Trauma and Loss

Trauma and Stressor Related Disorder

Are you feel
  • Fear
  • Sadness
  • Longing
  • Guilt
  • Shame
  • Anger
  • Numbness
  • Hopelessness

Trauma and Stressor Related Disorders

Generally speaking, it has been shown that traumatic death, especially violent deaths, lead to increased distress.  For example, a 2003 study looking at the bereavement trajectories of 173 parents who experienced the death of a child by accident, suicide, homicide, or undetermined causes found that five years after the violent death 27.5% of mothers and 12.5% of fathers met the diagnosis for PTSD.  These rates were significantly higher than those in the general population.

When someone experiences a traumatic death, their challenges become two-fold.  One, they must cope with the trauma and two, they have to cope with their grief.  The experiences of trauma and grief are two different things unto themselves, yet after a traumatic death, they get thrown into one big emotional blender. Things get tangled, thoughts and emotions get fused, and people sometimes find themselves utterly stuck.  Understandably, it is not uncommon for people who’ve experienced a traumatic death to experience significantly more intense, pervasive, and prolonged symptoms.

Reactive Attachment Disorder

This is a children’s disorder that from mostly age of 5. Symptoms are difficult to understand. During assessment must be focus Autism spectrum disorder symptoms. Persistent mean last 12 months.

All statements answer true or false

  1. Consistent pattern of Inhabit or withdrawal toward caregivers
  2. Rarely or minimally seek/respond comfort when distressed
  3. Persistent social or emotional disturbance (At least 2):
    a. Social and emotional responsiveness to others
    b. Limited positive affects
    c. Unexplained mood change such as sadness, irritability, or fearful in the normal situation
  4. Evidence of insufficient care (at least 1):
    a. Basic emotional need
    b. Repeated change of caregiver
    c. Unusual setting

Scoring Key

All items are important and any of the above is missing means the child not facing RAD.
But if all are above true then the child has saver condition of RAD.

Diagnosis through

Direct observation
History of child
Interview of Caretaker
Observation

Maybe overlap or similar

Adjustment disorder
Autism
PTSD
Mood Disorder

History

It was first introduced in the DSM in 1980. In 1987, two subtypes of reactive attachment disorder were introduced: inhibited and disinhibited. In 2013, the diagnosis was updated again. The DSM-5 refers to the disinhibited type as a separate condition called disinhibited social engagement disorder.

Disinhibited Social Engagement Disorder

Children with disinhibited social engagement disorder aren’t afraid of strangers. In fact, they are so comfortable around unfamiliar people that they wouldn’t think twice about climbing into a stranger’s car or accepting an invitation to a stranger’s home. This uninhibited friendliness toward people they don’t know can become a serious safety problem for children if the disorder is left untreated.

Neglect during infancy interferes with bonding and attachment. This impairs a child’s ability to develop trusting relationships with caregivers and often persists into adult life.

Note: Before Diagnosing the DSED, carefully check:

Neglect During Infancy
Social Neglect (Emotional Deprivation)
Repeated Caregiver changes
Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).
At least two of the following behaviors:
1. intense excitement or a lack of inhibition over meeting or interacting with strangers or unfamiliar adults
2. behaviors with strangers that are overly friendly, talkative, or physical and not age-appropriate or culturally acceptable
3. willingness or desire to leave a safe place or situation with a stranger
4. lack of desire or interest in checking in with a trusted adult prior to leaving a safe place, or in a situation that seems foreign, strange, or threatening

Treatment

Behavioral technique
Caregiver Technique

Posttraumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have directly or indirectly experienced a shocking, scary, or dangerous event that threatens themself or loved ones.

Before Diagnosing, Carefully check:

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month

  • At least one re-experiencing symptom
    o Flashbacks—reliving the trauma over and over, including physical symptoms like
    a racing heart or sweating
    o Bad dreams
    o Frightening thoughts
  • At least one avoidance symptom
    o Staying away from places, events, or objects that are reminders of the traumatic experience
    o Avoiding thoughts or feelings related to the traumatic event
  • At least two arousal and reactivity symptoms
    o Being easily startled
    o Feeling tense or “on edge”
    o Having difficulty sleeping
    o Having angry outbursts
  • At least two cognition and mood symptoms
    o Trouble remembering key features of the traumatic event
    o Negative thoughts about oneself or the world
    o Distorted feelings like guilt or blame
    o Loss of interest in enjoyable activities
    o Feelings of detachment from others.
    o Inability to experience positive emotions (happiness, satisfaction, or loving feelings)

PTSD Signs less than 6 years of age

  • Wetting the bed after having learned to use the toilet
  • Forgetting how to or being unable to talk
  • Acting out the scary event during playtime
  • Being unusually clingy with a parent or other adult

Overlap with

  • Acute Stress Disorder
  • OCD
  • Anxiety Disorder
  • Major Depressive Disorder
  • Personality disorder
  • Dissociative disorder
  • Conversion Disorder
  • Psychotic Disorder
  • Adjustment Disorder
  • Traumatic Brain Injury

Treatment

  • Medication
  • Talk Therapy
  • CBT
  • Exposure Therapy
  • Cognitive restructuring therapy

Acute Stress Disorder

ASD typically occurs within one month of a traumatic event. It lasts at least three days and can persist for up to one month. People with ASD have symptoms similar to those seen in posttraumatic stress disorder (PTSD). Develops in some people who have directly or indirectly experienced a shocking, scary, or dangerous event which threatens their self or loved ones.

At Least 9 symptoms presence

  • Re-experiencing symptom
    o Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
    o Bad dreams
    o Frightening thoughts
  • Avoidance symptom
    o Staying away from places, events, or objects that are reminders of the traumatic experience
    o Avoiding thoughts or feelings related to the traumatic event
  • Arousal and reactivity symptoms
    o Being easily startled
    o Feeling tense or “on edge”
    o Having difficulty sleeping
    o Having angry outbursts
    o having difficulty concentrating
    o being unable to stop moving or sit still
  • Cognition and mood symptoms
    o Trouble remembering key features of the traumatic event
    o Negative thoughts about oneself or the world
    o Distorted feelings like guilt or blame
    o Loss of interest in enjoyable activities
    o Feelings of detachment from others.
    o Inability to experience positive emotions (happiness, satisfaction, or loving feelings)

Overlap with:

  • PTSD
  • OCD
  • Anxiety Disorder
  • Major Depressive Disorder
  • Personality disorder
  • Dissociative disorder
  • Conversion Disorder
  • Psychotic Disorder
  • Adjustment Disorder
  • Traumatic Brain Injury

Treatment

  • Medication
  • Talk Therapy
  • CBT
  • Exposure Therapy
  • Cognitive restructuring therapy

Adjustment Disorder

Adjustment disorder (stress response syndrome) is a short-term condition that happens when you have great difficulty managing with, or adjusting to, a particular source of stress, such as a major life change, loss, or event.

The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s). Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.

There are many manifestations of an adjustment disorder, common ones include

Overlap with:

  • Depressed Mood
  • Anxiety
  • Disturbance in mood

Treatment

  • Medication
  • Therapy
  • Self Care

Other Specified Trauma and Stressor Related Disorder

Does not meet with any trauma and stress-related disorder criteria.
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 with-out prolonged duration of stressor.
  • Ataque de nervios: See DSM Page 833.
  • Other cultural syndromes: See Page 833
  • Persistent complex bereavement disorder: This disorder is characterized by severe and persistent grief and mourning reactions (see the chapter “Conditions for Further Study”).

Un-Specified Trauma and Stressor Related Disorder

The unspecified trauma- or stressor-related disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific trauma- and stressor-related disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).

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