Posttraumatic Stress Disorder and Acute Stress Disorder DSM-5

[PTSD] Diagnostic Criterion A (for 7+)

exposure to actual / threatened death, serious injury, or sexual violence in one or more of the following ways:

1. directly experienced the traumatic event

2. witnessed the traumatic event happen to someone else in person

3. learning the traumatic event happened to a close family member or friend

   • if event was actual / threatened death, it must have been violent or accidental

4. repeated or extreme exposure to details about the traumatic event

   • this doesn’t include exposure via electronic media, TV / movies, or pictures, unless the exposure is work-related

[PTSD] Diagnostic Criterion B (for 7+)

1+ intrusion symptoms associated w/ the traumatic event, only beginning after it happened

1. recurrent, involuntary, + intrusive distressing memories of the event

   • in kids: may appear as repetitive play involving themes / aspects of event

2. recurrent distressing dreams w/ content or affect related to event

   • in kids: dreams may be frightening without recognisable content

3. dissociative reactions (eg: flashbacks) in which the individual feels / acts like the event is recurring 

   • in kids: may be reenacted in play

4. intense / prolonged psychological distress when exposed to internal / external cues that symbolise / resemble an aspect of the event

5. marked physiological reactions to internal / external cues that symbolise / resemble an aspect of the event

[PTSD] Diagnostic Criterion C (for 7+)

one or both of these symptoms demonstrating persistent avoidance of stimuli associated w/ the traumatic event, starting after the event

1. avoiding / attempting to avoid distressing memories / thoughts / feelings about, or closely associated w/, the event

2. avoiding / attempting to avoid external reminders (eg: people, places, objects, situations, etc.) that prompt distressing memories / thoughts / feelings about, or closely associated w/, the event

[PTSD] Diagnostic Criterion D (for 7+)

2+ symptoms demonstrating negative changes in cognitions and mood associated w/ the traumatic event, starting or worsening after the event

1. inability to remember important part of the event (typically bc of dissociative amnesia — not TBI, alcohol, or drugs)

2. persistent + exaggerated negative beliefs / expectations of self, others, and/or the world

3. persistent distorted cognitions about cause / consequences of the event, leading to blaming self or others

4. persistent negative emotional state

5. diminished interest / participation in significant activities

6. feeling detached / estranged from others

7. persistent inability to experience positive emotions

[PTSD] Diagnostic Criterion E (for 7+)

2+ symptoms demonstrating marked changes in arousal + reactivity associated w/ traumatic event, starting or worsening after the event

1. irritable behaviour + angry outbursts (w/ little to no provocation), usually expressed as physical / verbal aggression toward people / objects

2. reckless / self-destructive behaviour

3. hypervigilance

4. exaggerated startle response

5. concentration problems

6. sleep disturbance (eg: difficult falling asleep, staying asleep, or restless sleep)

[PTSD] Diagnostic Criteria (for 7+)

A) traumatic event must meet criterion A

B) must experience 1+ intrusion symptoms, associated w/ traumatic event + starting after it happened

C) must experience 1+ avoidance symptoms, associated w/ traumatic event + starting after it happened

D) must experience 2+ cognition + mood symptoms, associated w/ traumatic event + starting / worsening after it happened

E) must experience 2+ arousal + reactivity symptoms, associated w/ traumatic event + starting / worsening after it happened

F) duration of the disturbance (criteria B - E) is longer than 1 month

G) causes clinically significant distress or impairs important areas of functionality

H) not attributable to physiological effects of a substance or another medical condition

[PTSD] Diagnostic Criterion A (for ≤6)

exposure to actual / threatened death, serious injury, or sexual violence in one or more of the following ways:

1. directly experienced the traumatic event

2. witnessed the traumatic event happen to someone else in person, esp. if it was a primary CG

3. learning the traumatic event happened to a parent or CG figure

[PTSD] Diagnostic Criterion B (for ≤6)

1+ intrusion symptoms associated w/ the traumatic event, only beginning after it happened

1. recurrent, involuntary, + intrusive distressing memories of the event

   • may not appear distressing + may be expressed in play reenactment

2. recurrent distressing dreams w/ content or affect related to event

   • may not be able to tell that content is related

3. dissociative reactions (eg: flashbacks) in which the individual feels / acts like the event is recurring. may be reenacted in play

4. intense / prolonged psychological distress when exposed to internal / external cues that symbolise / resemble an aspect of the event

