Trauma And Stressor-Related Disorders

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Reactive Attachment Disorders

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A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:

1. The child rarely or minimally seeks comfort when distressed.

2. The child rarely or minimally 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 affect.

3. Episodes of unexplained irritability, sadness, or fearfulness that are evident evenduring nonthreatening interactions with adult caregivers.

C. The child has experienced a pattern of extremes of insufficient care as evidenced byat least one of the following:

1. Social neglect or deprivation in the form of persistent lack of having basic emotionalneeds for comfort, stimulation, and affection met by caregiving adults.

2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).

3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).

D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate carein Criterion C).

E. The criteria are not met for autism spectrum disorder.

F. The disturbance is evident before age 5 years.

G. The child has a developmental age of at least 9 months.Specify if:Persistent: The disorder has been present for more than 12 months.

Specify current severity:

Reactive attachment disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.

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Trauma- and stressor-related disorders

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include disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion

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Trauma and Stressors-Related Disorders

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1. Reactive Attachment Disorder

2. Disinhibited Social Engagement Disorder

3. Posttraumatic Stress Disorder

4. Acute Stress Disorder

5. Adjustment Disorders

6. Others specified Trauma and Stressors-Related Disorders

7. Unspecified Trauma and Stressors-Related Disorders

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Disinhibited Social Engagement Disorders

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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. Reduced or absent reticence in approaching and interacting with unfamiliar adults.

2. Overly familiar verbal or physical behavior (that is not consistent with culturallysanctioned and with age-appropriate social boundaries).

3. Diminished or absent checking back with adult caregiver after venturing away, evenin unfamiliar settings.

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

B. The behaviors in Criterion A are not limited to impulsivity (as in attention-deficit/hyperactivity disorder) but include socially disinhibited behavior.

C. The child has experienced a pattern of extremes of insufficient care as evidenced byat least one of the following:

1. Social neglect or deprivation in the form of persistent lack of having basic emotionalneeds for comfort, stimulation, and affection met by caregiving adults.

2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).

3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).

D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).

E. The child has a developmental age of at least 9 months.

Specify if:

Persistent: The disorder has been present for more than 12 months.

Specify current severity:

Disinhibited social engagement disorder is specified as severe when the child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.

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Posttraumatic Stress Disorder

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A. Exposure to actual or threatened death, serious injury, or sexual violence

B. Presence of intrusion symptoms (1)

C. Persistent avoidance of stimuli associated with the traumatic event/s (1)

D. Negative alterations in cognitions and mood associated with the traumatic event/s (2)

E. Marked alterations in arousal and reactivity associated with the traumatic event/s (2)

F. Duration is more than one month

G. Functional Impairment

H. Not attributable to physiological effects of substance or any medical condition

Specify whether:

With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:

1. Depersonalization: Persistent or recurrent experiences of feeling detached from,and as if one were an outside observer of, one’s mental processes or body (e.g.,feeling as though one were in a dream; feeling a sense of unreality of self or bodyor of time moving slowly).

2. Derealization: Persistent or recurrent experiences of unreality of surroundings(e.g., the world around the individual is experienced as unreal, dreamlike, distant,or distorted).Note: To use this subtype, the dissociative symptoms must not be attributable to thephysiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Specify if:With delayed expression: If the full diagnostic criteria are not met until at least 6 monthsafter the event (although the onset and expression of some symptoms may be immediate).

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Acute Stress Disorder

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Fairly similar to those of PTSD, but the duration is shorter. • Symptoms occur between 3 days and 1 month after a trauma.

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Adjustment Disorder

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A. The development of emotional or behavioral symptoms in response to an identifiablestressor(s) occurring within 3 months of the onset of the stressor(s).

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 the cultural factors that might influencesymptom severity and presentation.

2. Significant impairment in social, occupational, or other important areas of functioning.

C. The stress-related disturbance does not meet the criteria for another mental disorderand is not merely an exacerbation of a preexisting mental disorder.

D. The symptoms do not represent normal bereavement.

E. Once the stressor or its consequences have terminated, the symptoms do not persistfor more than an additional 6 months.

Specify whether:

309.0 (F43.21) With depressed mood: Low mood, tearfulness, or feelings of hopelessness are predominant.

309.24 (F43.22) With anxiety: Nervousness, worry, jitteriness, or separation anxietyis predominant.

309.28 (F43.23) With mixed anxiety and depressed mood: A combination of depression and anxiety is predominant.

309.3 (F43.24) With disturbance of conduct: Disturbance of conduct is predominant.

309.4 (F43.25) With mixed disturbance of emotions and conduct: Both emotionalsymptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant.

309.9 (F43.20) Unspecified: For maladaptive reactions that are not classifiable as oneof the specific subtypes of adjustment disorder.

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1. Adjustment-like disorders with delayed onset of symptoms that occur more than3 months after the stressor.

2. Adjustment-like disorders with prolonged duration of more than 6 months without prolonged duration of stressor.

3. Ataque de nervios: See “Glossary of Cultural Concepts of Distress” in the Appendix.

4. Other cultural syndromes: See “Glossary of Cultural Concepts of Distress” in the Appendix.

5. Persistent complex bereavement disorder: This disorder is characterized by severeand persistent grief and mourning reactions (see the chapter “Conditions for FurtherStudy”).

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Examples of presentations that can be specified using the “other specified” designationinclude the following: