DSM-5: Trauma and Stress-Induced Disorders

1. DSM-5: Trauma and Stress-Induced Disorders Lynn Murphy Michalopoulos, PhD Assistant Professor Columbia School of Social Work

2. 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

3. 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)

4. 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

5. 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)

6. Reactive Attachment Disorder • DSM-IV two subtypes: emotionally withdrawn/inhibited and indiscriminately social/disinhibited • In DSM-5 subtypes are defined as distinct disorders: • reactive attachment disorder • disinhibited social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)

7. 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

8. PTSD DSM-5: Subtypes • Dissociative Subtype • Preschool Subtype • Behavioral and observable emphasis • Developmentally sensitive • 6 years old and younger • New algorithm

9. 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