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)