Najwa Bashir

I am a passionate and knowledgeable psychologist, with a Master of Philosophy (MPhil) in Psychology specializing in Counseling Psychology. Through my writing, I share my insights and thoughts on various psychiatric disorders, conduct analysis on films that touch on psychological issues, and explore other topics related to psychology, while also providing valuable information to psychology enthusiasts, students as well the general community.

Categories
Psychiatric Disorders

Prevalence, Diagnostic Criteria and Features of Prolonged Grief Disorder

One of the worst yet most frequent stresses in life is losing a loved one, which sets off a series of emotional, mental, and behavioral reactions that come to be known as grieving. People’s grief reactions vary depending on how they adjust to a significant death; they are not based on predetermined stages. When someone experiences a significant death, most go on to effectively adjust to the loss over time, and their sorrow develops from an acute to a more integrated state. A person who has lost more than one loved one may react to each death’s intense sorrow differently, based on a number of variables such as the deceased’s relationship to the survivor and other circumstances related to the particular loss. Acute grieving often entails a time of intense feelings and obsession with memories and thoughts of the departed individual, which may lead to a period of diminished involvement in life and previous activities. The duration and severity of acute grieving vary, and it is influenced by culture and religion. Most grieving people have integrated sorrow after this intense phase of mourning, which means they have come to terms with the loss and are able to meaningfully resume their life without the departed.

However, a sizable minority may experience relentless grieving reactions that lead to functional impairment that surpasses cultural norms; historically, these reactions have been classified as complex, traumatic, persistent, or pathological; more recently, Prolonged Grief Disorder (PGD) has become the accepted term.

According to the empirical evidence, PGD prevalence estimates varies from 10.4% to 32%. Gender, cognitive avoidance, long-term stresses such financial difficulties, trauma or other losses, and exposure to these factors seem to be linked to more severe symptoms or maybe a larger chance of PGD. On the other hand, statistics indicate that social support could be shielding.

As far as the diagnosis of PGD is concerned, the DSM 5 TR has put forward the following criteria and features to identify PGD:

Diagnostic Criteria

A. A person close to the bereaved died at least 12 months ago.

B. Since the death, there has been a consistent grief reaction marked by either one or both of the following symptoms, which remain present on the majority of days to a clinically significant degree. Furthermore, the symptom(s) have happened almost every day for at least the last month:

  1. Strong desire/longing for the deceased individual.
  2. Obsession with thoughts or recollections of the departed person (among children and adolescents, preoccupation may center on the circumstances of the death).

C. Following the death, no less than three of the following symptoms have been persisted on the majority of days in a clinically meaningful way. Furthermore, the symptoms have appeared almost every day for at least the last month:

  1. Identity disturbance (e.g., feeling as if a part of oneself has perished) following death.
  2. A strong sensation of disbelief regarding the death.
  3. Avoidance of reminders that the person has died (in children and adolescents, this may manifest as efforts to avoid reminders).
  4. Extreme emotional suffering (e.g., anger, bitterness, and grief) caused by the death.
  5. Difficulty reintegrating into one’s relationships and activities following death.
  6. Emotional numbness (no sign or significant reduction in emotional experience) as a result of death.
  7. Feeling as if existence is pointless after death. 8. Extreme loneliness as a result of the death.

D. The disturbance results in clinically substantial distress or impairment in social, vocational, or other critical areas of functioning.
E. The duration and severity of the grief reaction plainly exceed the individual’s cultural and religious norms.
F. The symptoms cannot be explained by another mental disorder, such as major depressive disorder or posttraumatic stress disorder, and they are not caused by the physiological effects of a drug (e.g., medication, alcohol) or another medical condition.

Diagnostic Features

  • Prolonged Grief Disorder (PGD) is a condition marked by a persistent and maladaptive grief reaction.
  • It can be diagnosed when symptoms last at least 12 months following the death of a close connection (6 months in children and adolescents).
  • PGD is characterized by a chronic grief reaction that includes deep desire or wanting for the departed, continuous obsession with memories or ideas about them, or, for children, the circumstances of the death.
  • The acute craving or obsession must be persistent on the majority of days and to a clinically noticeable extent for at least the previous month.
  • Furthermore, at least three of the subsequent signs and symptoms need to be present. Among these are identity disruptions, such having the sensation that a piece of oneself has vanished.
  • Another sign that someone is having trouble accepting the loss is disbelief about the death.
  • Key signs also include avoiding thoughts of the deceased and experiencing severe emotional distress, such as remorse or wrath.
  • Emotional numbness and trouble reintegrating into social interactions and activities are possible symptoms.
  • PGD is additionally characterized by a pervasive sensation of profound loneliness or meaninglessness in life.
  • The majority of the time, these symptoms must be present to a clinically significant extent, severely impairing the person’s ability to operate on a daily basis and maintain emotional stability.
  • These symptoms must cause considerable discomfort or impairment in social, occupational, or other crucial areas of functioning while also exceeding ordinary societal, cultural, or religious standards.
  • PGD may impact people of all genders, social backgrounds, and cultures, indicating a common yet diverse mourning experience.

Categories
Psychiatric Disorders

Prevalence, Causes, Diagnostic Criteria and Features of Adjustment Disorders

Adjustment disorder is defined as a maladaptive emotional and/or behavioral reaction to an identified psychosocial stressor, encompassing people who struggle to adjust after a stressful event on a scale disproportionate to the amount or degree of the stressor. The symptoms are distinguished by stress responses inconsistent with socially or culturally anticipated reactions to the stressor and/or produce significant anguish and deterioration in daily functioning. Unlike posttraumatic stress disorder (PTSD) and acute stress disorder (ASD), which have specific criteria for what defines a traumatic experience, adjustment disorder guidelines are not specific about what might be considered a stressor.

Population-based studies have revealed prevalence rates of less than 1%, which might be attributed to limitations in the diagnostic techniques utilized. In contrast, more recent studies employing improved diagnostic methods reported prevalence rates of 2% in general population studies. Rates are substantially higher in high-risk populations, such as the recently jobless (27%), and the widowed (18%).

