ABNORMAL PSYCHOLOGY
DSM – 5 – TR
TRAUMA AND STRESSOR
RELATED DISORDERs
o Exposure to a traumatic and stressful event.
Reactive Attachment Disorder
Diagnostic Criteria
A. A consistent pattern of inhibited, emotionally
withdrawn behavior toward adult caregivers.
 Child rarely or minimally seeks comfort when
distressed.
 Rarely or minimally responds to comfort when
distressed.
B. Persistent social and emotional disturbance.
 Minimal social and emotional responsiveness
to others.
 Limited positive affect.
 Episodes of unexplained irritability, sadness,
or fearfulness that are evident even during
nonthreatening interactions with adult
caregivers.
C. The child has experienced a pattern of extremes of
insufficient care.
 Social neglect or deprivation in the form of
persistent lack of having basic emotional
needs met by caregiving adults (comfort,
stimulation, and affection).
 Repeated changes of the primary caregivers
that limit opportunities to form stable
attachments.
 Rearing in unusual settings that severely limit
opportunities to form selective attachments.
D. The care in Criterion C is presumed to be
responsible for the disturbed behavior in Criterion A
(e.g., the disturbances in Criterion A began following
the lack of adequate care in Criterion C).
E. The criteria are not met for autism spectrum
disorder.
F. The disturbance is evident before age 5 years.
G. The child has a developmental age of at least 9
months.
Specify if: Persistent:
The disorder has been present for more than 12
months.
Specify current severity:
Reactive attachment disorder is specified as severe
when a child exhibits all symptoms of the disorder,
with each symptom manifesting at relatively high
levels.
Diagnostic Features
 Characterized by a pattern of markedly
disturbed and developmentally
inappropriate attachment behaviors, in
which a child rarely or minimally turns
preferentially to an attachment figure for
comfort, support, protection, and
nurturance.
 The essential feature is absent of grossly
underdeveloped attachment between the
child and putative caregiving adults.
 Believed to have the capacity to form
selective attachments.
 Because of limited opportunities during
early development, they fail to show the
behavioral manifestations of selective
attachments.
WHEN DISTRESSED:
 they show no consistent effort to obtain
comfort, support, nurturance, or protection
from caregivers.
 children with this disorder do not respond
more than minimally to comforting efforts
of caregivers.
*The disorder is associated with the absence of
expected comfort seeking and response to
comforting behaviors.
 show diminished or absent expression of
positive emotions during routine
interactions with caregivers.
 their emotion regulation capacity is
compromised, and they display episodes of
negative emotions of fear, sadness, or
irritability that are not readily explained.
Should not be made in children who are
developmentally unable to form selective
attachments.
The child must have a developmental age of at least
9 months.
Associated Features
Social Neglect
Often co-occurs with developmental delays (delays
in cognition and language)
Other associated features include stereotypies and
other signs of severe neglect (e.g., malnutrition or
signs of poor care)
ABNORMAL PSYCHOLOGY
DSM – 5 – TR

TREATMENT
Treating Reactive Attachment Disorder typically
involves a comprehensive approach that addresses
the child's emotional, social, and developmental
needs, as well as providing support and guidance
for caregivers.
 Psychotherapy: Individual therapy, play
therapy, or family therapy can help the child
develop secure attachments, process past
trauma, and learn healthy coping skills.
 Attachment-focused interventions:
Therapeutic approaches specifically
designed to promote secure attachments,
such as Dyadic Developmental
Psychotherapy (DDP) or Attachment and
Biobehavioral Catch-up (ABC).
 Parenting support and education:
Caregivers may benefit from education
about attachment theory, trauma-informed
care, and strategies for promoting healthy
attachment and emotional regulation in
their child.
 Supportive services: Access to community
resources, support groups, and specialized
services may be helpful for families coping
with the challenges of Reactive Attachment
Disorder.

DISINHIBITED SOCIAL ENGAGEMENT

DISORDER
DIAGNOSTIC CRITERIA
A. A pattern of behavior in which a child actively
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
approaches and interacts with unfamiliar adults and
exhibits at least two of the following:
 Reduced or absent reticence in approaching
and interacting with unfamiliar adults.
 Overly familiar verbal or physical behavior
(that is not consistent with culturally
sanctioned and with age-appropriate social
boundaries).
 Diminished or absent checking back with
adult caregiver after venturing away, even
in unfamiliar settings.
 Willingness to go off with an unfamiliar
adult with minimal or no hesitation.
B. The behaviors in Criterion A are not limited to
impulsivity (as in attentiondeficit/hyperactivity
disorder) but include socially disinhibited behavior.
C. The child has experienced a pattern of extremes
of insufficient care as evidenced by at least one of
the following:
 Social neglect or deprivation in the form of
persistent lack of having basic emotional
needs for comfort, stimulation, and
affection met by caregiving adults.
 Repeated changes of primary caregivers
that limit opportunities to form stable
attachments (e.g., frequent changes in
foster care).
 Rearing in unusual settings that severely
limit opportunities to form selective
attachments (e.g., institutions with high
child-to-caregiver ratios).
