Download Reactive Attachment Disorder (RAD) and Disinhibited Social

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
© 2014 S. Dziegielewski
© 2013 S. Dziegielewski
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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
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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
Attachment Disorders and the
Five Pathogenic Realms
 These are family and other environmental
events that affect a child and disorders arise
from them.
 One or more of these five essential
specifiers are needed for the diagnosis.
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Reactive Attachment Disorder
 Disinhibited Social Engagement
Disorder
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© 2014 S. Dziegielewski
The Five Pathogenic Care Realms
1. Persistent disregard for a child’s emotional
needs,
2. Persistent disregard for a child’s physical
needs,
3. Repeated changes in primary caregivers,
4. Raised in settings with limited
opportunities for stable attachments,
5. Persistent harsh punishment or other types
of grossly inept parenting.
© 2014 S. Dziegielewski
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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
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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
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Adults, Adolescents, and Children OLDER
than 6 (Criteria A-H)
Children Younger than 6 (Criteria A-G)
© 2014 S. Dziegielewski
Subtypes: Specify whether;
 With dissociative symptoms—
1. Depersonalization (sense of unreality);
2. Derealization (dreamlike, distant)
Specifiers: Specify if:
 With delayed expression (full diagnostic
criteria not met after 6 months)
© 2014 S. Dziegielewski
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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
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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
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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