ABNORMAL PSYCHOLOGY

DSM – 5 – TR
TRAUMA AND STRESSOR Diagnostic Features
RELATED DISORDERs  Characterized by a pattern of markedly
o Exposure to a traumatic and stressful event. disturbed and developmentally
inappropriate attachment behaviors, in
Reactive Attachment Disorder which a child rarely or minimally turns
Diagnostic Criteria preferentially to an attachment figure for
A. A consistent pattern of inhibited, emotionally comfort, support, protection, and
withdrawn behavior toward adult caregivers. nurturance.
 Child rarely or minimally seeks comfort when  The essential feature is absent of grossly
distressed. underdeveloped attachment between the
 Rarely or minimally responds to comfort when child and putative caregiving adults.
distressed.  Believed to have the capacity to form
B. Persistent social and emotional disturbance. selective attachments.
 Minimal social and emotional responsiveness  Because of limited opportunities during
to others. early development, they fail to show the
 Limited positive affect. behavioral manifestations of selective
 Episodes of unexplained irritability, sadness, attachments.
or fearfulness that are evident even during WHEN DISTRESSED:
nonthreatening interactions with adult  they show no consistent effort to obtain
caregivers. comfort, support, nurturance, or protection
C. The child has experienced a pattern of extremes of from caregivers.
insufficient care.  children with this disorder do not respond
 Social neglect or deprivation in the form of more than minimally to comforting efforts
persistent lack of having basic emotional of caregivers.
needs met by caregiving adults (comfort, *The disorder is associated with the absence of
stimulation, and affection). expected comfort seeking and response to
 Repeated changes of the primary caregivers comforting behaviors.
that limit opportunities to form stable  show diminished or absent expression of
attachments. positive emotions during routine
 Rearing in unusual settings that severely limit interactions with caregivers.
opportunities to form selective attachments.  their emotion regulation capacity is
D. The care in Criterion C is presumed to be compromised, and they display episodes of
responsible for the disturbed behavior in Criterion A negative emotions of fear, sadness, or
(e.g., the disturbances in Criterion A began following irritability that are not readily explained.
the lack of adequate care in Criterion C). Should not be made in children who are
E. The criteria are not met for autism spectrum developmentally unable to form selective
disorder. attachments.
F. The disturbance is evident before age 5 years. The child must have a developmental age of at least
G. The child has a developmental age of at least 9 9 months.
months.
Specify if: Persistent: Associated Features
The disorder has been present for more than 12 Social Neglect
months. Often co-occurs with developmental delays (delays
in cognition and language)
Specify current severity: Other associated features include stereotypies and
Reactive attachment disorder is specified as severe other signs of severe neglect (e.g., malnutrition or
when a child exhibits all symptoms of the disorder, signs of poor care)
with each symptom manifesting at relatively high
levels.
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TREATMENT
Treating Reactive Attachment Disorder typically
involves a comprehensive approach that addresses
the child's emotional, social, and developmental
needs, as well as providing support and guidance
for caregivers.
 Psychotherapy: Individual therapy, play
therapy, or family therapy can help the child
develop secure attachments, process past
trauma, and learn healthy coping skills.
 Attachment-focused interventions:
Therapeutic approaches specifically
designed to promote secure attachments,
such as Dyadic Developmental
Psychotherapy (DDP) or Attachment and
Biobehavioral Catch-up (ABC).
 Parenting support and education:
Caregivers may benefit from education
about attachment theory, trauma-informed
care, and strategies for promoting healthy
attachment and emotional regulation in
their child.
 Supportive services: Access to community
resources, support groups, and specialized
services may be helpful for families coping
with the challenges of Reactive Attachment
Disorder.

