Diagnostic Criteria:  exposure to actual or threatened death, serious, or sexual violence in one( or more) of the following ways: 1) Directly experiencing the traumatic events. 2) Witnessing in person 3) Learning that the traumatic event occur to close family member or friend. 4) Experiencing repeated or extreme exposure to aversive details of the traumatic events.

1. Trauma
And
Stressor-
Related
Disorder

2. Posttraumatic stress disorder
Diagnostic Criteria:
 exposure to actual or threatened death, serious, or sexual
violence in one( or more) of the following ways:
1) Directly experiencing the traumatic events.
2) Witnessing in person
3) Learning that the traumatic event occur to close family
member or friend.
4) Experiencing repeated or extreme exposure to aversive
details of the traumatic events.
 Presence of one or more of the following intrusion symptoms
associated with the traumatic event:
1) Recurrent distressing memories of the traumatic event.
2) Recurrent distressing dreams related with traumatic
events.
3) Flashbacks in which one feels or acts as if traumatic event
is occurring.
4) Intense or prolong psychological distress at exposure to
internal /external cues that reminds of traumatic event.
5) Marked physiological reactions to internal or external cues
that resemble an aspect of the traumatic events.
 Persistent avoidance of stimuli associate with traumatic
events, as evidence by one or both of following:
1) Avoidance of distressing memories, thoughts or feelings
associated with traumatic events.

3. 2) Avoidance of external reminders that arouse that
distressing memories associated with traumatic events.
 Negative alterations in cognitions and mood associated with
the traumatic events, beginning or worsening after the
traumatic events, as evidence by two or more of following:
1) Inability to remember important aspect of traumatic
events due to dissociative amnesia and to not other
factors such as head injury, alcohol, or drugs.
2) Persistent and exaggerated negative beliefs or
expectations about oneself, others or world.
3) Persistent, distorted cognitions about the cause or
consequences of the traumatic events that lead to
blaming of oneself.
4) Persistent negative emotional state.
5) Markedly diminished interest in significant activities.
6) Feeling of detachment from others.
7) Persistent inability to experience positive emotions.
 Marked alterations in arousal and reactivity associated with
the traumatic events, beginning or worsening after the
traumatic events occurred, as evidenced by two or more of
following:
1) Irritable behavior and angry outbursts.
2) Reckless or self-destructive behavior
3) Hyper vigilance.
4) Exaggerated startle response.
5) Problems with concentrations.
6) Sleep disturbances.
 Duration of disturbance is more than 1 month.

4.  Cause significant distress in social, occupational or other
important areas of functioning.
 It is not attributed to physiological effects of substance or
other medical conditions.
Prevalence:
3.5% in adult US populations.
Risk and prognostic factors:
 Temperamental:
Childhood emotional problems and prior mental
disorders.
 Environmental:
Low socioeconomic status, lower education, exposure
to prior trauma,
Childhood adversity, cultural characteristics, lower
intelligence,
minority racial/ethnic status, family psychiatric history.
 Genetic / Physiological:
Female gender, younger age at time of exposure.
DDx:
Adjustment disorders, other posttraumatic conditions,
acute distress disorders, anxiety disorders, major depressive
disorders, personality disorders, dissociative disorders, conversion
disorders, psychotic disorders, traumatic brain injury.
Acute Stress Disorder

5. Diagnostic Criteria:
 exposure to actual or threatening death, serious injury, or
sexual violation
in one or more of following ways:
a..1. Directly experiencing the traumatic events.
a..2. Witnessing in person the traumatic event.
a..3. Learning that event occur to other family
member.
a..4. Experiencing repeated or extreme exposure to
aversive details of the traumatic events.
 Presence of 9 or more of following symptoms from any five
categories:
a. intrusive symptoms:
a.1. Recurrent distressing memories of traumatic
event.
a.2. Recurrent distressing dreams
a.3. Dissociative reactions e.g, flash backs
a.4. Intense or prolong psychological distress or
marked physiological reaction to internal/external
cues,
b. negative mood:
a..5. Persistent inability to experience positive
emotions.
c. dissociative symptoms:
6. An alter sense of reality.
7. Inability to remember important aspect
of traumatic event.