5. marked physiological reactions to internal / external cues that symbolise / resemble an aspect of the event

[PTSD] Diagnostic Criterion C (for ≤6)

1+ symptoms, representing either persistent avoidance of stimuli (1 + 2) or negative changes in cognition / mood (3-6) associated w/ traumatic event, starting or worsening after event

1. avoiding / trying to avoid activities, places, and/or physical reminders that trigger memories of event avoidance)

2. avoiding / trying to avoid people, conversations, and/or interpersonal situations that trigger memories of event 

3. substantially increased frequency of negative emotional states

4. markedly decreased interest / participation in significant activities, including constriction of play

5. socially withdrawn behaviour

6. persistent reduction in expressing positive emotions

[PTSD] Diagnostic Criterion D (for ≤6)

2+ symptoms demonstrating marked changes in arousal + reactivity associated w/ traumatic event, starting or worsening after the event

1. irritable behaviour + angry outbursts (w/ little to no provocation), usually expressed as physical / verbal aggression toward people / objects, including extreme temper tantrums

2. hypervigilance

3. exaggerated startle response

4. concentration problems

5. sleep disturbance (eg: difficult falling asleep, staying asleep, or restless sleep)

[PTSD] Diagnostic Criteria (for ≤6)

A) traumatic event must meet criterion A

B) must experience 1+ intrusion symptoms, associated w/ traumatic event + starting after it happened

C) must experience 1+ avoidance and/or cognition + mood symptoms, associated w/ traumatic event + starting after it happened

D) must experience 2+ arousal + reactivity symptoms, associated w/ traumatic event + starting / worsening after it happened

E) duration of the disturbance (criteria B - D) is longer than 1 month

F) causes clinically significant distress or impairs relationships w/ others / school behaviour

G) not attributable to physiological effects of a substance or another medical condition

[PTSD] Specifiers

• w/ dissociative symptoms: meet criteria for PTSD, plus persistent + recurrent symptoms of depersonalisation (detached from + outside observer of mental processes / body) or derealisation (unreality of surroundings), not attributable to substance or another medical condition

• w/ delayed expression: full diagnostic criteria for PTSD not met until 6+ months after the traumatic event, tho some symptom onset / expression may be immediate

[PTSD] Diagnostic Features

• clinical presentation varies: some people’s symptoms are predominantly dissociative, some are arousal / reactive, some fear-based, etc. + some show combinations of symptom patterns

• being bullied can count as a criterion A experience if there’s a credible threat of serious harm / sexual violence

• life-threatening illness / debilitating medical condition can count as a traumatic experience if it was a life-threatening medical emergency (eg: anaphylaxis) or a particular event in treatment that caused catastrophic feelings of terror / pain / helplessness / imminent death

• exposure to multiple traumatic events is common — can be different types at different times, or same type during an extended period / during different times

  • may be useful to determine if there’s a “worst” example event to use for criteria B + C — but if they can’t pick one, just use the overall exposure

• distinguish intrusive recollections from rumination — they have vivid, sensory, + emotional parts that cause distress

• dissociative states (flashbacks) take place on a spectrum, from brief sensory flashes of the event to a complete loss of awareness of current surroundings

[PTSD] Associated Features

• developmental regression

• auditory pseudo-hallucinations + paranoid ideation

• following prolonged, repeated, + severe traumatic events: difficult regulating emotions, maintaining stable relationships, + dissociative symptoms

• if traumatic event involves violent death of a close relationship, symptoms of prolonged grief disorder may also be present

[PTSD] Prevalence

• lifetime prevalence for US adults: 6.1 - 8.3%

• higher among veterans + people w/ jobs that increase risk of traumatic exposure 

• highest rates (btwn 1/3 - ½ of those exposed to trauma) in survivors of rape, military combat + captivity, internment + genocide

• may vary across development: children + adolescents have generally shown lower prevalence after exposure to serious traumatic events, but that may be bc prev. criteria weren’t developmentally informed enough

• higher rates in US Latinx, African Americans, + Native Americans than white people

[PTSD] Development + Course

• can occur at any age after first year of life

• symptoms usually start within 3 months after the traumatic event, but may be delayed by months or years

• duration of symptoms varies: ½ of adults have full recovery within 3 months, while others are symptomatic for years / decades

• symptoms may recur / intensify in response to reminders of original trauma, ongoing life stressors, or to new traumatic events