D. The care in Criterion C is presumed to be
responsible for the disturbed behavior in Criterion A
(e.g., the disturbances in Criterion A began
following the pathogenic care in Criterion C).
E. The child has a developmental age of at least 9
months.
Specify if: Persistent:
The disorder has been present for more than 12
months.
Specify current severity:
Disinhibited social engagement disorder is specified
as severe when the child exhibits all symptoms of
the disorder, with each symptom manifesting at
relatively high levels.
DIAGNOSTIC FEATURES
A pattern of behavior that involves culturally
inappropriate, overly familiar behavior with relative
strangers (Criterion A).
Violates the social boundaries of the culture.
Should not be made before children are
developmentally able to form selective
attachments.
 The child must have a developmental age of
at least 9 months.
Associated features
Social Neglect
Disinhibited social engagement disorder may co-
occur with developmental delays, especially
cognitive and language delays, stereotypies, and
other signs of severe neglect, such as malnutrition
or poor care.
Signs of the disorder often persist even after these
other signs of neglect are no longer present.
It is not uncommon for children with the disorder to
present with no current signs of neglect.
The condition can present in children who show no
signs of disordered attachment.
Disinhibited social engagement disorder may be
seen in children with a history of neglect who lack
attachments or whose attachments to their
caregivers range from disturbed to secure.
TREATMENT
Treatment for Disinhibited Social Engagement
Disorder often involves a comprehensive approach
that addresses the child's emotional, social, and
developmental needs, as well as providing support
and guidance for caregivers.
Psychotherapy: Individual therapy, play therapy, or
family therapy can help the child develop
appropriate social boundaries, improve social skills,
and process past trauma.
Attachment-focused interventions: Therapeutic
approaches aimed at promoting secure
attachments and healthy social relationships, such
as Dyadic Developmental Psychotherapy (DDP) or
Attachment and Biobehavioral Catch-up (ABC).
Parenting support and education: Caregivers may
benefit from education about attachment theory,
trauma-informed care, and strategies for promoting
healthy social development in their child.
POSTTRAUMATIC STRESS DISORDER
DIAGNOSTIC CRITERIA
Posttraumatic Stress Disorder in Individuals Older
than 6 Years
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
Note: The following criteria apply to adults,
adolescents, and children older than 6 years.
A. Exposure to actual or threatened death, serious
injury, or sexual violence in one (or more) of the
following ways:
 Directly experiencing the traumatic
event(s).
 Witnessing, in person, the event(s) as it
occurred to others.
 Learning that the traumatic event(s)
occurred to a close family member or close
friend. In cases of actual or threatened
death of a family member or friend, the
event(s) must have been violent or
accidental.
 Experiencing repeated or extreme
exposure to aversive details of the
traumatic event(s) (e.g., first responders
collecting human remains; police officers
repeatedly exposed to details of child
abuse).
Note: Criterion A4 does not apply to exposure
through electronic media, television, movies, or
pictures, unless this exposure is work related.
B. Presence of one (or more) of the following
intrusion symptoms associated with the traumatic
event(s), beginning after the traumatic event(s)
occurred:
 Recurrent, involuntary, and intrusive
distressing memories of the traumatic
event(s).
Note: In children older than 6 years, repetitive play
may occur in which themes or aspects of the
traumatic event(s) are expressed.
 Recurrent distressing dreams in which the
content and/or affect of the dream are
related to the traumatic event(s).
Note: In children, there may be frightening dreams
without recognizable content.
 Dissociative reactions (e.g., flashbacks) in
which the individual feels or acts as if the
traumatic event(s) were recurring. (Such
reactions may occur on a continuum, with
the most extreme expression being a
complete loss of awareness of present
surroundings.)
Note: In children, trauma-specific reenactment
may occur in play.
 Intense or prolonged psychological distress
at exposure to internal or external cues
that symbolize or resemble an aspect of
the traumatic event(s).
 Marked physiological reactions to internal
or external cues that symbolize or
resemble an aspect of the traumatic
event(s).
C. Persistent avoidance of stimuli associated with
the traumatic event(s), beginning after the
traumatic event(s) occurred, as evidenced by one
or both of the following:
 Avoidance of or efforts to avoid distressing
memories, thoughts, or feelings about or
closely associated with the traumatic
event(s).
 Avoidance of or efforts to avoid external
reminders (people, places, conversations,
activities, objects, situations) that arouse
distressing memories, thoughts, or feelings
about or closely associated with the
traumatic event(s).
D. Negative alterations in cognitions and mood
associated with the traumatic event(s), beginning,
or worsening after the traumatic event(s) occurred,
as evidenced by two (or more) of the following:
 Inability to remember an important aspect
of the traumatic event(s) (typically due to
dissociative amnesia and not to other
factors such as head injury, alcohol, or
drugs).
 Persistent and exaggerated negative beliefs
or expectations about oneself, others, or
the world (e.g., “I am bad,” “No one can be
trusted,” “The world is completely
dangerous,” “My whole nervous system is
permanently ruined”).
 Persistent, distorted cognitions about the
cause or consequences of the traumatic
event(s) that lead the individual to blame
himself/herself or others.