DISINHIBITED SOCIAL ENGAGEMENT

DISORDER
DIAGNOSTIC CRITERIA
A. A pattern of behavior in which a child actively
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approaches and interacts with unfamiliar adults and strangers (Criterion A).
exhibits at least two of the following: Violates the social boundaries of the culture.
 Reduced or absent reticence in approaching Should not be made before children are
and interacting with unfamiliar adults. developmentally able to form selective
 Overly familiar verbal or physical behavior attachments.
(that is not consistent with culturally  The child must have a developmental age of
sanctioned and with age-appropriate social at least 9 months.
boundaries).
 Diminished or absent checking back with Associated features
adult caregiver after venturing away, even Social Neglect
in unfamiliar settings. Disinhibited social engagement disorder may co-
 Willingness to go off with an unfamiliar occur with developmental delays, especially
adult with minimal or no hesitation. cognitive and language delays, stereotypies, and
B. The behaviors in Criterion A are not limited to other signs of severe neglect, such as malnutrition
impulsivity (as in attentiondeficit/hyperactivity or poor care.
disorder) but include socially disinhibited behavior. Signs of the disorder often persist even after these
C. The child has experienced a pattern of extremes other signs of neglect are no longer present.
of insufficient care as evidenced by at least one of It is not uncommon for children with the disorder to
the following: present with no current signs of neglect.
 Social neglect or deprivation in the form of The condition can present in children who show no
persistent lack of having basic emotional signs of disordered attachment.
needs for comfort, stimulation, and Disinhibited social engagement disorder may be
affection met by caregiving adults. seen in children with a history of neglect who lack
 Repeated changes of primary caregivers attachments or whose attachments to their
that limit opportunities to form stable caregivers range from disturbed to secure.
attachments (e.g., frequent changes in
foster care). TREATMENT
 Rearing in unusual settings that severely Treatment for Disinhibited Social Engagement
limit opportunities to form selective Disorder often involves a comprehensive approach
attachments (e.g., institutions with high that addresses the child's emotional, social, and
child-to-caregiver ratios). developmental needs, as well as providing support
D. The care in Criterion C is presumed to be and guidance for caregivers.
responsible for the disturbed behavior in Criterion A Psychotherapy: Individual therapy, play therapy, or
(e.g., the disturbances in Criterion A began family therapy can help the child develop
following the pathogenic care in Criterion C). appropriate social boundaries, improve social skills,
E. The child has a developmental age of at least 9 and process past trauma.
months. Attachment-focused interventions: Therapeutic
Specify if: Persistent: approaches aimed at promoting secure
The disorder has been present for more than 12 attachments and healthy social relationships, such
months. as Dyadic Developmental Psychotherapy (DDP) or
Attachment and Biobehavioral Catch-up (ABC).
Specify current severity: Parenting support and education: Caregivers may
Disinhibited social engagement disorder is specified benefit from education about attachment theory,
as severe when the child exhibits all symptoms of trauma-informed care, and strategies for promoting
the disorder, with each symptom manifesting at healthy social development in their child.
relatively high levels.
POSTTRAUMATIC STRESS DISORDER
DIAGNOSTIC FEATURES DIAGNOSTIC CRITERIA
A pattern of behavior that involves culturally Posttraumatic Stress Disorder in Individuals Older
inappropriate, overly familiar behavior with relative than 6 Years
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Note: The following criteria apply to adults, that symbolize or resemble an aspect of
adolescents, and children older than 6 years. the traumatic event(s).
A. Exposure to actual or threatened death, serious  Marked physiological reactions to internal
injury, or sexual violence in one (or more) of the or external cues that symbolize or
following ways: resemble an aspect of the traumatic
 Directly experiencing the traumatic event(s).
event(s). C. Persistent avoidance of stimuli associated with
 Witnessing, in person, the event(s) as it the traumatic event(s), beginning after the
occurred to others. traumatic event(s) occurred, as evidenced by one
 Learning that the traumatic event(s) or both of the following:
occurred to a close family member or close  Avoidance of or efforts to avoid distressing
friend. In cases of actual or threatened memories, thoughts, or feelings about or
death of a family member or friend, the closely associated with the traumatic
event(s) must have been violent or event(s).
accidental.  Avoidance of or efforts to avoid external
 Experiencing repeated or extreme reminders (people, places, conversations,
exposure to aversive details of the activities, objects, situations) that arouse
traumatic event(s) (e.g., first responders distressing memories, thoughts, or feelings
collecting human remains; police officers about or closely associated with the
repeatedly exposed to details of child traumatic event(s).
abuse). D. Negative alterations in cognitions and mood
Note: Criterion A4 does not apply to exposure associated with the traumatic event(s), beginning,
through electronic media, television, movies, or or worsening after the traumatic event(s) occurred,
pictures, unless this exposure is work related. as evidenced by two (or more) of the following:
B. Presence of one (or more) of the following  Inability to remember an important aspect
intrusion symptoms associated with the traumatic of the traumatic event(s) (typically due to
event(s), beginning after the traumatic event(s) dissociative amnesia and not to other
occurred: factors such as head injury, alcohol, or
 Recurrent, involuntary, and intrusive drugs).
distressing memories of the traumatic  Persistent and exaggerated negative beliefs
event(s). or expectations about oneself, others, or
Note: In children older than 6 years, repetitive play the world (e.g., “I am bad,” “No one can be
may occur in which themes or aspects of the trusted,” “The world is completely
traumatic event(s) are expressed. dangerous,” “My whole nervous system is
 Recurrent distressing dreams in which the permanently ruined”).
content and/or affect of the dream are  Persistent, distorted cognitions about the
related to the traumatic event(s). cause or consequences of the traumatic
Note: In children, there may be frightening dreams event(s) that lead the individual to blame
without recognizable content. himself/herself or others.
 Dissociative reactions (e.g., flashbacks) in  Persistent negative emotional state (e.g.,
which the individual feels or acts as if the fear, horror, anger, guilt, or shame).
traumatic event(s) were recurring. (Such  Markedly diminished interest or
reactions may occur on a continuum, with participation in significant activities.
the most extreme expression being a  Feelings of detachment or estrangement
complete loss of awareness of present from others.