• clinical expression of reexperiencing varies across development

[PTSD] Pretraumatic Risk Factors

• temperamental: personality traits associated w/ negative emotional responses, childhood emotional problems by age 6, prior mental disorders

• environmental: lower socioeconomic status, education, or intelligence; exposure to prior trauma (esp. childhood); childhood adversity; ethnic discrimination + racism; family psychiatric history

• genetic: moderately heritable, may be epigenetic

[PTSD] Peritraumatic Risk Factors

• environmental: severity of trauma, perceived life threat, personal injury, interpersonal violence (esp. trauma committed by a caregiver or involving witnessing a threat to a caregiver in kids), dissociation, fear, panic, + other peritraumatic responses that persister after end of trauma. in military personnel: being a perpetrator, witnessing atrocities, killing the enemy

[PTSD] Posttraumatic Risk Factors

• temperamental: negative appraisals, inappropriate coping strategies, development of acute stress disorder

• environmental: subsequent exposure to upsetting reminders of trauma, subsequent adverse life events, financial + other trauma-related losses. forced migration + high levels of daily stressors and exposure to racial / ethnic discrimination can lead to a more chronic course

[PTSD] Culture-Related Diagnostic Issues

• different demographics have different levels of exposure to traumatic events — risk of developing PTSD following similar levels of exposure may vary across cultural, ethnic, + racialised gaps

• harder to predict individual PTSD in communities exposed to pervasive + ongoing traumatic environments

• some cultural contexts see blaming self / having negative beliefs about self in response to trauma as normative behaviour (eg: karma)

• cultural concepts of distress can influence presentation

[PTSD] Sex + Gender-Related Diagnostic Issues

• more prevalent in women across lifespan: 8 - 11% of women vs. 4.1 - 5.5% of men

• potentially due to women’s increased risk for likelihood of childhood sexual abuse, sexual assault, + other forms of interpersonal violence (forms of trauma w/ highest risks for PTSD)

• difference may also be caused by gender differences in emotional + cognitive processing of trauma, + the effects of reproductive hormones

• typically women experience PTSD longer than men do

• overall, symptom profiles + factor structures are similar between women + men

[PTSD] Functional Consequences

• associated w/ suicidal thoughts, suicide attempts, + suicide deaths

• associated w/ likelihood of escalating from suicidal thoughts to a suicide plan or attempt

• associated w/ high impairment in functioning, lower quality of life, + physical health problems

• associated w/ poor social + family relationships, absenteeism from work, & lower income, education, + work success

[PTSD] Psychotherapy

• trauma-focused therapies = gold standard

• trauma-focused cognitive behavioural therapies (TF-CBT): identify + change maladaptive trauma-related thoughts, feelings, + behaviours

  • cognitive processing therapy (CPT): writing + re-evaluating trauma narratives, challenging distorted trauma-related beliefs

  • prolonged exposure therapy (PE): repeated, controlled re-exposure to trauma memories (imaginal exposure) + trauma reminders (in vivo exposure), reducing reactivity + avoidance

  • trauma-focused cognitive behavioural therapy (TF-CBT): modified for kids + adolescents, focusing on psychoeducation, relaxation, affect regulation, + gradual exposure

• eye moment desensitisation + reprocessing (EMDR)

  • combines trauma recall w/ bilateral stimulation

  • reprocess distressing memories, reducing their emotional intensity

  • shown to be as effective as PE + TF-CBT for many clients

• narrative exposure therapy (NET)

  • developed for complex trauma + refugees

  • builds chronological life narrative integrating traumatic + non-traumatic experiences

• brief eclectic psychotherapy (BEP)

  • integrates parts of CBT, psychodynamic therapy, + psychoeducation

  • focus on emotional processing + meaning making

[PTSD] Psychotherapy

• used as adjunct or second-line treatment 

• first-line meds: SSRIS (reduce hyperarousal, avoidance behaviours, + intrusive symptoms) + SNRIs (core PTSD symptoms + comorbid anxiety / depression)

• adjunctive / targeted meds: prazosin (trauma-related nightmares, sleep disturbances), atypical antipsychotics (severe agitation + intrusive thoughts), mood stabilisers (for prominent irritability / impulsivity)

• not recommended: benzos (can worsen avoidance, dependence risk, impede recovery) + opioids / cannabis (may complicate trauma-related symptoms)

[PTSD] Supportive + Complementary Approaches

• group therapy: normalises experiences, provides peer support + shared coping strategies; works best when trauma-focused

