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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 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 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. **** Reactive Attachment Disorder Disinhibited Social Engagement Disorder © 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 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; 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 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