 Persistent negative emotional state (e.g.,
fear, horror, anger, guilt, or shame).
 Markedly diminished interest or
participation in significant activities.
 Feelings of detachment or estrangement
from others.
 Persistent inability to experience positive
emotions (e.g., inability to experience
happiness, satisfaction, or loving feelings).
E. Marked alterations in arousal and reactivity
associated with the traumatic event(s), beginning,
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
or worsening after the traumatic event(s) occurred,
as evidenced by two (or more) of the following:
 Irritable behavior and angry outbursts
(with little or no provocation) typically
expressed as verbal or physical aggression
toward people or objects.
 Reckless or self-destructive behavior.
 Hypervigilance.
 Exaggerated startle response.
 Problems with concentration.
Sleep disturbance (e.g., difficulty falling or
staying asleep or restless sleep).
F. Duration of the disturbance (Criteria B, C, D, and
E) is more than 1 month.
G. The disturbance causes clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.
H. The disturbance is not attributable to the
physiological effects of a substance (e.g.,
medication, alcohol) or another medical condition.
Specify whether:
With dissociative symptoms: The individual’s
symptoms meet the criteria for posttraumatic
stress disorder, and in addition, in response to the
stressor, the individual experiences persistent or
recurrent symptoms of either of the following:
 Depersonalization: Persistent or recurrent
experiences of feeling detached from, and
as if one were an outside observer of, one’s
mental processes or body (e.g., feeling as
though one were in a dream; feeling a
sense of unreality of self or body or of time
moving slowly).
 Derealization: Persistent or recurrent
experiences of unreality of surroundings
(e.g., the world around the individual is
experienced as unreal, dreamlike, distant,
or distorted).
Note: To use this subtype, the dissociative
symptoms must not be attributable to the
physiological effects of a substance (e.g., blackouts,
behavior during alcohol intoxication) or another
medical condition (e.g., complex partial seizures).
Specify if:
With delayed expression: If the full diagnostic
criteria are not met until at least 6 months after the
event (although the onset and expression of some
symptoms may be immediate).
Posttraumatic Stress Disorder in Children 6 Years
and Younger
A. In children 6 years and younger, exposure to
actual or threatened death, serious injury, or sexual
violence in one (or more) of the following ways:
 Directly experiencing the traumatic
event(s).
 Witnessing, in person, the event(s) as it
occurred to others, especially primary
caregivers.
 Learning that the traumatic event(s)
occurred to a parent or caregiving figure.
B. Presence of one (or more) of the following
intrusion symptoms associated with the traumatic
event(s), beginning after the traumatic event(s)
occurred:
 Recurrent, involuntary, and intrusive
distressing memories of the traumatic
event(s).
Note: Spontaneous and intrusive memories may
not necessarily appear distressing and may be
expressed as play reenactment.
 Recurrent distressing dreams in which the
content and/or affect of the dream are
related to the traumatic event(s).
Note: It may not be possible to ascertain that the
frightening content is related to the traumatic
event.
 Dissociative reactions (e.g., flashbacks) in
which the child feels or acts as if the
traumatic event(s) were recurring. (Such
reactions may occur on a continuum, with
the most extreme expression being a
complete loss of awareness of present
surroundings.) Such trauma-specific
reenactment may occur in play.
 Intense or prolonged psychological distress
at exposure to internal or external cues
that symbolize or resemble an aspect of
the traumatic event(s).
 Marked physiological reactions to
reminders of the traumatic event(s).
C. One (or more) of the following symptoms,
representing either persistent avoidance of stimuli
associated with the traumatic event(s) or negative
alterations in cognitions and mood associated with
the traumatic event(s), must be present, beginning
after the event(s) or worsening after the event(s):
Persistent Avoidance of Stimuli
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
 Avoidance of or efforts to avoid activities,
places, or physical reminders that arouse
recollections of the traumatic event(s).
 Avoidance of or efforts to avoid people,
conversations, or interpersonal situations
that arouse recollections of the traumatic
event(s).
Negative Alterations in Cognitions
 Substantially increased frequency of
negative emotional states (e.g., fear, guilt,
sadness, shame, confusion).
 Markedly diminished interest or
participation in significant activities,
including constriction of play.
 Socially withdrawn behavior.
 Persistent reduction in expression of
positive emotions.
D. Alterations in arousal and reactivity associated
with the traumatic event(s), beginning, or
worsening after the traumatic event(s) occurred, as
evidenced by two (or more) of the following:
 Irritable behavior and angry outbursts (with
little or no provocation) typically expressed
as verbal or physical aggression toward
people or objects (including extreme
temper tantrums).
 Hypervigilance.
 Exaggerated startle response.
 Problems with concentration. 5. Sleep
disturbance (e.g., difficulty falling or staying
asleep or restless sleep).
E. The duration of the disturbance is more than 1
month.
F. The disturbance causes clinically significant
distress or impairment in relationships with
parents, siblings, peers, or other caregivers or with
school behavior.
G. The disturbance is not attributable to the
physiological effects of a substance (e.g.,
medication or alcohol) or another medical
condition.
