TRAUMA

Question 1

Ito ay grupo ng mga kondisyon kung saan ang exposure sa traumatic o stressful na event ay requirement para ma-diagnose.
- Lahat ng disorders na ito ay nagsisimula sa isang stressful event, tapos sinusundan ng matinding emotional reactions.
- Karaniwan, may mga symptoms na related sa anxiety o takot. Pero ang pinaka-prominenteng clinical features ay:

Anhedonic at dysphoric symptoms – parang nawawalan ng gana sa buhay, malungkot, walang energy.

Externalizing angry at aggressive symptoms – madaling magalit, nagiging agresibo.

Dissociative symptoms – parang hiwalay ang isip sa realidad, disconnected sa paligid.

Answer 1

TRAUMA

Question 2

A. Consistent pattern ng withdrawn behavior sa adult caregivers
1. Ang bata bihira o halos hindi humihingi ng comfort kapag distressed.
2. Ang bata bihira o halos hindi rin tumutugon sa comfort kapag distressed.

B. Persistent social at emotional disturbance (kailangan at least 2):
1. Minimal ang social at emotional responsiveness sa ibang tao.
2. Limited ang positive affect (halos walang saya o tuwa).
3. Episodes ng irritability, sadness, o fearfulness kahit sa nonthreatening interactions with caregivers.

C. History ng insufficient care (at least 1):
1. Social neglect o deprivation — hindi natutugunan ang basic emotional needs (comfort, stimulation, affection).
2. Repeated changes ng primary caregivers (hal. palipat-lipat ng foster care) kaya walang stable attachment.
3. Rearing sa unusual settings (hal. institutions na sobrang dami ng bata kumpara sa caregivers) na naglilimit ng selective attachments.

D. Connection ng care at behavior:
- Ang lack of adequate care (Criterion C) ang presumed cause ng disturbed behavior (Criterion A).

Other conditions:

Hindi ito autism spectrum disorder.

Answer 2

RAD (Reactive detachment disorder)

Question 3

• Dapat evident bago mag-___ years old.
• Ang bata ay may developmental age na at least _______ months.(bago nito, hindi pa fully developed ang capacity ng bata para makabuo ng attachment.)
• 9-month-old baby na hindi tumitingin o nagre-respond sa nanay kapag kinakausap o kinikiss siya, at parang walang interest sa comfort

Answer 3

RAD
5
9

Question 4

___ Ibig sabihin, present o nakikita pa rin ang symptoms for more than 12 months.
Halimbawa: Kung ang bata ay patuloy na withdrawn at hindi humihingi ng comfort sa loob ng isang taon o higit pa, considered persistent na ang disorder.

_____ Kapag ang bata ay nagpapakita ng lahat ng symptoms, at bawat isa ay lumalabas sa mataas na level o matindi ang manifestation.
Halimbawa: Hindi lang siya bihirang humingi ng comfort, kundi consistent na hindi tumutugon, lagi ring irritable, malungkot, takot, at halos walang positive emotions — lahat ng criteria ay present at malala.

Answer 4

RAD
Persistent
Severe

Question 5

12 months to lifetime

Answer 5

RAD

Question 6

• Any, most common in children
• for more than 5 years old, be careful on diagnosing

Answer 6

RAD

Question 7

Diagnostic Criteria

A. Pattern of behavior kung saan ang bata ay actively lumalapit at nakikipag-interact sa mga unfamiliar adults, at nagpapakita ng at least 2:

1. Walang hiya o takot (reduced/absent reticence) sa paglapit at pakikipag-usap sa strangers.
2. Overly familiar verbal o physical behavior (hindi bagay sa age o cultural boundaries).
3. Hindi nagche-check back sa caregiver kahit nasa unfamiliar setting.
4. Willing sumama sa strangers na halos walang hesitation.
5. Hindi lang impulsivity (katulad ng ADHD), kundi socially disinhibited behavior talaga.(socially inappropriate)
   - ang impulsivity ay nakatuon sa social behavior. Ang bata ay walang normal na social boundaries — sobrang lapit, sobrang trusting, o overly familiar sa kahit sinong adult, kahit strangers.