Furthermore, research has discovered that feminine gender, younger age, unemployment, stress, physical disease and injury, limited social support, and a history of mental health issues all predict adjustment disorders. The majority of these factors distinguish persons with adjustment issues from those without mental health conditions. Participants with adjustment problems are more likely to be involved in accidents than those with posttraumatic stress disorder, although they had been far less likely to have been assaulted, neglected, or maltreated. More study is needed to discover the characteristics that distinguish adjustment disorders from other mental health illnesses.

The diagnostic criteria and features of adjustment disorders are discussed next in light of DSM 5 TR:

Diagnostic Criteria

A. Within three months of the stressor(s) beginning, the emergence of behavioral or emotional symptoms in reaction to one or more recognized stressors.
B. One or both of the following demonstrate the clinical significance of these symptoms or behaviors:
1. Noticeable suffering that is disproportionate to the stressor’s intensity or severity, taking into consideration cultural and environmental variables that may have an impact on the presentation and severity of symptoms.
2. Considerable impairment in critical domains of functioning, such as social, professional, or other.
C. The stress-related disturbance is not only an aggravation of a previous mental disorder; it does not fit the criteria for another mental disorder.
D. Prolonged grief is not a better explanation for the symptoms, which do not reflect typical grieving.

E. The symptoms disappear when the stressor or its effects have passed, usually within a further six months.
Indicate whether:
F43.21. Feeling down: There is a general sense of melancholy, tears, or hopelessness.
F43.22. When there is anxiety, the main symptoms are jitteriness, nervousness, or separation anxiety.
F43.23. With mixed anxiety and a gloomy mood: Anxiety and depression are the main symptoms.
F43.24. When it comes to disruptive behavior: disruptive behavior predominates.
F43.25. With a combined disturbance of emotions and behavior: The major symptoms are a disruption of conduct as well as emotional symptoms (such as sadness, and anxiety).
F43.20 Unspecified. Maladaptive responses that cannot be assigned to a particular category of adjustment disorder.
Indicate if:
Acute: If symptoms have persisted for less than six months, this specifier can be used to describe them.
Chronic (persistent): This specifier can be used to describe symptoms that have persisted for at least six months. By definition, the duration of symptoms cannot continue past six months following the cessation of the stressor or any associated repercussions. Therefore, when a disturbance lasts longer than six months as a result of a chronic stressor or a stressor with long-lasting effects, the persistent specifier is applicable.

Diagnostic Features

  • The primary characteristic of adjustment disorders is the manifestation of behavioral or emotional symptoms in reaction to a recognized stressor (Criterion A).
  • One stressor may be the end of a love connection, for example, or there could be several stressors at once, such as persistent marital issues and business setbacks.
  • Stressors can be continuous (e.g., a chronic painful sickness with growing handicap, living in a crime-ridden area) or cyclical (e.g., linked to seasonal business problems, unfulfilling sexual relationships).
  • Stressors can impact a single person, a family as a whole, or a wider society (such as a natural disaster).
  • Specific developmental events (such as starting school, moving away from or back into one’s parent’s house, getting married, starting a family, not achieving career ambitions, etc.) may come with certain pressures.

Categories
Psychiatric Disorders

Prevalence, Diagnostic Criteria, and Features of Acute Stress Disorder

Acute stress disorder (ASD) was added to the DSM-IV 20 years ago, but not much is known about how common it is, especially in the general community. ASD is a different diagnosis from PTSD, but the only difference is how long the symptoms last. This makes it harder to figure out how common ASD is. The rate of ASD varies a lot depending on the study and the type of stress. The rates of ASD were found to be 24.0% to 24.6% less than one week after an injury and 11.7% to 40.6% one to two weeks after an accident.

Survey-based studies show that twenty to ninety percent of people have at least one very stressful event happen to them in their life. Even though a lot of people are vulnerable, only 1.3% to 11.2% of people with ASD went on to develop a long-term disease with symptoms, like PTSD.

Studies show that ASD is the main cause of problems in many areas of living. It affects people of all ages and affects both mental and physical health. However, it makes life less enjoyable and social events less fun. Therefore, diagnosis and treatment of this disorder is imperative for optimal functioning. The diagnostic criteria and features of ASD in light of DSM 5 TR are outlined below:

Diagnostic Criteria

A. Being exposed to death, major damage, or sexual violence in one or more of the ways below, or being threatened with them:
1. Going through the painful event(s) firsthand.
2. Being there in person to see the event(s) as other people saw them.

3. Learning that the event(s) happened to a close family member or close friend.
Note: If a family member or friend was killed or was about to be killed, the event(s) must have been violent or accidental.
4. Being exposed to the painful event(s) over and over again or in a very strong way (for example, first responders receiving dead bodies or police officers being exposed to details of child abuse over and over again).
Note: This does not cover exposure from electronic media like TV, movies, or pictures unless the exposure is connected to work.
B. Having nine or more of the following symptoms from any of the five groups: intrusion, negative mood, dissociation, avoidance, and arousal, starting or getting worse after the stressful event(s):

Intrusion Symptoms

1. Recurrent, involuntary, and intense upsetting thoughts of the stressful event(s). Note: Children may play over and over again, and in those games, they may show themes or parts of the stressful event(s).
2. Frequent, upsetting dreams about the event(s) that have something to do with the dream’s content or mood. Note: Kids can have scary dreams that don’t make sense.
3. The person feels or acts as if the stressful event(s) are happening again, which is known as a dissociative response. (These kinds of responses can happen on a scale, with losing consciousness being the worst.) It’s important to note that children may recreate stress in their play.
4. Severe or long-lasting mental discomfort or clear physical responses to internal or external cues that represent or look like a part of the stressful event(s).

Negative Mood

5. The persistent inability to feel good emotions, such as the inability to feel happy, satisfied, or caring.

Dissociative Symptoms

6. A change in how real one’s surroundings or oneself seems (for example, seeing oneself from someone else’s point of view, being in a daze, or time slowing down).
7. Not being able to remember an important part of the traumatic event(s) (usually because of detached amnesia and not after a head injury, drinking, or using drugs).