Specify whether: With dissociative symptoms:
The individual’s symptoms meet the criteria for
posttraumatic stress disorder, and the individual
experiences persistent or recurrent symptoms of
either of the following:
 Depersonalization: Persistent or recurrent
experiences of feeling detached from, and
as if one were an outside observer of, one’s
mental processes or body (e.g., feeling as
though one were in a dream; feeling a
sense of unreality of self or body or of time
moving slowly).
 Derealization: Persistent or recurrent
experiences of unreality of surroundings
(e.g., the world around the individual is
experienced as unreal, dreamlike, distant,
or distorted).
Note: To use this subtype, the dissociative
symptoms must not be attributable to the
physiological effects of a substance (e.g., blackouts)
or another medical condition (e.g., complex partial
seizures).
Specify if: With delayed expression: If the full
diagnostic criteria are not met until at least 6
months after the event (although the onset and
expression of some symptoms may be immediate).
Diagnostic Features
The development of characteristic symptoms
following exposure to one or more traumatic
events.
The clinical presentation of PTSD varies.
 fear-based reexperiencing, emotional, and
behavioral symptoms may predominate.
 anhedonic or dysphoric mood states and
negative cognitions may be most
prominent.
 arousal and reactive-externalizing
symptoms are prominent.
 dissociative symptoms predominate. Finally,
some individuals exhibit combinations of
these symptom patterns.
Note: Some individuals exhibit combinations of
these symptom patterns.
Specific criteria for PTSD refer to specific criteria for
adults; criteria for children 6 years or younger may
differ in criterion numbering given differences in
applicable criteria for this age group.
ASSOSIATED FEATURES
 Developmental regression, such as loss of
language in young children, may occur.
 Auditory pseudo-hallucinations, such as
having the sensory experience of hearing
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
one’s thoughts spoken in one or more recalling traumatic memories or triggers.
different voices, as well as paranoid This technique aims to help individuals
ideation, can be present. process traumatic memories and reduce
 Prolonged, repeated, and severe traumatic associated distress.
events (e.g., childhood abuse, torture), the  Medications: Antidepressants, particularly
individual may additionally experience selective serotonin reuptake inhibitors
difficulties in regulating emotions or (SSRIs) and serotonin-norepinephrine
maintaining stable interpersonal reuptake inhibitors (SNRIs), may be
relationships, or dissociative symptoms. prescribed to help alleviate symptoms of
 When the traumatic event involves the depression, anxiety, and hyperarousal
violent death of someone with whom the associated with PTSD.
individual had a close relationship,  Supportive interventions: Peer support
symptoms of both prolonged grief disorder groups, psychoeducation, stress
and PTSD may be present. management techniques, and relaxation
exercises can provide additional support
DIFFERENTIAL DIAGNOSIS and coping strategies for individuals with
 Adjustment Disorders PTSD.
 Other posttraumatic disorders and
conditions
 Acute Stress Disorder
 Anxiety Disorders and Obsessive-
Compulsive Disorder
 Major Depressive Disorder
 Attention-deficit/Hyperactivity Disorder
 Personality Disorders
 Dissociative Disorders
 Functional Neurological Symptom Disorder
(Conversion Disorder)
 Psychotic Disorders
 Traumatic Brain Injury

TREATMENT
Treatment for PTSD typically involves a combination
of psychotherapy, medication, and supportive
interventions.
 Cognitive-Behavioral Therapy (CBT): CBT,
including techniques such as exposure
therapy and cognitive restructuring, is often
considered the first-line treatment for PTSD.
Exposure therapy involves gradually
confronting and processing traumatic
memories or reminders in a safe and
controlled manner. Cognitive restructuring
ACUTE STRESS DISORDER
helps individuals challenge and change
Diagnostic Criteria
negative beliefs and thoughts related to the
A. Exposure to actual or threatened death, serious
traumatic event.
injury, or sexual violence in one (or more) of the
 Eye Movement Desensitization and
following ways:
Reprocessing (EMDR): EMDR is a specialized
 Directly experiencing the traumatic
form of therapy that involves bilateral
event(s).
stimulation (such as eye movements) while
 Witnessing, in person, the event(s) as it
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
occurred to others.
 Learning that the event(s) occurred to a
close family member or close friend.
Note: In cases of actual or threatened death of a
family member or friend, the event(s) must have
been violent or accidental.
 Experiencing repeated or extreme exposure
to aversive details of the traumatic event(s)
(e.g., first responders collecting human
remains, police officers repeatedly exposed
to details of child abuse).
Note: This does not apply to exposure through
electronic media, television, movies, or pictures,
unless this exposure is work related.
B. Presence of nine (or more) of the following
symptoms from any of the five categories of
intrusion, negative mood, dissociation, avoidance,
and arousal, beginning or worsening after the
traumatic event(s) occurred:
Intrusion Symptoms
 Recurrent, involuntary, and intrusive
distressing memories of the traumatic
event(s).
Note: In children, repetitive play may occur in which
themes or aspects of the traumatic event(s) are
expressed.
