mos.

 Symptom profile: stressor is milder than ones experienced

by people with ASD and PTSD. Different in severity and
type than Criterion A in ASD and PTSD. Also diagnosed
when person (1) experiences symptoms that do not
reach diagnostic threshold, (2) when person does not
experience traumatic event but manifests full symptom
profile
 Reactive attachment disorder
and
Disinhibited Social Engagement
disorder
 Social neglect is a shared etiology for both disorders.

 Both Disorders differ in terms of Criterion A & B:

Inhibited, emotionally withdrawn behavior Social and emotional disturbance
towards adults (both) (at least 2)

 Minimal social and emotional

 Rare or minimal comfort responsive to others
seeking when distressed  Limited Positive affect
 Episodes of unexplained
 Rare or minimal responds to irritability, sadness or
comfort when distressed fearfulness even during non-
threatening interactions
 Active approach and interaction w/
unfamiliar adults (at least 2)

 Reduced or absent retinence

in approaching and
interacting w/ adults  Not limited to impulsivity but
 Overly familiar verbal or include socially disinhibited
physical behavior behavior
 Diminished or absent
checking back with adult
caregiver
 Willingness to go w/
unfamiliar adult with minimal
or no hesitation
Both have a shared Criteria C and
D... Pattern of extreme, insufficient care
Social neglect or deprivation. Lack of comfort,
affection and stimulation

Repeated changes of primary caregivers which

limit formation of stable attachments

Rearing in unusual settings that severely limit

opportunities to form selective attachments

 The care is found to be responsible for disturbed behavior

 Reactive Attachment Disorder...
 Criteria not met for Autism

 Disturbance is before 5 years

 The child has a developmental age of atleast 9 months

Specify if: Persistent. D/o has been present for more than 12
mos. Severe when a child exhibits all symptoms of disorder at
high levels
 Disinhibited Social Engagement
Disorder....

 Thechild has a developmental age

of atleast 9 months

Specify if: Persistent. D/o has been present

for more than 12 mos. Severe when a
child exhibits all symptoms of disorder
at high levels
END :)