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ANXIETY DISORDERS
Generalized Anxiety Disorder (GAD)
This is more than the normal anxiety people experience day to day. It’s chronic and
exaggerated worry and tension, even though nothing seems to provoke it. Having this
disorder means always anticipating the worst, usually worrying excessively about
health, family, or work, and finances. But sometimes, the source of the worry is hard to
pinpoint. Simply the thought of getting through the day provokes anxiety.
People with GAD can’t seem to shake their concerns, even though they usually realize
that their anxiety is more intense than the situation warrants. People with GAD seem
unable to relax. They can have trouble falling and/or staying asleep. Their worries are
accompanied by physical symptoms, especially muscle tension, headaches, and feeling
exhausted. They may also feel lightheaded or out of breath. They may feel nauseated
or have to go to the bathroom frequently.
GAD comes on gradually and most often hits people in childhood or adolescence, but
can begin in adulthood, as well.
Emotional symptoms of Generalized Anxiety Disorder
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Constant worrying
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Feeling like your anxiety is uncontrollable
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Intrusive thoughts about things that make you anxious
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An inability to tolerate uncertainty
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A pervasive feeling of apprehension or dread
Behavioral symptoms of Generalized Anxiety Disorder
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Inability to relax, enjoy quiet time, or be by yourself
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Difficulty concentrating or focusing on things
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Putting things off because you feel overwhelmed
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Avoiding situations that make you anxious
Physical symptoms of Generalized Anxiety Disorder
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Feeling tense; having muscle tightness or body aches
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Being easily fatigued
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Having trouble falling asleep or staying asleep
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Feeling edgy, restless, or jumpy
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Stomach problems, nausea, diarrhea
Panic Disorder
People with panic disorder have sudden and repeated attacks of fear that last for
several minutes. Sometimes symptoms may last longer. These are called panic attacks.
Panic attacks are characterized by a fear of disaster or of losing control even when
there is no real danger. A person may also have a strong physical reaction during a
panic attack. It may feel like having a heart attack. Panic attacks can occur at any time,
and many people with panic disorder worry about and dread the possibility of having
another attack.
Signs and Symptoms
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Sudden and repeated attacks of fear
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A feeling of being out of control during a panic attack
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An intense feeling of dread
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An intense worry about when the next attack will happen
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A fear or avoidance of places where panic attacks have occurred in the past
Physical symptoms during an attack might be:
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Pounding or racing heart
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Sweating
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Difficulty breathing/Chest pain
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Weakness
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Dizziness
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Feeling hot or a cold chill
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Tingly or numb hands
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Sensation of choking
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Nausea/Stomachache
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Trembling
Panic attacks can occur at any time, even during sleep. An attack usually peaks within
10 minutes, but some symptoms may last much longer. People who have full-blown,
repeated panic attacks can become very disabled by their condition and should seek
treatment before they start to avoid places or situations where panic attacks have
occurred.
Social Anxiety Disorder (Social Phobia)
Social Anxiety Disorder is a strong fear of being judged by others and of being
embarrassed.
Signs and Symptoms:
•
Being very anxious about being with other people and have a hard time talking to
them
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Being very self-conscious in front of other people and feel embarrassed easily
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Being very afraid that other people will judge them
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Worry for days or weeks before an event where other people will be
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Stay away from places where there are other people
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Have a hard time making friends and keeping friends
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Blush, sweat, or tremble around other people
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Feel nauseous or sick to their stomach when with other people
Separation Anxiety Disorder
The essential feature of Separation Anxiety Disorder is excessive anxiety concerning
separation by a child from the home or from those (in adolescents and adults) to whom
the person is attached. This anxiety is beyond that which is expected for the individual’s
developmental level. The fear, anxiety, or avoidance is persistent, lasting at least 4
weeks in children and adolescents and typically 6 months or more in adults.
Depending on their age, individuals may have fears of animals, monsters, the dark,
muggers, burglars, kidnappers, car accidents, plane travel, and other situations that are
perceived as presenting danger to the integrity of the family or themselves. Concerns
about death and dying are common. School refusal may lead to academic difficulties
and social avoidance. Children may complain that no one loves them or cares about
them and that they wish they were dead. When extremely upset at the prospect of
separation, they may show anger or occasionally hit out at someone who is forcing
separation.
Signs and Symptoms
Developmentally inappropriate and excessive anxiety concerning separation from home
or from those to whom the individual is attached, as evidenced by three (or more) of the
following:
•
Recurrent excessive distress when separation from home or major attachment
figures occurs or is anticipated
•
Persistent and excessive worry about losing, or about possible harm befalling,
major attachment figures
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Persistent and excessive worry that an untoward event will lead to separation
from a major attachment figure (e.g., getting lost or being kidnapped)
•
Persistent reluctance or refusal to go to school or elsewhere because of fear of
separation
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Persistently and excessively fearful or reluctant to be alone or without major
attachment figures at home or without significant adults in other settings
•
Persistent reluctance or refusal to go to sleep without being near a near a major
attachment figure or to sleep away from home
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Repeated nightmares involving the theme of separation
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Repeated complaints of physical symptoms (such as headaches, stomachaches,
nausea, or vomiting) when separation from major attachment figures occurs or is
anticipated.
Agoraphobia
The essential feature of Agoraphobia is anxiety about being in (or anticipating)
situations from which escape might be difficult or in which help may not be available in
the event of having a panic attack (or panic-like symptoms). Oftentimes, when in this
situation, an individual may have the vague thought that something dreadful may
happen. Such concerns must persist for at least 6 months and occur virtually every time
an individual encounters the place or situation.
Agoraphobic fears typically involve characteristic clusters of situations that include being
outside the home alone; being in a crowd or standing in a line, being on a bridge, and
traveling in a bus, train, or automobile.
Specifically, an individual experiences intense fear in response to (or when anticipating
entering) at least 2 of the following 5 situations:
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Using public transportation, such as automobiles, buses, trains, ships, or planes
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Being in open spaces, such as parking lots, marketplaces, or bridges
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Being in enclosed spaces, such as shops, theaters, or cinemas
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Standing in line or being in a crowd
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Being outside of the home alone
A person who experiences agoraphobia avoids such situations (ex. travel is restricted;
the person changes daily routines) or else they are endured with significant distress. For
example, people with agoraphobia often require the presence of a companion, such as
a family member, partner, or friend, to confront the situation.
Specific Phobia
Many people experience specific phobias, intense, irrational fears of certain things or
situations–dogs, closed-in places, heights, escalators, tunnels, highway driving, water,
flying, and injuries involving blood are a few of the more common ones. Phobias aren’t
just extreme fear; they are irrational fear. You may be able to ski the world’s tallest
mountains with ease but panic going above the 10th floor of an office building. Adults
with phobias realize their fears are irrational, but often facing, or even thinking about
facing, the feared object or situation brings on a panic attack or severe anxiety.
Specific phobias strike more than 1 in 10 people. No one knows just what causes them,
though they seem to run in families and are more prevalent in women. Phobias usually
first appear in adolescence or adulthood. They start suddenly and tend to be more
persistent than childhood phobias; only about 20 percent of adult phobias vanish on
their own. When children have specific phobias - for example, a fear of animals - those
fears usually disappear over time, though they may continue into adulthood. No one
knows why they hang on in some people and disappear in others.
Signs and Symptoms:
•
Marked and persistent fear that is excessive or unreasonable, cued by the
presence or anticipation of a specific object or situation (e.g., flying, heights,
animals, receiving an injection, seeing blood).
•
The fear is persistent, typically lasting at least 6 months.
•
Exposure to the phobia almost always provokes an immediate anxiety response,
which may take the form of a panic attack (in children, the anxiety may be
expressed by crying, tantrums, freezing, or clinging).
•
The fear or anxiety is out of proportion to the actual danger posed by the specific
object or situation and is not a typical response in the person’s social or cultural
context. Most adults will recognize that their fear is excessive or unreasonable
and are bothered by the fact that they have this fear.