B. History ng insufficient care (at least 1):

1. Social neglect o deprivation — hindi natutugunan ang basic emotional needs (comfort, stimulation, affection).
2. Repeated changes ng primary caregivers (hal. palipat-lipat ng foster care) kaya walang stable attachment.
3. Rearing sa unusual settings (hal. institutions na sobrang dami ng bata kumpara sa caregivers) na naglilimit ng selective attachments.

C. Connection ng care at behavior:
- Ang pathogenic care (Criterion C) ang presumed cause ng disturbed behavior (Criterion A).

Other conditions:

Ang bata ay may developmental age na at least 9 months.

Answer 7

Disinhibited Social engagement
Disorder (actively approachable)

Question 8

A. Pattern of behavior:
Child actively approaches and interacts with unfamiliar adults, showing at least 2 of the following:

• Reduced/absent reticence: Walang hiya o takot sa paglapit sa strangers.
• Overly familiar behavior: Sobrang close agad (verbal o physical), hindi culturally or age-appropriate.
• Diminished checking back: Hindi bumabalik o nagche-check sa caregiver kahit nasa unfamiliar setting.
• Willingness to go off: Madaling sumama sa strangers na walang hesitation.

👉 Note: Hindi lang ito impulsivity (like ADHD), kundi socially disinhibited behavior.

B. History of insufficient care (at least 1):
- Social neglect/deprivation: Walang consistent emotional needs met (comfort, affection, stimulation).
- Repeated caregiver changes: Madalas palit ng primary caregivers (e.g., foster care), kaya walang stable attachment.
-Unusual rearing settings: Lumaki sa institutions na sobrang dami ng bata vs caregivers, kaya walang chance mag-form ng selective attachments.

C. Link between care & behavior:
- Ang pathogenic care (Criterion B) ay presumed cause ng disturbed behavior (Criterion A).

D. Developmental age:
- Child must be at least 9 months old (kasi kailangan ng minimum age para mag-form ng attachments).

Answer 8

DSED

Question 9

Diagnostic Criteria (Exposure)
Note: Applicable sa adults, adolescents, at children older than 6 years. (May separate criteria for kids ≤6 years).

• Exposure to trauma (actual or threatened death, serious injury, or sexual violence) in one or more of the following ways:

Direct experience:
- Ikaw mismo ang nakaranas ng traumatic event.

Witnessing in person:
- Nakita mo mismo habang nangyayari sa iba.

Learning about trauma to close family/friend:
- Nalaman mo na ang traumatic event ay nangyari sa close family member o friend.
→ Kung death, dapat ito ay violent o accidental.

Repeated/extreme exposure to details:
- Halimbawa: first responders na paulit-ulit nakikita ang human remains, o police officers na exposed sa child abuse cases.

Important Note:
Criterion A4 does not apply kung exposure ay via TV, movies, pictures, or electronic media, maliban kung ito ay work-related (e.g., police reviewing footage).

Answer 9

PTSD

Question 10

Avoidance & Negative Cognitions/Mood
C. Persistent Avoidance (after trauma): At least 1 of the following:

Avoidance of internal reminders:
- Iwas sa memories, thoughts, o feelings na related sa trauma.

Avoidance of external reminders:
- Iwas sa tao, lugar, conversations, activities, objects, o situations na nagti-trigger ng trauma memories.

D. Negative Alterations in Cognitions & Mood (after trauma): At least 2 of the following:

Inability to remember important aspects of trauma (usually dahil sa dissociative amnesia, not head injury or substances).

Persistent, exaggerated negative beliefs/expectations:
→ e.g., “I am bad,” “No one can be trusted,” “The world is dangerous.”

Distorted cognitions about cause/consequences:
- Self-blame o blaming others.

Persistent negative emotional state:
- e.g., fear, horror, anger, guilt, shame.

Diminished interest/participation in activities:
- Nawawalan ng gana sa dati niyang ginagawa.

Feelings of detachment/estrangement:
- Feeling na hiwalay o disconnected sa ibang tao.

Persistent inability to feel positive emotions:
- Hirap makaramdam ng happiness, satisfaction, o love.

