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

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

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)

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

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)

Reactive Attachment Disorder DSM-IV two subtypes: emotionally withdrawn/inhibited and indiscriminately social/disinhibited In DSM-5 subtypes are defined as distinct disorders: reactive attachment disorder disinhibited social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

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

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

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