Transcript DSM-5: Trauma and Stress

DSM-5: Trauma and StressInduced Disorders
Lynn Murphy Michalopoulos, PhD
Assistant Professor
Columbia School of Social Work
Agenda
• Trauma and Stress-Induced Disorders
• Overview of Acute Stress Disorder, Adjustment Disorder, Reactive
Attachment Disorder
• Post Traumatic Stress Disorder
– Changes
– Similarities
• Clinical case examples for PTSD diagnosis
• Significance to clinical social work practice
• Questions
Trauma and Stress-Related Disorders
• DSM IV considered to be correct---any changes required substantial data
• PTSD did not neatly fit category of anxiety, stress-induced, or internalizing
disorder
• New chapter created
• All diagnoses require that “onset or worsening of symptoms was preceded
by exposure to an adverse event”
(Friedman, 2013, p.549)
Acute Stress Disorder
• Changes to
– stressor criterion
– eliminated the unexpected death of a loved one
– eliminated subjective reaction to event
– recognition that symptom expression heterogeneous
– must have 9 out of 14 symptoms in any category
Adjustment Disorders
• DSM-5: heterogeneous stress-response syndrome after exposure to
adverse event
• DSM-IV: category for individuals who display clinical distress without
meeting criteria for a more specific disorder
• Subtypes remain the same: depressed mood, anxious symptoms, or
disturbances in conduct
(American Psychiatric Association, 2012)
Reactive Attachment Disorder
• DSM-IV two subtypes: emotionally withdrawn/inhibited and
indiscriminately social/disinhibited
• In DSM-5 subtypes are defined as distinct disorders:
– reactive attachment disorder
– disinhibited social engagement disorder
• Both are the result of social neglect or other situations that limit a
young child’s opportunity to form selective attachments.
– Differ in terms of correlates, course, and response to treatment
(American Psychiatric Association, 2012)
Other Important Changes
• Intrusion
– No changes
• Avoidance
- Previously the DSM-IV identified 7 symptoms. DSM-5 has 2
• Negative alterations in cognitions and mood
– Two new symptoms added related to distorted attribution and
emotional state
• Alterations in arousal and reactivity (Arousal)
– One new symptom added related to reckless or self destructive
behavior
PTSD DSM-5: Subtypes
• Dissociative Subtype
• Preschool Subtype
– Behavioral and observable emphasis
– Developmentally sensitive
– 6 years old and younger
– New algorithm
Implications
• Diagnosis for preschool children
• Removal of unexpected death
– Lowered prevalence rates
• Parallels with complex PTSD with new items (negative alterations
in cognition and mood)
– main focus of trauma treatment
• Dissociative subtype
– Research found association with more severe trauma
– Repeated trauma
– Early adverse experience
– Increase functional impairment
– Increase suicidality
– Interferes with emotional learning
– Informs potential inclusion of complex PTSD
• Reactive Attachment Disorder
• Better reliability in diagnosis with DSM-5