Trauma- Stress Related Disorders

1. Trauma- Stress Related Disorders

2. 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.

3. 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.

4. 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

5. 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

6. 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)

7. 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

8. PTSD - DSM-5 • 4.Persistent negative trauma-related emotions (e.g. fear, horror, anger, guilt, or shame) • 5.Markedly diminished interest in (pre-traumatic) significant activities • 6.Feeling alienated from others (e.g. detachment or estrangement) • 7.Constricted affect: persistent inability to experience positive emotions

9. 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

10. 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

11. 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)

12. 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

13. 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

14. 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

15. 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…)

16. 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

17. 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