Answer 10

PTSD

Question 11

Intrusion Symptoms (Criterion B) Presence of one or more intrusion symptoms after the traumatic event(s):

Recurrent, involuntary, distressing memories:
- Paulit-ulit na pumapasok sa isip ang traumatic memories kahit ayaw mo.
- Note: Sa mga bata >6 years, puwedeng lumabas sa repetitive play na may themes ng trauma.

Recurrent distressing dreams:
- Panaginip na may content o emotions na related sa trauma.
- Note: Sa mga bata, puwedeng nakakatakot na panaginip kahit walang clear content.

Dissociative reactions (flashbacks):
- Feeling o acting na parang nangyayari ulit ang trauma.
- Range: mula sa mild flashbacks hanggang sa complete loss of awareness sa surroundings.
- Note: Sa mga bata, puwedeng lumabas bilang trauma reenactment sa play.

Intense psychological distress:
- Malakas na emotional reaction kapag exposed sa internal o external cues na nagre-remind ng trauma.

Marked physiological reactions:
- Physical responses (e.g., heart racing, sweating) kapag may cues na nagre-remind ng trauma.

Answer 11

PTSD

Question 12

– Arousal & Reactivity (Criterion E) Marked changes in arousal/reactivity after trauma (need ≥2):

Irritable behavior & angry outbursts:
- Madalas magalit kahit maliit na bagay, puwedeng verbal o physical aggression.

Reckless/self-destructive behavior:
- Gumagawa ng risky o harmful actions.

Hypervigilance:
- Laging alert, parang “on guard” palagi.

Exaggerated startle response:
- Sobrang gulat kahit sa maliit na stimuli.

Problems with concentration:
- Hirap mag-focus o mag-concentrate.

Sleep disturbance:
- Hirap makatulog, madaling magising, o restless sleep.

Answer 12

PTSD

Question 13

Severity:
- Mas matindi at long-lasting kapag ang stressor ay interpersonal at intentional (e.g., torture, sexual violence).

Possible symptoms: Major Types of Trauma Linked to PTSD

Natural disasters (bagyo, lindol, etc.)
- Mass interpersonal violence (not war-related)
- Large-scale transportation accidents (plane crash, train accident)
- Domestic fires (sunog sa bahay)
- Motor vehicle accidents
- Rape & sexual assault
- Stranger physical assault
- Domestic violence
- Torture
- War
- Child abuse

Emergency worker exposure (e.g., rescuers, police, firefighters)
- Auditorypseudo-hallucinations (parang naririnig ang sariling thoughts sa ibang voices).
- Paranoid ideation (pakiramdam na may nagbabantay o may threat).

Clinical presentation varies:
- Some: fear-based symptoms (takot, hyperarousal).
- Others: anhedonia/dysphoric mood (lungkot, kawalan ng gana).
- Others: arousal & reactive-externalizing (galit, aggression).
- Others: dissociative symptoms (depersonalization, derealization).
- Some: mixed combinations.

Answer 13

PTSD

Question 13

Specifier
With_____
→ Kung full criteria ay na-meet ≥6 months after trauma, kahit may immediate symptoms.

Answer 13

PTSD
delayed expression:

Question 13

Duration Requirement
Symptoms (Criteria B, C, D, E) must last more than ____ month.

Reason: Normal stress reactions after trauma usually fade within a month.

Answer 13

PTSD
1

Question 13

Specifier: With Dissociative Symptoms
When used: Kapag ang individual ay may PTSD symptoms at, in response to trauma, nakakaranas ng persistent o recurrent dissociative symptoms tulad ng:

_____:
- Feeling na detached sa sarili o parang outsider observer ng sariling isip o katawan.
- Halimbawa: parang nasa panaginip, sense of unreality, o pakiramdam na mabagal ang takbo ng oras.

_____:
- Feeling na unreal ang surroundings.
- Halimbawa: ang mundo ay parang dreamlike, distant, o distorted.

Important Note:

Hindi puwedeng gamitin ang specifier kung ang dissociative symptoms ay dahil sa substance use (e.g., alcohol intoxication, blackouts) o medical condition (e.g., seizures).