Avoidance Symptoms

8. Trying to stay away from memories, thoughts, or feelings that are upsetting and related to the stressful event(s).
9. Trying to stay away from things, people, places, talks, activities, items, and situations that bring up upsetting memories, thoughts, or feelings related to or connected to the traumatic event(s).

Arousal Symptoms

10. Sleep disturbance (e.g., trouble going or staying asleep, restless sleep).
11. Irritable behavior and bouts of anger that happen with little or no reason, usually by being violent or screaming at people or things.
12. Being too alert.
13. Having trouble focusing.
14. A shock reaction that is too strong.
C. The disturbance (the signs in Criterion B) lasts three days to one month after the shock.
Note: Symptoms usually start immediately after the stress, but they have to last for at least three days and no more than one month to meet the standards for a disorder.
D. The disturbance leads to sadness or problems in social, professional, or other important areas of functioning that are clinically serious.
E. The disturbance is not caused by the effects of a drug (like booze or medicine) or a medical condition (like a mild traumatic brain injury) and there aren’t any other conditions that would explain it better.

Diagnostic Features

  • After one or more stressful incidents, acute stress disorder symptoms persist for three days to one month (Criterion A). These symptoms match PTSD Criterion A (see “Diagnostic Features” for PTSD).
  • The symptoms of acute stress disorder vary, but most entail an anxious reaction to the stressful experience.
  • Intrusion, negative mood, disconnectedness, avoidance, and excitation symptoms are signs (Criterion B1–B14).
  • Dissociated or detached looks may be the predominant trait, yet these people frequently have significant emotional or bodily reactions to trauma reminders.
  • A strong anger reaction might cause restlessness or hostility in certain people.
  • PTSD Criterion B1–B5 intrusion symptoms resemble “Diagnostic Features” symptoms.
  • Remember that acute stress disorder Criterion B4 covers PTSD Criterion B4 and B5.
  • Acute stress disorder can prevent people from feeling happiness, joy, fulfillment, intimacy, compassion, or sexuality. However, they may experience fear, despair, rage, guilt, or humiliation (Criterion B5).
  • Depersonalization and derealization are changes in awareness that can cause one to think things are moving slowly, see things in a daze, or not notice events that one would normally encode (Criterion B6).
  • Some say they cannot remember a crucial portion of the distressing incident that was undoubtedly stored in their brain.
  • Criteria B7 states that dissociative forgetting causes this illness, not head injuries, alcohol, or narcotics.
  • Avoiding pain-related stimuli is consistent.
  • The person may distract themselves or use drugs to block out internal reminders of the event (Criterion B8), as well as conversations, activities, places, things, or people that remind them of it (Criterion B9).
  • Many persons with acute stress disorder have problems sleeping and keeping asleep.
  • This may be due to nightmares, safety concerns, or heightened alertness that prevents sleep (Criterion B10).
  • Acute stress disorder can cause people to shout, fight, or smash items without being provoked (Criterion B11).
  • After a car accident, people with acute stress disorder are more aware of the dangers of cars and trucks, as well as those unrelated to the trauma (Criterion B12).
  • Concentration issues (Criterion B13) might cause someone to forget their phone number, or everyday events like finishing a book or newspaper, or focus on one thing for a long period, like listening to a speaker.
  • Acute stress disorder sufferers may jump or be startled by loud noises like ringing phones or unexpected sights (Criterion B14).
  • Startle answers are automatic and immediate.
  • Strong startle reactions (Criterion B14) are not always associated with stress.
  • After a traumatic occurrence, three days to one month should pass (Criterion C).
  • Symptoms following an event that lasts less than three days are not acute stress disorder.
Categories
Psychiatric Disorders

Diagnostic Criteria for Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a common and intricate psychiatric problem that develops as a result of experiencing traumatic experiences, greatly affecting an individual’s mental health. PTSD is a condition that can cause a variety of symptoms, affecting cognitive abilities, emotions, physical sensations, and behavior. This can result in long-term difficulties and a higher likelihood of having other mental diseases, as well as an increased vulnerability to suicide. Empirical evidence reveals that people who have PTSD are more likely to have health problems, such as somatoform, cardiorespiratory, musculoskeletal, gastric, and immune system issues. It is also linked to a lot of other mental health problems, a higher chance of suicide, and a big financial load. Studies show that at any given period, around 3% of individuals suffer from PTSD. The lifetime prevalence rates range from 1.9% to 8.8%.

The DSM 5 TR provides an extensive criterion for the diagnosis of PTSD. This criteria is outlined as follows:

Diagnostic Criteria

In Individuals Above Age 6

A. Actual or threatened death, serious harm, or sexual assault in any of the following ways:
1. Directly experiencing trauma.
2. Being present when others experienced the event(s).
3. Learning that a close family member or acquaintance experienced the trauma. Violence or accident must have caused a family or friend’s death.
4. Repeated or intense exposure to unpleasant aspects of the traumatic event(s) (e.g., first responders gathering human remains; police personnel regularly exposed to child abuse details).
Note: Unless work-related, Criterion A4 does not apply to electronic media, television, movies, or photos.
B. One or more of the following intrusive symptoms linked with the traumatic event(s) arising afterward:
1. Recurring, involuntary, intrusive trauma recollections.
Note: Children older than 6 years may play repetitively about the trauma.
2. Recurring painful nightmares about the tragedy.
Note: Children may have scary, unrecognizable nightmares.
3. Dissociative reactions like flashbacks that make the person think or act like the incident is happening again. The most severe response is complete loss of consciousness of present surroundings.
Note: Children may play trauma-specifically.
4. Intense or protracted psychological suffering at exposure to internal or external signals representing the trauma.
5. Strong physiological responses to internal or external factors that represent the trauma.
C. After the traumatic event(s), persistent avoidance of stimuli associated with them, as shown by one or both of the following:
1. Avoiding painful memories, thoughts, or feelings regarding the experience.
2. Avoiding external reminders (people, places, conversations, activities, items, circumstances) that evoke upsetting memories, thoughts, or feelings regarding the traumatic event(s).
D. Negative cognitive and emotional changes related to the traumatic event(s), commencing or worsening afterward, as shown by two or more of the following:
1. Loss of memory of a significant trauma experience (usually due to dissociative amnesia, not head damage, alcohol, or drugs).
2. Extreme negative thoughts or expectations about oneself, others, or the world (“I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
3. Recurrent, erroneous thoughts regarding the source or effects of the trauma that lead to self- or other-blame.
4. Chronic terror, horror, rage, remorse, or humiliation.
5. Disinterest in important activities.
6. Disconnection from others.
7. Chronic inability to feel happy, satisfied, or loved.
E. Significant modifications in arousal and reactivity related to the traumatic event(s), commencing or worsening afterward, as shown by two or more of the following:
1. Irritated conduct and outbursts (without provocation) that involve verbal or physical hostility toward persons or objects.
2. Risky or dangerous activity.