surroundings.)  Persistent inability to experience positive
Note: In children, trauma-specific reenactment emotions (e.g., inability to experience
may occur in play. happiness, satisfaction, or loving feelings).
 Intense or prolonged psychological distress E. Marked alterations in arousal and reactivity
at exposure to internal or external cues associated with the traumatic event(s), beginning,
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or worsening after the traumatic event(s) occurred, Posttraumatic Stress Disorder in Children 6 Years
as evidenced by two (or more) of the following: and Younger
 Irritable behavior and angry outbursts A. In children 6 years and younger, exposure to
(with little or no provocation) typically actual or threatened death, serious injury, or sexual
expressed as verbal or physical aggression violence in one (or more) of the following ways:
toward people or objects.  Directly experiencing the traumatic
 Reckless or self-destructive behavior. event(s).
 Hypervigilance.  Witnessing, in person, the event(s) as it
 Exaggerated startle response. occurred to others, especially primary
 Problems with concentration. caregivers.
Sleep disturbance (e.g., difficulty falling or  Learning that the traumatic event(s)
staying asleep or restless sleep). occurred to a parent or caregiving figure.
F. Duration of the disturbance (Criteria B, C, D, and B. Presence of one (or more) of the following
E) is more than 1 month. intrusion symptoms associated with the traumatic
G. The disturbance causes clinically significant event(s), beginning after the traumatic event(s)
distress or impairment in social, occupational, or occurred:
other important areas of functioning.  Recurrent, involuntary, and intrusive
H. The disturbance is not attributable to the distressing memories of the traumatic
physiological effects of a substance (e.g., event(s).
medication, alcohol) or another medical condition. Note: Spontaneous and intrusive memories may
Specify whether: not necessarily appear distressing and may be
With dissociative symptoms: The individual’s expressed as play reenactment.
symptoms meet the criteria for posttraumatic  Recurrent distressing dreams in which the
stress disorder, and in addition, in response to the content and/or affect of the dream are
stressor, the individual experiences persistent or related to the traumatic event(s).
recurrent symptoms of either of the following: Note: It may not be possible to ascertain that the
 Depersonalization: Persistent or recurrent frightening content is related to the traumatic
experiences of feeling detached from, and event.
as if one were an outside observer of, one’s  Dissociative reactions (e.g., flashbacks) in
mental processes or body (e.g., feeling as which the child feels or acts as if the
though one were in a dream; feeling a traumatic event(s) were recurring. (Such
sense of unreality of self or body or of time reactions may occur on a continuum, with
moving slowly). the most extreme expression being a
 Derealization: Persistent or recurrent complete loss of awareness of present
experiences of unreality of surroundings surroundings.) Such trauma-specific
(e.g., the world around the individual is reenactment may occur in play.
experienced as unreal, dreamlike, distant,  Intense or prolonged psychological distress
or distorted). at exposure to internal or external cues
Note: To use this subtype, the dissociative that symbolize or resemble an aspect of
symptoms must not be attributable to the the traumatic event(s).
physiological effects of a substance (e.g., blackouts,  Marked physiological reactions to
behavior during alcohol intoxication) or another reminders of the traumatic event(s).
medical condition (e.g., complex partial seizures). C. One (or more) of the following symptoms,
representing either persistent avoidance of stimuli
associated with the traumatic event(s) or negative
Specify if: alterations in cognitions and mood associated with
With delayed expression: If the full diagnostic the traumatic event(s), must be present, beginning
criteria are not met until at least 6 months after the after the event(s) or worsening after the event(s):
event (although the onset and expression of some
symptoms may be immediate). Persistent Avoidance of Stimuli
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 Avoidance of or efforts to avoid activities, mental processes or body (e.g., feeling as
places, or physical reminders that arouse though one were in a dream; feeling a
recollections of the traumatic event(s). sense of unreality of self or body or of time
 Avoidance of or efforts to avoid people, moving slowly).
conversations, or interpersonal situations  Derealization: Persistent or recurrent
that arouse recollections of the traumatic experiences of unreality of surroundings
event(s). (e.g., the world around the individual is
Negative Alterations in Cognitions experienced as unreal, dreamlike, distant,
 Substantially increased frequency of or distorted).
negative emotional states (e.g., fear, guilt, Note: To use this subtype, the dissociative
sadness, shame, confusion). symptoms must not be attributable to the
 Markedly diminished interest or physiological effects of a substance (e.g., blackouts)
participation in significant activities, or another medical condition (e.g., complex partial
including constriction of play. seizures).
 Socially withdrawn behavior.
 Persistent reduction in expression of Specify if: With delayed expression: If the full
positive emotions. diagnostic criteria are not met until at least 6
D. Alterations in arousal and reactivity associated months after the event (although the onset and
with the traumatic event(s), beginning, or expression of some symptoms may be immediate).
worsening after the traumatic event(s) occurred, as
evidenced by two (or more) of the following: Diagnostic Features
 Irritable behavior and angry outbursts (with The development of characteristic symptoms
little or no provocation) typically expressed following exposure to one or more traumatic
as verbal or physical aggression toward events.
people or objects (including extreme The clinical presentation of PTSD varies.
temper tantrums).  fear-based reexperiencing, emotional, and
 Hypervigilance. behavioral symptoms may predominate.
 Exaggerated startle response.  anhedonic or dysphoric mood states and
 Problems with concentration. 5. Sleep negative cognitions may be most
disturbance (e.g., difficulty falling or staying prominent.
asleep or restless sleep).  arousal and reactive-externalizing
E. The duration of the disturbance is more than 1 symptoms are prominent.
month.  dissociative symptoms predominate. Finally,
F. The disturbance causes clinically significant some individuals exhibit combinations of
distress or impairment in relationships with these symptom patterns.
parents, siblings, peers, or other caregivers or with Note: Some individuals exhibit combinations of
school behavior. these symptom patterns.
G. The disturbance is not attributable to the Specific criteria for PTSD refer to specific criteria for
physiological effects of a substance (e.g., adults; criteria for children 6 years or younger may
medication or alcohol) or another medical differ in criterion numbering given differences in
condition. applicable criteria for this age group.
Specify whether: With dissociative symptoms:

