This document provides an overview of Trauma- and Stressor-Related Disorders as categorized in the DSM-5. It describes the new category and disorders included, such as Posttraumatic Stress Disorder, Acute Stress Disorder, and Adjustment Disorders. Criteria for specific disorders are outlined and treatment options discussed, including various forms of psychotherapy and medications.

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Trauma- and Stressor-Related
Disorders
DSM-5
Dr. Christine Chasek LIMHP, LADC, NCC
Trauma- and Stressor-Related Disorders
! What are Trauma- and Stressor-Related Disorders?
! New Category
! Criteria for specific Trauma-
and Stressor-Related Disorders
! Treatment

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+What are Trauma- and Stressor-
Related Disorders ?
! Include disorders in which exposure to a traumatic or
stressful event is listed explicitly as a diagnosis criterion.
! The disorders include:
! Reactive Attachment Disorder
! Disinhibited Social Engagement Disorder
! Posttraumatic Stress Disorder
! Acute Stress Disorder
! Adjustment Disorders
+ Attachment Disorders
! In Infancy or Early Childhood: a pattern of disturbed or
developmentally inappropriate attachment behaviors
There were two subtypes in DSM-IV-TR that are now defined as
distinct disorders in DSM-5:
313.89 (F94.1) Reactive Attachment Disorder
313.89 (F94.2) Disinhibited Social Engagement Disorder
This is a result of how different the disorders manifest
themselves and the different responses to intervention that
have been found to occur

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Posttraumatic Stress Disorder pg 271
! 309.81 (F43.10) Posttraumatic Stress Disorder
! ~Many changes in this disorder~
! The stressor criterion is explicit in whether the individual experienced
the trauma directly, indirectly, or witnessed the event.
! The criteria regarding the person’s subjective reaction has been
eliminated
! There are 4 symptoms clusters now rather than 3:
! 1) Re-experiencing, 2) Avoidance, 3) Persistent Negative Alterations in
Cognitions and Mood, 4) Arousal and Reactivity
! Divided into two categories: Adults, Adolescents, and Children over 6;
Children Under 6
! Specify whether there are dissociative symptoms:
! Depersonalization
! Derealization
And Delayed Expression
+Acute Stress Disorder pg 280
308.3 (F43.0) Acute Stress Disorder
The stressor criterion is explicit in whether the individual
experienced the trauma directly, indirectly, or witnessed the
event which includes exposure to actual or threatened death,
serious injury, or sexual violation.
*Does not however include exposure through
electronic media, television, movies, or pictures.
Must include the presence of any 9 of the 14 criteria listed in B
in the categories of Intrusion Symptoms, Negative Mood,
Dissociative Symptoms, Avoidance Symptoms, Arousal
Symptoms. Duration of symptoms is between 3 days to 1
month after the trauma.
**The criteria regarding the person’s subjective reaction has
been eliminated: ie “the person’s responses involved intense
fear, helplessness, or horror”

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+Adjustment Disorders pg 286
The Diagnosis number is determined by the specifier (see page 287)
! Re-conceptualized as an array of stress-response syndromes that occur after
exposure to a distressing event- either traumatic or non-traumatic; need to be
able to identify the stressor
! The development of emotional or behavioral symptoms in response to an
identifiable stressor occurring with 3 months of the onset of the stressor
! The symptoms are significant as evidenced by
! Marked distress that is out of proportion to the severity of intensity of the stressor
! Significant impairment in social, occupational, or other important areas of functioning
! Criteria is not met for any other mental disorder
! The symptoms do not represent normal bereavement
! The symptoms do not persist for more than 6 months after the stressor is
terminated
! Criteria and subtypes are unchanged.
+“Other”Trauma- Stressor Related
Disorders
! Other Specified
Trauma- and Stressor-
Related Disorder pg
289
! 309.89 (F43.8)
! Clinician Specifies a
reason for the
diagnosis
! Unspecified Trauma-
and Stressor-Related
Disorder pg 290
! 309.9 (F43.9)
! No reason specified
by the clinician

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Assessments / Screenings
! The military has devoted many resources to assessing,
screening, and treating PTSD
! http://www.ptsd.va.gov/professional/assessment/screens/
index.asp
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! Medications
! Psychotherapy:
! Cognitive-behavioral therapy (CBT)
! Exposure Therapy (*Prolonged Exposure Therapy)
! Cognitive Restructuring
! Stress Inoculation Training
! Other
! Trauma Informed Care
! Neurocognitive Therapy
! Intensive Trauma Therapy
Trauma- and Stressor-Related
Disorders Treatment

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Dissociative Disorders
DSM-5
Dr. Christine Chasek LIMHP, LADC, NCC
+! What are the Dissociative Disorders?
! Major changes in this category.
! Derealization is now included in the name and structure of the
depersonalization disorder and is now called Depresonalization/
Derealization Disorder
! Dissociative Fugue is now a specifier of
Dissociative Amnesia rather than a
separate disorder
! Criteria for Dissociative Identity Disorder
have been changed to indicate that symptoms
of disruption to identity can be reported as
well as observed; may also occur in everyday events not just
traumatic ones