•
The phobic situation or situations are avoided or else are endured with intense
anxiety or distress.
•
The avoidance, anxious anticipation, or distress in the feared situation(s)
interferes significantly with the person’s normal routine, occupational (or
academic) functioning, or social activities or relationships, or there is marked
distress about having the phobia.
ATTENTION DEFICIT HYPERACTIVITY DISORDER
ADHD has three subtypes:
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Predominantly hyperactive-impulsive
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Predominantly inattentive
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Combined hyperactive-impulsive and inattentive
Signs and Symptoms
Symptoms of inattention may include:
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Being easily distracted, missing details, forgetting things, and frequently switch
from one activity to another
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Have difficulty focusing on one thing
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Becoming bored with a task after only a few minutes, unless doing something
enjoyable
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Have difficulty focusing attention and completing a task
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Losing things that are important often
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Isn’t able to listen well
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Daydreams, become easily confused
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Struggles to follow instructions
Symptoms of hyperactivity may include:
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Fidgeting often
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Talking nonstop
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Being constantly in motion
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Having difficulty doing things quietly
Symptoms of impulsivity may include:
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Being very impatient
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Blurting out inappropriate comments
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Often interrupting conversations
BIPOLAR AND RELATED DISORDERS
Bipolar disorder (also known as manic-depressive) is a brain disorder that causes
drastic shifts in mood, energy and activity levels.
Signs and Symptoms
An immensely joyful or overexcited state is called a manic episode, and an extremely
sad or hopeless state is called a depressive episode. Sometimes, a mood episode
includes symptoms of both mania and depression. This is called a mixed state. People
with bipolar disorder also may be explosive and irritable during a mood episode.
Extreme changes in energy, activity, sleep, and behavior go along with these changes
in mood. Symptoms of bipolar disorder are described below.
Symptoms of mania or a manic episode:
Mood Changes
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A long period of feeling “high” - an overly happy or outgoing mood
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Extreme irritability
Behavioral Changes
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Talking very fast
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Jumping from one idea to the next
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Racing thoughts
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Being easily distracted
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Getting a lot done in a short amount of time
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Being restless
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Sleeping very little or not being tired at all
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Behaving impulsively
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Engaging in high risk behaviors (promiscuous sex, reckless driving, etc.)
Symptoms of a depressive episode:
Mood Changes
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An overly long period of feeling sad or hopeless
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Loss of interest in activities once enjoyed
Behavioral Changes
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Feeling tired
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Having problems concentrating, remembering, and making decisions
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Being irritable
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Changing eating, sleeping, or other habits
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Thinking of death or suicide, or attempting suicide
Bipolar disorder can be present when mood swings are less extreme. Some people with
bipolar disorder experience hypomania, which is a less severe form of mania. When
people experience this, they might feel great and productive but are still dealing with the
symptoms of mania, just on a less intense scale.
Bipolar disorder may also be present in a mixed state, in which you might experience
both mania and depression at the same time.
People in a mixed state may feel very sad or hopeless while at the same time feel
extremely energized. Sometimes, a person with severe episodes of mania or
depression have psychotic symptoms.
Bipolar I Disorder - Defined by manic or mixed episodes that last at least seven days,
or by manic symptoms that are so severe that the person needs immediate hospital
care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks.
Bipolar II Disorder - Defined by a pattern of depressive episodes and hypomanic
episodes, but no full-blown manic or mixed episodes.
Cyclothymic Disorder - A mild form of bipolar disorder. People with cyclothymia have
episodes of hypomania as well as mild depression for at least 2 years. However, the
symptoms do not meet the diagnostic requirements for any other type of bipolar
disorder.
CONDUCT DISORDER(S)
Oppositional Defiant Disorder
ODD is a childhood disorder that is characterized by negative, defiant, disobedient and
often hostile behavior toward adults and authority figures primarily. In order to be
diagnosed, the behaviors must occur for at least a period of 6 months.
Negative and defiant behaviors are expressed by persistent stubbornness, resistance to
directions, and unwillingness to compromise, give in, or negotiate with adults or peers.
Defiance may also include deliberate or persistent testing of limits, usually by ignoring
orders, arguing, and failing to accept blame for misdeeds. Hostility can be directed at
adults or peers and is shown by deliberately annoying others or by verbal aggression
(usually without the more serious physical aggression seen in Conduct Disorder).
Manifestations of the disorder are almost always present in the home setting, but may
not be evident at school or in the community. Symptoms of the disorder are typically
more evident in interactions with adults or peers the individual knows well, and therefore
may not be apparent during clinical examination.
Signs of ODD generally begin before a child is 8 years old. Sometimes ODD may
develop later, but almost always before the early teen years. When ODD behavior
develops, the signs tend to begin gradually and then worsen over months or years.
Signs and Symptoms:
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Negativity
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Defiance
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Disobedience
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Hostility directed toward authority figures
These behaviors might cause your child to regularly and consistently:
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Have temper tantrums
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Be argumentative with adults
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Refuse to comply with adult requests or rules
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Annoy other people deliberately
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Blames others for mistakes or misbehavior
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Acts touchy and is easily annoyed
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Feel anger and resentment
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Be spiteful or vindictive
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Act aggressively toward peers
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Have difficulty maintaining friendships
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Have academic problems
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Feel a lack of self-esteem
DEPRESSIVE DISORDERS
Everyone gets sad occasionally. But these feelings of sadness are usually short-lived.
Severe symptoms that interfere with your ability to work, sleep, study, eat, and enjoy life
are usually indicative of something more serious:
Signs and Symptoms
People with depressive illnesses do not all experience the same symptoms. The
severity, frequency, and duration of symptoms vary depending on the individual.
•
Persistent sad, anxious, or "empty" feelings
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Feelings of hopelessness and worthlessness
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Pessimism
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Feelings of guilt
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Feelings of helplessness
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Irritability and/or restlessness
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Loss of interest in activities or hobbies once that you once enjoyed
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Fatigue
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Difficulty concentrating and lack of focus
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Difficultly making decisions
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Insomnia, early-morning wakefulness, or excessive sleeping
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Overeating or appetite loss
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Thoughts of suicide or suicide attempts
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Body aches
Major Depressive Disorder (clinical depression) - To meet the criteria, you must
either have a depressed mood or a loss of interest or pleasure in daily activities
consistently for at least a 2 week period.
If you would like information on Major Depressive Disorder with psychotic features, visit
this website about: Psychotic Depression
Persistent Depressive Disorder (Dysthymia) - A depressed mood that occurs for
most of the day, for more days than not, for at least 2 years (at least 1 year for children
and adolescents).
Disruptive Mood Dysregulation Disorder
Disruptive mood dysregulation disorder (DMDD) is a condition in which a child is
chronically irritable and experiences frequent, severe temper outbursts that seem
grossly out of proportion to the situation at hand.
Signs and Symptoms:
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Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or
behaviorally (e.g., physical aggression toward people or property) that are
grossly out of proportion in intensity or duration to the situation or provocation.
•
The temper outbursts are inconsistent with developmental level (e.g., the child is
older than you would expect to be having a temper tantrum).
•
The temper outbursts occur, on average, three or more times per week.
•
The mood between temper outbursts is persistently irritable or angry most of the
day, nearly every day, and is observable by others (e.g., parents, teachers,
friends).
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The above criteria have been present for 1 year or more, without a relief period of
longer than 3 months. The above criteria must also be present in two or more
settings (e.g., at home and school), and are severe in at least one of these
settings.
•
The diagnosis should not be made for the first time before age 6 years or after
age 18. Age of onset of these symptoms must be before 10 years old.
•
As with all child mental disorders, the symptoms also cannot be attributable to
the physiological effects of a substance or to another medical or neurological
condition.
Postpartum Depression is much more serious than the "baby blues" that many women
experience after giving birth.