6. d. avoidance symptoms
8. Effort to avoid distressing memories.
9. Efforts to avoid external reminders of
traumatic event.
e. arousal symptoms
10. Sleep disturbances
11. Irritable behaviors
12. Hypervigilence.
13. Problems with concentration.
14. Exaggerated startle response.
 Duration of disturbance is 3 days to 1 month after trauma
exposure.
 Clinical significant distress in social, occupational and other
important areas of functioning.
 It is not attributed to physiological effects of a substance or
other medical condition.
Associated features:
a..6. feeling excess guilty
a..7. Flashback memories of trauma.
a..8. panic attacks
a..9. Chaotic or impulsive behavior.
Prevalence:
Less than 20% after trauma

7. Risk and Prognostic Factors:
 Temperamental: prior mental disorders, neuroticism,etc
 Envirmental: exposure to trauma
 Genetic and Physiological: females
DDx:
Adjustment disorders, panic disorders, dissociative disorders,
PTSD, OCD, psychotic disorders, traumatic brain injury.
Adjustment disorder
Diagnostic criteria
Emotional or behavioral response to an identifiable
stressor(s) occurring within 3 month of onsent of the
stressor(s)
Marked distress that is out of proportion to the severity or
intensity of the stressor
Significant impairment in social, occupational, or other
important areas of functions
Stress-related disturbance does not meet the criteria for
another mental disorder
Symptoms do not represent normal bereavement
Once the stressor or its consequence have terminated, the
symptoms do not persist for more than an additional 6
months

8. Prevalence
Outpatient 5- 20%
In hospital psychiatric consultation, most common
diagnosis, reaching 50%
Risk factors and prognostic features
 Environmental
a..1. Disadvantaged life circumstances experience
high rates of stressors
Associated features
The stressor may be a single event or multiple stressors
Stressors may be recurrent or continuous
Stressors can affect a single individual, the entire family,
or large group/community
Some stressors may accompany a specific developmental
event
May be diagnosed after the death of a loved one
DDx
MDD,PTSD ,Personality disorders ,Normative stress
reaction, Psychological factors affecting other medical
conditions

9. Reactive attachment disorder
Diagnostic criteria
 Emotionally drawn behavior towards adult caregivers;
manifested by both of the following:
a..1. Child minimally seeks comfort when distressed
a..2. Child minimally responds to comfort when
distressed
Social and emotional disturbance characterized by at least
two of the following:
a..1. Minimal social/ emotional responsiveness to
others
a..2. Limited positive affect
a..3. Episodes if unexplained irritability, sadness, or
fearfulness
Experienced a pattern of extremes of insufficient care
The criteria are not met for autism spectrum disorder
Evident before age 5 years
Child has development age of 9 months
Prevalence
Rare
Found in children exposed to severe neglect before being
placed in foster care
Occurs in less than 10% of children exposed to severe
neglect

10. Risk factors and prognostic factors
Environmental- being exposed to extreme cases of
neglect; however the majority of children that experience
such neglect do not develop this disorder
Prognosis depends on the quality of care giving following
serious neglect
Associated features
Developmental delays
a..1. Delay in cognition and language
Malnutrition or other signs of poor care
DDx
Autism spectrum disorder ,Intellectual disability
,Depressive disorders
Disinhibited social engagement disorder
Diagnostic criteria
Pattern of behavior in which a child actively approaches
and interacts with unfamiliar adults
Behaviors are not limited to impulsivity
The child had experience a pattern of extremes of
insufficient care

11. The child has a developmental age of 9 months
Prevalence
Rarely seen in the clinical setting
High risk populations, occurs in only 20% of children
Risk and prognostic factors
Environmental
Course modifiers- signs of this disorder may persist after
placement in normative care giving
Associated Features
Developmental delays (Cognitive and language delays )
Malnutrition or other signs of poor care
DDx
Attention deficit/ hyperactive disorder