3. Hypervigilance.
4. Exaggerated startle.
5. Concentration issues.
6. Sleep disruption (difficulty falling or staying asleep, restlessness).
F. Criteria B, C, D, and E disturbances last more than a month.
The disturbance produces clinically considerable distress or impairment in social, occupational, or other crucial areas of functioning.
H. The disturbance is not caused by medicine, alcohol, or any medical condition.

Specify if:
With dissociative symptoms: The individual has posttraumatic stress disorder symptoms and persistent or repeated symptoms of any of the following in reaction to the stressor:
1. Depersonalization: Feeling disconnected from and as if one were an outside spectator of one’s mental processes or body (e.g., feeling like one is in a dream, feeling unreal, or perceiving time flowing slowly).
2. Derealization: Persistent or recurring perceptions of unreality (e.g., the world is unreal, dreamy, remote, or distorted).
Note: This class excludes dissociative symptoms caused by drugs or medical conditions such as complex partial seizures.
Specify if:
With delayed expression: If the entire diagnostic criteria are not satisfied until at least 6 months after the occurrence (although certain symptoms may be immediate).

In Individuals Aged 6 and Below

A. Actual or threatening death, serious harm, or sexual assault in children under 6:
1. Directly experiencing trauma.
2. Being there while others, especially main caregivers, saw the event(s).
3. Learning that a parent or caregiver experienced trauma.
B. One or more of the following intrusive symptoms linked with the traumatic event(s) arising afterward:
1. Recurring, involuntary, intrusive trauma recollections.
Note: Playing out bothersome memories may not be distressing.
2. Recurring painful nightmares about the tragedy.
Note: The disturbing material may not be connected to the trauma.
3. Dissociative reactions (e.g., flashbacks) in which the youngster responds as if the experience is happening again. The most severe response is complete loss of consciousness of present surroundings. Play may recreate trauma.
4. Intense or protracted psychological suffering at exposure to internal or external signals representing the trauma.
5. Strong physiological responses to trauma reminders.
C. One or more of the following symptoms, showing persistent avoidance of stimuli or unfavorable modifications in cognitions and emotions linked with the traumatic event(s), must be present, beginning or worsening after the event:

Persistent Avoidance of Stimuli

1. Avoiding activities, locations, or physical reminders of the trauma.
2. Avoiding persons, discussions, or situations that trigger terrible memories.

Negative Alterations in Cognitions

3. Significantly elevated negative emotions (fear, guilt, sadness, humiliation, uncertainty).
4. Significantly reduced interest or engagement, including play restrictions.
5. Social withdrawal.
6. Consistently lower happy feelings.
D. Changes in arousal and reactivity related to the traumatic event(s), commencing or worsening afterward, as shown by two or more of the following:
1. Unprovoked anger and verbal or physical hostility toward persons or objects (including excessive temper tantrums).
2. Hypervigilance.
3. Exaggerated startle.
4. Concentration issues.
5. Trouble falling or staying asleep or restless sleep.
E. The disturbance lasts over a month.
F. It causes clinically substantial suffering or impairment in relationships with parents, siblings, classmates, or other caregivers or school conduct.
G. The disruption is not caused by medicine, alcohol, or any medical condition.
Specify if:
Dissociative symptoms: The individual has posttraumatic stress disorder symptoms and chronic or recurring symptoms of either:
1. Depersonalization: Feeling disconnected from and as if one were an outside spectator of one’s mental processes or body (e.g., feeling like one is in a dream, feeling unreal, or perceiving time flowing slowly).
2. Derealization: Persistent or recurring perceptions of unreality (e.g., the world is unreal, dreamy, remote, or distorted).
Dissociative symptoms must not be caused by a drug (e.g., blackouts) or a medical condition (e.g., complex partial seizures) to utilize this classification.

Specify if:

With delayed expression: If the entire diagnostic criteria are not satisfied until at least 6 months after the occurrence (although certain symptoms may be immediate).

Conclusion

PTSD symptoms emerge after exposure to one or more stressful incidents. Clinical manifestation of PTSD varies on the basis of the age of the individual. Sometimes fear-based re-experiencing, emotional, and behavioral symptoms prevail. Others may focus on negative thoughts and anhedonic or dysphoric moods. Some people have arousal and reactive-externalizing symptoms, while others have dissociative symptoms. Finally, some have a mix of symptoms. Identification of these symptoms and seeking required help on time is crucial to ensure the health and safety of the individuals.   

Categories
Psychiatric Disorders

Prevalence, Diagnostic Criteria, and Features of Disinhibited Social Engagement Disorder

Disinhibited social engagement disorder (DSED) is characterized by socially abnormal actions including straying from a caregiver, agreeing to travel with a stranger, and engaging in excessively familiar physical activities (such as hugging strangers) with strangers.

The frequency range of symptoms for DSED is found to be between 4% and 11% and its prevalence rate of diagnosis is found to be 8%.