 Recurrent distressing dreams in which the
content and/or affect of the dream are
related to the event(s).
Note: In children, there may be frightening dreams
without recognizable content.
 Dissociative reactions (e.g., flashbacks) in
which the individual feels or acts as if the
traumatic event(s) were recurring. (Such
reactions may occur on a continuum, with
the most extreme expression being a
complete loss of awareness of present
surroundings.)
Note: In children, trauma-specific reenactment may
occur in play.
 Intense or prolonged psychological distress
or marked physiological reactions in
response to internal or external cues that
symbolize or resemble an aspect of the
traumatic event(s).
Negative Mood
 Persistent inability to experience positive
emotions (e.g., inability to experience
happiness, satisfaction, or loving feelings).
Dissociative Symptoms
 An altered sense of the reality of one’s
surroundings or oneself (e.g., seeing
oneself from another’s perspective, being in
a daze, time slowing).
 Inability to remember an important aspect
of the traumatic event(s) (typically due to
dissociative amnesia and not to other
factors such as head injury, alcohol, or
drugs).
Avoidance Symptoms
 Efforts to avoid distressing memories,
thoughts, or feelings about or closely
associated with the traumatic event(s).
 Efforts to avoid external reminders (people,
places, conversations, activities, objects,
situations) that arouse distressing
memories, thoughts, or feelings about or
closely associated with the traumatic
event(s).
Arousal Symptoms
 Sleep disturbance (e.g., difficulty falling or
staying asleep, restless sleep).
 Irritable behavior and angry outbursts (with
little or no provocation), typically expressed
as verbal or physical aggression toward
people or objects.
 Hypervigilance.
 Problems with concentration.
 Exaggerated startle response.
C. Duration of the disturbance (symptoms in
Criterion B) is 3 days to 1 month after trauma
exposure.
Note: Symptoms typically begin immediately after
the trauma, but persistence for at least 3 days and
up to a month is needed to meet disorder criteria.
D. The disturbance causes clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.
E. The disturbance is not attributable to the
physiological effects of a substance (e.g.,
medication or alcohol) or another medical condition
(e.g., mild traumatic brain injury) and is not better
explained by brief psychotic disorder.
DIAGNOSTIC FEATURES
The development of characteristic symptoms lasting
from 3 days to 1 month following exposure to one
or more traumatic events (Criterion A), which are
the same type as described in PTSD Criterion A.
May vary by individual but typically involves an
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
anxiety response that includes some form of
reexperiencing of or reactivity to the traumatic
event. Presentations may include intrusion
symptoms, negative mood, dissociative symptoms,
avoidance symptoms, and arousal symptoms
(Criterion B1–B14).
IN SOME INDIVIDUALS:
 a dissociative or detached presentation can
predominate, although these individuals
typically will also display strong emotional
or physiological reactivity in response to
trauma reminders.
 there can be a strong anger response in
which reactivity is characterized by irritable
or possibly aggressive responses.
Individuals with acute stress disorder may have a
persistent inability to feel positive emotions (e.g.,
happiness, joy, satisfaction, or emotions associated
with intimacy, tenderness, sexuality) but can
experience negative emotions such as fear, sadness,
anger, guilt, or shame (Criterion B5).
Alterations in awareness can include
depersonalization, a detached sense of oneself
(e.g., seeing oneself from the other side of the
room), or derealization, having a distorted view of
one’s surroundings (e.g., perceiving that things are
moving in slow motion, seeing things in a daze, not
being aware of events that one would normally
encode) (Criterion B6).
Some individuals also report an inability to
remember an important aspect of the traumatic
event that was presumably encoded. This symptom
is attributable to dissociative amnesia and is not
attributable to head injury, alcohol, or drugs
(Criterion B7).
Stimuli associated with the trauma are persistently
avoided. The individual commonly makes deliberate
efforts to avoid thoughts, memories, or feelings
(e.g., by using distraction or suppression
techniques, including substance use, to avoid
internal reminders) (Criterion B8)
To avoid activities, conversations, objects,
situations, or people who arouse recollections of it
(Criterion B9)
Individuals with acute stress disorder to experience
problems with sleep onset and maintenance, which
may be associated with nightmares and safety
concerns or with generalized elevated arousal that
interferes with adequate sleep (Criterion B10).
May exhibit irritable behavior and may even engage
in aggressive verbal or physical behavior with little
or no provocation (e.g., yelling at people, getting
into fights, destroying objects) (Criterion B11).
Often characterized by a heightened vigilance for
potential threats, including those that are related to
the traumatic experience (e.g., following a motor
vehicle accident, being especially sensitive to the
threat potentially caused by cars or trucks) and
those not related to the traumatic event (e.g., being
fearful of suffering a heart attack) (Criterion B12).
Concentration difficulties (Criterion B13) include
difficulty remembering familiar facts (e.g.,
forgetting one’s telephone number) or daily events
(e.g., having recently read part of a book or
newspaper) or attending to focused tasks (e.g.,
following a conversation for a sustained period of
time).
May be very reactive to unexpected stimuli,
displaying a heightened startle response or
jumpiness to loud noises (e.g., in response to a
telephone ringing) or unexpected movements
(Criterion B14).