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+Diagnosis included in this category
of disorders:
! Dissociative Identity Disorder
! Dissociative Amnesia
! Depersonalization/Derealization
Disorder
! Other Specified Dissociative
Disorder
! Unspecified Dissociative Disorder
+ 300.14 (F44.81) Dissociative Identity
Disorder pg 292-298
! Characterized by the presence of two or more distinct
personality states or an experience of possession and
recurrent episodes of amnesia. This is what Sybil suffered
from. Remember Sybil??
! Changes~
! the inclusion of certain possession-form phenomena
and functional neurological symptoms have been added
to account for a more diverse presentation of the disorder.
! The transitions in identity may be observable by others or self-
reported
! Gaps in recall may occur in in everyday events not just
traumatic ones
! Kim Noble is a modern day woman with
many Personalities; she was featured on
Oprah; look her up- Fascinating! We have
come a long way with treatment.

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300.12 (F44.0) Dissociative Amnesia
pg. 298-302
! Characterized by an inability to remember autobiographical
information; it is more than just being forgetful.These
individuals lose time and can’t remember things about the
self.
! Need to assess for and code Dissociative Fugue: purposeful
travel or bewildering wondering; this is coded 300.13 (F44.1)
Dissociative Amnesia, with dissociative fugue
This disorder is the “plot” of 50 First Dates
+300.6 (F48.1) Depersonalization/
Derealization Disorder pg 302-306
! The essential feature of this disorder is experiences of
unreality or detachment from one’s mind, self, or body or
surroundings; however the person does have intact reality
testing.
! Either one or both can be present for this diagnosis to be
made.

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Other and Unspecified
Dissociative Disorder pg306-307
! 300.15 (F44.89) Other
Specified Dissociative
Disorder
! Used when there is evidence
of Dissociative disorder
criteria that causes significant
distress but does not meet all
the required criteria for a
specific dissociative or other
related disorder
! Clinician describes the
reasons for this diagnosis
! 300.15 (F44.9)
Unspecified Dissociative
Disorder
! Used when there is evidence
of dissociative disorder
criteria that causes significant
distress but does not meet all
the required criteria for a
specific dissociative or other
related disorder but the
clinician does NOT want to
describe the reasons for this
diagnosis
+Treatment
! This class of disorders requires specialized
training in order to be effective as a clinician
! Psychotherapy:
! Cognitive-behavioral therapy (CBT)
! Medication
! There is no specific medication for dissociative
disorder, the medication is used to treat the
symptoms related to the disorder such as
depression
! Other
! Art Therapy
! Hypnosis
! Eye Movement Desensitization (EMDR)

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Feeding and Eating Disorders
DSM-5
Dr. Christine Chasek LIMHP, LADC, NCC
+Feeding and Eating Disorders
! What are the Eating and Feeding Disorders?
! Previously call Eating Disorders
! Includes several feeding and eating disorders that were included
in the DSM-IV-TR in the Disorders First Diagnosed in Infancy,
Childhood, and Adolescence.
! Characterized by a persistent disturbance of eating or eating-
related behavior that results in the altered consumption of or
absorption of food that significantly affects physical health or
psychosocial functioning.
! This chapter is greatly expanded from DSM-IV-TR

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+Diagnoses included in this Disorder:
! Pica
! Rumination Disorder
! Avoidant/Restrictive Food Intake Disorder
! Anorexia Nervosa
! Bulimia Nervosa
! **Binge-Eating Disorder
! Other Specified Feeding or Eating Disorder
! Unspecified Feeding or Eating Disorder
+Eating Disorders
! Characterized by severe disturbances in eating behavior
! 307.1 (the ICD-10 code depends on the subtype) Anorexia
Nervosa
! Criteria are largely unchanged from DSM-IV-TR; however the
amenorrhea criteria has been eliminated and more clarity has
been provided for some of the other criteria.
! 307.51 (F50.2) Bulimia Nervosa
! The only change in criteria is a reduction in the required
minimum average frequency of binge
eating and inappropriate compensatory
behaviors from twice weekly to once
weekly.