The individual’s symptoms meet the criteria for

posttraumatic stress disorder, and the individual
experiences persistent or recurrent symptoms of ASSOSIATED FEATURES
either of the following:  Developmental regression, such as loss of
 Depersonalization: Persistent or recurrent language in young children, may occur.
experiences of feeling detached from, and  Auditory pseudo-hallucinations, such as
as if one were an outside observer of, one’s having the sensory experience of hearing
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one’s thoughts spoken in one or more recalling traumatic memories or triggers.
different voices, as well as paranoid This technique aims to help individuals
ideation, can be present. process traumatic memories and reduce
 Prolonged, repeated, and severe traumatic associated distress.
events (e.g., childhood abuse, torture), the  Medications: Antidepressants, particularly
individual may additionally experience selective serotonin reuptake inhibitors
difficulties in regulating emotions or (SSRIs) and serotonin-norepinephrine
maintaining stable interpersonal reuptake inhibitors (SNRIs), may be
relationships, or dissociative symptoms. prescribed to help alleviate symptoms of
 When the traumatic event involves the depression, anxiety, and hyperarousal
violent death of someone with whom the associated with PTSD.
individual had a close relationship,  Supportive interventions: Peer support
symptoms of both prolonged grief disorder groups, psychoeducation, stress
and PTSD may be present. management techniques, and relaxation
exercises can provide additional support
DIFFERENTIAL DIAGNOSIS and coping strategies for individuals with
 Adjustment Disorders PTSD.
 Other posttraumatic disorders and
conditions
 Acute Stress Disorder
 Anxiety Disorders and Obsessive-
Compulsive Disorder
 Major Depressive Disorder
 Attention-deficit/Hyperactivity Disorder
 Personality Disorders
 Dissociative Disorders
 Functional Neurological Symptom Disorder
(Conversion Disorder)
 Psychotic Disorders
 Traumatic Brain Injury