Startle responses are involuntary and reflexive
(automatic, instantaneous), and stimuli that evoke
exaggerated startle responses (Criterion B14) need
not be related to the traumatic event.
The full symptom picture must last for at least 3
days after the traumatic event but should not last
longer than 1 month (Criterion C). Symptoms that
occur immediately after the event but resolve in
less than 3 days would not meet criteria for acute
stress disorder.
ASSOCIATED FEATURES
Commonly engage in catastrophic or extremely
negative thoughts about their role in the traumatic
event, their response to the traumatic experience,
or the likelihood of future harm.
 (e.g., an individual with acute stress
disorder may feel excessively guilty about
not having prevented the traumatic event
or about not adapting to the experience
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
more successfully) including techniques such as trauma-
May also interpret their symptoms in a catastrophic focused cognitive restructuring and
manner, such that flashback memories or emotional exposure therapy, is often used to treat
numbing may be interpreted as a sign of diminished ASD. Exposure therapy involves gradually
mental capacity. confronting and processing traumatic
Experience panic attacks in the initial month after memories or triggers in a safe and
trauma exposure that may be triggered by trauma controlled manner to reduce distress and
reminders or may apparently occur spontaneously. reactivity.
May display chaotic or impulsive behavior. For  Medications: Antidepressants, particularly
example, individuals may drive recklessly, make selective serotonin reuptake inhibitors
irrational decisions, or gamble excessively. (SSRIs) and serotonin-norepinephrine
In children, there may be significant separation reuptake inhibitors (SNRIs), may be
anxiety, possibly manifested by excessive needs for prescribed to help alleviate symptoms of
attention from caregivers. anxiety, depression, and hyperarousal
In the case of bereavement following a death that associated with ASD.
occurred in traumatic circumstances, the  Supportive interventions: Psychoeducation,
symptoms of acute stress disorder can involve acute stress management techniques, relaxation
grief reactions. exercises, and peer support groups can
 reexperiencing, dissociative, and arousal provide additional support and coping
symptoms may involve reactions to the loss, strategies for individuals with ASD.
such as intrusive memories of the
circumstances of the individual’s death,
disbelief that the individual has died, and
anger about the death.
Postconcussive symptoms (e.g., headaches,
dizziness, sensitivity to light or sound, irritability,
concentration deficits), which occur frequently
following mild traumatic brain injury (TBI), are also
frequently seen in individuals with acute stress
disorder.
 equally common in brain-injured and non-
brain-injured populations, and the frequent
occurrence of postconcussive symptoms
could be attributable to acute stress
disorder symptoms.

Differential Diagnosis
 Adjustment Disorders
 Panic Disorder
 Dissociative Disorders
 Posttraumatic stress disorder
 Obsessive-compulsive disorder Adjustment Disorder
 Psychotic Disorders Diagnostic Criteria
 Traumatic Brain Injury A. The development of emotional or behavioral
symptoms in response to an identifiable stressor(s)
TREATMENT occurring within 3 months of the onset of the
Treatment for Acute Stress Disorder typically stressor(s).
involves a combination of psychotherapy, B. These symptoms or behaviors are clinically
medication, and supportive interventions. significant, as evidenced by one or both of the
 Cognitive-Behavioral Therapy (CBT): CBT, following:
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
 Marked distress that is out of proportion to
the severity or intensity of the stressor,
taking into account the external context
and the cultural factors that might influence
symptom severity and presentation.
 Significant impairment in social,
occupational, or other important areas of
functioning.
C. The stress-related disturbance does not meet the
criteria for another mental disorder and is not
merely an exacerbation of a preexisting mental
disorder.
D. The symptoms do not represent normal
bereavement and are not better explained by
prolonged grief disorder.
E. Once the stressor or its consequences have
terminated, the symptoms do not persist for more
than an additional 6 months.
Specify whether:
 F43.21 With depressed mood: Low mood,
tearfulness, or feelings of hopelessness are
predominant.
 F43.22 With anxiety: Nervousness, worry,
jitteriness, or separation anxiety is
predominant.
 F43.23 With mixed anxiety and depressed
mood: A combination of depression and
anxiety is predominant.
 F43.24 With disturbance of conduct:
Disturbance of conduct is predominant.
 F43.25 With mixed disturbance of
emotions and conduct: Both emotional
symptoms (e.g., depression, anxiety) and a
disturbance of conduct are predominant.
 F43.20 Unspecified: For maladaptive
reactions that are not classifiable as one of
the specific subtypes of adjustment
disorder.
Specify if:
 Acute: This specifier can be used to indicate
persistence of symptoms for less than 6
months.
 Persistent (chronic): This specifier can be
used to indicate persistence of symptoms
for 6 months or longer. By definition,
symptoms cannot persist for more than 6
months after the termination of the
stressor or its consequences. The persistent
specifier therefore applies when the
duration of the disturbance is longer than 6
months in response to a chronic stressor or
to a stressor that has enduring
consequences.
