Trauma and Stress-Related Disorders

In DSM-5, the stressor criterion (Criterion A) is now explicit for acute stress disorder and posttraumatic stress disorder regarding whether the trauma was experienced directly, witnessed, or experienced indirectly. Also, the DSM-IV A2 Criterion regarding the subjective reaction to the traumatic event (for example, experiencing “fear, helplessness, or horror”) is eliminated. Adjustment disorder served as a residual diagnostic category in DSM-IV for individuals who exhibit clinically significant distress but do not meet diagnostic criteria for a more discrete disorder. In DSM-5, it is reconceptualized as a heterogeneous array of stress-response syndromes that occur after exposure to a distressing (traumatic or nontraumatic) event. Whereas for posttraumatic stress disorder there were three major symptom clusters in DSM-IV (for example, reexperiencing, avoidance/numbing, and arousal), in DSM-5 there are now four symptom clusters because the avoidance/numbing cluster is divided into two clusters: avoidance and persistent negative alterations in cognition and mood. The DSM-IV childhood diagnosis of reactive attachment disorder had two subtypes: the emotionally withdrawn/inhibited subtype and the indiscriminately social/disinhibited subtype. In DSM-5, these subtypes are defined as distinct disorders: reactive attachment disorder and disinhibited social engagement disorder.

The questions below are from DSM-5 Self-Exam Questions: Test Questions for the Diagnostic Criteria, which may be preordered from American Psychiatric Publishing at http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62467. The answers and rationales are posted at http://www.psychnews.org/pdfs/DSM-5_Self_Examination_QandA_10.pdf. The book, available in October, contains 500 questions for all the categories of psychiatric disorders and includes Section III. The questions were developed under the leadership of Philip Muskin, M.D., a professor of clinical psychiatry at Columbia University College of Physicians and Surgeons.

1. Posttraumatic stress disorder in DSM-5 is placed within which of the following diagnostic categories?

a) anxiety disordersb) depressive disordersc) trauma and stress related disordersd) other disorderse) Section III

2. DSM-IV required which type of reaction to the trauma as a criterion for the diagnosis that has been eliminated in DSM-5?

a) fear, helplessness, or horrorb) insomnia or hypersomniac) avoidanced) foreshortened sense of the futuree) flashbacks

3. Two years after the death of her husband, a 70-year-old woman is seen for complaints of sadness, anger regarding her husband’s unexpected death after a heart attack, a yearning for him to come back, and unsuccessful attempts to move out of her large home because of her inability to remove his belongings. Which diagnosis would best fit this patient?

a) major depressive disorderb) posttraumatic stress disorderc) adjustment disorderd) personality disordere) normative stress reaction ■