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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