Empirical evidence reveals that children diagnosed with Disinhibited Social Engagement Disorder (DSED) regularly exhibit worse social skills compared to their classmates who are not maltreated and to a control group from a normal household. Consistently, higher levels of peer difficulties have been seen, which might be associated with low self-esteem or a negative self-perception in terms of social acceptance. The results concerning social interaction and communication abilities are found to be inconclusive. Moreover, children diagnosed with Disruptive Social Emotional Dysregulation (DSED) exhibit difficulties in social relationships that go beyond the main symptoms of the disease. However, how much co-existing neurodevelopmental issues contribute to these difficulties is still uncertain. The diagnostic criteria and features of Disinhibited Social Engagement Disorder in light of DSM 5 TR are discussed next:

Diagnostic Criteria

A. A behavioral pattern in which a child proactively seeks and engages with people they don’t know and shows at least two of the following:
1. Fewer or no fears about approaching and talking to people they don’t know.
2. Overly familiar verbal or physical behavior (that is not consistent with nationally sanctioned and with age-appropriate social limits).
3: Less or no checking back with an adult helper after going somewhere, even if it’s somewhere new.
4. Being willing to go off with an adult they don’t know with little or no doubt.
B. The behaviors listed in Criterion A don’t just include acting on impulse (like in attention-deficit/hyperactivity disorder), they also include acting without inhibitions around other people. C. The child has had a trend of extremes of not getting enough care, as shown by at least one of the following:
1. Social neglect or deprivation in the form of long-term not getting basic emotional needs like safety, excitement, and love met by adults who care for them.
2. Changing main providers a lot, which makes it hard to form stable bonds (for example, a lot of changes in foster care).
3. Growing up in strange places that make it hard to form appropriate bonds, like institutions with high child-to-caregiver ratios.
D. It is likely that the care in Criterion C caused the behavior problems in Criterion A (for example, the problems in Criterion A started after the harmful care in Criterion C).
E. The kid is at least 9 months in terms of developmental age.
Specify if:
Persistent: The problem has been going on for more than a year.
Specify current severity:
If a child has all of the signs of disinhibited social engagement disorder and shows them at pretty high levels, then the disorder is considered serious.

Diagnostic Features

  • Disinhibited social engagement disorder is characterized by a pattern of behavior that includes acting too familiarly and culturally inappropriately with people they don’t know well.
  • This behavior that is too common breaks the social rules of society.
  • It is not advisable to diagnose disinhibited social engagement disorder in kids before they are fully developed and able to choose which ties to make.
  • The child must have at least 9 months of developmental age for this purpose.
Categories
Psychiatric Disorders

Prevalence, Diagnostic Criteria, and Features of Reactive Attachment Disorder

Reactive attachment disorder is a trauma- and stressor-related early childhood syndrome caused by social neglect or maltreatment, according to the DSM-5. Children with this condition have trouble making emotional connections, cannot feel pleasant emotions, cannot tolerate physical or emotional contact, and may react aggressively when held, caressed, or comforted. Children with this condition are unpredictable, hard to soothe, and hard to discipline. Children may seem to live in a “flight, fight, or freeze” state due to mood swings. Most want to control their surroundings and make decisions. Sudden routine changes, punishment efforts, or unwanted consolation may cause fury, aggression, or self-harm. These obstacles hinder academic learning and lead to teacher and peer rejection.

Social functioning is severely impaired by reactive attachment disorder (RAD). Research suggests that children with RAD may have low cognitive and verbal skills, although it is mostly from biased, institutionalized samples. An epidemiological study of 1,600 children examined the incidence of reactive attachment disorder in the general community. All children who were suspected or likely diagnosed with RAD were included in the study. It was found that children with RAD are more likely to have multiple comorbidities, lower IQs than population norms, more disorganized attachment, more problem behaviors, and poorer social skills than the general population, resulting in ESSENCE-like complexity.

Sources report that this condition is considered to be quite uncommon, with an estimated frequency of 0.9% in 1.5-year-olds. Research conducted to determine the prevalence of RAD in a community of children that come from a poor background revealed that 23 children were definitively diagnosed with RAD, indicating that the prevalence of RAD in this community of 1.40%.

The diagnostic criteria and features of RAD in the light of DSM 5 TR are given below:

Diagnostic Criteria

A. A continuous pattern of constrained, emotionally detached conduct toward adult caregivers, as evidenced by both of the following:
1. When the kid is disturbed, he or she seeks just limited reassurance.
2. When the kid is unhappy, he or she responds very little to consolation.
B. A persistent social and emotional disturbance that includes at least two of the following:
1. Low social and emotional receptivity to others.
2. Limited beneficial impact.
3. Unexplained irritation, sorrow, or fearfulness that persists even during nonthreatening encounters with adult caregivers.
C. The kid has had a pattern of extremely inadequate care, as shown by at least one of the following:
1. Social neglect or deprivation is defined as a continuous absence of essential emotional requirements for comfort, excitement, and love supplied by caring adults.
2. Frequent changes in main caregivers restrict the possibility of building solid relationships (for example, in foster care).
3. Raising children in atypical circumstances that significantly limit possibilities for selective attachment (for example, institutions with high child-to-caregiver ratios).
D. The care in Criterion C is assumed to be accountable for the disturbed behavior in Criterion A (for example, the disruptions in Criterion A began as a result of the absence of proper care in Criterion C).
E. The autism spectrum disorder diagnostic criteria are not met.
F. The disruption appears before the age of five years.
G. The child’s developmental age is at least nine months.
Specify if
Persistent: The condition has existed for longer than 12 months.
Specify the current severity:
Reactive attachment disorder is considered severe when a kid displays all of the condition’s symptoms at relatively high levels.

Diagnostic Features

  • Developmentally inappropriate attachment behaviors are called reactive attachment disorder.
  • This condition causes a youngster to seldom seek comfort, support, protection, and care from an attachment figure.
  • The child’s lack of contact with caregivers is the key indicator.
  • Some believe reactive attachment disorder youngsters can form choice attachments. However, they don’t exhibit selective bonding behavior since they don’t have many opportunities to do so as young animals.
  • They don’t always seek comfort, support, care, or protection from guardians when disturbed.
  • Kids with this condition don’t react well to adult soothing attempts when distressed. Thus, the condition involves not seeking or responding to soothing techniques.
  • This makes reactive attachment disorder youngsters less pleased with their caretakers.
  • They also have problems managing their emotions, causing unexplained dread, despair, and fury.
  • Reactive attachment disorder should not be diagnosed in youngsters who cannot build selected attachments yet. For this, the youngster must be 9 months old.
  • Multiple sources aid diagnosis, demonstrating that signals are visible in varied circumstances.
Categories
Psychiatric Disorders

Prevalence, Treatment, Diagnostic Criteria, and Features of Excoriation (Skin-Picking) Disorder

Excoriation disorder, often known as skin picking disorder, is a mental health problem defined by the recurrent act of picking one’s skin, resulting in tissue damage and causing functional impairment and/or discomfort. This pathological, obsessive, and repeated picking of skin that causes tissue damage is also referred to as neurotic excoriation, dermatillomania, or psychogenic excoriation. Anxietiestic picking has been recognized as a health issue in medical literature for quite some time. The term “neurotic excoriation” was initially used by Erasmus Wilson in 1875 to characterize the exceedingly difficult-to-control picking activities seen in neurotic patients.