TREATMENT
Treatment for PTSD typically involves a combination
of psychotherapy, medication, and supportive
interventions.
 Cognitive-Behavioral Therapy (CBT): CBT,
including techniques such as exposure
therapy and cognitive restructuring, is often
considered the first-line treatment for PTSD.
Exposure therapy involves gradually
confronting and processing traumatic
memories or reminders in a safe and
controlled manner. Cognitive restructuring
ACUTE STRESS DISORDER
helps individuals challenge and change
Diagnostic Criteria
negative beliefs and thoughts related to the
A. Exposure to actual or threatened death, serious
traumatic event.
injury, or sexual violence in one (or more) of the
 Eye Movement Desensitization and
following ways:
Reprocessing (EMDR): EMDR is a specialized
 Directly experiencing the traumatic
form of therapy that involves bilateral
event(s).
stimulation (such as eye movements) while
 Witnessing, in person, the event(s) as it
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occurred to others.  An altered sense of the reality of one’s
 Learning that the event(s) occurred to a surroundings or oneself (e.g., seeing
close family member or close friend. oneself from another’s perspective, being in
Note: In cases of actual or threatened death of a a daze, time slowing).
family member or friend, the event(s) must have  Inability to remember an important aspect
been violent or accidental. of the traumatic event(s) (typically due to
 Experiencing repeated or extreme exposure dissociative amnesia and not to other
to aversive details of the traumatic event(s) factors such as head injury, alcohol, or
(e.g., first responders collecting human drugs).
remains, police officers repeatedly exposed Avoidance Symptoms
to details of child abuse).  Efforts to avoid distressing memories,
Note: This does not apply to exposure through thoughts, or feelings about or closely
electronic media, television, movies, or pictures, associated with the traumatic event(s).
unless this exposure is work related.  Efforts to avoid external reminders (people,
B. Presence of nine (or more) of the following places, conversations, activities, objects,
symptoms from any of the five categories of situations) that arouse distressing
intrusion, negative mood, dissociation, avoidance, memories, thoughts, or feelings about or
and arousal, beginning or worsening after the closely associated with the traumatic
traumatic event(s) occurred: event(s).
Intrusion Symptoms Arousal Symptoms
 Recurrent, involuntary, and intrusive  Sleep disturbance (e.g., difficulty falling or
distressing memories of the traumatic staying asleep, restless sleep).
event(s).  Irritable behavior and angry outbursts (with
Note: In children, repetitive play may occur in which little or no provocation), typically expressed
themes or aspects of the traumatic event(s) are as verbal or physical aggression toward
expressed. people or objects.
 Recurrent distressing dreams in which the  Hypervigilance.
content and/or affect of the dream are  Problems with concentration.
related to the event(s).  Exaggerated startle response.
Note: In children, there may be frightening dreams C. Duration of the disturbance (symptoms in
without recognizable content. Criterion B) is 3 days to 1 month after trauma
 Dissociative reactions (e.g., flashbacks) in exposure.
which the individual feels or acts as if the Note: Symptoms typically begin immediately after
traumatic event(s) were recurring. (Such the trauma, but persistence for at least 3 days and
reactions may occur on a continuum, with up to a month is needed to meet disorder criteria.
the most extreme expression being a D. The disturbance causes clinically significant
complete loss of awareness of present distress or impairment in social, occupational, or
surroundings.) other important areas of functioning.
Note: In children, trauma-specific reenactment may E. The disturbance is not attributable to the
occur in play. physiological effects of a substance (e.g.,
 Intense or prolonged psychological distress medication or alcohol) or another medical condition
or marked physiological reactions in (e.g., mild traumatic brain injury) and is not better
response to internal or external cues that explained by brief psychotic disorder.
symbolize or resemble an aspect of the
traumatic event(s). DIAGNOSTIC FEATURES
Negative Mood The development of characteristic symptoms lasting
 Persistent inability to experience positive from 3 days to 1 month following exposure to one
emotions (e.g., inability to experience or more traumatic events (Criterion A), which are
happiness, satisfaction, or loving feelings). the same type as described in PTSD Criterion A.
Dissociative Symptoms May vary by individual but typically involves an
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anxiety response that includes some form of May exhibit irritable behavior and may even engage
reexperiencing of or reactivity to the traumatic in aggressive verbal or physical behavior with little
event. Presentations may include intrusion or no provocation (e.g., yelling at people, getting
symptoms, negative mood, dissociative symptoms, into fights, destroying objects) (Criterion B11).
avoidance symptoms, and arousal symptoms Often characterized by a heightened vigilance for
(Criterion B1–B14). potential threats, including those that are related to
IN SOME INDIVIDUALS: the traumatic experience (e.g., following a motor
 a dissociative or detached presentation can vehicle accident, being especially sensitive to the
predominate, although these individuals threat potentially caused by cars or trucks) and
typically will also display strong emotional those not related to the traumatic event (e.g., being
or physiological reactivity in response to fearful of suffering a heart attack) (Criterion B12).
trauma reminders. Concentration difficulties (Criterion B13) include
 there can be a strong anger response in difficulty remembering familiar facts (e.g.,
which reactivity is characterized by irritable forgetting one’s telephone number) or daily events
or possibly aggressive responses. (e.g., having recently read part of a book or
Individuals with acute stress disorder may have a newspaper) or attending to focused tasks (e.g.,
persistent inability to feel positive emotions (e.g., following a conversation for a sustained period of
happiness, joy, satisfaction, or emotions associated time).
with intimacy, tenderness, sexuality) but can May be very reactive to unexpected stimuli,
experience negative emotions such as fear, sadness, displaying a heightened startle response or
anger, guilt, or shame (Criterion B5). jumpiness to loud noises (e.g., in response to a
Alterations in awareness can include telephone ringing) or unexpected movements
depersonalization, a detached sense of oneself (Criterion B14).
(e.g., seeing oneself from the other side of the Startle responses are involuntary and reflexive
room), or derealization, having a distorted view of (automatic, instantaneous), and stimuli that evoke
one’s surroundings (e.g., perceiving that things are exaggerated startle responses (Criterion B14) need
moving in slow motion, seeing things in a daze, not not be related to the traumatic event.
being aware of events that one would normally The full symptom picture must last for at least 3
encode) (Criterion B6). days after the traumatic event but should not last
Some individuals also report an inability to longer than 1 month (Criterion C). Symptoms that
remember an important aspect of the traumatic occur immediately after the event but resolve in
event that was presumably encoded. This symptom less than 3 days would not meet criteria for acute
is attributable to dissociative amnesia and is not stress disorder.
attributable to head injury, alcohol, or drugs
(Criterion B7).
Stimuli associated with the trauma are persistently
avoided. The individual commonly makes deliberate
efforts to avoid thoughts, memories, or feelings
(e.g., by using distraction or suppression
techniques, including substance use, to avoid
internal reminders) (Criterion B8)
To avoid activities, conversations, objects, ASSOCIATED FEATURES
situations, or people who arouse recollections of it Commonly engage in catastrophic or extremely
(Criterion B9) negative thoughts about their role in the traumatic
event, their response to the traumatic experience,
Individuals with acute stress disorder to experience or the likelihood of future harm.
problems with sleep onset and maintenance, which  (e.g., an individual with acute stress
may be associated with nightmares and safety disorder may feel excessively guilty about
concerns or with generalized elevated arousal that not having prevented the traumatic event
interferes with adequate sleep (Criterion B10). or about not adapting to the experience
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more successfully) including techniques such as trauma-
May also interpret their symptoms in a catastrophic focused cognitive restructuring and
manner, such that flashback memories or emotional exposure therapy, is often used to treat
numbing may be interpreted as a sign of diminished ASD. Exposure therapy involves gradually
mental capacity. confronting and processing traumatic
Experience panic attacks in the initial month after memories or triggers in a safe and
trauma exposure that may be triggered by trauma controlled manner to reduce distress and
reminders or may apparently occur spontaneously. reactivity.
May display chaotic or impulsive behavior. For  Medications: Antidepressants, particularly
example, individuals may drive recklessly, make selective serotonin reuptake inhibitors
irrational decisions, or gamble excessively. (SSRIs) and serotonin-norepinephrine
In children, there may be significant separation reuptake inhibitors (SNRIs), may be
anxiety, possibly manifested by excessive needs for prescribed to help alleviate symptoms of
attention from caregivers. anxiety, depression, and hyperarousal
In the case of bereavement following a death that associated with ASD.
occurred in traumatic circumstances, the  Supportive interventions: Psychoeducation,
symptoms of acute stress disorder can involve acute stress management techniques, relaxation
grief reactions. exercises, and peer support groups can
 reexperiencing, dissociative, and arousal provide additional support and coping
symptoms may involve reactions to the loss, strategies for individuals with ASD.
such as intrusive memories of the
circumstances of the individual’s death,
disbelief that the individual has died, and
anger about the death.
Postconcussive symptoms (e.g., headaches,
dizziness, sensitivity to light or sound, irritability,
concentration deficits), which occur frequently
following mild traumatic brain injury (TBI), are also
frequently seen in individuals with acute stress
disorder.
 equally common in brain-injured and non-
brain-injured populations, and the frequent
occurrence of postconcussive symptoms
could be attributable to acute stress
disorder symptoms.