• family / couples therapy: focus on relationship strain, communication, + re-establishing trust after trauma; most useful when PTSD symptoms affect attachment or caregiving (esp. in vets / parents)

• mindfulness + somatic-based approaches: mindfulness-based stress reduction (MBSR), yoga, somatic experiencing, etc. reduces hyperarousal & improves emotional regulation + grounding

  • not primary treatments, but used adjunctly

[PTSD] Differential Diagnoses

• adjustment disorders

• other posttraumatic disorders + conditions

• acute stress disorder

• obsessive-compulsive disorder

• anxiety disorders

• major depressive disorder

• ADHD

• personality disorders

• dissociative disorders

• functional neurological symptom disorder (conversion disorder)

• psychotic disorders

• traumatic brain injury

[PTSD] Differential Diagnosis: Adjustment Disorders

in adjustment disorder, stressor can be of any severity / type — not bound to criterion A like PTSD

diagnosed when response to a criterion A event doesn’t meet all other PTSD criteria, or when the symptom pattern of PTSD happens in response to a non-criterion A event

[PTSD] Differential Diagnosis: Other Posttraumatic Disorders and Conditions

PTSD requires trauma exposure to happen before the onset / worsening of pertinent symptoms

if symptom response pattern to stressor meets criteria for another disorder, that diagnosis should be given instead of PTSD, or in addition to if severe

other diagnoses shouldn’t be given if the symptoms are better explained by PTSD

[PTSD] Differential Diagnosis: Acute Stress Disorder

symptom pattern in ASD only lasts between 3 days and 1 month after the traumatic event

[PTSD] Differential Diagnosis: Obsessive-Compulsive Disorder

recurrent intrusive thoughts also exist in OCD, but they meet criteria to be obsessions + probably aren’t related to an experienced traumatic event. compulsions are usually present + other PTSD symptoms are usually absent

[PTSD] Differential Diagnosis: Anxiety Disorders

panic disorder’s arousal + dissociative symptoms & general anxiety disorder’s avoidance, irritability, + anxiety aren’t associated w/ a specific traumatic event

symptoms of separation anxiety are linked to separation from home / family, not trauma

[PTSD] Differential Diagnosis: Major Depressive Disorder

MDD can be preceded by a traumatic event + should be diagnosed if full criteria are met. symptoms of MDD don’t include any of PTSD criterion B or C symptoms + doesn’t include many from criterion D or E

if full criteria for both disorders are met, both diagnoses should be given

[PTSD] Differential Diagnosis: ADHD

overlap in potential concentration problems — but ADHD symptom onset happens before age 12, whereas PTSD onset is after a traumatic event. PTSD concentration issues also stem from alertness to danger + exaggerated startle response

[PTSD] Differential Diagnosis: Personality Disorders

interpersonal problems that start or worsen after a traumatic event might be due to PTSD, whereas difficulties stemming from personality disorder would happen independently

[PTSD] Differential Diagnosis: Dissociative Disorders

dissociative amnesia, DID, + depersonalisation-derealisation disorder may or may not be preceded by a traumatic event + may or may not have co-occurring PTSD symptoms. if full PTSD criteria are met, PTSD w/ dissociative symptoms subtype should be considered

[PTSD] Differential Diagnosis: Functional Neurological Symptom Disorder (Conversion Disorder)

new onset of somatic symptoms after a traumatic event may indicate PTSD instead of conversion disorder

[PTSD] Differential Diagnosis: Psychotic Disorders

flashbacks must be distinguished from illusions / hallucinations that happen in psychiatric disorders or psychotic subtypes of other disorders, as they’re directly related to the traumatic event + occur in absense of other psychotic or substance-induced features

[PTSD] Differential Diagnosis: Traumatic Brain Injuries

some events increase risk of both PTSD + TBI bc they involve a head injury — may be comorbid in those cases. people w/ PTSD + TBI may have persistent postconcussive symptoms (eg: headaches, sensitivity to light / sound, dizziness, etc.), but these can also occur in non-brain-injury

may need differential diagnosis based on specific symptoms: reexperiencing + avoidance are PTSD characteristics, while persistent disorientation + confusion are more common in TBI. TBI memory problems are due to injury-related inability to encode the information, vs PTSD’s dissociative amnesia

[PTSD] Comorbidity

• more likely than people without PTSD to have symptoms meeting criteria for at least one other disorder

