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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:

• Constant worrying
• Feeling like your anxiety is uncontrollable
• Intrusive thoughts about things that make you anxious
• An inability to tolerate uncertainty
• A pervasive feeling of apprehension or dread

Behavioral symptoms of Generalized Anxiety Disorder:

• Inability to relax, enjoy quiet time, or be by yourself
• Difficulty concentrating or focusing on things
• Putting things off because you feel overwhelmed
• Avoiding situations that make you anxious

Physical symptoms of Generalized Anxiety Disorder:

• Feeling tense; having muscle tightness and/or body aches
• Being easily fatigued
• Having trouble falling asleep or staying asleep because your mind won’t quiet down
• Feeling edgy, restless, or jumpy
• Stomach problems, nausea, diarrhea

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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:

• Sudden and repeated attacks of fear
• A feeling of being out of control during a panic attack
• An intense feeling of dread
• An intense worry about when the next attack will happen
• A fear or avoidance of places where panic attacks have occurred in the past

Physical symptoms during an attack might be:

• Pounding or racing heart
• Difficulty breathing / Chest pain
• Sweating
• Dizziness / Lightheadeness
• Feeling hot or a cold chill
• Tingly or numb hands
• Sensations of smothering and/or feelings of choking
• Nausea/Stomachache
• Trembling or shaking

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.

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Social Anxiety Disorder (Social Phobia)

Everyday social interactions cause irrational anxiety, fear, self-consciousness, and embarrassment in people who struggle with Social Anxiety Disorder.

Signs and Symptoms:

• Being very anxious about being with other people and have a hard time talking to them
• Being very self-conscious in front of other people and feel embarrassed easily
• Being very afraid that other people will judge them
• Worry for days or weeks before an event where other people will be
• Stay away from places where there are other people
• Have a hard time making friends and keeping friends
• Blush, sweat, or tremble around other people
• Feel nauseous or sick to their stomach when with other people

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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
• 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
• 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
• Repeated nightmares involving the theme of separation
• Repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated.

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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:

• Using public transportation, such as automobiles, buses, trains, ships, or planes
• Being in open spaces, such as parking lots, marketplaces, or bridges
• Being in enclosed spaces, such as shops, theaters, or cinemas
• Standing in line or being in a crowd
• 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.

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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.

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BIPOLAR AND RELATED DISORDERS

Bipolar disorder (also known as manic-depressive) causes drastic shifts in mood, energy and activity levels. 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 mania or a manic episode:

• Mood Changes
• A long period of feeling “high” – an overly happy or outgoing mood
• Extreme irritability

Behavioral Changes

• Talking very fast
• Jumping from one idea to the next
• Racing thoughts
• Being easily distracted
• Getting a lot done in a short amount of time
• Being restless
• Sleeping very little or not being tired at all
• Behaving impulsively
• Engaging in high risk behaviors (promiscuous sex, reckless driving, etc.)

Symptoms of a depressive episode:

• Mood Changes
• An overly long period of feeling sad or hopeless
• Loss of interest in activities once enjoyed

Behavioral Changes

• Feeling tired
• Having problems concentrating, remembering, and making decisions
• Being irritable
• Changing eating, sleeping, or other habits
• 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.

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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.

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DISRUPTIVE, IMPULSE CONTROL, & CONDUCT DISORDERS

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.
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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:

• Negativity
• Defiance
• Disobedience
• Hostility directed toward authority figures

These behaviors might cause your child to regularly and consistently:

• Have temper tantrums
• Be argumentative with adults
• Refuse to comply with adult requests or rules
• Annoy other people deliberately
• Blames others for mistakes or misbehavior
• Acts touchy and is easily annoyed
• Feel anger and resentment
• Be spiteful or vindictive
• Act aggressively toward peers
• Have difficulty maintaining friendships
• Have academic problems
• Feel a lack of self-esteem

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Intermittent Explosive Disorder

Intermittent Explosive Disorder involves involves frequent episodes of impulsive anger that’s out of proportion to the event that triggered it. People with IED have a low tolerance for frustration and can be aggressive, have angry verbal outbursts and engage in violent behavior. Road rage, domestic abuse, throwing or breaking objects, or other temper tantrums may be symptoms.