Seasonal Affective Disorder (SAD) - Characterized by the onset of depression during
the winter months when there is less natural sunlight. The depression generally lifts
during spring and summer. Antidepressant medication and psychotherapy can reduce
SAD symptoms, either alone or in combination with light therapy.
DISSOCIATIVE DISORDERS
Dissociative Identity Disorder (DID)
Dissociative identity disorder (DID), also known as multiple personality disorder, is a
dissociative disorder involving a disturbance of identity in which two or more separate
and distinct personality states (or identities) control an individual's behavior at different
times. When under the control of one identity, a person is usually unable to remember
the events that occurred while other personalities were in control. The different identities
(referred to as alters), may exhibit differences in speech, mannerisms, attitudes,
thoughts and gender orientation. The alters may even present physical differences.
A person living with DID may have as few as two alters or as many as 100. The average
number is about 10. Often alters are stable over time, continuing to play specific roles in
the person's life for years.
A very common complaint in people affected by this disorder is episodes of time loss.
These individuals may be unable to remember events in all or part of a previous time
period. They may repeatedly encounter unfamiliar people who claim to know them, find
themselves somewhere without knowing how they got there or find items that they don't
remember purchasing among their possessions.
Signs and Symptoms
•
Depression
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Suicidal tendencies
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Anxiety and/or panic attacks
•
Alcohol and/or drug abuse
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Confusion
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Memory problems
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Delusions
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Headaches
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Flashbacks
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Eating disorders
•
Personality change
•
Selective loss of memory
•
Disorientation
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Lapses in memory
Other types of dissociative disorders include depersonalization disorder (feeling
detached from themselves or surroundings), dissociative amnesia (memory problems
associated with a traumatic experience), dissociative fugue (abandonment of familiar
surroundings and memory lapse for the past), and dissociative disorder, not otherwise
specified (episodes of dissociation that do not qualify for one of the specific dissociative
disorders just described).
Symptoms of depersonalization include:
•
Feelings that you're an outside observer of your thoughts, feelings, your body or
parts of your body, perhaps as if you were floating in air above yourself
•
Feeling like a robot or that you're not in control of your speech or movements
•
The sense that your body, legs or arms appear distorted, enlarged or shrunken,
or that your head is wrapped in cotton
•
Emotional or physical numbness of your senses or responses to the world
around you
•
A sense that your memories lack emotion, and that they may or may not be your
own memories
Symptoms of derealization include:
•
Feeling emotionally disconnected from people you care about
•
Surroundings that appear distorted, blurry, colorless, two-dimensional or artificial,
or a heightened awareness and clarity of your surroundings
•
Distortions in perception of time, such as recent events feeling like the distant
past
•
Distortions of distance and the size and shape of objects
Episodes of depersonalization-derealization disorder may last hours, days, weeks or
even months at a time. In some people, these episodes turn into ongoing feelings of
depersonalization or derealization that may periodically get better or worse.
In this disorder, feelings of depersonalization and derealization are not caused by drugs,
alcohol, or a medical condition.
EATING DISORDERS
Anorexia Nervosa
Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized
by self-starvation and excessive weight loss.
Thoughts about dieting, food, and your body may take up most of your day - leaving
little time for friends, family, and other activities you used to enjoy. Life becomes a
relentless pursuit of thinness and going to extremes to lose weight.
TYPES OF ANOREXIA:
Restricting type – The person restricts their food intake on their own and does not
engage in binge-eating or purging behavior.
Signs and Symptoms of Restricting
•
Dieting despite being thin – Following a severely restricted diet. Eating only
certain low-calorie foods. Banning “bad” foods such as carbohydrates and fats.
•
Obsession with calories, fat grams, and nutrition – Reading food labels,
measuring and weighing portions, keeping a food diary, reading diet books.
•
Pretending to eat or lying about eating – Hiding, playing with, or throwing away
food to avoid eating. Making excuses to get out of meals (“I had a huge lunch” or
“My stomach isn’t feeling good.”).
•
Preoccupation with food – Constantly thinking about food. Cooking for others,
collecting recipes, reading food magazines, or making meal plans while eating
very little.
•
Strange or secretive food rituals – Refusing to eat around others or in public
places. Eating in rigid, ritualistic ways (e.g. cutting food “just so”, chewing food
and spitting it out, using a specific plate).
•
Dramatic weight loss – Rapid, drastic weight loss with no medical cause.
•
Feeling fat, despite being underweight – You may feel overweight in general or
just “too fat” in certain places such as the stomach, hips, or thighs.
•
Fixation on body image – Obsessed with weight, body shape, or clothing size.
Frequent weigh-ins and concern over tiny fluctuations in weight.
•
Harshly critical of appearance – Spending a lot of time in front of the mirror
checking for flaws. There’s always something to criticize. You’re never thin
enough.
•
Denial that you’re too thin – You may deny that your low body weight is a
problem, while trying to conceal it (drinking a lot of water before being weighed,
wearing baggy or oversized clothes).
Binge eating/purging type - The person self-induces vomiting or misuses laxatives,
diuretics, or enemas. Anorexic appearance and body image signs and symptoms.
Signs and Symptoms of Purging:
•
Using diet pills, laxatives, or diuretics – Abusing water pills, herbal appetite
suppressants, prescription stimulants, ipecac syrup, and other drugs for weight
loss.
•
Throwing up after eating – Frequently disappearing after meals or going to the
bathroom. May run the water to disguise sounds of vomiting or reappear smelling
like mouthwash or mints.
•
Compulsive exercising – Following a punishing exercise regimen aimed at
burning calories. Exercising through injuries, illness, and bad weather. Working
out more.
What need does anorexia meet in your life?
It’s important to understand that anorexia meets a need in your life. For example, you
may feel powerless in many parts of your life, but you can control what you eat. Saying
“no” to food, getting the best of hunger, and controlling the number on the scale may
make you feel strong and successful—at least for a short while. You may even come to
enjoy your hunger pangs as reminders of a “special talent” that most people can’t
achieve.
Anorexia may also be a way of distracting yourself from difficult emotions. When you
spend most of your time thinking about food, dieting, and weight loss, you don’t have to
face other problems in your life or deal with complicated emotions.
Unfortunately, any boost you get from starving yourself or shedding pounds is extremely
short-lived. Dieting and weight loss can’t repair the negative self-image at the heart of
anorexia. The only way to do that is to identify the emotional need that self-starvation
fulfills and find other ways to meet it.
Effects of Anorexia
One thing is certain about anorexia - severe calorie restriction has dire physical effects.
When your body doesn’t get the fuel it needs to function normally, it goes into starvation
mode and slows down to conserve energy. Essentially, your body begins to consume
itself. If self-starvation continues and more body fat is lost, medical complications pile up
and your body and mind pay the price.
Some of the physical effects of anorexia include:
•
Severe mood swings; depression
•
Lack of energy and weakness
•
Slowed thinking; poor memory
•
Dry, yellowish skin and brittle nails
•
Constipation and bloating
•
Tooth decay and gum damage
•
Dizziness, fainting, and headaches
•
Growth of fine hair all over the body and face
Bulimia Nervosa
Bulimia is a serious, potentially life-threatening eating disorder characterized by a cycle
of bingeing and compensatory behaviors such as self-induced vomiting designed to
undo or compensate for the effects of binge eating.
Signs and Symptoms of Binge Eating:
•
Lack of control over eating, inability to stop eating, eating until the point of
physical discomfort and pain.
•
Secrecy surrounding eating (going to the kitchen after everyone else has gone to
bed, going out alone on unexpected food runs, wanting to eat in privacy).
•
Eating unusually large amounts of food with no obvious change in weight.
•
Disappearance of food, numerous empty wrappers or food containers in the
garbage, or hidden stashes of junk food.
•
Alternating between overeating and fasting – Rarely eats normal meals. It’s allor-nothing when it comes to food.