  • common: depressive, bipolar, anxiety, + substance use disorders

• higher risk of major neurocognitive disorder

• women are more likely to develop PTSD after a mild TBI

• young children also usually have at least one other disorder, but comorbidity patterns are different than adults

  • common: oppositional defiant disorder + separation anxiety disorder

[Acute Stress Disorder] Diagnostic Criterion A

exposure to actual / threatened death, serious injury, or sexual violence in one or more of the following ways:

1. directly experienced the traumatic event

2. witnessed the traumatic event happen to someone else in person

3. learning the traumatic event happened to a close family member or friend

   • if event was actual / threatened death, it must have been violent or accidental

4. repeated or extreme exposure to details about the traumatic event

   • this doesn’t include exposure via electronic media, TV / movies, or pictures, unless the exposure is work-related

[Acute Stress Disorder] Diagnostic Criterion B

9+ symptoms from any of the 5 categories: intrusion, negative mood, dissociation, avoidance, + arousal. symptoms start or worsen after a traumatic event.

INTRUSION

1. recurrent, involuntary, + intrusive distressing memories of traumatic event

2. recurrent distressing dreams w/ content or affect related to traumatic event

3. dissociative reactions (eg: flashbacks) in which the person feels / acts like the traumatic event is recurring

4. intense / prolonged psychological distress or physiological reactions to internal / external cues that symbolise / resemble an aspect of the traumatic event

NEGATIVE MOOD

1. persistent inability to experience positive emotions

DISSOCIATIVE

1. altered sense of reality of surroundings / self

2. inability to remember an important part of the traumatic event

AVOIDANCE

1. efforts to avoid distressing memories / thoughts / feelings about or associated w/ the traumatic event

2. efforts to avoid external reminders that trigger distressing memories / thoughts / feelings about or associated w/ the traumatic event

AROUSAL

1. sleep disturbance

2. irritable behaviour + angry outbursts (usually w/ little or no provocation), usually as verbal / physical aggression to people / objects

3. hypervigilance

4. concentration problems

5. exaggerated startle response

[Acute Stress Disorder] Diagnostic Criteria

A) traumatic event has to meet criterion A

B) 9+ symptoms from intrusion, negative mood, dissociation, avoidance, + arousal categories, starting or worsening after traumatic event

C) disturbance duration lasts between 3 days - 1 month after the traumatic event

• symptoms usually start right after the event, but persistence for at least 3 days is required

D) causes clinically significant distress or functional impairment

E) not attributable to physiological effects of a substance or another medical condition + can’t be better explained by brief psychotic disorder

[Acute Stress Disorder] Diagnostic Features

• presentation varies between people but usually involves anxiety response w/ some form of reexperiencing / reactivity to event

• some people present predominantly dissociative / detached, but usually still show strong emotional / physiological reactivity to trauma reminders

• some have strong anger response where reactivity is characterised by irritable / aggressive responses

• problems with sleep onset + maintenance are common

[Acute Stress Disorder] Associated Features

• common to have catastrophic / extremely negative thoughts about their role in the traumatic event, their response to the event, or potential of future harm

• may interpret their symptoms in catastrophic ways

• common to have panic attacks in the month after the event, either triggered by trauma reminders or seemingly spontaneously

• chaotic + impulsive behaviours

• separation anxiety in children

• acute grief reactions in cases of bereavement after traumatic loss (eg: intrusive memories about circumstances of death, anger + disbelief)

• frequently see postconcussive symptoms, both in people w/ + without brain injuries

[Acute Stress Disorder] Prevalence

• varies depending on the nature of the traumatic event + assessment context

• in US, UK, + Australia, <20% of ppl develop ASD after a traumatic event not involving interpersonal assault

  • 19 - 50% of ppl develop ASD after an interpersonal traumatic event

[Acute Stress Disorder] Development + Course

• can progress to PTSD after 1 month or remit

  • approx. ½ of people w/ PTSD had an ASD diagnosis first

• symptoms can remit, remain constant or worsen over time

  • usually bc of ongoing life stressors or more traumatic events

• forms of reexperiencing can vary across development stages

  • young kids may have scary dreams without trauma-related content

  • young kids might not show frightened reactions at the time of trauma or during reexperiencing

  • kids under 6 are more likely to express symptoms through play referring to trauma (directly or symbolically)

  • kids sometimes get preoccupied w/ reminders of trauma

  • parents usually report a range of emotional expression in traumatised kids (eg: anger, shame, withdrawal, excessive brightness)