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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:

Note: 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
• Feelings of hopelessness and worthlessness
• Pessimism
• Feelings of guilt
• Feelings of helplessness
• Irritability and/or restlessness
• Loss of interest in activities or hobbies once that you once enjoyed
• Fatigue
• Difficulty concentrating and lack of focus
• Difficultly making decisions
• Insomnia, early-morning wakefulness, or excessive sleeping
• Overeating or appetite loss
• Thoughts of suicide or suicide attempts
• Body aches

Major Depressive Disorder – 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 here: Psychotic Depression

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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:

• 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).
• 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.

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Persistent Depressive Disorder (Dysthymia)

Persistent Depressive Disorder is characterized by a milder but more chronic form of depression. People with PDD experience a sad or depressed mood nearly every day for at least 2 years. In children, the mood may manifest as irritability.

Signs and Symptoms

• Changes in appetite (poor appetite or overeating)
• Sleep difficulties (too little or too much sleep)
• Lack of energy or fatigue
• Poor self-esteem
• Hopelessness or feeling stuck in a rut
• Trouble concentrating or difficulty making decisions

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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.

Postpartum Depression – Many women experience PPD after giving birth. They may be mistaken for baby blues at first, but the symptoms of Postpartum Depression are more intense and last longer. They may even interfere with your ability to handle daily tasks and make it difficult to bond with your baby.

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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
• Suicidal tendencies
• Anxiety and/or panic attacks
• Alcohol and/or drug abuse
• Confusion
• Memory problems
• Delusions
• Headaches
• Flashbacks
• Eating disorders
• Personality change
• Selective loss of memory
• Disorientation
• Lapses in memory

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Depersonalization / Derealization Disorder

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.

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Other types of dissociative disorders include 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).

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FEEDING & EATING DISORDERS

Anorexia Nervosa

Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by an obsession with weight, food, and calories. People struggling with AN have an intense fear of gaining weight, leading to a significant restriction of food intake. (Note: Anorexia without significant low body weight is classified as Atypical Anorexia)

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:

• Fixation on body image – obsessed with weight, body shape, or clothing size; frequent body checking, weigh-ins and concern over tiny fluctuations in weight.
• Obsession with calories, carbohydrates, fat grams, and nutrition – reading food labels, measuring and weighing portions, keeping a food diary, reading diet books.
• Dieting despite being thin – following a severely restricted diet, eating only certain low-calorie foods, banning “bad” foods such as carbohydrates and fats.
• 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).
• Harshly critical of appearance – spending a lot of time in front of the mirror checking for flaws.
• Denial – You may deny that your disordered behaviors are a problem, while also 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.

Effects of Anorexia:

• 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
• Loss of menstrual periods
• Growth of fine hair all over the body and face

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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 all-or-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:

• 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.

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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.

Avoidant/Restrictive Food Intake Disorder:

ARFID is a condition characterized by the avoidance of certain foods or types of food, having restricted intake in terms of overall amount eaten, or both.

Signs and Symptoms:

• Lack of appetite or interest in food
• Restriction in amount or type of food eaten
• Stunted weight gain and height growth; dramatic weight loss
• Gastrointestinal issues that seemingly have no known cause
• Fear of illness, choking, or vomiting
• No body image concerns
• Menstrual irregularities
• Anemia, low hormone levels, low potassium, slow heart rate
• Dizziness or falling
• Muscle weakness
• Fine or brittle nails

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GENDER DYSPHORIA

In order for someone to be diagnosed with Gender Dysphoria, 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.

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NEURODEVELOPMENTAL DISORDERS

Intellectual Disability – Involves impairments of general mental abilities that impact adaptive functioning in three domains. These domains determine how well an individual copes with everyday tasks:

• The conceptual domain includes skills in language, reading, writing, math, reasoning, knowledge, and memory.

• The social domain refers to empathy, social judgment, interpersonal communication skills, the ability to make and retain friendships, and similar capacities.

• The practical domain centers on self-management in areas such as personal care, job responsibilities, money management, recreation, and organizing school and work tasks.

While intellectual disability does not have a specific age requirement, an individual’s symptoms must begin during the developmental period and are diagnosed based on the severity of deficits in functioning. The disorder is considered chronic and often co-occurs with other mental health conditions like depression, attention-deficit/hyperactivity disorder, and autism spectrum disorder.

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Autism Spectrum Disorder – ASD is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave.

