Trauma disorder changes in DSM-5

Changes in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) relating to trauma and stressor-related disorders have important implications for optimizing care of pediatric patients, said Mary Margaret Gleason, MD, assistant professor, departments of Pediatrics and Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana.

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In sessions titled “Trauma and stress in the DSM-5: Important diagnoses in pediatrics” held on Saturday, October 24, Dr Gleason discussed the addition of specific criteria for diagnosis of posttraumatic stress disorder (PTSD) in children age 6 years or younger and a shift in nosology that defines reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) as distinct entities.

“These changes in DSM-5 are exciting because they are developmentally-specific, empirically-supported criteria for disorders in children affected by adversity,” said Dr Gleason.  “The new diagnoses highlight the importance of thinking about mental health in very young children affected by stress.”

The introduction of developmentally specific diagnostic criteria for PTSD in preschool age children should translate into improved access to appropriate care for these young patients who are impaired by their symptoms but who might not meet the previous diagnostic threshold for PTSD.

The definition of RAD and DSED as distinct disorders was based on data demonstrating that while they share an etiological pathway (ie, social neglect or other situations that limit a child’s opportunity to form selective attachments), they differ in their correlates,  trajectories, and especially in the response to quality caregiving.

Whereas symptoms of RAD reflect the current caregiving environment and improve quickly when the child is placed in an appropriate family-based home, symptoms in children with DSED reflect a history of caregiving adversity and may persist for years after removal from the adverse environment, Dr Gleason explained.

“The slow resolution of DSED is important for clinicians and families to understand so that current caregiving is not thought to be the cause of the symptoms,” she said.

“Related though is that high quality caregiving is the only factor known to be associated with reduction in DSED symptoms. Therefore, families need intensive support to ensure that children experience consistent and sensitive caregiving for the best possible outcomes.”