Diagnostic Features
The presence of emotional or behavioral symptoms
in response to an identifiable stressor is the
essential feature of adjustment disorders
(Criterion A).
The stressor may be a single event (e.g., a
termination of a romantic relationship), or there
may be multiple stressors (e.g., marked business
difficulties and marital problems).
Stressors may be recurrent (e.g., associated with
seasonal business crises, unfulfilling sexual
relationships) or continuous (e.g., a persistent
painful illness with increasing disability, living in a
crime-ridden neighborhood).
Stressors may affect a single individual, an entire
family, or a larger group or community (e.g., a
natural disaster).
Some stressors may accompany specific
developmental events (e.g., going to school, leaving
a parental home, reentering a parental home,
getting married, becoming a parent, failing to attain
occupational goals, retirement).
May be diagnosed following the death of a loved
one when the intensity, quality, or persistence of
grief reactions exceeds what normally might be
expected, when cultural, religious, or age-
appropriate norms are taken into account and the
grief reaction does not meet criteria for prolonged
grief disorder.
Differential Diagnosis
 Major Depressive Disorder
 Posttraumatic stress disorder
 Acute stress disorder
 Bereavement
 Psychological factors affecting other
medical conditions
 Normative stress reactions
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
Treatment
Treatment for Adjustment Disorder typically
involves psychotherapy, support, and coping
strategies to help individuals manage stressors and
adapt to changes.
 Psychotherapy: Cognitive-behavioral
therapy (CBT), supportive therapy, or
problem-solving therapy can help
individuals identify and address
maladaptive thoughts and behaviors,
develop effective coping skills, and improve
stress management techniques.
 Supportive interventions: Social support
from family, friends, or support groups can
provide emotional validation, practical
assistance, and a sense of belonging during
challenging times.
 Stress management techniques: Relaxation
exercises, mindfulness meditation, and
stress reduction strategies can help
individuals manage symptoms of anxiety,
depression, and other emotional distress
associated with Adjustment Disorder.
 Medications: In some cases, medications
such as antidepressants or anti-anxiety
medications may be prescribed to alleviate
symptoms of depression, anxiety, or sleep
disturbances. However, medication is
generally not the first-line treatment for
Adjustment Disorder and is typically
reserved for individuals with severe or
persistent symptoms.

Prolonged Grief Disorder

Diagnostic Criteria
A. The death, at least 12 months ago, of a person
who was close to the bereaved individual (for
children and adolescents, at least 6 months ago).
B. Since the death, the development of a persistent
grief response characterized by one or both of the
following symptoms, which have been present most
days to a clinically significant degree. In addition,
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
the symptom(s) has occurred nearly every day for at
least the last month:
 Intense yearning/longing for the deceased
person.
 Preoccupation with thoughts or memories
of the deceased person (in children and
adolescents, preoccupation may focus on
the circumstances of the death).
C. Since the death, at least three of the following
symptoms have been present most days to a
clinically significant degree. In addition, the
symptoms have occurred nearly every day for at
least the last month:
 Identity disruption (e.g., feeling as though
part of oneself has died) since the death.
 Marked sense of disbelief about the death.
 Avoidance of reminders that the person is
dead (in children and adolescents, may be
characterized by efforts to avoid
reminders).
 Intense emotional pain (e.g., anger,
bitterness, sorrow) related to the death.
 Difficulty reintegrating into one’s
relationships and activities after the death
(e.g., problems engaging with friends,
pursuing interests, or planning for the
future).
 Emotional numbness (absence or marked
reduction of emotional experience) as a
result of the death.
 Feeling that life is meaningless as a result of
the death.
 Intense loneliness as a result of the death.
D. The disturbance causes clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.
E. The duration and severity of the bereavement
reaction clearly exceed expected social, cultural, or
religious norms for the individual’s culture and
context.
F. The symptoms are not better explained by
another mental disorder, such as major depressive
disorder or posttraumatic stress disorder, and are
not attributable to the physiological effects of a
substance (e.g., medication, alcohol) or another
medical condition.
Diagnostic Features
Represents a prolonged maladaptive grief reaction
that can be diagnosed only after at least 12 months
(6 months in children and adolescents) have
elapsed since the death of someone with whom the
bereaved had a close relationship (Criterion A).
The condition involves the development of a
persistent grief response characterized by intense
yearning or longing for the deceased person (often
with intense sorrow and frequent crying) or
preoccupation with thoughts or memories of the
deceased, although in children and adolescents,
this preoccupation may focus on the circumstances
of the death.
The intense yearning/longing or the preoccupation
has been present most days to a clinically significant
degree and has occurred nearly every day for at
least the last month (Criterion B).
since the death, at least three additional symptoms
have been present most days to a clinically
significant degree and have occurred nearly every
day for at least the past month.