Signs and Symptoms:

Social communication / interaction behaviors may include

• Making little or inconsistent eye contact
• Appearing not to look at or listen to people who are talking
• Infrequently sharing interest, emotion, or enjoyment of objects or activities (including infrequent pointing at or showing things to others)
• Not responding or being slow to respond to one’s name or to other verbal bids for attention
• Having difficulties with the back and forth of conversation
• Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond
• Displaying facial expressions, movements, and gestures that do not match what is being said
• Having an unusual tone of voice that may sound sing-song or flat and robot-like
• Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions
• Difficulties adjusting behaviors to social situations
• Difficulties sharing in imaginative play or in making friends

Restrictive / repetitive behaviors may include

• Repeating certain behaviors or having unusual behaviors, such as repeating words or phrases (a behavior called echolalia)
• Having a lasting intense interest in specific topics, such as numbers, details, or facts
• Showing overly focused interests, such as with moving objects or parts of objects
• Becoming upset by slight changes in a routine and having difficulty with transitions
• Being more sensitive or less sensitive than other people to sensory input, such as light, sound, clothing, or temperature

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Attention-Deficit/Hyperactivity Disorder – ADHD is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

ADHD has three subtypes:

• Predominantly hyperactive-impulsive
• Predominantly inattentive
• Combined hyperactive-impulsive and inattentive

Signs and Symptoms:

Symptoms of inattention may include:

• Being easily distracted, missing details, forgetting things, and frequently switch from one activity to another
• Have difficulty focusing on one thing
• Becoming bored with a task after only a few minutes, unless doing something enjoyable
• Have difficulty focusing attention and completing a task
• Losing things that are important often
• Isn’t able to listen well
• Daydreams, become easily confused
• Struggles to follow instructions

Symptoms of hyperactivity may include:

• Fidgeting often
• Talking nonstop
• Being constantly in motion
• Having difficulty doing things quietly

Symptoms of impulsivity may include:

• Being very impatient
• Blurting out inappropriate comments
• Often interrupting conversations

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Specific Learning Disorder – LD’s are characterized by a persistent impairment in at least one of three major areas: reading, written expression, and/or math and are typically diagnosed in early school-aged children, although may not be recognized until adulthood.

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Tourette’s Disorder – Characterized by sudden, involuntary movements and/or sounds called tics. Tics can range from mild/inconsequential to moderate and severe, and are disabling in some cases.

Signs and Symptoms:

Motor Tics

• Motor tics are movements. Simple motor tics include but are not limited to: eye blinking, facial grimacing, jaw movements, head bobbing/jerking, shoulder shrugging, neck stretching, and arm jerking. Complex motor tics involve multiple muscle groups or combinations of movements and tend to be slower and more purposeful in appearance,(e.g., hopping, twirling, jumping).

Vocal/Phonic Tics

• Vocal (phonic) tics produce a sound. Simple vocal tics include but are not limited to sniffing, throat clearing, grunting, hooting, and shouting. Complex vocal tics are words or phrases that may or may not be recognizable but that consistently occur out of context. In 10-15% of cases, the words may be inappropriate (i.e., swear words, ethnic slurs, or other socially unacceptable words or phrases).

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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.

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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.

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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 long-standing 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.

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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. In addition, these individuals are very sensitive to environmental circumstances. The perception of any impending separation or rejection can lead to significant changes in their self-image, 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

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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.

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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

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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. In addition, 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

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Paranoid Personality Disorder

People with paranoid personality disorder are generally characterized by having a long-standing 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 hypervigilant 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

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​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 expressing emotions and does so typically in very restricted range, especially when communicating with others. They may also appear to lack a desire for intimacy, and will avoid close relationships with other. 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

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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

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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. In addition, 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

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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. Individuals with OCPD 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

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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 and may be excessively opinionated, self-assured, or cocky. In addition, 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.

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SCHIZOPHRENIA SPECTRUM & OTHER 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, negative, and cognitive.

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 – these 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 – these 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 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 are subtle. 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)

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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)

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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:

• Delusions
• Hallucinations
• Communication is incoherent, frequent derailment of ideas
• Disorganized or catatonic behavior
• Person appears emotionally withdrawn

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Delusional Disorder

A condition in which an individual displays one or more delusions for one month or longer with no other psychotic symptoms. If a person has delusional disorder, functioning is generally not impaired and behavior is not obviously odd, with the exception of the delusion.

