DSM-5 ™ in Action: Diagnostic and Treatment Implications Section 2, Chapters 5–13 PART 2 of Section 2 Chapters 8–16 by Sophia F. Dziegielewski, PhD, LCSW © 2014 S. Dziegielewski

Anxiety and Stress © 2014 S. Dziegielewski

© 2013 S. Dziegielewski

 Reactive Attachment Disorder;  Disinhibited Social Engagement Disorder;  Acute Stress Disorder;  Posttraumatic Stress Disorder (PTSD in Preschool Children);  Adjustment Disorder;  Other Specified Trauma- or Stressor-Related Disorders;  Unspecified Trauma or Stressor-Related disorder © 2014 S. Dziegielewski

 Two subtypes: inhibited type and disinhibited type  In past little research on these subtypes, which has called DSM-IV diagnosis of this into question  Alternate set of criteria being used does not support the subtypes but rather TWO separate diagnoses © 2014 S. Dziegielewski

RAD is now two disorders; Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) © 2013 S. Dziegielewski

© 2014 S. Dziegielewski

 PTSD is no longer be listed as an “anxiety disorder” and listed in that section.  A new chapter was developed called Trauma and Stressor-Related Disorders  All disorders in this chapter describe conditions where the onset of symptoms occurred after exposure to adverse events.  PTSD criteria are more developmentally sensitive to children and adolescents. © 2014 S. Dziegielewski

 The term developmental manifestation in DSM-5 refers to age-specific expressions of one or another criterion that is used to make a diagnosis across age groups.  For children, inclusion of loss of a parent or other attachment figure is being considered.  The optimal number of required symptoms for both adults and children will be further examined with empirical data. © 2014 S. Dziegielewski

 Adults, Adolescents, and Children OLDER than 6 (Criteria A-H)  Children Younger than 6 (Criteria A-G) © 2014 S. Dziegielewski

Subtypes: Specify whether;Subtypes: Specify whether;  With dissociative symptoms— 1. Depersonalization (sense of unreality); 2. Derealization (dreamlike, distant) Specifiers: Specify if:Specifiers: Specify if:  With delayed expression (full diagnostic criteria not met after 6 months) © 2014 S. Dziegielewski

 Both age groupings are similar in that the individual must have exposure to the actual or threatened death, serious injury, or sexual violence in at least:  One of the four ways listed for adults and children.  At least one of the three ways listed for children under age 6 (directly or witnessing experiencing the event to self or others, especially the primary caregiver or hearing that the traumatic event happened to a parent or caregiver). © 2014 S. Dziegielewski

 Criterion B: One or more intrusion symptoms  Criterion C: Persistent avoidance of stimuli  Criterion D: Alterations in cognitive, arousal, mood, reactivity, etc.  Duration in both is more than 1 month and causes clinically significant distress.  Remaining criteria differ slightly for both groups. © 2014 S. Dziegielewski

 The trauma experienced in acute stress disorder will not include: ◦ Witnessing events on television ◦ Witnessing events through electronic media  Will also drop the criteria that the person must experience intense fear.  Symptoms may no longer need to involve feelings of dissociation.  The work group is also proposing to eliminate the requirement that individuals experience profound fear or helplessness or horror at the time of a traumatic event. © 2014 S. Dziegielewski