Signs and Symptoms of Purging:
•
Going to the bathroom after meals – frequently disappears after meals or takes a
trip to the bathroom to throw up (may run the water to disguise sounds of
vomiting).
•
Using laxatives, diuretics, or enemas after eating.
•
May also take diet pills to curb appetite or use the sauna to “sweat out” water
weight.
•
Smell of vomit – the bathroom or the person may smell like vomit. They may try
to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.
•
Excessive exercising – works out strenuously, especially after eating (typical
activities include high-intensity calorie burners such as running or aerobics).
Physical signs and symptoms:
•
Calluses or scars on the knuckles or hands from sticking fingers down the throat
to induce vomiting.
•
Puffy cheeks caused by repeated vomiting.
•
Discolored teeth from exposure to stomach acid when throwing up. May look
yellow, ragged, or clear.
Effects of Bulimia:
When you are living with bulimia, you are putting your body - and even your life - at risk.
The most dangerous side effect of bulimia is dehydration due to purging. Vomiting,
laxatives, and diuretics can cause electrolyte imbalances in the body, most commonly in
the form of low potassium levels. Low potassium levels trigger a wide range of
symptoms ranging from lethargy and cloudy thinking to irregular heartbeat and death.
Chronically low levels of potassium can also result in kidney failure.
Medical complications and adverse effects of bulimia include:
•
Abdominal pain/bloating
•
Swelling of the hands and feet
•
Chronic sore throat/hoarseness
•
Broken blood vessels in the eyes
•
Weakness and dizziness
•
Tooth decay and mouth sores
•
Acid reflux or ulcers
•
Ruptured stomach or esophagus
•
Loss of menstrual periods
•
Chronic constipation from laxative abuse
•
Swollen cheeks and salivary glands
The dangers of ipecac syrup:
If you use ipecac syrup to induce vomiting, side effects such as fast and irregular
heartbeat, difficulty breathing, diarrhea, stiffness of muscles, and weakness can
occur. Regular use of ipecac syrup can be deadly! Ipecac builds up in the body
over time. Eventually it can lead to heart damage and sudden cardiac arrest.
Binge Eating Disorder
The defining characteristic of binge eating disorder is recurrent episodes of binge eating
that occur, on average, at least once per month (for at least 3 months). Binge eating is
eating an abnormally more amount of food than a person would normally eat in a similar
period of time. The specific type of food doesn’t matter — what matters is the sheer
amount of food consumed in one sitting.
People with binge-eating disorder (BED) often feel ashamed and embarrassed by their
eating issues, and may attempt to conceal their symptoms. Binge eating usually occurs
in secrecy, or at least as inconspicuously as possible. After a binge eating episode,
people with this disorder often feel depressed and ashamed of themselves.
Signs and Symptoms:
1. Recurrent episodes of binge eating - An episode of binge eating is characterized by
both of the following:
•
Eating - in a discrete period of time (within any 2 hour period) - an amount of food
that is definitely larger than what most people would eat in a similar period of
time under similar circumstances.
•
A sense of lack of control over eating during the episode (a feeling that one
cannot stop eating or control what or how much one is eating).
2. The binge-eating episodes are associated with 3 or more of the following:
•
Eating much more rapidly than normal.
•
Eating until feeling uncomfortably full.
•
Eating large amounts of food when not feeling physically hungry.
•
Eating alone because of feeling embarrassed by how much one is eating.
•
Feeling disgusted with oneself, depressed, or very guilty afterward.
3. Feeling distress regarding binge eating.
4. The binge eating occurs, on average, at least once a week for 3 months.
5. The binge eating is not associated with the recurrent use of inappropriate
compensatory behavior, as in bulimia, and does not occur exclusively during the course
of bulimia or anorexia.
Severity is also noted in the diagnosis, from mild to extreme:
• Mild: 1-3 binge-eating episodes per week
• Moderate: 4-7 episodes
• Severe: 8-13 episodes
• Extreme: 14 or more episodes
If you would like information about Avoidant/Restrictive Food Intake Disorder, visit
this website: ARFID
GENDER DYSPHORIA
Gender Dysphoria
In order for someone to be diagnosed with Gender Dysphoria today, they must exhibit a
strong and persistent cross-gender identification (not merely a desire for any perceived
cultural advantages of being the other sex).
Signs and Symptoms:
In children, the disturbance is manifested by six (or more) of the following for at least a
6-month duration:
•
Repeatedly stated desire to be, or insistence that he or she is, the other sex
•
In boys, preference for cross-dressing or simulating female attire; in girls,
insistence on wearing only stereotypical masculine clothing
•
Strong and persistent preferences for cross-sex roles in make-believe play or
persistent fantasies of being the other sex
•
A strong rejection of typical toys/games typically played by one’s sex.
•
Intense desire to participate in the stereotypical games and pastimes of the other
sex
•
Strong preference for playmates of the other sex
•
A strong dislike of one’s sexual anatomy
•
A strong desire for the primary (penis, vagina) or secondary (menstruation) sex
characteristics of the other gender
In adolescents and adults, the disturbance is manifested by symptoms such as:
•
A stated desire to be the other sex
•
Frequent passing as the other sex
•
Desire to live or be treated as the other sex, or the conviction that he or she has
the typical feelings and reactions of the other sex.
•
Persistent discomfort with his or her sex or sense of inappropriateness in the
gender role of that sex.
•
The disturbance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
OBSESSIVE COMPULSIVE AND RELATED
DISORDERS
Obsessive Compulsive Disorder
The thoughts and rituals associated with OCD cause distress and get in the way of daily
life. The frequent upsetting thoughts are called obsessions. To try to control them, a
person will feel an overwhelming urge to repeat certain rituals or behaviors called
compulsions. People with OCD can't control these obsessions and compulsions. Most
of the time, the rituals end up controlling them. Performing these rituals are not fun. At
their best, it produces a temporary relief from the anxiety created by their obsessive
thoughts.
Common rituals are a need to repeatedly check things, touch things (especially in a
particular sequence), or count things. Some common obsessions include having
frequent thoughts of violence and harming loved ones, persistently thinking about
performing sexual acts the person dislikes, or having thoughts that are prohibited by
religious beliefs, be preoccupied with precise order and symmetry or hoard unnecessary
items.
Signs and Symptoms
•
Have repeated thoughts or images about many different things, such as fear of
germs, dirt, or intruders; acts of violence; hurting loved ones; sexual acts;
conflicts with religious beliefs; or being overly tidy.
•
Do the same rituals over and over such as washing hands, locking and unlocking
doors, counting, keeping unneeded items, or repeating the same movements
again and again.
•
Can't control the unwanted thoughts and behaviors.
•
Don't get pleasure when performing the behaviors or rituals, but get brief relief
from the anxiety the thoughts cause.
•
Spend at least 1 hour a day on the thoughts and rituals, which cause distress
and get in the way of daily life.
Body Dysmorphic Disorder
Body Dysmorphic Disorder is a mental disorder characterized by a preoccupation with a
defect in the person’s physical appearance. The defect is either imagined, or, if a slight
physical anomaly is present, the individual’s concern is markedly excessive. The
preoccupation must cause significant distress or impairment in social, occupational, or
other important areas of functioning.
Complaints commonly involve imagined or slight flaws of the face or head such as hair
thinning, acne, wrinkles, scars, vascular markings, paleness or redness of the
complexion, swelling, facial asymmetry or disproportion, or excessive facial hair. Other
common preoccupations include the shape, size, or some other aspect of the nose,
eyes, eyelids, eyebrows, ears, mouth, lips, teeth, jaw, chin, cheeks, or head. However,
any other body part may be the focus of concern (e.g., the genitals, breasts, buttocks,
abdomen, arms, hands, feet, legs, hips, shoulders, spine, larger body regions, or overall
body size).