Delusions, by definition, are fixed beliefs that do not change, even when a person is presented with conflicting evidence. They may seem believable at face value, and people suffering with them may appear normal as long as an outsider does not touch upon their delusional themes.

Some of the most frequently encountered types of delusions are:

• Delusional jealousy – That one’s sexual partner is unfaithful.
• Bizarre – A delusion involving a phenomenon that is impossible, not understandable, and unrelated to normal life.
• Erotomanic – A delusion that another person, more frequently someone of higher status, is in love with the individual.
• Grandiose – An individual believes that he or she has some great but unrecognized talent or insight, a special identity, knowledge, power, self-worth, or relationship with someone famous or with God.
• Persecutory – An individual believes that he or she is being cheated, spied on, drugged, followed, slandered, or somehow mistreated. The central theme is being conspired against, attacked, harassed, or obstructed in the pursuit of long-term goals.
• Somatic – These involve bodily functions and sensations, an example being an individual that believes he or she is experiencing physical sensations or bodily dysfunctions, such as foul odors or insects crawling on or under the skin.
• Mixed – No single theme is prevalent.
• Thought broadcasting – Delusion that one’s thought is projected and perceived by others.
• Thought insertion – A delusion that one’s thought is not one’s own but inserted into their mind by an external source or entity.

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SLEEP-WAKE DISORDERS

Insomnia

The predominant complaint in insomnia disorder is difficulty initiating or maintaining sleep, or non-restorative 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.

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Narcolepsy – A chronic neurological condition that disrupts the normal sleep-wake cycle. People with this sleep disorder can experience overwhelming fatigue and uncontrollable sleepiness; they nap or fall asleep often throughout the day and can lapse into fully unplanned sleep at any time. They may also take multiple “micro-naps,” lasting just a few seconds at a time. During severe bouts of sleepiness, they may continue with their normal activities in a kind of automatic state, but may feel dazed and have no memory of engaging in the activity.

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Parasomnia(s) – Involves unusual and undesirable physical events or experiences that disrupt your sleep. Parasomnia(s) can occur before or during sleep or during arousal from sleep. If you have a parasomnia, you might have abnormal movements, talk, express emotions or do unusual things you wouldn’t do if you were awake. There can be categorized into three main types: NREM-related, REM-related, and other.

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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 even 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)

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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)

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TRAUMA & STRESSOR RELATED 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).

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Reactive Attachment Disorder

RAD is a condition that can develop in infants or young children who fail to form healthy emotional attachments with their parents or primary caregivers. This occurs when the child’s fundamental needs for comfort, affection, and nurturing are not adequately met, preventing the establishment of loving, stable, and caring relationships with others.

Signs and Symptoms:

• Unexplained withdrawal, fear, sadness or irritability
• Sad and listless appearance
• Not seeking comfort or showing no response when comfort is given
• Failure to smile
• Watching others closely but not engaging in social interaction
• Failure to reach out when picked up
• No interest in playing peekaboo or other interactive games
• Behavior problems
• Failing to seek support or assistance

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Post Traumatic Stress Disorder

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. Typically, PTSD develops after a terrifying event that involved physical harm or the threat of physical harm. The person who develops it 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.

TYPICAL PRESENTATION

• Intrusion or Re-experiencing
• Intrusive thoughts or memories
• Nightmares related to the traumatic event
• Flashbacks, feeling like the event is happening again
• Psychological and physical reactivity to reminders of the traumatic event

Avoidant symptoms:

• Avoiding thoughts or feelings connected to the traumatic event
• Avoiding people or situations connected to the traumatic event

Negative alterations in mood or cognitions:

• Memory problems that are exclusive to the event
• Negative thoughts or beliefs about one’s self or the world
• Distorted sense of blame for one’s self or others, related to the event
• Being stuck in severe emotions related to the trauma (horror, shame, sadness)
• Severely reduced interest in pre-trauma activities
• Feeling detached, isolated or disconnected from other people

Increased arousal symptoms:

• Difficulty concentrating
• Irritability, increased temper, or anger
• Difficulty falling or staying asleep
• Hypervigilance
• Being easily startled

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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:

• Marked distress that is in excess of what would be expected from exposure to the stressor
• 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