In order to determine the prevalence of skin-picking disorder, a survey was administered to 10,169 persons (ranging in age from 18 to 69) who were chosen at random from the US population. 213 people (2.1%), or 55.4% of the total, reported having a skin-picking problem at the present moment, while 318 people (3.1%), or 54.1% of the total, reported having a skin-picking condition at some point in their lives. Compared to those who never picked at their skin, those with a present skin-picking condition were more likely to be female. Most often endorsed were mental health comorbidities, with 63.4% having generalized Anxiety disorder, 53.1% having depression, and 27.7% having panic disorder. Findings from this study point to the prevalence of skin-picking disorder and the high comorbidity rates that are characteristic of this illness in the general population.

The clinical evaluation of individuals with skin-picking problems involves a comprehensive mental and physical assessment, promoting a multidisciplinary strategy for diagnosis and therapy. Medication (such as naltrexone, serotonin reuptake inhibitors, or N-acetylcysteine) and cognitive-behavioral therapy (such as habit reversal or acceptance-enhanced behavior therapy) should be part of any treatment plan.

According to sources, treatment of dermatillomania requires a multi-pronged strategy that addresses the underlying mental disease, alleviates itching, and addresses the lesions on the skin. When it comes to treating dermatillomania’s mental component, selective serotonin reuptake inhibitors (SSRIs) have been quite helpful. Patients with dermatillomania have also found success with very little side effects from non-pharmacological therapies including behavioral therapy, habit reversal exercises, and support groups.

It is important to look for the signs and symptoms of the disorder to be able to diagnose the problem and seek the required treatment on time. The DSM 5 TR criteria and diagnostic features for skin picking disorder are given below:

Diagnostic Criteria

A. Skin lesions caused by repetitive skin plucking.
B. Multiple attempts to try to reduce or eliminate skin picking.
C. The skin picking leads to major trouble in social, occupational, or other crucial areas of functioning, or produces clinically substantial distress.
D. The skin picking is not caused by a medical ailment (like scabies) or the physiological effects of a drug (like cocaine).
E. No other mental disorder characterized by symptoms similar to skin picking (such as psychotic delusions or tactile hallucinations, body dysmorphic disorder, stereotypic movement disorder, non-suicidal self-injury, or attempts to improve one’s perceived appearance) is a more appropriate explanation.

Diagnostic Features

  • As per Criterion A, the defining characteristic of excoriation (skin-picking) disorder is the increased frequency with which the affected individual picks at their skin.
  • Although many people choose from a variety of body parts, the most popular ones are the face, arms, and hands.
  • People can pick at perfectly normal skin, at little skin imperfections, at lesions like calluses or pimples, or even at scabs that have formed as a result of picking at other areas.
  • While most people use their fingernails, tweezers, pins, and other instruments are also used.
  • Behaviors such as biting, squeezing, lancing, and skin plucking are also possible.
  • People who suffer from excoriation disorder frequently pick at their skin for long periods of time, sometimes even hours at a time, and this picking habit can last for months or even years.
  • Despite the fact that people with this illness frequently try to hide or mask their skin lesions (e.g., with makeup or clothes), criterion A states that skin picking must result in skin lesions.
  • Criteria B indicates that the individual with excoriation disease has made many attempts to reduce or cease skin picking.
  • If skin picking is clinically substantial and impairs social, occupational, or other critical areas of functioning, then it meets criterion C.
  • Distress encompasses a range of negative emotions that people with skin picking may experience, including a sense of helplessness, humiliation, and shame.
  • When people avoid social interactions, it can have a negative impact on their ability to perform in several aspects of life, including social, occupational, academic, and leisure activities.
Categories
Psychiatric Disorders

History, Prevalence, Diagnostic Criteria, and Features of Hoarding Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes hoarding disorder (HD) in the group of obsessive-compulsive and related disorders (OCRD), which also includes trichotillomania, excoriation disorder, and body dysmorphic disorder. A person with a hoarding problem develops an unjustified attachment to their material belongings and finds it difficult to let go of them. The serious societal ramifications of this condition, which is all too frequently dismissed as a strictly medical problem, are still not well understood. At present, the prevalence of Hoarding Disorder (HD) is ambiguous as a result of methodological issues in the evidence base. Estimates have varied significantly, spanning from 1.5% to 6% of the general population.

Studies state that due to reality TV shows on hoarding, the public is more aware of it. Popular culture portrays hoarding as a simple problem with an easy solution: “Just clean it up.” Unlike these sensationalist depictions, hoarding disorder is a real mental condition that has been studied empirically in psychiatry, psychology, and related sciences for over 20 years. In 1947, Erich Fromm defined a “hoarding orientation” in which people felt secure by collecting and keeping goods. In 1962, Scandinavian psychiatrist Jens Jansen used the phrase “collector’s mania” to describe elderly persons who overfilled their dwellings. Hoarding was recognized as an OCD disorder by the American Psychiatric Association in 2013. Obsessive-compulsive disorder, or hoarding disorder, requires six diagnostic criteria. Two specifiers rate hoarding acquisition and insight. In 1996, Frost and Hartl defined hoarding as acquiring a large number of useless or low-value items and failing to discard them, living spaces that are too cluttered to allow normal activities, and significant distress or impairment in functioning. Starting with this description, hoarding disorder diagnostic criteria were created. Current definitions of hoarding include an excessive gathering of goods in the home and difficulty getting rid of things most people would not keep.

