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DSM-5: Trauma and Stress-Induced Disorders

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Presentation on theme: "DSM-5: Trauma and Stress-Induced Disorders"— Presentation transcript:

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DSM-IV two subtypes: emotionally withdrawn/inhibited and indiscriminately social/disinhibited In DSM-5 subtypes are defined as distinct disorders: reactive attachment disorder disinhibited social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

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