Answer 13

PTSD
Depersonalization
Derealization

Question 14

Other Specified PTSD-like Presentations
Other specified:
- Kapag may persistent response to trauma na may PTSD-like symptoms pero subthreshold/partial (hindi fully pasok sa criteria).
- Symptoms last >6 months pero hindi sapat para sa full PTSD diagnosis.
- Minsan tinatawag na partial PTSD.

Question 15

Biological Factors
Family history of anxiety:
- Kung may history ng anxiety sa pamilya, mas mataas ang biological vulnerability sa PTSD.

Hyperactivity in HPA axis:
- Ang stress-response system ng katawan (Hypothalamic-Pituitary-Adrenal axis) ay sobrang active, kaya mas matindi ang reaction sa stress.

Damage in hippocampus:
- Ang hippocampus (part ng brain na responsible sa memory at regulation ng stress) ay puwedeng maapektuhan, kaya hirap mag-process ng trauma memories.

Question 16

Psychosocial Factors
Positive coping strategies (protective):
→ Active problem-solving, constructive coping → nakakatulong para bumaba ang risk ng PTSD.

Negative coping strategies (risk):
- Pagiging galitin o blaming others mas mataas ang chance na mag-develop ng PTSD.

Question 17

For Children 6 Years and Younger
A. Exposure to trauma (death, injury, sexual violence):
- Direct experience: Bata mismo ang nakaranas ng trauma.

Witnessing in person: Nakita ng bata habang nangyayari sa iba, lalo na sa primary caregiver.
- Note: Hindi counted kung nakita lang sa TV, movies, o pictures.

Learning about trauma: Nalaman ng bata na nangyari ang trauma sa parent o caregiver.

B. Intrusion Symptoms (≥1):

Recurrent distressing memories: Paulit-ulit na pumapasok sa isip ang trauma.
- Note: Sa bata, puwedeng lumabas bilang play reenactment.

Recurrent distressing dreams: Panaginip na nakakatakot, minsan hindi clear kung related sa trauma.

Dissociative reactions (flashbacks): Feeling na nangyayari ulit ang trauma.
- Note: Sa bata, puwedeng lumabas bilang trauma reenactment sa play.

Intense psychological distress: Malakas na emotional reaction kapag may reminders ng trauma.

Marked physiological reactions: Physical responses (e.g., heart racing, sweating) kapag may trauma reminders.

C. Avoidance OR Negative Cognitions/Mood (≥1):

Avoidance: Iwas sa thoughts, feelings, o reminders ng trauma.

Negative changes:
- e.g., sadness, fear, guilt, detachment, loss of interest, or inability to feel positive emotions.

Answer 17

Posttraumatic Stress Disorder for Children 6 Years and Younger

Question 18

Children ≤6 Years (Continuation)

C. Persistent Avoidance of Stimuli (> _____):
- Iwas sa activities, places, o physical reminders ng trauma.
- Iwas sa tao, conversations, o interpersonal situations na nagre-remind ng trauma.

D. Negative Alterations in Cognitions & Mood (≥__-):
- Increased negative emotions: Fear, guilt, sadness, shame, confusion.
- Diminished interest/participation: Nawawalan ng gana sa activities, pati play constriction.
- Social withdrawal: Lumalayo o hindi nakikipag-socialize.
- Reduced positive emotions: Hirap magpakita ng happiness, love, o satisfaction.

E. Alterations in Arousal & Reactivity (≥____):
- Irritable behavior & angry outbursts: Puwedeng verbal/physical aggression, extreme tantrums.
- Hypervigilance: Laging alert, parang “on guard.
- Exaggerated startle response: Sobrang gulat kahit maliit na stimuli.
- Problems with concentration: Hirap mag-focus.

Sleep disturbance: Hirap matulog, madaling magising, restless sleep.

Answer 18

Posttraumatic Stress Disorder for Children 6 Years and Younger
1
1
2

Question 19

Duration:

Symptoms last >1 month (normal stress reactions usually fade within weeks).

Answer 19

Posttraumatic Stress Disorder for Children 6 Years and Younger

Question 20

Specifier: With Dissociative Symptoms
Depersonalization: Feeling detached sa sarili, parang outsider observer, parang nasa panaginip.

Derealization: Feeling na unreal ang surroundings, dreamlike, distant, distorted.