The preoccupation may simultaneously focus on several body parts. Although the
complaint is often specific (ex. a “crooked” lip or a “bumpy” nose), it is sometimes vague
(e.g., a “falling” face or “inadequately firm” eyes).
Most individuals with this disorder experience marked distress over their supposed
deformity, often describing their preoccupations as “intensely painful,” “tormenting,” or
“devastating.” Most find their preoccupations difficult to control, and they may make little
or no attempt to resist them.
Signs and Symptoms:
•
Preoccupation with an imagined defect in appearance. If a slight physical
anomaly is present, the person’s concern is markedly excessive.
•
The preoccupation causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
•
The preoccupation is not better accounted for by another mental disorder.
Hoarding Disorder
The main feature of hoarding disorder is a person’s irrational, persistent difficulty in
discarding or parting with possessions — regardless of their actual value. This is a longstanding difficulty, not just something related to a one-time circumstance (such as
having difficulty discarding property from something you inherited from a loved
one).Discarding means that the person can’t seem to give away, throw away, recycle, or
sell things they no longer need (or sometimes, even want).
When faced with the prospect of discarding or parting with their things, a person with
hoarding disorder will experience distress.
A person with this disorder will usually collect so many things over a long period of time,
that the actual use of any given item - or indeed the person’s normal living space - is
next to impossible. The clutter collected over time impedes the person from living in
their apartment or home in a normal manner. For instance, their bed may be so full of
collected clothes or newspapers, they sleep on the floor; kitchen counters are so full of
things, there is no place to prepare and cook food.
Signs and Symptoms
•
Persistent difficulty discarding or parting with possessions, regardless of their
actual value.
•
This difficulty is due to a perceived need to save the items and to distress
associated with discarding them.
•
The difficulty discarding possessions results in the accumulation of possessions
that congest and clutter active living areas and substantially compromises their
intended use. If living areas are uncluttered, it is only because of the
interventions of third parties (e.g., family members, cleaners, or the authorities).
•
The hoarding causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning (including maintaining a
safe environment safe for oneself or others).
•
The hoarding is not attributable to another medical condition.
•
The hoarding is not better explained by the symptoms of another mental
disorder.
If you would like information about trichotillomania (hair pulling) and excoriation
(skin picking), visit this website: Learn about Trich
PERSONALITY DISORDERS
**Because personality disorders describe long-standing and enduring patterns of
behavior, they are most often diagnosed in adulthood. It is uncommon for them to be
diagnosed in childhood or adolescence, because a child or teen is under constant
development, personality changes and maturation. However, if it is diagnosed in a child
or teen, the features must have been present for at least 1 year.**
Borderline Personality Disorder
Borderline personality disorder is distinguished by unstable moods, relationships, and
self-image. Individuals with BPD are also usually very impulsive, oftentimes
demonstrating self-injurious behaviors.
These individuals are very sensitive to environmental circumstances. The perception of
any impending separation or rejection can lead to significant changes in their selfimage, emotions, and behavior.
Signs and Symptoms
•
Extreme reactions - including panic, depression, rage, or frantic actions - to
abandonment, whether real or perceived
•
A pattern of intense and stormy relationships with family, friends, and loved ones,
often veering from extreme closeness and love (idealization) to extreme dislike or
anger (devaluation)
•
Distorted and unstable self-image or sense of self, which can result in sudden
changes in feelings, opinions, values, or plans and goals for the future (such as
school or career choices)
•
Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex,
substance abuse, reckless driving, and binge eating
•
Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
•
Intense and highly changeable moods, with each episode lasting from a few
hours to a few days
•
Chronic feelings of emptiness and/or boredom
•
Inappropriate, intense anger or problems controlling anger
•
Having stress-related paranoid thoughts or severe dissociative symptoms, such
as feeling cut off from oneself, observing oneself from outside the body, or losing
touch with reality
Narcissistic Personality Disorder
Narcissistic personality disorder is a disorder in which people have an excessive sense
of self-importance and an extreme preoccupation with themselves. This condition is
characterized by a long standing pattern of grandiosity (either in fantasy or actual
behavior), an overwhelming need for admiration, and a lack of empathy toward others.
People with this disorder often believe they are of primary importance in everybody’s
life.
Signs and Symptoms
•
Has a grandiose sense of self-importance (exaggerates achievements and
talents)
•
Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or
ideal love
•
Believes that he or she is “special” and unique
•
Requires excessive admiration
•
Has a very strong sense of entitlement
•
Is exploitative of others (takes advantage of others)
•
Lacks empathy (is unwilling to recognize or identify with the feelings and needs
of others)
•
Is often envious of others or believes that others are envious of him or her
•
Regularly shows arrogance or attitudes
The long-term goal of psychotherapy for NPD is to reshape your personality, at least to
some degree, so that you a person with this disorder can change patterns of thinking
that distort their self-image and create a realistic self-image.
Avoidant Personality Disorder
People with avoidant personality disorder experience long-standing feelings of
inadequacy and are extremely sensitive to what others think about them. These feelings
of inadequacy leads the person to be socially inhibited. It typically manifests itself by
early adulthood and includes a majority of the following symptoms.
Signs and Symptoms
•
Avoids occupational activities that involve significant interpersonal contact,
because of fears of criticism, disapproval, or rejection
•
An unwillingness to get involved with people unless certain of being liked
•
Shows restraint within intimate relationships because of the fear of being shamed
or ridiculed
•
Is preoccupied with being criticized or rejected in social situations
•
Is inhibited in new interpersonal situations because of feelings of inadequacy
•
Views themselves as socially inept, personally unappealing, or inferior to others
•
Is unusually reluctant to take personal risks or to engage in any new activities
because they may prove embarrassing
Dependent Personality Disorder
Dependent personality disorder is described as an excessive need to be taken care of
that leads to a submissive and clinging behavior as well as fears of separation that can
cause distress and anxiety.
Individuals with dependent personality disorder have great difficulty making every day
without an excessive amount of advice and reassurance from others. These individuals
tend to be very passive and allow other people to assume responsibility for most areas
of their life. This need for others to assume responsibility goes beyond age-appropriate
and situation-appropriate requests for assistance from others.
Signs and Symptoms
•
Difficulty making decisions without reassurance from others
•
Extreme passivity
•
Problems expressing disagreements with others
•
Avoiding personal responsibility
•
Avoiding being alone
•
Devastation or helplessness when relationships end
•
Unable to meet ordinary demands of life
•
Preoccupied with fears of being abandoned
•
Easily hurt by criticism or disapproval
•
Willingness to tolerate mistreatment and abuse from others
Paranoid Personality Disorder
People with paranoid personality disorder are generally characterized by having a longstanding pattern of distrust and suspiciousness of others. A person with paranoid
personality disorder will almost always believe that other people’s motives are suspect
or even malicious.
Individuals with this disorder assume that other people will exploit, harm, or deceive
them, even if no evidence exists to support this expectation. They generally find it
difficult to get along with others and often have problems with close relationships. Their
excessive suspiciousness and hostility may be expressed in overt argumentativeness,
in recurrent complaining, or by hostile aloofness. Because they are hyper-vigilant for
potential threats, they may act in a guarded and secretive manner that may appear to
be “cold.”
Signs and Symptoms:
•
Suspects, without sufficient basis, that others are exploiting, harming, or
deceiving him or her
•
Is preoccupied with unjustified doubts about the loyalty or trustworthiness of
friends or associates
•
Is reluctant to confide in others because of unwarranted fear that the information
will be used maliciously against him or her
•
Reads hidden demeaning or threatening meanings into benign remarks or events
•
Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights)
•
Perceives attacks on his or her character or reputation that are not apparent to
others, and is quick to react angrily or to counterattack
•
Has recurrent suspicions, without justification, regarding fidelity of spouse or
sexual partner
Schizoid Personality Disorder
Schizoid Personality Disorder is characterized by a long-standing pattern of detachment
from social relationships. A person with schizoid personality disorder often has difficulty
expression emotions and does so typically in very restricted range, especially when
communicating with others.
