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DSM-IV two subtypes: emotionally withdrawn/inhibited and indiscriminately social/disinhibited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