TRAUMA & STRESSOR-RELATED DISORDERS

Indicated by a chronic pattern of emotionally withdrawn behavior with adult caretakers manifested before age 5, and child is developmentally at least 9 months old. Condition is revealed by the presence of both of the following: child rarely seeks comfort when distressed, child is minimally responsive to the comfort provided when distressed. Additionally, at least two of the following manifest: minimal social responsiveness, minimal positive affect, periods of inexplicable irritability, fear, or sadness during periods of nonthreatening interaction with adult caretakers. The child has received extremely insufficient care as revealed by at least one of the following: severe neglect due to chronic lack of adequate emotional care by adult care-takers, instability from having frequent changes in adult caretakers, being raised in settings that severely limit the availability of attachments to adult caretakers.

Manifested by a child's pattern of seeking out and interacting with unfamiliar adults, and the presence of at least two of the following: lack of reticence when interacting with unfamiliar adults, overly familiar physical or verbal behavior with unfamiliar adults, little regard for reconnecting with adult caretakers even in unfamiliar environments, unhesitatingly accompanying unfamiliar adults.

Condition lasts at least 1 month and results from experiencing actual or threatened death, serious injury, or sexual violence as manifested by at least one of the following;

• Directly experiencing or witnessing a traumatic
  event(s)
• Becoming aware of close friends or family members suffering a traumatic event(s)
• Repeated exposure to aversive aspects of traumatic
  events

Intrusion Symptoms: Presence of at least one of the following after experiencing traumatic event(s):

• Recurring distressing memories of the event
• Frequent nightmares involving the traumatic event (s)
• Flashbacks that may be accompanied by dissociative reactions as if the individual were reliving the traumatic event(s)
• Intense reactive distress when in the presence of cues that serve as reminders of the traumatic events)
• Severe physiological reactions upon exposure to cues resembling aspects of the traumatic event(s)
• 
  

Avoidance Symptoms: Chronic avoidance behaviors beginning after occurrence of traumatic events), as manifested by at least one of the following: attempts to avoid distressing thoughts, feelings or memories reminiscent of the traumatic event(s) avoidance of external stimuli that may serve a. reminders of the traumatic events).

Negative Mood: Negative transformations of mood or thought related to the traumatic events), with onset after the event transpired, and manifested by at least two of the following:

• Dissociative amnesia--inability to remember details of the traumatic event(s)
• Chronic and exceedingly negative attitudes and expectations about oneself, others, or surroundings
• Self-blame (or blame others) due to chronic inaccurate thoughts about the cause or effect of traumatic event(s)
• Chronic negative affect
• Loss of interest in significant activities
• Alienation from others
• Chronic inability to experience positive affect

Arousal Symptoms: Significant changes in sensitivity to traumatic event(s) starting or worsening after the traumatic event(s), as indicated by at least two of the following:

• Unprovoked irritability and temper tantrums
• Irresponsible self-destructive activities
• Hypervigilance
• Heightened startle reaction
• Difficulty in focusing and concentrating
• Disrupted sleep patterns

The symptoms of this disorder are the same as those for posttraumatic stress disorder. At least nine symptoms manifest starting immediately after the trauma and lasting from 3 days to 1 month.

Manifested by the appearance of emotional or behavioral symptoms as a reaction to definitive stress-inducing events, with such symptoms making their appearance within 3 months of the events). Symptoms include one or both of the following: severe distress that is disproportionate to the intensity of the stress-producing event, significant deterioration in key areas of functioning. Once the stress-producing events) or its consequences have ceased, symptoms endure for no more than 6 months.

Essential features include the presence of two or more distinct personality states or identities that recurrently assume control of the individual's behavior, accompanied with the inability to recall important personal information that is too extensive to be accounted for by ordinary forgetfulness.

The inability to recall important personal information, usually of a traumatic or stressful nature, that cannot be explained with ordinary forgetfulness.

Characterized by a persistent and recurring feeling of being estranged from oneself, of being a spectator of one's own life, and of being detached from one's mental processes or body that is accompanied by intact reality testing (i.e., the individual is aware that this is only a feeling of self-alienation and not reality as such).

Characterized by the presence of observable physical symptoms that are indicative of a general medical condition yet are not fully explained by a general medical condition, the direct effects of a substance, or another mental disorder. The symptoms must cause clinically significant distress or impairment in social, vocational, or other areas of functioning. Furthermore, the symptoms must be unintentional (not under voluntary control).

The preoccupation with the fear of having, or the idea that one is afflicted with, a serious disease based on the individual's misinterpretation of bodily symptoms functions.

Indicated by unexplained symptoms or deficits affecting voluntary motor or sensory functions that suggest a neurological or other general medical condition. Psychological factors are believed to be involved with the symptoms or deficits.

Psychological Factors Affecting Other Medical Conditions: A medical condition is negatively affected by psychological factors by exacerbating the medical condition, disrupting treatment, bringing about additional health risks, or exacerbating or eliciting additional symptoms.

These disorders are characterized by physical or psychological symptoms that are intentionally produced or feigned in order to pretend to be ill. The conclusion that a particular symptom is intentionally produced is made by reference to direct evidence (e.g., the individual is found to be in possession of drugs that can produce the symptoms) or by a process of elimination whereby alternative causes are ruled out.