Differential Diagnosis
 Adjustment Disorders
 Panic Disorder
 Dissociative Disorders
 Posttraumatic stress disorder
 Obsessive-compulsive disorder Adjustment Disorder
 Psychotic Disorders Diagnostic Criteria
 Traumatic Brain Injury A. The development of emotional or behavioral
symptoms in response to an identifiable stressor(s)
TREATMENT occurring within 3 months of the onset of the
Treatment for Acute Stress Disorder typically stressor(s).
involves a combination of psychotherapy, B. These symptoms or behaviors are clinically
medication, and supportive interventions. significant, as evidenced by one or both of the
 Cognitive-Behavioral Therapy (CBT): CBT, following:
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 Marked distress that is out of proportion to stressor or its consequences. The persistent
the severity or intensity of the stressor, specifier therefore applies when the
taking into account the external context duration of the disturbance is longer than 6
and the cultural factors that might influence months in response to a chronic stressor or
symptom severity and presentation. to a stressor that has enduring
 Significant impairment in social, consequences.
occupational, or other important areas of
functioning. Diagnostic Features
C. The stress-related disturbance does not meet the The presence of emotional or behavioral symptoms
criteria for another mental disorder and is not in response to an identifiable stressor is the
merely an exacerbation of a preexisting mental essential feature of adjustment disorders
disorder. (Criterion A).
D. The symptoms do not represent normal The stressor may be a single event (e.g., a
bereavement and are not better explained by termination of a romantic relationship), or there
prolonged grief disorder. may be multiple stressors (e.g., marked business
E. Once the stressor or its consequences have difficulties and marital problems).
terminated, the symptoms do not persist for more Stressors may be recurrent (e.g., associated with
than an additional 6 months. seasonal business crises, unfulfilling sexual
Specify whether: relationships) or continuous (e.g., a persistent
 F43.21 With depressed mood: Low mood, painful illness with increasing disability, living in a
tearfulness, or feelings of hopelessness are crime-ridden neighborhood).
predominant. Stressors may affect a single individual, an entire
 F43.22 With anxiety: Nervousness, worry, family, or a larger group or community (e.g., a
jitteriness, or separation anxiety is natural disaster).
predominant. Some stressors may accompany specific
 F43.23 With mixed anxiety and depressed developmental events (e.g., going to school, leaving
mood: A combination of depression and a parental home, reentering a parental home,
anxiety is predominant. getting married, becoming a parent, failing to attain
 F43.24 With disturbance of conduct: occupational goals, retirement).
Disturbance of conduct is predominant. May be diagnosed following the death of a loved
 F43.25 With mixed disturbance of one when the intensity, quality, or persistence of
emotions and conduct: Both emotional grief reactions exceeds what normally might be
symptoms (e.g., depression, anxiety) and a expected, when cultural, religious, or age-
disturbance of conduct are predominant. appropriate norms are taken into account and the
 F43.20 Unspecified: For maladaptive grief reaction does not meet criteria for prolonged
reactions that are not classifiable as one of grief disorder.
the specific subtypes of adjustment
disorder.