Note: Hindi ito dahil sa drugs o medical illness.

Answer 20

Posttraumatic Stress Disorder for Children 6 Years and Younger

Question 21

More prevalent among women

Answer 21

ASD

Question 21

Diagnostic Criteria A. Exposure to trauma (death, injury, sexual violence): - Direct experience: Ikaw mismo ang nakaranas ng traumatic event. - Witnessing in person: Nakita mo habang nangyayari sa iba. - Learning about trauma: Nalaman mo na nangyari ito sa close family member o friend (death must be violent or accidental). - Repeated/extreme exposure to trauma details: Halimbawa: first responders na paulit-ulit nakikita ang human remains, o police officers na exposed sa child abuse cases. 👉 Note: Hindi counted kung exposure ay via TV, movies, pictures, electronic media, maliban kung work-related. B. Symptoms (≥9 required): From any of the 5 categories: Intrusion → Paulit-ulit na alaala, bangungot, flashbacks, matinding distress, o physical reactions kapag naalala ang trauma. Negative mood → Hirap makaramdam ng positive emotions (parang laging empty o numb). Dissociation → Feeling detached, parang hindi totoo ang paligid, o may memory gaps. Avoidance → Iwas sa thoughts, feelings, o reminders ng trauma (hal. ayaw dumaan sa lugar ng aksidente). Arousal → Hirap matulog, madaling magalit, sobrang alert (hypervigilant), hirap mag-concentrate, o sobrang nagugulat.

Answer 21

ASD

Question 22

Symptom Categories Intrusion Symptoms (paulit-ulit na trauma reminders): Recurrent, involuntary, distressing memories. - Sa bata: puwedeng lumabas bilang play reenactment. - ibig sabihin, sa laro ng bata, inuulit o ginagaya nila ang traumatic event na naranasan o nakita nila. Halimbawa: Kung nakakita sila ng car accident, puwede nilang laruin ang toy cars na nagba-banggaan. Recurrent distressing dreams. - Sa bata: minsan nakakatakot na panaginip kahit walang clear trauma content. Dissociative reactions (flashbacks). - Feeling na nangyayari ulit ang trauma, minsan nawawala ang awareness sa surroundings. - Sa bata: trauma reenactment sa play. - Intense distress o physiological reactions kapag may trauma reminders. Negative Mood: - Persistent inability to feel positive emotions (happiness, satisfaction, love). Dissociative Symptoms: - Altered sense of reality (parang nasa panaginip, time slowing, detached sa sarili). - Inability to remember important aspects of trauma (dissociative amnesia, not due to injury or substances). Avoidance Symptoms: - Efforts to avoid distressing memories, thoughts, or feelings about trauma. - Efforts to avoid external reminders (tao, lugar, conversations, activities, objects, situations). Arousal Symptoms: - Sleep disturbance (hirap matulog, restless sleep). - Irritable behavior & angry outbursts (verbal/physical aggression, tantrums). - Hypervigilance (laging alert). - Problems with concentration. - Exaggerated startle response (sobrang gulat kahit maliit na stimuli).

Answer 22

ASD

Question 23

– Duration & Functional Impact ⏳ Duration: Symptoms (Criterion B) must last 3 days to 1 month after trauma exposure. Note: Usually nagsisimula agad pagkatapos ng trauma, pero kailangan mag-persist ng ≥3 days para ma-meet ang criteria. ⚠️ Distress/Impairment: Symptoms cause clinically significant distress or impairment sa: - Social functioning (relationships, family, friends) - Occupational functioning (trabaho) - Other important areas of life 🚫 Exclusion: - Symptoms are not due to substances (e.g., medication, alcohol). - Not due to another medical condition (e.g., mild traumatic brain injury). - Not better explained by brief psychotic disorder.