A person with this disorder may appear to lack a desire for intimacy, and will avoid close
relationships with others. They may often prefer to spend time with themselves rather
than socialize or be in a group of people. A person with SPD might be thought of as the
typical “loner.”
Schizoid personality disorder is characterized by a pattern of detachment from social
relationships and a restricted range of expression of emotions in social settings. This
disorder usually begins by early adulthood.
Signs and Symptoms:
•
Neither desires nor enjoys close relationships, including being part of a family
•
Almost always chooses solitary activities
•
Has little, if any, interest in having sexual experiences with another person
•
Takes pleasure in few, if any, activities
•
Lacks close friends or confidants other than first-degree relatives
•
Appears indifferent to the praise or criticism of others
•
Shows emotional coldness and detachment
Schizotypal Personality Disorder
People with schizotypal personality disorder have difficulty forming close relationships
and have peculiar beliefs, perceptions, and behaviors that interfere in their daily life.
Signs and Symptoms:
•
Ideas of reference (incorrect interpretations of casual incidents and external
events as having a particular and unusual meaning)
•
Odd beliefs or magical thinking that influences behavior and is inconsistent with
subcultural norms (being superstitious, belief in clairvoyance, telepathy, or “sixth
sense”, bizarre fantasies or preoccupations)
•
Unusual perceptual experiences, including bodily illusions
•
Odd thinking and speech (vague, circumstantial, metaphorical, overelaborate, or
stereotyped)
•
Suspiciousness or paranoid ideation
•
Inappropriate or constricted affect
•
Behavior or appearance that is odd, eccentric, or peculiar
•
Lack of close friends or confidants other than first-degree relatives
•
Excessive social anxiety that does not diminish with familiarity
Histrionic Personality Disorder
Histrionic personality disorder is characterized by a long-standing pattern of attention
seeking behavior and extreme emotionality. Someone with histrionic personality
disorder wants to be the center of attention in any group of people, and feel
uncomfortable when they are not. While often lively, interesting and sometimes
dramatic, they have difficulty when people aren’t focused exclusively on them. People
with this disorder may be perceived as being shallow, and may engage in sexually
seductive or provocative behavior to draw attention to themselves.
People with histrionic personality disorder may crave novelty, stimulation, and
excitement and have a tendency to become bored with their usual routine. These
individuals are often intolerant of, or frustrated by, situations that involve delayed
gratification, and their actions are often directed at obtaining immediate satisfaction.
Although they often initiate a projects with great enthusiasm, they may lose interest
quickly.
Signs and Symptoms:
•
Is uncomfortable in situations in which he or she is not the center of attention
•
Interaction with others is often characterized by inappropriate sexually seductive
or provocative behavior
•
Displays rapidly shifting and shallow expression of emotions
•
Consistently uses physical appearance to draw attention to themselves
•
Has a style of speech that is excessively suggestive and lacking in detail
•
Shows self-dramatization, theatricality, and exaggerated expression of emotion
•
Is highly suggestible, i.e., easily influenced by others or circumstances
•
Considers relationships to be more intimate than they actually are
Obsessive Compulsive Personality Disorder
Obsessive-Compulsive Personality Disorder is characterized by a preoccupation with
orderliness, perfectionism, and mental and interpersonal control, at the expense of
flexibility, openness, and efficiency.
When rules and established procedures do not dictate the correct answer, decision
making may become a time-consuming, often painful process. Individuals with
Obsessive-Compulsive Personality Disorder may have such difficulty deciding which
tasks take priority or what is the best way of doing some particular task that they may
never get started on anything.
Signs and Symptoms:
•
Is preoccupied with details, rules, lists, order, organization, or schedules to the
extent that the major point of the activity is lost
•
Shows perfectionism that interferes with task completion (is unable to complete a
project because his or her own overly strict standards are not met)
•
Is excessively devoted to work and productivity to the exclusion of leisure
activities and friendships (not accounted for by obvious economic necessity)
•
Is over conscientious, scrupulous, and inflexible about matters of morality, ethics,
or values (not accounted for by cultural or religious identification)
•
Is unable to discard worn-out or worthless objects even when they have no
sentimental value
•
Is reluctant to delegate tasks or to work with others unless they submit to exactly
his or her way of doing things
•
Adopts a miserly spending style toward both self and others; money is viewed as
something to be hoarded for future catastrophes
•
Shows significant rigidity and stubbornness
Antisocial Personality Disorder
Antisocial personality disorder is characterized by a long-standing pattern of a disregard
for other people’s rights. It usually begins in childhood or as a teen and continues into
their adult lives.
Individuals with this disorder lack empathy and have a tendency to be cynical,
insensitive, and disrespectful of the feelings, rights, and sufferings of others. They have
an inflated view of themselves and are arrogant. They may be excessively opinionated,
self-assured, or cocky. They can be very skilled at displaying a superficial charm.
Signs and Symptoms
•
Disregard for right and wrong
•
Persistent lying or deceit to exploit others
•
Using charm or wit to manipulate others for personal gain or for sheer personal
pleasure
•
Intense egocentrism and sense of superiority
•
Recurring difficulties with the law
•
Repeatedly violating the rights of others by the use of intimidation, dishonesty
and misrepresentation
•
Child abuse or neglect
•
Hostility, significant irritability, agitation, impulsiveness, aggression or violence
•
Lack of empathy for others and lack of remorse about harming others
• Unnecessary risk-taking or dangerous behaviors
•
Poor or abusive relationships
•
Irresponsible work behavior
•
Failure to learn from the negative consequences of behavior
There should also be evidence of Conduct Disorder in the individual as a child.
PSYCHOTIC DISORDERS
Schizophrenia
People with the disorder may hear voices other people don't hear. They may believe
other people are reading their minds, controlling their thoughts, or plotting to harm them.
This can terrify people with the illness and other people around them. It can also make
the individual with this mental illness withdrawn or extremely agitated.
Signs and Symptoms
The symptoms of schizophrenia fall into three broad categories: positive
symptoms, negative symptoms, and cognitive symptoms.
Positive symptoms
Positive symptoms are psychotic behaviors not seen in healthy people. Schizophrenics
with positive symptoms often "lose touch" with reality. These symptoms can come and
go. Sometimes they are severe and at other times they are barely noticeable,
depending on whether the individual is receiving treatment. They include the following:
Hallucinations are things a person sees, hears, smells, or feels that no one else can
see, hear, smell, or feel. Hearing voices are the most common type of hallucination in
schizophrenia. Many people with the disorder hear voices.
Other types of hallucinations include seeing people or objects that are not there,
smelling odors that no one else detects, and feeling things when no one is near them.
Delusions are false beliefs that are not part of the person's culture and do not change.
The person believes delusions even after other people prove that the beliefs are not
true or logical. People with schizophrenia can have delusions that seem bizarre, such
as believing that neighbors can control their behavior with magnetic waves. They may
also believe that people on television are directing special messages to them, or that
radio stations are broadcasting their thoughts to others. Sometimes they believe they
are someone famous. They may have delusions and believe that others are trying to
harm them, such as by cheating, harassing, poisoning, spying on, or plotting against
them or the people they care about.
Negative symptoms
Negative symptoms are associated with disruptions to normal emotions and behaviors.
These symptoms are harder to recognize as part of the disorder and can be easily
mistaken for other conditions. These symptoms include the following:
•
"Flat affect" (a person's face does not move or he or she talks in a dull or
monotonous voice)
•
Lack of pleasure in everyday life
•
Lack of ability to begin and sustain planned activities
•
Only speaking a little bit.
People with negative symptoms need help with everyday tasks. They often neglect
basic personal hygiene. This may make them seem lazy or unwilling to help
themselves, but the problems are symptoms caused by the schizophrenia.