Specify if: Differential Diagnosis

 Acute: This specifier can be used to indicate  Major Depressive Disorder
persistence of symptoms for less than 6  Posttraumatic stress disorder
months.  Acute stress disorder
 Persistent (chronic): This specifier can be  Bereavement
used to indicate persistence of symptoms  Psychological factors affecting other
for 6 months or longer. By definition, medical conditions
symptoms cannot persist for more than 6  Normative stress reactions
months after the termination of the
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DSM – 5 – TR
Treatment
Treatment for Adjustment Disorder typically
involves psychotherapy, support, and coping
strategies to help individuals manage stressors and
adapt to changes.
 Psychotherapy: Cognitive-behavioral
therapy (CBT), supportive therapy, or
problem-solving therapy can help
individuals identify and address
maladaptive thoughts and behaviors,
develop effective coping skills, and improve
stress management techniques.
 Supportive interventions: Social support
from family, friends, or support groups can
provide emotional validation, practical
assistance, and a sense of belonging during
challenging times.
 Stress management techniques: Relaxation
exercises, mindfulness meditation, and
stress reduction strategies can help
individuals manage symptoms of anxiety,
depression, and other emotional distress
associated with Adjustment Disorder.
 Medications: In some cases, medications
such as antidepressants or anti-anxiety
medications may be prescribed to alleviate
symptoms of depression, anxiety, or sleep
disturbances. However, medication is
generally not the first-line treatment for
Adjustment Disorder and is typically
reserved for individuals with severe or
persistent symptoms.

Prolonged Grief Disorder

Diagnostic Criteria
A. The death, at least 12 months ago, of a person
who was close to the bereaved individual (for
children and adolescents, at least 6 months ago).
B. Since the death, the development of a persistent
grief response characterized by one or both of the
following symptoms, which have been present most
days to a clinically significant degree. In addition,
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
the symptom(s) has occurred nearly every day for at (6 months in children and adolescents) have
least the last month: elapsed since the death of someone with whom the
 Intense yearning/longing for the deceased bereaved had a close relationship (Criterion A).
person. The condition involves the development of a
 Preoccupation with thoughts or memories persistent grief response characterized by intense
of the deceased person (in children and yearning or longing for the deceased person (often
adolescents, preoccupation may focus on with intense sorrow and frequent crying) or
the circumstances of the death). preoccupation with thoughts or memories of the
C. Since the death, at least three of the following deceased, although in children and adolescents,
symptoms have been present most days to a this preoccupation may focus on the circumstances
clinically significant degree. In addition, the of the death.
symptoms have occurred nearly every day for at The intense yearning/longing or the preoccupation
least the last month: has been present most days to a clinically significant
 Identity disruption (e.g., feeling as though degree and has occurred nearly every day for at
part of oneself has died) since the death. least the last month (Criterion B).
 Marked sense of disbelief about the death. since the death, at least three additional symptoms
 Avoidance of reminders that the person is have been present most days to a clinically
dead (in children and adolescents, may be significant degree and have occurred nearly every
characterized by efforts to avoid day for at least the past month.
reminders). These symptoms include identity disruption since
 Intense emotional pain (e.g., anger, the death (e.g., feeling as though part of oneself
bitterness, sorrow) related to the death. has died) (Criterion C1)
 Difficulty reintegrating into one’s  a marked sense of disbelief about the death
relationships and activities after the death (Criterion C2)
(e.g., problems engaging with friends,  avoidance of reminders that the person is
pursuing interests, or planning for the dead, which in children and adolescents
future). may be characterized by efforts to avoid
 Emotional numbness (absence or marked reminders (Criterion C3)
reduction of emotional experience) as a  intense emotional pain (e.g., anger,
result of the death. bitterness, guilt) since the death (Criterion
 Feeling that life is meaningless as a result of C4)
the death.  having difficulty reintegrating into personal
 Intense loneliness as a result of the death. relationships and activities since the death
D. The disturbance causes clinically significant (e.g., problems engaging with friends,
distress or impairment in social, occupational, or pursuing interests, or planning for the
other important areas of functioning. future) (Criterion C5)
E. The duration and severity of the bereavement  emotional numbness (absence or marked
reaction clearly exceed expected social, cultural, or reduction of emotional experience) as a
religious norms for the individual’s culture and result of the death (Criterion C6)
context.  feeling that life is meaningless as a result of
F. The symptoms are not better explained by the death (Criterion C7)
another mental disorder, such as major depressive  intense loneliness as a consequence of the
disorder or posttraumatic stress disorder, and are death (Criterion C8).
not attributable to the physiological effects of a Must result in clinically significant distress or
substance (e.g., medication, alcohol) or another impairment in social, occupational, or other
medical condition. important areas of functioning in the bereaved
individual (Criterion D).
Diagnostic Features The nature, duration, and severity of the
Represents a prolonged maladaptive grief reaction bereavement reaction must clearly exceed expected
that can be diagnosed only after at least 12 months social, cultural, or religious norms for the
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
individual’s culture and context (Criterion E). memories, and reactions to the loss. CGT
typically involves interventions aimed at
Associated Features facilitating the completion of grieving tasks,
Often experience maladaptive cognitions about the promoting emotional expression, and
self, guilt about the death, and diminished future fostering adaptation to the loss.
life expectancy and life goals.  Supportive interventions: Social support
Somatic complaints commonly accompany the from family, friends, support groups, or
condition and may be related to comorbid bereavement organizations can provide
depression and anxiety, social identity disruption, emotional validation, practical assistance,
and increased health care visits; the somatic and a sense of connection during the
symptoms may be associated with those that were grieving process.
experienced by the deceased (e.g., changes in  Cognitive-behavioral therapy (CBT): CBT
appetite). techniques may be used to help individuals
Harmful health behaviors related to decreased self- identify and challenge maladaptive
care and concern are also common in individuals thoughts and behaviors related to the loss,
with symptoms of prolonged grief disorder. develop coping skills, and improve problem-
Hallucinations about the deceased (e.g., hearing the solving abilities.
deceased person’s voice) may occur during normal  Medications: In some cases, medications
grief but may be more common in individuals with such as antidepressants or anti-anxiety
symptoms of prolonged grief disorder. medications may be prescribed to alleviate
 Hallucinations experienced by individuals symptoms of depression, anxiety, or sleep
with prolonged grief disorder symptoms disturbances associated with prolonged
may be associated with disruptions of social grief. However, medication is generally not
identity and purpose related to the death the first-line treatment for PGD and is
(e.g., confusion about one’s role in life, typically reserved for individuals with
feeling of meaninglessness). severe or persistent symptoms.
Bitterness, anger, or restlessness; blaming others
for the death; and decreased sleep quantity and
quality.