Answer 23

ASD

Question 24

Key Diagnostic Notes Acute Stress Disorder (ASD): - Hindi puwedeng i-diagnose agad pagkatapos ng trauma. - Diagnosis possible only after 3 days post-trauma, at symptoms must last 3 days to 1 month. - Kung symptoms persist >1 month and meet PTSD criteria - diagnosis changes to PTSD. Panic Disorder (PD): - PD is diagnosed only if panic attacks are unexpected (hindi triggered by specific situations) and may kasamang anxiety about future attacks. PTSD Transition: - ASD can evolve into PTSD if symptoms continue beyond 1 month and meet full PTSD criteria. Psychological Debriefing: -Isang crisis intervention technique kung saan ang trauma victims ay pinapagsalita extensively tungkol sa kanilang feelings and reactions within days of the incident. - Note: Research shows mixed effectiveness — minsan helpful, minsan hindi, depende sa context. 👉 In short (Taglish): ASD = 3 days to 1 month after trauma. PTSD = >1 month with full criteria. PD = unexpected panic attacks + worry about future attacks. Psychological Debriefing = early intervention, pero hindi laging effective.

Answer 24

ASD

Question 25

Psychosocial: ● Prior trauma ● Negative affectivity or neuroticism. neuroticism) ●Overestimating the consequence of the traumatic event -- exaggerated appraisals of future harm, guilt, or hopelessness, is strongly predictive of acute stress disorder. ● Avoidant coping style. Biological: ● Elevated reactivity (startle response or pagiging magugulatin)

Answer 25

ASD

Question 26

Diagnostic Criteria A. Onset: Nagkakaroon ng emotional o behavioral symptoms bilang tugon sa isang identifiable stressor. **Lumalabas ang sintomas within 3 months mula nang mangyari ang stressor.** B. Types of Stressors: **Single event**: - e.g., breakup, failure in school. **Multiple stressors: ** - e.g., isang married man na may business difficulties + marital problems. **Recurrent stressors: ** - e.g., seasonal business crises, unfulfilling sexual relationships. - Paulit-ulit na nangyayari, pero may pagitan o cycle. - Seasonal business crisis tuwing holidays. - Paulit-ulit na away ng mag-asawa tuwing may trigger. - Exams stress na bumabalik kada semester. **Continuous stressors:** → e.g., chronic painful illness, living in a crime-ridden neighborhood. - Tuloy-tuloy, araw-araw, walang pahinga. - Chronic painful illness na araw-araw nararamdaman. - Pamumuhay sa crime-ridden neighborhood na laging may threat. C. Scope of Stressors: - Stressors can affect: - Single individual - Entire family - Larger group/community (e.g., natural disaster) D. Developmental Events as Stressors: - Some stressors accompany life transitions, e.g.: - Going to school - Leaving/reentering parental home - Getting married - Becoming a parent - Failing occupational goals - Retirement

Answer 26

ADJUSTMENT DISORDER (AD)

Question 27

Clinical Significance & Exclusions Clinically significant symptoms/behaviors (need ≥1): Marked distress out of proportion to the stressor. - Halimbawa: sobrang emotional reaction na hindi tugma sa severity ng stressor, considering context at cultural factors. Significant impairment in functioning. - e.g., problems sa social life, trabaho, school, or other important areas. Exclusions: - The disturbance does not meet criteria for another mental disorder (e.g., PTSD, MDD). - Not just an exacerbation of a preexisting disorder. - Not normal bereavement (grief after loss). Duration: - Kapag natapos na ang stressor o ang consequences nito, ang symptoms hindi puwedeng magtagal ng higit sa 6 months. - Ang AD ay isang short-term reaction sa isang stressor (halimbawa: breakup, job loss, o relocation). - Kung tuloy-tuloy pa rin ang stressor (e.g., ongoing financial problems), puwedeng magpatuloy ang symptoms habang naroon pa ang stressor. - Pero kung tapos na ang stressor at wala na ang epekto nito, dapat mawala rin ang symptoms within 6 months. - Kung lumampas na sa 6 months, hindi na siya considered AD; baka ibang disorder na (halimbawa: Major Depressive Disorder o Generalized Anxiety Disorder).