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New Disorder Alert!!!
! 307.51 (F50.8) Binge Eating Disorder pg 350-353
! This has been researched extensively and was in the
Appendix of DSM-IV-TR
! Criteria: recurrent episodes of binge-eating that
must occur on average at least once per week for 3
months
! An episode of binge-eating is defined as eating in a
discrete period of time an amount of food that is
definitely larger than most people would eat in a
similar time under similar circumstances
! Must be accompanied by a sense of lack of control
! Must not be any “compensatory” behaviors to rid
body of the food (this is bulimia criteria)
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Personality Disorders
DSM-5
Dr. Christine Chasek LIMHP, LADC, NCC

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+! Did the Personality Disorders Change?
Short Answer NO; same as DSM-IV-TR
Now let me tell you the Longer answer…………
+What is a Personality Disorder?
! 10 Specific personality Disorders
! A Personality Disorder is an:
! enduring pattern of inner experience and behavior that deviates markedly
from the expectations of the individual s culture;
! is pervasive and inflexible;
! has an onset in early adolescence or early adulthood;
! is stable over time; and
! leads to distress or impairment.
! From DSM-IV-TR to DSM-5: There was to be a major revision of personality
disorders however the research was not conclusive to make a major
change. Therefore, more research is needed and is on-going. Personality
disorders are also in Section III of the DSM-5.

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Personality Disorders
! Paranoid Personality Disorder
! Schizoid Personality Disorder
! Schizotypal Personality
Disorder
! Antisocial Personality Disorder
! Borderline Personality
Disorder
! Histrionic Personality Disorder
! Narcissistic Personality
Disorder
! Avoidant Personality Disorder
! Dependent Personality
Disorder
! Obsessive-compulsive
Personality Disorder
! Personality change due to
another medical condition
! Other Specified Personality
Disorder and Unspecified
Personality Disorder
+ Personality Disorders
! Cluster A : These individuals often appear odd or eccentric
! 301.0 (F60.0) Paranoid Personality Disorder pg 649: pattern of
distrust and suspiciousness
! 301.20 (F60.1) Schizoid Personality Disorder pg 652: detachment
from social relationships, restricted range of emotional expression
! 301.22 (F21) Schizotypal Personality Disorder pg 655:acute
discomfort in close relationships, cognitive or perceptual
distortions, eccentric behavior

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+ Personality Disorders
! Cluster B : These individuals appear dramatic, emotional, or
erratic
! 301.7 (F60.2) Antisocial Personality Disorder, pg 659: disregard
for and violation of the rights of others
! https://www.youtube.com/watch?v=0qyCR9tPDgM
! 301.83 (F60.3) Borderline Personality Disorder, pg 663 : pattern of
instability in interpersonal relationships, self-image, and affects,
marked impulsivity
! 301.50 (F60.4) Histrionic Personality Disorder pg. 667: pattern of
excessive emotionality and attention seeking
! 301.81(F60.81) Narcissistic Personality Disorder pg. 669: pattern
of grandiosity, need for admiration, and lack of empathy
https://www.youtube.com/watch?v=FRTgvq-Wfi4
+ Personality Disorders
! Cluster C : These individuals often appear anxious or fearful
! 301.82 (F60.6) Avoidant Personality Disorder, pg 672 – pattern of
social inhibition, feelings of inadequacy and hypersensitivity to
negative evaluation
! 301.6 (F60.7) Dependent Personality Disorder, pg 675- pattern of
submissive and clinging behavior related to an excessive need to
be taken care of
! 301.4 (F60.5) Obsessive-Compulsive
Personality Disorder, pg 678 -
pattern of preoccupation with
orderliness, perfectionism, and control

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+ Other Personality Disorders
! 310.1 (F07.0) Personality Change Due to Another Medical
Condition pg 682
! 301.89 (F60.89) Other Specified Personality Disorder pg 684
! 301.9 (F60.9) Unspecified Personality Disorder pg 684
! the personality pattern meets the general criteria for a personality
disorder and traits of several different personality disorders are present,
but the criteria for any specific disorder is not met; clinician can choose to
specify or not
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Treatment Options
! CBT : Cognitive Behavioral Therapy
! DBT : Dialectic Behavioral Therapy
! Medications – some work

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+Other Categories of Mental
Disorders Included in DSM-5
! SleepWake Disorders: Provides greater specificity for sleep
disorders to highlight that sleep disorders are needing of their
own clinical attention rather than as a part of a medical condition
! Somatic Symptoms and Related Disorders : Used to be
Somatoform Disorders; Hypochondrias has been removed
! Sexual Dysfunctions: More specification regarding the
differences in gender specific sexual dysfunctions have been
made
! Neurocognitive Disorders: Includes the disorders of delirium,
dementia, and amnestic disorders; all renamed
! Paraphilic Disorders: Major changes include specifiers “in a
controlled environment” and “in remission”; changed from
Paraphilia to Paraphilic Disorders
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Next Steps for DSM 5- What does this
mean for you?
Making the Switch : Deciding when and how
THE TIME IS NOW!!!
! As a group (your practice) decide when to change and have a plan
! Things to consider that may influence your decision:
! The new ICD-10 will be mandatory 10-1-15.
! Frequently Asked Questions Document _APA
! Frequently Asked Questions Value Options
! Frequently asked Questions Medicaid/Medicare

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+Questions / Wrap Up / Evaluations
! Questions?
! Thank you for coming!!