If you wish to know how Hoarding Disorder might manifest, check out this link to our storybook.

According to the DSM 5 TR, the following are the diagnostic criteria and features of hoarding disorder:

Diagnostic Criteria

A. Having persistent trouble getting rid of or leaving with things, no matter how valuable they are.

B. This is hard because people think they need to keep the things and it makes them feel bad to throw them away.

C. Because people have a hard time getting rid of things, they end up collecting things that make busy living places crowded and less useful for what they were meant for. Living areas are only clear because someone else did something about it, like family members, workers, or the police.

D. The hoarding causes clinically significant grief or impairment in social, professional, or other important areas of functioning, such as keeping myself and others safe.

E. The collecting isn’t caused by another health problem, like a brain injury, heart disease, or Prader-Willi syndrome.

F. A person is hoarding if their symptoms are not better explained by those of another mental disorder. For example, obsessions in OCD, low energy in MDD, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, and limited interest in autism spectrum disorder are all examples of mental disorders.

Specify if:

With too much acquisition: If having a hard time getting rid of things is followed by getting too many things that you don’t need or have room for.

Specify if:

With good or fair understanding, the person knows that their hoarding-related thoughts and actions (like having a hard time getting rid of things, having too much stuff, or buying too much) are not healthy.

With little insight: The person is mostly sure that hoarding-related beliefs and behaviors (like having trouble getting rid of things, having too much stuff, or buying too much) are not a problem, even though there is proof of the opposite.

Without understanding or delusional beliefs: The person is sure that hoarding-related beliefs and behaviors (like having trouble getting rid of things, having too much stuff, or buying too much) are not a problem, even though there is evidence of the opposite.

Diagnostic Features

  • No matter how useful, collecting disorder is characterized by difficulty getting rid of or giving up goods (Criterion A).
  • The phrase “persistent” alludes to a long-term issue, not a short-term occurrence like obtaining property.
  • Criterion A states things are hard to get rid of.
  • People say this is challenging since they love their possessions or think they are helpful or pretty.
  • Some individuals are careful not to throw away their stuff because they feel accountable for their fate.
  • Many worry about losing vital data.
  • Newspapers, magazines, clothing, bags, books, mail, and paperwork are kept most, although nearly anything can be salvaged.
  • Stuff includes more than just worthless or low-value stuff.
  • People who collect and keep valuables sometimes stack them with less valuable items.
  • Hoarding disorder patients actively preserve items and feel anxious, frustrated, regretful, unhappy, and guilty about abandoning them (Criterion B).
  • The active preservation of goods distinguishes hoarding disorder from other psychopathologies that involve passive accumulation or little grief when possessions are removed.
  • People collect many objects that clutter active living places and make their intended use impossible (Criterion C).
  • The person may not be able to cook, sleep, or sit in a chair. Space can be exploited, but not easily.
  • Clutter is a chaotic collection of mostly unconnected or somewhat related items on tabletops, floors, and hallways.
  • Criterion C prioritizes the “active” living sections of the home over garages, attics, and basements, which are occasionally congested in non-hoarders’ homes.
  • Hoarding disorder sufferers frequently have items that flow beyond active living areas and impede the usage of automobiles, yards, the workplace, and friends’ and relatives’ homes.
  • Some living environments are only decluttered by third parties (family, cleaners, local authorities).
  • People legally made to clean out their homes still have symptoms of hoarding disorder, even though their homes are not as cluttered because of outside help.
  • Hoarding disorder is different from normal collecting behavior, which is planned and selected.
  • However, the amount of things a person has may be similar to the amount that someone with a hoarding disorder accumulates.
  • Normal collecting does not lead to the mess, stress, or problems that come with hoarding disorder.
  • Symptoms (like having trouble getting rid of trash and clutter) must cause clinically significant anxiety or impairment in social, professional, or other important areas of functioning, such as keeping oneself and others safe (Criterion D).
  • In some cases, especially when there is not enough understanding, the person may not say they are in pain, and only those close to them may notice the impairment.
  • Third parties trying to get rid of or clear out the things, on the other hand, cause a lot of grief.
Categories
Film

7 Movies You Should Watch to Understand Panic Attacks

Are you looking for movies on panic attacks to understand what they look like? If that is the case, you are at the right place! The following is the list of 7 movies you must watch to understand panic attacks:

Girl, Interrupted (1999)

In the film, Winona Ryder plays the role of a young lady who, following an unsuccessful attempt at suicide, is sent to a psychiatric institution for a period of eighteen months between the years 1967 and 1968. In light of the fact that anxiety problems are the root cause of her nervous breakdown, she makes use of a wide range of coping techniques. At the end of the day, she discovers a way to achieve wellness by avoiding escapism and engaging with her creative side.

Safe (1995)

Safe is a challenging film about an extreme kind of anxiety disorder. Julianne Moore shines in the role of the protagonist in this psychological horror film. An unidentified sickness does, in fact, cause a lady from a suburban area to assume that she is developing an allergy to everything that is present in contemporary life. It demonstrates how anxiety can lead to further anxiety.

The Aviator (2004)

Who would have thought that a film about Howard Hughes would be considered one of the top 10 movies on anxiety disorder? On the other hand, success and money do not provide protection against mental disease. Because of his anxiety problem and the various phobias he suffers from, Hughes chooses to spend the latter years of his life in seclusion.

The Black Swan (2010)

In the ballet Swan Lake, Natalie Portman plays the role of a ballet dancer who is competing for the role of the White Swan. As a result, the narrative illustrates how anxiousness may be caused by imaginative expectations. In point of fact, she engages in combat with the dark dancer, Mila Kunis, who is an excellent performance for the role of the Black Swan. On the other hand, is the dark dancer a genuine person, or is she only a representation of the White Swan’s dread and fear?

The Spider Within: A Spider-Verse Story (2023)

Following an especially trying day, Miles suffers a panic attack, which compels him to confront the symptoms of his worry and teaches him that calling out for assistance may be just as courageous an act as defending his city from impending danger.