These symptoms include identity disruption since
the death (e.g., feeling as though part of oneself
has died) (Criterion C1)
 a marked sense of disbelief about the death
(Criterion C2)
 avoidance of reminders that the person is
dead, which in children and adolescents
may be characterized by efforts to avoid
reminders (Criterion C3)
 intense emotional pain (e.g., anger,
bitterness, guilt) since the death (Criterion
C4)
 having difficulty reintegrating into personal
relationships and activities since the death
(e.g., problems engaging with friends,
pursuing interests, or planning for the
future) (Criterion C5)
 emotional numbness (absence or marked
reduction of emotional experience) as a
result of the death (Criterion C6)
 feeling that life is meaningless as a result of
the death (Criterion C7)
 intense loneliness as a consequence of the
death (Criterion C8).
Must result in clinically significant distress or
impairment in social, occupational, or other
important areas of functioning in the bereaved
individual (Criterion D).
The nature, duration, and severity of the
bereavement reaction must clearly exceed expected
social, cultural, or religious norms for the
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
individual’s culture and context (Criterion E).
Associated Features
Often experience maladaptive cognitions about the
self, guilt about the death, and diminished future
life expectancy and life goals.
Somatic complaints commonly accompany the
condition and may be related to comorbid
depression and anxiety, social identity disruption,
and increased health care visits; the somatic
symptoms may be associated with those that were
experienced by the deceased (e.g., changes in
appetite).
Harmful health behaviors related to decreased self-
care and concern are also common in individuals
with symptoms of prolonged grief disorder.
Hallucinations about the deceased (e.g., hearing the
deceased person’s voice) may occur during normal
grief but may be more common in individuals with
symptoms of prolonged grief disorder.
 Hallucinations experienced by individuals
with prolonged grief disorder symptoms
may be associated with disruptions of social
identity and purpose related to the death
(e.g., confusion about one’s role in life,
feeling of meaninglessness).
Bitterness, anger, or restlessness; blaming others
for the death; and decreased sleep quantity and
quality.
Differential Diagnosis
 Normal Grief
 Depressive disorders
 Posttraumatic stress disorder
 Separation anxiety disorder
 Psychotic disorder
Treatment
Treatment for Prolonged Grief Disorder typically
involves a combination of psychotherapy, support,
and coping strategies to help individuals process
their grief and adapt to life without their loved one.
 Grief-focused psychotherapy: Therapeutic
approaches such as Complicated Grief
Therapy (CGT), which is specifically
designed to address symptoms of
prolonged grief, can help individuals
explore and process their emotions,
memories, and reactions to the loss. CGT
typically involves interventions aimed at
facilitating the completion of grieving tasks,
promoting emotional expression, and
fostering adaptation to the loss.
 Supportive interventions: Social support
from family, friends, support groups, or
bereavement organizations can provide
emotional validation, practical assistance,
and a sense of connection during the
grieving process.
 Cognitive-behavioral therapy (CBT): CBT
techniques may be used to help individuals
identify and challenge maladaptive
thoughts and behaviors related to the loss,
develop coping skills, and improve problem-
solving abilities.
 Medications: In some cases, medications
such as antidepressants or anti-anxiety
medications may be prescribed to alleviate
symptoms of depression, anxiety, or sleep
disturbances associated with prolonged
grief. However, medication is generally not
the first-line treatment for PGD and is
typically reserved for individuals with
severe or persistent symptoms.
Other Specified Trauma- and Stressor-Related
Disorder
This category applies to presentations in which
symptoms characteristic of a traumaand stressor-
related disorder that cause clinically significant
distress or impairment in social, occupational, or
other important areas of functioning predominate
but do not meet the full criteria for any of the
disorders in the trauma- and stressor-related
disorders diagnostic class. The other specified
ABNORMAL PSYCHOLOGY
DSM – 5 – TR
trauma- and stressor-related disorder category is and stressor-related disorder category is used in
used in situations in which the clinician chooses to situations in which the clinician chooses not to
communicate the specific reason that the specify the reason that the criteria are not met for a
presentation does not meet the criteria for any specific trauma- and stressor-related disorder and
specific trauma- and stressor-related disorder. This includes presentations in which there is insufficient
is done by recording “other specified trauma- and information to make a more specific diagnosis (e.g.,
stressor-related disorder” followed by the specific in emergency room settings).
reason (e.g., “persistent response to trauma with
PTSD-like symptoms”).
Examples of presentations that can be specified
using the “other specified” designation include the
following:
 Adjustment-like disorders with delayed
onset of symptoms that occur more than 3
months after the stressor.
 Adjustment-like disorders with prolonged
duration of more than 6 months without
prolonged duration of stressor.
 Persistent response to trauma with PTSD-
like symptoms (i.e., symptoms occurring in
response to a traumatic event that fall short
of the diagnostic threshold for PTSD and
that persist for longer than 6 months,
sometimes referred to as
“subthreshold/partial PTSD”).
 Ataque de nervios: See “Culture and
Psychiatric Diagnosis” in Section III.
 Other cultural syndromes: See “Culture
and Psychiatric Diagnosis” in Section III.

Unspecified Trauma- and Stressor-Related Disorder

This category applies to presentations in which

symptoms characteristic of a traumaand stressor-
related disorder that cause clinically significant
distress or impairment in social, occupational, or
other important areas of functioning predominate
but do not meet the full criteria for any of the
disorders in the trauma- and stressor-related
disorders diagnostic class. The unspecified trauma-