Cognitive symptoms
Cognitive symptoms are subtle. Like negative symptoms, cognitive symptoms may be
difficult to recognize as part of the disorder. Often, they are detected only when other
tests are performed. Cognitive symptoms include the following:
•
Poor "executive functioning" (the ability to understand information and use it to
make decisions)
•
Trouble focusing or paying attention
•
Problems with "working memory" (the ability to use information immediately after
learning it)
Schizoaffective Disorder
Schizoaffective disorder is a condition in which a person experiences a combination of
schizophrenia symptoms - such as hallucinations or delusions - and mood disorder
symptoms, such as mania or depression.
Depressive symptoms associated with schizoaffective disorder include:
•
Depressed mood (with or without suicidal thoughts)
•
Hopelessness and helplessness
•
Guilt and worthlessness
•
Disrupted appetite
•
Disturbed sleep
•
Inability to concentrate
Manic (bipolar) symptoms associated with schizoaffective disorder include:
•
Increased energy
•
Decreased sleep (or decreased need for sleep)
•
Distractibility
•
Fast (“pressured”) speech
•
Increased impulsive behaviors (sexual activities, drug and alcohol abuse,
gambling or spending large amounts of money)
Schizophreniform
The characteristic symptoms of schizophreniform disorder are identical to those of
Schizophrenia, but schizophreniform disorder is distinguished by its duration. An
episode of the disorder lasts at least one month but less than 6 months.
In some cases, the diagnosis is provisional because it is unclear whether the individual
will recover from the disturbance within the 6-month period. If the disturbance persists
beyond 6 months, the diagnosis should be changed to schizophrenia. Individuals who
recover from schizophreniform disorder are projected to have a better functional
prognosis.
Another way schizophreniform disorder differs from schizophrenia is that impaired social
and occupational functioning are not required criteria. While such impairments may
potentially be present, they are not necessary for a diagnosis of schizophreniform
disorder. However, most individuals experience dysfunction in several areas of daily
functioning, such as school or work, interpersonal relationships, and self-care.
Signs and Symptoms:
1. Delusions
2. Hallucinations
3. Communication is incoherent, frequent derailment of ideas
4. Disorganized or catatonic behavior
5. Person appears emotionally withdrawn
SLEEP-WAKE DISORDERS
Insomnia
The predominant complaint in insomnia disorder is difficulty initiating or maintaining
sleep, or nonrestorative sleep, occurring at least 3 nights per week for at least 3
months, despite adequate opportunity for sleep.
The sleep disturbance (or associated daytime fatigue) causes clinically significant
distress or impairment in social, occupational, or other important areas of functioning.
The insomnia is not attributable to the physiological effects of a substance (a drug of
abuse, a medication). However, insomnia can occur alongside or as a result of a
coexisting mental or medical condition as long as the insomnia is significant enough to
warrant its own clinical attention and treatment. For instance, insomnia may also
manifest as a clinical feature of a more predominant mental disorder.
•
Episodic insomnia refers to when symptoms last at least 1 month but less than 3
months.
•
Persistent insomnia refers to chronic insomnia lasting 3 months or longer.
•
Recurrent insomnia refers to repeated episodes (1-3 month duration) of insomnia
within the course of a year.
SOMATIC SYMPTOM AND RELATED DISORDERS
Somatic Symptom Disorder
Somatic Symptom disorder involves being distressed or having one’s life disrupted by
concerns involving physical symptoms for which a physical cause cannot be found. A
person with this disorder may worry excessively over a certain health sensations and
symptoms. They may believe the sensation indicates a serious illness like stomach
cancer, although they may not have objective evidence from a doctor to substantiate
that concern.
They may go to great lengths to attend to or to investigate their health symptoms.
Diagnosis of SSD requires that the individual has experienced these symptoms for at
least six months.
Signs and Symptoms:
Cardiac
•
•
•
Shortness of breath
Palpitations
Chest pain
Gastrointestinal
•
•
•
•
•
•
Vomiting
Abdominal pain
Difficulty swallowing
Nausea
Bloating
Diarrhea
Musculoskeletal
•
•
Pain in the legs or arms
Back and joint pain
Neurological
•
•
•
•
•
Headaches
Dizziness
Amnesia
Vision changes
Paralysis or muscle weakness
Urogenital
•
•
•
•
•
Pain during urination
Low libido
Dyspareunia (painful intercourse)
Impotence
Dysmenorrhea (painful menstrual cramps)
Conversion Disorder
Conversion disorder is a condition in which you show psychological stress in physical
ways. This physical expression is characterized by the presentation of signs and
symptoms that are inconsistent or cannot be explained by known anatomy or
physiology.
The onset of conversion symptoms usually occurs abruptly during adolescence or early
adulthood, often following a stressful life event. Symptoms often appear neurological
encompassing sensory and/or motor presentations. Generally, patients present with one
symptom at any given time and the severity of symptoms may vary under certain
circumstances.
Signs and Symptoms:
•
Anesthesia
•
Paralysis
•
Ataxia (inability to coordinate movements)
•
Tremor
•
Psychogenic Non-Epileptic Seizures
•
Deafness
•
Blindness
•
Aphonia (loss of voice)
•
Globus hystericus (sensation of having a lump in the throat when there’s nothing
there)
•
Parkinsonism (movement abnormalities)
•
Syncope (fainting)
•
Coma
•
Anosmia (inability to perceive odor)
•
Nystagmus (repetitive uncontrolled movements of the eyes)
•
Facial weakness
•
Ageusia (loss of taste functions on the tongue)
TRAUMA DISORDERS
Acute Stress Disorder
Acute Stress Disorder is characterized by the development of severe anxiety,
dissociative, and other symptoms that occurs within one month after exposure to an
extreme traumatic stressor (ex. witnessing a death or serious accident). As a response
to the traumatic event, the individual develops dissociative symptoms. Individuals with
ASD have a decrease in emotional responsiveness, often finding it difficult or impossible
to experience pleasure in previously enjoyable activities, and frequently feel guilty about
pursuing usual life tasks.
A person with Acute Stress Disorder may experience difficulty concentrating, feel
detached from their bodies, experience the world as unreal or dreamlike, or have
increasing difficulty recalling specific details of the traumatic event (dissociative
amnesia).
Signs and Symptoms:
Acute stress disorder is most often diagnosed when an individual has been exposed to
a traumatic event in which both of the following were present:
•
The person experienced, witnessed, or was confronted with (e.g., can include
learning of) an event or events that involved actual or threatened death or
serious injury, or a threat to the physical integrity of self or others.
•
Though not required, the person’s response is likely to involve intense fear,
helplessness, or horror.
Either while experiencing or after experiencing the distressing event, the individual has
3 or more of the following dissociative symptoms:
•
A subjective sense of numbing, detachment, or absence of emotional
responsiveness
•
A reduction in awareness of his or her surroundings (ex. “being in a daze”)
•
Derealization
•
Depersonalization
•
Dissociative amnesia (inability to recall an important aspect of the trauma)
The traumatic event is persistently re-experienced in at least one of the following ways:
recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving
the experience; or distress on exposure to reminders of the traumatic event.
Acute stress disorder is also characterized by significant avoidance of stimuli that
arouse recollections of the trauma (ex. avoiding thoughts, feelings, conversations,
activities, places, people). The person experiencing acute stress disorder also has
significant symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability,
poor concentration, hypervigilance, exaggerated startle response, motor restlessness).
Post Traumatic Stress Disorder
PTSD develops after a terrifying event that involved physical harm or the threat of
physical harm. The person who develops PTSD may have been the one who was
harmed, the harm may have happened to a loved one, or the person may have
witnessed a harmful event that happened to loved ones or strangers.
PTSD can happen to anyone who has been through an incident of trauma, such as:
wars, rape, torture, child abuse, kidnapping, torture, car accidents, train wrecks, plane
crashes, bombings, or natural disasters.