Answer 27

AD

Question 28

Specifiers / Subtypes 309.0 (F43.21) _____ - Predominant symptoms = low mood, tearfulness, hopelessness. 309.24 (F43.22) ____: - Predominant symptoms = nervousness, worry, jitteriness, separation anxiety. 309.28 (F43.23) With mixed anxiety and depressed mood: - Combination of depression + anxiety symptoms. 309.3 (F43.24) _____: - Predominant = behavioral problems (e.g., rule-breaking, aggression, acting out). 309.4 (F43.25) With mixed disturbance of emotions and conduct: - Both emotional symptoms (depression, anxiety) + conduct disturbance. 309.9 (F43.20) ____: - Maladaptive reactions to stress that don’t fit neatly into the above subtypes

Answer 28

AD With depressed mood: With anxiety With disturbance of conduct Unspecified

Question 29

Course Specifiers Acute: - Symptoms persist for less than 6 months. - Usually linked to a stressor that ends quickly or has short-term consequences. Persistent (Chronic): - Symptoms last longer than 6 months. - Happens when stressor is chronic (e.g., ongoing illness, long-term financial problems) or has enduring consequences (e.g., permanent disability, lasting loss). 👉 In short (Taglish): Adjustment Disorder can be acute (<6 months) or persistent/chronic (>6 months) depending on how long the stressor and its effects continue

Answer 29

AD (adjustment)

Question 30

Common and general but higher cases in women

Answer 30

AD

Question 31

Diagnostic Criteria A. Timing of Loss: - Adults: Death of a close person at least 12 months ago. - Children/adolescents: Death at least 6 months ago. B. Core Symptoms (need ≥1, present most days, nearly every day for ≥1 month): - intense yearning/longing for the deceased. Preoccupation with thoughts/memories of the deceased. - Sa bata/adolescents: focus may be on circumstances of death. C. Additional Symptoms (need ≥3, present most days, nearly every day for ≥1 month): - identity disruption: Feeling na parang part of self ay “namatay.” - Marked disbelief: Hirap tanggapin ang death. Avoidance of reminders: Iwas sa tao, lugar, o bagay na nagre-remind ng death. - Sa bata: puwedeng iwas sa reminders. - Intense emotional pain: Anger, bitterness, sorrow. - Difficulty reintegrating: Hirap bumalik sa relationships, activities, future planning. - Emotional numbness: Reduced emotional experience. - Feeling life is meaningless dahil sa death. - Intense loneliness dahil sa death.

Answer 31

PGD

Question 32

Clinical Significance & Exclusions Clinically significant impact: - Symptoms cause distress or impairment in social life, work, or other important areas of functioning. Beyond cultural norms: - The duration and severity of grief clearly exceed expected social, cultural, or religious norms for bereavement in the person’s context. Exclusions: - Symptoms are not better explained by another mental disorder (e.g., Major Depressive Disorder, PTSD). - Not due to substance use (e.g., medication, alcohol) or another medical condition. 👉 In short (Taglish): Prolonged Grief Disorder = persistent grief that goes beyond normal cultural expectations, causes distress/impairment, and is not explained by another disorder or substance/medical condition.

Answer 32

PGD

Question 33

Focus on loss/separation: - Symptoms are centered on feelings of loss and longing for a deceased loved one, not a generalized low mood. Distress tied to the deceased: - Emotional pain, yearning, and loneliness are directly connected to the person who died, rather than broad sadness or fear.

Answer 33

PGD

Question 34

High risk of suicidal ideation: - People with PGD are more prone to suicidal thoughts. Violent loss increases risk: - Loss due to homicide, suicide, or accident = greater risk for suicidal ideation. Death of a child: - Losing a child, especially under age 25, strongly linked to PGD + suicidal ideation. COVID-19 “grief pandemic”: - Millions of unexpected deaths during the pandemic increased PGD cases worldwide. 📊 Prevalence Higher in trauma-exposed populations: - e.g., war zones, disaster-affected communities. Higher in high-income Western countries compared to Asian countries. Exception: China shows relatively higher prevalence compared to other Asian nations.

Answer 34

PGD

Question 35

Older age: Mas mataas ang risk sa older adults. - Dependency on the deceased: Kung sobrang dependent sa namatay bago ang death, mas mataas ang risk. - Death of a child: Lalo na kung bata ay under 25 years old, risk is intensified. Violent or unexpected deaths: e.g., homicide, suicide, accidents - mas mataas ang chance ng PGD + suicidal ideation. - Death of spouse/partner or child: Mas malakas ang impact kaysa sa ibang kinship losses. - Caregiver availability: Sa mga bata, kung kulang ang caregiver support, mas mataas ang risk. - Funerary rituals: Sa ilang kultura, kung hindi nagawa ang funeral rites, puwedeng lumala ang PGD dahil sa worry about spiritual status ng deceased.