Differential Diagnosis
 Normal Grief
 Depressive disorders
 Posttraumatic stress disorder
 Separation anxiety disorder
 Psychotic disorder

Treatment Other Specified Trauma- and Stressor-Related

Treatment for Prolonged Grief Disorder typically Disorder
involves a combination of psychotherapy, support,
and coping strategies to help individuals process This category applies to presentations in which
their grief and adapt to life without their loved one. symptoms characteristic of a traumaand stressor-
 Grief-focused psychotherapy: Therapeutic related disorder that cause clinically significant
approaches such as Complicated Grief distress or impairment in social, occupational, or
Therapy (CGT), which is specifically other important areas of functioning predominate
designed to address symptoms of but do not meet the full criteria for any of the
prolonged grief, can help individuals disorders in the trauma- and stressor-related
explore and process their emotions, disorders diagnostic class. The other specified
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
trauma- and stressor-related disorder category is and stressor-related disorder category is used in
used in situations in which the clinician chooses to situations in which the clinician chooses not to
communicate the specific reason that the specify the reason that the criteria are not met for a
presentation does not meet the criteria for any specific trauma- and stressor-related disorder and
specific trauma- and stressor-related disorder. This includes presentations in which there is insufficient
is done by recording “other specified trauma- and information to make a more specific diagnosis (e.g.,
stressor-related disorder” followed by the specific in emergency room settings).
reason (e.g., “persistent response to trauma with
PTSD-like symptoms”).
Examples of presentations that can be specified
using the “other specified” designation include the
following:
 Adjustment-like disorders with delayed
onset of symptoms that occur more than 3
months after the stressor.
 Adjustment-like disorders with prolonged
duration of more than 6 months without
prolonged duration of stressor.
 Persistent response to trauma with PTSD-
like symptoms (i.e., symptoms occurring in
response to a traumatic event that fall short
of the diagnostic threshold for PTSD and
that persist for longer than 6 months,
sometimes referred to as
“subthreshold/partial PTSD”).
 Ataque de nervios: See “Culture and
Psychiatric Diagnosis” in Section III.
 Other cultural syndromes: See “Culture
and Psychiatric Diagnosis” in Section III.

Unspecified Trauma- and Stressor-Related Disorder

This category applies to presentations in which

symptoms characteristic of a traumaand stressor-
related disorder that cause clinically significant
distress or impairment in social, occupational, or
other important areas of functioning predominate
but do not meet the full criteria for any of the
disorders in the trauma- and stressor-related
disorders diagnostic class. The unspecified trauma-