Transcript 3- trauma-stress related disorders dsm 5

Trauma- Stress Related Disorders
Posttraumatic stress Disorder (PTSD) DSM-5
• A. The person was exposed to: death,
threatened death, actual or threatened
serious injury, or actual or threatened
sexual violence, as follows:
– 1. Direct exposure
– 2.Witnessing, in person
– 3.Indirectly, by learning that a close relative
or close friend was exposed to trauma. If
the event involved actual or threatened
death, it must have been violent or
accidental.
PTSD - DSM-5
– 4. Repeated or extreme indirect exposure to
aversive details of the event(s), usually in
the course of professional duties (e.g., first
responders, collecting body parts;
professionals repeatedly exposed to details
of child abuse). This does not include
indirect non-professional exposure through
electronic media, television, movies or
pictures.
PTSD - DSM-5
• B. Intrusion (1/5 symptoms needed)
– 1.Recurrent, involuntary and intrusive
recollections memories of traumatic event
• In children may express this symptom in
repetitive play
– 2.Traumatic distressing dreams or
nightmares of the traumatic event
• In children may have disturbing dreams
without content related to trauma
PTSD - DSM-5
– 3. Dissociative reactions (e.g. flashbacks)in
which the individual feels or acts as if the
traumatic event were recurring. Such
reaction may occur on a continuum from
brief episodes to complete loss of
consciousness
• In children may re-enact the event in play
– 4. Intense or prolonged distress after
exposure to traumatic reminders
– 5. Marked physiological reactivity after
exposure to trauma-related stimuli
PTSD - DSM-5
• C. Persistent effortful avoidance of distressing
trauma-related stimuli after the event (1/2
symptoms needed):
– 1. Trauma-related thoughts or feelings
– 2. Trauma-related external reminders (e.g.
people, places, conversations, activities,
objects or situations)
PTSD - DSM-5
• D. Negative alterations in cognitions and mood
that began or worsened after the traumatic event
(2/7 symptoms needed)
– 1.Inability to recall key features of the
traumatic event (usually dissociative amnesia;
not due to head injury, alcohol or drugs)
– 2.Persistent (& often distorted) negative beliefs
and expectations about oneself or the world
(e.g. “I am bad,” “the world is completely
dangerous”)
– 3.Persistent distorted blame of self or others
for causing the traumatic event or for resulting
consequences
PTSD - DSM-5
– 4.Persistent negative trauma-related
emotions (e.g. fear, horror, anger, guilt, or
shame)
– 5.Markedly diminished interest in (pretraumatic) significant activities
– 6.Feeling alienated from others (e.g.
detachment or estrangement)
– 7.Constricted affect: persistent inability to
experience positive emotions
PTSD - DSM-5
• E. Trauma-related alterations in arousal and
reactivity that began or worsened after the
traumatic event (2/6 symptoms needed)
– 1.Irritable or aggressive behavior
– 2.Self-destructive or reckless behavior
– 3.Hypervigilance
– 4.Exaggerated startle response
– 5.Problems in concentration
– 6.Sleep disturbance (difficulty falling asleep
or restless sleep
PTSD - DSM-5
• F. Persistence of symptoms (in Criteria B, C, D
and E) for more than one month
• G. Significant symptom-related distress or
functional impairment
• H. Not due to medication, substance or illness
Acute stress disorder
• Criteria A as in posttraumatic stress disorder
• Criteria B
– Intrusion symptoms (as in posttraumatic
stress disorder
– Negative mood
• 5. persistent inability to experience
positive emotions (inability to experience
happiness, satisfaction or loving feelings)
Acute stress disorder
• Avoidance symptoms
– 6. Effort to avoid distressing memories,
thoughts or feelings about or clearly
associated with traumatic events
– 7. Efforts to avoid external reminders
(people, places, activities, conversations …)
that arouses the distressing memories of
the traumatic event
Acute stress disorder
• Arousal symptoms
– 10. sleep disturbance
– 11. Irritable behavior and angry out bursts
(with little or small provocation) expressed
as aggression towards people or objects
– 12. Hyper-vigilance
– 13. Problems with concentration
– 14. Exaggerated startle response
Acute stress disorder
• C. Duration of the disturbance (criterion B) is 3
days to 1 month after trauma exposure
• D. the disturbance causes clinically significant
impairment in social, occupational or other
important areas of functioning
• E. The disturbance is not attributable to
physiological effects of substance abuse,
medications or other medical condition (mild
trauma brain injury) and not explained by brief
psychotic disorder
Adjustment disorders
• A. The development of emotional or
behavioral symptoms resulting to an
identifiable stressor(s) occurring within 3
months of the onset (example of stressor is
the termination of a romantic relationship,
business difficulties, painful illness with
progressive disability, natural disasters, getting
married, death of loved one…)
Adjustment disorders
• B. These symptoms or behaviors are clinically
significant as evidenced by one or both of the
following:
– 1. Marked distress that is out of proportion to
the severity or intensity of the stressor, taking
into account the external context and cultural
factors that might influence symptom severity
(risk of suicide)
• Significant impairment in social, occupational or
other important functioning
Adjustment disorders
• C. The stress related disturbance does not
meet the criteria for another mental disorder
• D. The symptoms do not represent normal
bereavement
• E. Once the stressor or consequences have
terminated the symptoms do not persist for
more than 6 months