DSM-5-TR - Trauma- and Stressor-Related Disorders

Posttraumatic Stress Disorder

Core: Symptoms after exposure to death, serious injury, or sexual violence (direct, witnessed, learned, or repeated exposure).

Criteria (Adults >6)

Intrusion (≥1): memories, nightmares, flashbacks, distress/physiological reactivity.

Avoidance (≥1): of thoughts/feelings or external reminders.

Negative mood/cognition (≥2): amnesia, negative beliefs/blame, negative mood, loss of interest, detachment, inability to feel positive emotions.

Arousal/reactivity (≥2): irritability, reckless behavior, hypervigilance, startle, poor concentration, sleep disturbance.

Duration >1 mo; distress/impairment; not substance/medical.

Specifiers

With dissociative symptoms (depersonalization, derealization).

With delayed expression (full criteria ≥6 mo post-trauma).

Children ≤6: Fewer symptoms required; often expressed via play, regression, withdrawal.

Prevalence: Lifetime 6-8% adults (higher in women, veterans, assault survivors); ~5% adolescents; lower in kids.

Course: Onset usually within 3 mo (may be delayed); half remit in 3 mo, others chronic; symptoms fluctuate with reminders.

Risk Factors

Pre: prior mental disorder, childhood adversity, low SES.

Peri: trauma severity, interpersonal violence, dissociation.

Post: poor support, further stressors, discrimination.

Genetic: modest heritability, neuroticism, impulsivity.

Impact: Major social, occupational, health impairment; poor relationships, job/school issues, ↓ quality of life. ↑ suicide risk.

Differential Dx: Adjustment disorder, acute stress disorder, OCD, MDD, GAD, ADHD, dissociative disorders, psychosis, TBI.

Comorbidity: Depression, bipolar, anxiety, substance use; in kids → ODD, separation anxiety.

Adjustment Disorders

Core: Emotional/behavioral symptoms in response to identifiable stressor(s), onset within 3 months.

Criteria

Distress out of proportion to stressor and/or impairment.

Not another mental disorder or normal bereavement.

Symptoms resolve within 6 months after stressor ends (unless persistent/chronic stressor).

Specifiers

With depressed mood (F43.21)

With anxiety (F43.22)

With mixed anxiety & depressed mood (F43.23)

With disturbance of conduct (F43.24)

With mixed disturbance of emotions & conduct (F43.25)

Unspecified (F43.20)

Acute (<6 mo) or Persistent/Chronic (≥6 mo, tied to ongoing stressor).

Features

Stressors: single, multiple, recurrent, continuous, or developmental (e.g., school, divorce, illness).

May complicate medical illness (noncompliance, longer hospital stay).

Prevalence

Common (5-20% in outpatients; up to 50% in hospital consults).

Higher in women.

Course

Onset within days of stressor, resolves within months if stressor ends.

Persistent form if stressor ongoing or has enduring consequences.

Risk Factors

Higher in disadvantaged backgrounds; migrants/refugees vulnerable.

Suicide Risk

Increased risk, esp. in migrants.

Impact

Impaired work/school performance, strained relationships, reduced functioning.

Differential Dx

MDD (meets full criteria).

PTSD/ASD (trauma type/timing different).

Personality disorders (lifelong patterns vs. stress reaction).

Bereavement (normative unless excessive/impairing; >12 mo → prolonged grief).

Psych factors affecting medical conditions (different causal pathway).

Normative stress reactions (less severe, no impairment).

Comorbidity

Can occur alongside most mental or medical disorders if stress-response symptoms are distinct.