1. Distress and Disorder Fernanda Garcia-Costas Child and Adolescent Consultant Psychiatrist Plym Bridge House Fernanda.garcia-costas@nhs.net

2. Distress Distress needed for the diagnosis of mental disorder in many conditions as depression, anxiety, obsessive compulsive disorder, post traumatic stress disorder... No possibility of diagnosis without certain level of distress

3. ...distress without disorder Distress due to normal transitions, challenges and losses (associated with education and work, family life, relationships) Distress associated with social deprivation, exclusion or persecution. Distress associated with physical illness.

4. Childhood psychiatric disorder: Definition Persistent disturbance of behaviour, emotions or relationships that is abnormal for the socio-cultural background and stage of development and is accompanied by impaired social and personal functioning and/or disturbance of development. All of the above needed for diagnosis of disorder, not distress in isolation

5. Developmental context Year 1: Attachment to the primary care giver Year 2 : Beginning to be independent: – Child learns to feed and toilet – Move around independently – Communicate using language Year 3-5: – Play creatively – Links with others – Further development of language skills

6. Dev context. Cont Year 5-7: – Learning to relate to other children – Build up a sense of self esteem Adolescence: – Learns to become independent and separated from parents – Relationships outside the home incl sexual relationships – Develops academic and physical skills – Develops sense of his/her own identity