[Acute Stress Disorder] Risk + Prognostic Factors

• temperamental

  • risk factors: prior mental disorders, high levels of negative affectivity / neuroticism, higher perceived severity of event, avoidant coping style, catastrophic tendencies 

  • predictors: catastrophic tendences when evaluating traumatic experience (often w/ exaggerated appraisals of future harm / guilt / hopelessness)

• environmental

  • must be exposed to a traumatic event for ASD to occur

  • risk factor: history of past trauma

• genetic

  • risk factor: elevated reactivity prior to exposure

[Acute Stress Disorder] Culture-Related Diagnostic Issues

• symptoms (esp. dissociative, somatic, avoidance, + nightmares) can vary across cultures

• dissociative symptoms can have variant expressions (possession / trancelike behaviours) in some cultures

• panic symptoms may be more likely in Cambodians (trauma associated w/ khyâl attacks) + Latin Americans (ataque de nervios)

[Acute Stress Disorder] Sex + Gender-Related Diagnostic Issues

• more prevalent in women than men

  • potentially due to women’s increased risk for likelihood of childhood sexual abuse, sexual assault, + other forms of interpersonal violence

  • sex-linked neurobiological differences in stress response + sociocultural factors may also contribute

[Acute Stress Disorder] Functional Consequences

• in survivors of accidents, assaults, + rape: impaired functioning in social, interpersonal, + work areas

• extreme anxiety levels may interfere w/ sleep, energy levels, + ability to do tasks

• avoidance can lead to general withdrawal from situations that seem potentially threatening (eg: medical appointments, work, etc)

[Acute Stress Disorder] Differential Diagnoses

• adjustment disorders

• panic disorder

• dissociative disorders

• posttraumatic stress disorder

• obsessive-compulsive disorder

• psychotic disorders

• traumatic brain injuries

[Acute Stress Disorder] Differential Diagnosis: Adjustment Disorders

in adjustment disorders, stressors can be of any severity rather than having to meet criterion A

diagnosed when response to a criterion A event doesn’t meet the criteria for ASD (or another disorder), or when ASD symptom pattern happens in response to a non-criterion A event

some severe stress responses are better described w/ adjustment disorder even if they have some ASD symptoms — depressive, guilty, + angry responses, for example. important to distinguish rumination from intrusive thoughts in these cases

[Acute Stress Disorder] Differential Diagnosis: Panic Disorder

spontaneous panic attacks are common in ASD, but panic disorder diagnosis requires unexpected attacks w/ anxiety about future attacks or maladaptive behaviour changes to avoid future attacks

[Acute Stress Disorder] Differential Diagnosis: Dissociative Disorders

severe dissociative symptoms (without other ASD symptoms) can be diagnosed as derealisation/depersonalisation disorder

if severe amnesia of trauma persists (without other ASD symptoms), may be diagnosed w/ dissociative amnesia

[Acute Stress Disorder] Differential Diagnosis: Posttraumatic Stress Disorder

ASD symptom pattern must resolve within 1 month of traumatic event. if symptoms meet criteria for PTSD + last longer than 1mo, diagnosis changes to PTSD

[Acute Stress Disorder] Differential Diagnosis: Obsessive-Compulsive Disorder

recurrent intrusive thoughts also exist in OCD, but they meet criteria to be obsessions + probably aren’t related to an experienced traumatic event. compulsions are usually present + other ASD symptoms are usually absent

[Acute Stress Disorder] Differential Diagnosis: Psychotic Disorders

flashbacks must be distinguished from illusions / hallucinations that happen in psychiatric disorders or psychotic subtypes of other disorders, as they’re directly related to the traumatic event + occur in absense of other psychotic or substance-induced features

[Acute Stress Disorder] Differential Diagnosis: Traumatic Brain Injuries

some events increase risk of both ASD + TBI bc they involve a head injury — may be comorbid in those cases. people w/ ASD + TBI may have persistent postconcussive symptoms (eg: headaches, sensitivity to light / sound, dizziness, etc.), but these can also occur in non-brain-injury

may need differential diagnosis based on specific symptoms: reexperiencing + avoidance are ASD characteristics, while persistent disorientation + confusion are more common in TBI. TBI memory problems are due to injury-related inability to encode the information, vs ASD’s dissociative amnesia. symptoms of ASD only persist for up to 1mo after the traumatic event, while TBI symptoms may persist longer.