TYPICAL PRESENTATION:
Intrusion or Re-experiencing
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Intrusive thoughts or memories
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Nightmares related to the traumatic event
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Flashbacks, feeling like the event is happening again
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Psychological and physical reactivity to reminders of the traumatic event
Avoidant symptoms
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Avoiding thoughts or feelings connected to the traumatic event
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Avoiding people or situations connected to the traumatic event
Negative alterations in mood or cognitions
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Memory problems that are exclusive to the event
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Negative thoughts or beliefs about one’s self or the world
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Distorted sense of blame for one’s self or others, related to the event
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Being stuck in severe emotions related to the trauma (horror, shame, sadness)
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Severely reduced interest in pre-trauma activities
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Feeling detached, isolated or disconnected from other people
Increased arousal symptoms
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Difficulty concentrating
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Irritability, increased temper, or anger
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Difficulty falling or staying asleep
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Hypervigilance
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Being easily startled
Adjustment Disorder
An adjustment disorder is characterized by the development of emotional or behavioral
symptoms in response to an identifiable stressor (or stressors) occurring within 3
months of the onset of the stressor. A stressor is anything that causes a great deal of
stress in the person’s life. It could be a positive event, like a wedding or purchasing a
new home, or a negative event, like a family member’s death, the breakup of an
important relationship, or loss of a job.
These symptoms or behaviors are clinically significant as evidenced by either of the
following:
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Marked distress that is in excess of what would be expected from exposure to
the stressor
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Significant impairment in social, occupational or educational functioning
The stress-related disturbance does not meet the criteria for another specific mental
disorder. Once the stressor (or its consequences) has ended, the symptoms do not
persist for more than an additional 6 months. By definition, if your feelings related to the
event last longer than 6 months, it will no longer qualify for an adjustment disorder
diagnosis.
Adjustment disorders are further categorized by the specific symptoms experienced:
• Adjustment disorder with depressed mood
• Adjustment disorder with anxiety
• Adjustment disorder with mixed anxiety and depressed mood
• Adjustment disorder with disturbance of conduct
• Adjustment disorder with mixed disturbance of emotions and conduct
• Adjustment disorder, Unspecified
Developmental Trauma Disorder (DTD)
Complex trauma is a precursor to a host of biological and psychological problems not
captured in any DSM diagnosis. Symptoms can interfere with developmental tasks,
complicating the clinical picture as children mature. This provisional diagnosis is based
on the concept that multiple exposures to interpersonal trauma, such as abandonment,
betrayal, physical or sexual assaults, or witnessing domestic violence, have consistent
and predictable consequences that affect many areas of functioning. (van der Kolk
2005)
Note: Though DTD was not officially accepted by the DSM V, the diagnosis is widely
recognized and has significant merit.
Major diagnostic criteria for DTD:
1. Witnessing or experiencing multiple adverse interpersonal events involving
caretaker(s) for at least one year.
2. Affective and physiological dysregulation.
3. Attentional and behavioral dysregulation.
4. Self and relational dysregulation.
5. Chronically altered perception and expectations.
6. At least two posttraumatic symptoms.
7. Functional impairment- at least two of the following areas: academic, family,
peers, legal, health.
8. Duration of disorder is at least 6 months.
Developmental impacts of DTD: DTD can have wide ranging impacts on
development, which if not addressed, can distort the developmental trajectory for the
remainder of the individual’s life span.
• Somatic effects: Trauma can affect appetite, digestion, excretory functioning, sleep,
the immune system, and temperature regulation.
• Autoimmune disorders: DTD can generate autoimmune disorders because chronic
overreactivity to subjectively perceived threats depletes the immune system (elevated
cortisol levels). This too often gets treated purely as a medical problem. The result is
ineffective medical care. Application of medical intervention may produce short term
improvement, but with the traumatic energy in the body continuing to drive the
perception of threat, the immune system will only wear out again. This can lead to a
“medical” conclusion of a chronic physiological condition that may need ongoing
medical treatment. As a result, the real solution gets tragically overlooked.
• Speech + language: Speech is impaired, and this blocks being able to talk about a
traumatic state while in it. Because the language areas in the prefrontal cortex are not
well connected to the amygdala, traumatic emotion can’t be effectively talked through.
Language, as a whole, can’t accurately convey internal experience. However, the
presence of emotion cannot be disguised out of the voice, as emotion is neurologically
transported by the vagus nerve which runs right through the larynx.
• Dissociation: In traumatized states, emotion, sensation, perception and thought are
dissociated into separate fragments. This literally blocks understanding of what is
happening which disturbs later memory processing. This sets the stage for learning to
ignore the body and what is going on within it. DTD children organize themselves
around “not experiencing”. Because they are simply “not present” a lot of the time,
children do not reliably take in new information nor do they internalize information
accurately across time. This clearly is highly relevant to academic achievement, to
learning from past experience, and to future planning skills. These impairments rob
these children of important tools everyone uses for self-regulation.
• Sensory systems: DTD can impair processing in one or more sensory systems if those
systems were involved in early traumatic interactions. This can look like sensory based
learning disabilities, but it isn’t. As a result, when LD approaches are applied in school,
they often are ineffective. This is because the sensory processing system is
compromised by the presence of a traumatic emotional charge embedded within it, like
so much static in a radio station signal, rather than the processing system itself being
impaired.
• Attentional system: DTD also dysregulates the attentional system. This, of course,
looks like ADHD and gets overwhelmingly labeled and treated as such. Trauma takes
executive functioning skills offline as well. The experience of trauma tends to blunt
innate curiosity and exploratory impulses.
• Fragmentation/disorganization: Whatever is communicated as being off limits to an
infant’s caretaker is also off limits to the Self. Infants quickly pick up implicitly, what their
caretakers do not want to see, will reject, are afraid of, and will retaliate against. These
elements become “off limits” which lays the groundwork for fragmenting the child’s Self
construct. This fragmentation of the Self produces a pervasive state of internal
disorganization that causes further fragmentation as time moves forward, and so the
disorganization is both effect and then cause. This internal disorganization impairs
integrative processing so much that the integration of sensory, cognitive, emotional, and
behavioral experience does not occur.
• Fragmentation/emotional awareness: The fragmentation of the Self disconnects
children from their own feelings. Consequently, they may not know what they are feeling
and may not even realize they are having an emotional experience. This will cause a
block in developing skills to regulate emotions. Being internally disconnected will also
prevent children from knowing what other people feel.
• The human face: As infants cannot escape the emotion on the caregiver’s face, they
are trapped by what that face conveys. If the caregiver’s face conveys frightening
emotion, the human face itself can become imprinted as a traumatic trigger. Here lies
the origins of future avoidance of eye contact and physical closeness to the face which
obstructs attachment.
• Internal Working Model: Children with DTD assemble an IWM that portrays the world
as inevitably bringing hurt and pain, and themselves as “terrible, horrible…” So they
come to expect continuing traumatic experiences. Hence, their behavior is aimed at
maintaining some sense of safety by reducing external threat and blocking internal
experience and fragmentation. Yet, action that originates from themselves they often
see as “evil or bad”, thereby creating an exquisite and very difficult dilemma to work
through on their own. Unfortunately this is frequently not understood by the adult world,
and this survival behavior is given stigmatizing labels such as “oppositional” which
reinforces the destructive view of the Self. This actually blocks emotional healing, as
healing requires enormous safety to do the integrative work of connecting traumatic
memories to other neural networks such that the traumatic material is ultimately
integrated into the overall autobiographical narrative.
• Guilt & shame: Trauma victims carry guilt and shame about what they did or didn’t do,
in response to what was done to them at the time (trauma/shame interface). Trauma
victims hate the little child within who complied - and did not fight - the abuser. This lays
the foundation for a shame-based identity which reinforces the impact of
fragmentation/disorganization on the Self.
The information above on Developmental Trauma Disorder was obtained from:
http://www.attachmentdisordermaryland.com/traumadisorders.htm