Stutz (2022)

As Hill and his therapist investigate his mental health and the constantly worsening anxiety attacks induced by movie marketing, which have turned his perfect profession into a nightmare, you will be able to follow their journey.

The Perks of Being a Wallflower (2012)

Depression and suicide are important issues that are dealt with in this movie. For example, Charlie is released from a mental hospital after being depressed for a long time after his friend’s death. Charlie meets brothers; Patrick (Ezra Miller) and Sam (Emma Watson), who also feel like “outsiders” at school. As they become friends, these three kids win over viewers’ hearts. Based on the famous book of the same name, The Perks of Being a Wallflower does a good job of showing how hard it is to deal with mental illness, make friends, fit in, and deal with trauma. Many people can connect to this. In the end, it’s a beautiful story about trying to fit in and make friends, and it shows exactly how kids deal with the ups and downs of being a teenager.

So these are the 7 movies you must add to your watch list to understand panic attacks better! If you have seen these movies, do let us know your reviews about them!

Categories
Psychiatric Disorders

Prevalence, Diagnostic Criteria, and Features of Body Dysmorphic Disorder

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5-TR) defines body dysmorphic disorder (BDD) as a condition in which a person is fixated on what they think is wrong with their appearance when in reality they look fine. BDD is a common mental illness that is often not recognized. It is marked by an overwhelming focus on perceived flaws in the body, which can lead to upsetting repeated behaviors and, in some cases, suicidal thoughts and actions. People who have BDD often seek surgery that is not necessary.

The Italian doctor Enrico Morselli first talked about BDD more than 100 years ago. He came up with the word “dysmorphophobia,” which comes from the Greek word “dysmorphia,” which means “ugliness.” However, there is evidence that it is still not being identified enough.

According to the empirical evidence, Due to the obsession, the stress that comes with it, and the worry that other people will reject them, there is almost always impairment in one or more areas of social, professional, academic, and role performance. Patients may avoid close relationships, stop going to school or work, stop doing social things, and even end up being unable to leave their homes at all. A lot of people with BDD also think about killing themselves. A new meta-analysis found that people with BDD were four times more likely than people without BDD to have suicidal thoughts and 2.6 times more likely to try to kill themselves. Additionally, sources report that 7.4% of people who work in mental health settings have BDD while in cosmetic and skincare settings, the rate of incidence is higher (20.0%).

A lot of different mental illnesses have been linked to BDD. The most common ones are major depressive disorder, social fear, obsessive-compulsive disorder, and drug abuse disorders. A person may be diagnosed with another problem along with their BDD, but the BDD may not be picked up, so they do not get the right care they need.

Not recognizing BDD can have bad effects on a person’s health and mental health, and if they don’t get help, BDD seems to last a long time. Hence timely diagnosis and management of the disorder is crucial. The following are the diagnostic criteria and features of BDD in light of DSM 5 TR.

Diagnostic Criteria

A. Being preoccupied with one or more flaws or faults in one’s look that others don’t see or think are not important.
B. At some point during the disorder, the person has done repeated actions or thoughts (like looking in the mirror, over-grooming, picking at their skin, or looking for confirmation) because they were worried about how they looked around other people.
C. The obsession causes pain or poor performance in social, professional, or other important areas of functioning that are clinically significant.
D. The obsession with looks cannot be explained by worries about body fat or weight in a person whose symptoms meet the standards for an eating disorder.

Specify if:

With muscle dysmorphia: When someone has muscle dysmorphia, they are obsessed with the idea that their body is too small or not strong enough. It is okay for the person to be focused on other parts of their body; this specifier is still used.  

Specify if:

Rate how much you understand about the beliefs that cause body dysmorphic disorder, such as “I look ugly” or “I look deformed.”
With good or fair insight: If someone has a good or fair understanding, they know that their body dysmorphic disorder views are either definitely false or probably false, or they know that they may or may not be true.
With poor insight: With little or no understanding, the person believes that the views about body dysmorphic disorder are most likely true.
With absent insight/delusional beliefs: If someone has missing understanding or delusional beliefs, they are sure that their body dysmorphic disorder beliefs are true.

Diagnostic Features

  • Body dysmorphic disorder (previously dysmorphophobia) causes people to obsess about one or more physical imperfections they perceive make them ugly, unpleasant, strange, or deformed (Criterion A).
  • People notice problems that are not there or appear small to others.
  • People worry about looking “ugly”, “not right” “hideous” or “like a monster.”
  • Most preoccupations include the skin (acne, scars, lines, wrinkles, or pallor), hair (“thinning” hair or “excessive” body or facial hair), or nose. However, it can be the eyes, teeth, weight, stomach, breasts, legs, etc.
  • Some worry about their body’s unevenness.
  • Preoccupations are irritating, unwelcome, and time-consuming (3–8 hours a day). They are difficult to avoid and manage.
  • Concern causes excessive mental or behavioral behaviors like comparison (Criterion B).
  • Despite being unpleasant and maybe harmful, the person must perform these tasks. They are time-consuming and difficult to handle.
  • Common behaviors include comparing one’s appearance to others, looking at perceived flaws in mirrors or other reflective surfaces or directly, taking too many “selfies,” over-grooming (e.g., combing, styling, shaving, plucking, or pulling hair), wanting reassurance about perceived flaws, touching areas one does not like to check out, overworking out or lifting weights, and looking for cosmetic procedures.
  • To disguise a “pale” complexion or acne, some people tan too much, change their clothes often, or spend too much on cosmetic goods.
  • People regularly pick at their skin to repair defects, which can damage it, cause disease, or rupture blood vessels.
  • Body dysmorphic disorder sufferers repeat actions to disguise perceived faults.
  • They may repeatedly wear cosmetics, shirts, or caps or alter their hair to conceal their eyes or forehead.
  • Criteria C requires clinically severe discomfort or impairment in social, professional, or other critical performance domains from the obsession.
  • Body dysmorphic disorder and eating disorders must be distinguished.
  • An obsession with imperfections in the appearance of someone else, generally a partner or spouse but sometimes a parent, child, sibling, or stranger, is called body dysmorphic disorder via proxy.