Which disorder should not be included in the differential diagnosis of a 6-year-old boy exhibiting aggressive behavior, scary dreams, and avoidance behaviors after being exposed to a traumatic event, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)?

Which Disorder Should NOT Be Included in the Differential Diagnosis

"Trauma-related disorder" should NOT be included as a differential diagnosis because it is not a distinct diagnostic entity in DSM-5-TR. This is a non-existent diagnostic category that does not appear in the DSM-5-TR classification system.

Rationale for Exclusion

The term "trauma-related disorder" is not a specific diagnosis in DSM-5-TR. While there is a chapter called "Trauma- and Stressor-Related Disorders" that includes conditions like PTSD, Acute Stress Disorder, and Adjustment Disorders, there is no standalone diagnosis simply called "trauma-related disorder." 1, 2

Valid Differential Diagnoses to Consider

Posttraumatic Stress Disorder (PTSD)

This SHOULD be included in the differential. The child witnessed a traumatic event (tornado), has nightmares (re-experiencing), refuses to leave the house (avoidance), and shows increased arousal with aggressive behavior. 1

• PTSD requires three symptom clusters: (1) re-experiencing the event with distressing dreams and flashbacks, (2) persistent avoidance of trauma-related stimuli, and (3) increased arousal 1
• The boy's "scary dreams" represent re-experiencing symptoms, his refusal to leave home represents avoidance, and his aggressive behavior represents hyperarousal 1
• Trauma exposure and PTSD are recognized comorbidities that must be screened for in children presenting with behavioral problems 3

Separation Anxiety Disorder

This SHOULD be included in the differential. The child refuses to sleep in his own bed and doesn't want to leave his house, which are classic separation anxiety symptoms. 3

• Separation anxiety is characterized by developmentally inappropriate, excessive worry or distress associated with separation from a primary caregiver or major attachment figure 3
• The refusal to sleep alone and leave the house could represent fear of separation rather than trauma-related avoidance 3

Disruptive Mood Dysregulation Disorder (DMDD)

This SHOULD be included in the differential. The child is "easily upset" and shows aggressive behavior with physical altercations. 3

• DMDD is characterized by chronic irritability and temper outbursts that are out of proportion to the situation 3
• The aggressive behavior and emotional dysregulation could represent DMDD rather than trauma-related symptoms 3
• However, distinguishing irritable mood disorders from trauma-related irritability requires careful assessment 3

Conduct Disorder

This SHOULD be included in the differential. The child has had physical altercations with multiple peers, representing aggressive behavior toward others. 4, 5

• Conduct disorder is characterized by aggression toward people or animals, destruction of property, deceitfulness, and serious rule violations 4
• At least three symptoms should be present in the past 12 months, with at least one in the past six months 4
• The aggressive behavior with peers meets criteria for conduct disorder symptoms, though the temporal relationship to trauma and other symptoms suggest alternative diagnoses may be more likely 5, 6

Critical Clinical Pitfall

The key error would be selecting "trauma-related disorder" as a valid differential diagnosis when it does not exist as a distinct DSM-5-TR entity. While the child clearly has trauma exposure and trauma-related symptoms, the correct diagnosis would be PTSD or another specific disorder from the Trauma- and Stressor-Related Disorders chapter, not a vague "trauma-related disorder." 1, 2