Answer 35

PGD

Question 36

Special Considerations Older adults with PGD: May risk for progressive cognitive decline. Children: Disturbances in caregiver support can worsen grief reactions. Cultural context: Beliefs about funerary rituals and spiritual well-being of the deceased can intensify symptoms.

Answer 36

PGD

Question 37

PTSD Diagnostic Criteria Criterion A: Trauma Exposure Direct experience of actual/threatened death, serious injury, or sexual violence - Witnessing trauma in person - Learning about trauma to close family/friend (violent or accidental) - Repeated/extreme exposure to traumatic details (e.g., first responders) Criterion B: Intrusion Symptoms (≥1 required) Recurrent, involuntary, distressing memories - Distressing dreams related to trauma - Dissociative reactions (flashbacks) - intense psychological distress at reminders - Physiological reactions to reminders Criterion C: Avoidance (≥1 required) - Avoidance of distressing memories, thoughts, feelings - Avoidance of external reminders (people, places, conversations, activities) Criterion D: Negative Alterations in Cognition/Mood (≥2 required) - Inability to remember important aspects of trauma - Persistent negative beliefs/expectations (“I’m ruined,” “No one can be trusted”) - Distorted blame of self/others - Persistent negative emotional state (fear, anger, guilt, shame) - Diminished interest in activities - Feelings of detachment/estrangement Inability to experience positive emotions Criterion E: Arousal/Reactivity (≥2 required) Irritable behavior or angry outbursts - Reckless/self-destructive behavior - Hypervigilance - Exaggerated startle response - Problems with concentration - Sleep disturbance

Question 38

Onset (simula ng symptoms): ASD → within 3–30 days after trauma PTSD → symptoms persist beyond 30 days Duration: ASD → short-term, pwedeng mawala kapag na-process agad PTSD → long-term, tumatagal ng months to years Symptoms: ASD → intrusion, dissociation, avoidance, arousal (focus sa dissociation) PTSD → intrusion, avoidance, negative mood, arousal, dissociation (mas broad at persistent) Diagnosis: ASD → early reaction to trauma PTSD → chronic condition kapag hindi na-resolve Risk: ASD → may chance na mag-progress into PTSD kung hindi maagapan PTSD → established disorder, harder to treat

Question 39

Single Stressor: Halimbawa: Si Ana, bumagsak sa board exam. Within weeks, nagkaroon siya ng matinding lungkot, hirap mag-focus, at nag-withdraw sa friends. → Adjustment Disorder with depressed mood. Multiple Stressors: Halimbawa: Si Mark, isang married man, may business na nalulugi at sabay pa may marital conflict. Naging irritable siya, madaling magalit, at nagkaroon ng anxiety. → Adjustment Disorder with mixed disturbance of emotions and conduct. Recurrent Stressors: Halimbawa: Si Liza, every summer bumabagsak ang sales ng business nila. Tuwing mangyari ito, nagiging anxious at sleepless siya. → Adjustment Disorder recurring with anxiety. Continuous Stressors: Halimbawa: Si Carlo, nakatira sa neighborhood na mataas ang crime rate. Lagi siyang hypervigilant, hirap matulog, at nagiging withdrawn. → Adjustment Disorder due to continuous environmental stress. Developmental/Life Transition Stressors: Halimbawa: Si Mia, bagong pasok sa college. Nahihirapan mag-adjust sa bagong environment, nagiging socially withdrawn at anxious. → Adjustment Disorder related to life transition.

Answer 39

AD

Question 40

Ang mga taong may PTSD with dissociatve subtype ay HYPO aroused (numb, detached, space out) kaysa hyper aroused (laging gulat or alert)

Question 41

Sa adjustment disorder - dapat nawala ang symptoms within 6 months - Kapag lumampas ibang disorder na ito

Question 42

Ang pagkawala ng anak ay maituturing na prolonged grief disorder