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Trauma Symptoms

Symptoms of trauma can present in ways almost identical to those of anxiety. Some anxious symptoms that can be a sign of trauma include panic attacks, fear/avoidance, and hyper-vigilance. The difference between anxiety in general and trauma response is that a trauma response happens following a trauma (primary or secondary) and relates to this trauma in ways such as triggering by a specific stimuli, flashbacks related to the trauma, and obsessive thoughts about the trauma/related subjects.

Reactive Attachment Disorder F94.1

  • Onset: Before age 5 (developmental age has reached at least 9 months)

  • Symptoms:

    • Inappropriate social interactions caused by persistent disregard of child's emotional and/or physical needs, or repeated changes in caregiver. Criteria for Autism Spectrum Disorder have not been met.

  • Differential:

    • Autism Spectrum Disorder – (history of neglect/restricted interest/ritualistic behavior)

    • Depressive Disorders – (impairment in attachment, but could have both)

    • Intellectual Disability – (do not have “profound” reduction in positive affect/emotions)

Disinhibited Social Engagement Disorder F94.2

  • Onset: Experience of neglect prior to age 2, developmental age of 9 months or more

  • Symptoms:

    • Child behaves in an overly familiar way with unfamiliar adults.

    • History is inclusive of a poverty of care in a minimum of one or more ways.

  • Differential:

    • ADHD – (attention/hyperactivity)

Post-Traumatic Stress Disorder F43.1

  • Duration: More than 1 month – typically starts within 3 months of trauma

  • Onset: any age

  • Symptoms: TRAUMA

    • Traumatic Event

    • Recurrent Intrusions

    • Arousal

    • Unable to: Remember, trust, feel connected, experience happiness

    • More than 1 month

    • Avoidance of stimuli associated with trauma

    • - At least one element of intrusive symptoms (ex. dreams, flashbacks, anxiety at exposure to cues, numbing of responsiveness, dissociative reactions)

    • - At least one element of avoidance symptom required

    • - At least two elements of negative alterations related to mood and cognitions (ex. difficulty recalling elements of the traumatic event, negative beliefs about self or the world, misplaced blame, anhedonia, isolating/detaching from others emotionally or physically)

    • - At least two changes in level of arousal or reactivity (ex. irritability/aggression, recklessness, hypervigilance, difficulty concentrating, startle response, insomnia)

§ Children 6 and under:

  • Duration: More than 1 month

  • Onset: Follows a traumatic event that involved actual or threat of death/serious injury to self or others. This EXCLUDES events observed through electronic media of all forms and photos.

  • Symptoms: Response to trauma involved intense fear, helplessness, horror as evidenced by:

    • At least one element of intrusive symptoms (ex. bad dreams, flashbacks, anxiety at exposure to cues, numbing of responsiveness, etc.; the child may not appear distressed per se, but rather the distressing content may be expressed through play or play re-enactment)

    • At least one element related to the traumatic event (ex. avoidance of trauma-associated cues or elements of trauma, reduced participation in meaningful activities, isolating/detaching from others emotionally or physically, reduced positive emotional expression)

    • At least two of these: irritability/aggression (to include severe temper tantrums), hypervigilance, difficulty concentrating, startle response, restlessness or difficulty sleeping

  • Etiology:

    • Traumatic event

    • Biological or psychology vulnerability

    • Lack of support network

  • Differential:

    • Acute Stress Disorder – (duration 3 days – 1 month)

    • Adjustment Disorders – (stressor not trauma, any severity)

    • Personality Disorders – (not caused by trauma)

    • Dissociative Disorders – (full criteria for PTSD not met, if it is then PTSD w dissoc)

    • Other Posttraumatic Disorders – (issues caused by trauma, but meets other d/o criteria better or is better explained by other disorder)

    • Psychotic Disorders – (psychosis not flashbacks, actual hallucination/delusions etc)

    • Major Depressive Disorder – (does not meet PTSD criteria even if trauma caused)

    • Conversion Disorder – (somatic sx caused by trauma COULD be PTSD)

    • Traumatic Brain Injury – (sx are direct result of the injury not just the trauma)

  • Rule Out:

    • Stroke

    • Epilepsy

    • Pseudotumor cerebri /idiopathic intracranial hypertension

    • Addiction

    • Traumatic Brain Injury (TBI)

    • Post-Concussive Syndrome

Acute Stress Disorder F43.0

  • Duration: 3 days to 1 month

  • Onset: Within 1 month following a traumatic event that involved actual or threat of death, serious injury, or sexual violation

  • Symptoms: 9 or more symptoms from these 5 categories: DIANA

    • Dissociation

    • Intrusion

    • Arousal

    • Negative mood

    • Avoidance

  • Differential:

    • Other Traumatic D/O – (see PTSD and Adjustment D/O)

    • Panic Disorder – (presence of unexpected panic attacks)

    • Psychotic Disorders – (psychosis not just flashbacks)

    • Dissociative Disorders – (severe dissociative responses)

    • Obsessive-Compulsive Disorder – (recurrent intrusive thoughts not related to trauma)

    • Traumatic Brain Injury – (symptoms caused by injury not trauma)

Adjustment Disorder F43.2

  • Onset – within 3 months of the stressor

  • Duration – must resolve within 6 months of stressor termination

  • Symptoms: IT’S BAD

    • Impairment (relational, occupational, social, ed)

    • Three months or less

    • Six months max

    • Bereavement has been excluded

    • Another d/o excluded

    • Distress is beyond expectation for stressor

  • Types:

    • With depressed mood F43.21

    • With anxious mood F43.22

    • With mixed Depressed Mood and Anxiety F43.23

    • With disturbance of conduct F43.24 (violate rights of others/social norms)

    • With mixed disturbance of emotions and conduct F43.25 (emotional/behavioral)

    • Unspecified F43.2

  • Differential:

    • Other trauma D/O – (see PTSD and ASD, also rule out normal response to stress)

    • Major Depressive Disorder – (if meets criteria for MDD, AD not applicable)

    • Personality Disorders – (not caused by specific stressor/trauma)

    • Psychological Factors Affecting Other Medical Conditions – (exacerbation of and caused by preexisting medical condition)


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