Category: Psychiatric Disorders

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Psychiatric Disorders

What Causes Stress Disorders (Acute Stress Disorder & Post-traumatic Stress Disorder)

How intrusive thoughts in PTSD pollute the mind

Stress disorders are psychiatric conditions that occur as a response to psychological trauma. In this article, I will attempt to explain how these symptoms can develop following a traumatic event. There are two major stress disorders, known as Acute Stress Disorder and Post-traumatic Stress Disorder.

Trauma Response

Dramatic and malignant events in human life often can be traumatic. When a person’s sense of identity, worth and the meaning of everything they do has been challenged in a cruel incident, they tend to have long lasting effects. These vile incidents have two major aspects to them. They are

  • Physical
  • Psychological
  • Mixture of both

Physical Violence

Some traumatic incidents constitute physical or sexual violence. Both the actual happenstance of violence and the threat of violence can be considered ‘violent’ because of the involvement of extreme physical or sexual insecurity. If a certain incident made them extremely insecure about themselves, their life or autonomy, there is a chance that their responses to cope with it will be extreme as well.

Psychological Violence

Often events which cause a person extreme stress are psychologically violent. These incidents might involve exposure to or the response of extreme emotional disturbance and the loss of ‘belief’ or severe dysregulation of behavior. An example could be of a very emotionally draining divorce with a partner who was psychologically abusive.

Mixture of both

Traumatic events usually involve violence of both a physical and a psychological nature. For example, soldiers in war while also facing insecurity about their physical wellbeing also have to go through extreme amounts of psychological stress.

By the very nature of the extreme response to trauma in both Acute Stress Disorder and Post-traumatic Stress Disorder, these violent incidents have both physical and psychological aspects.

Experience of Trauma in Acute Stress Disorder

Violence makes us hyperaware of the indications where that violence has a greater chance of influencing us. This includes the smell, sounds, and visual aspects that we were exposed to, during that incident.

So, every time the traumatized person is exposed to a similar environment or cue, they experience extreme psychological disturbance.

Why does this happen?

Well, because we want to protect ourselves from danger.

We are observing things around us, learning how things work so that we could either achieve a reward or stave off danger.

And when something really threatens our security, we tend to remember the cues around us. This is because the next time we are exposed to danger, we can cope better with it.

However, the emotional disturbance that a person with ASD or PTSD experiences during that traumatic event is too extreme. They can experience hyperventilation, severe anxiety, worry and their sleep cycle can also be disturbed significantly. These responses become conditioned to certain cues from the environment.

Thus, every time the person is exposed to similar cues, they generate such responses – especially if they pay attention to those cues.

In the case of Acute Stress Disorder, these conditioned responses become lesser and lesser, and stop before a month after the traumatic incident.

On the other hand, in the case of Post-traumatic Stress Disorder, they persist for much longer periods of time.

Conclusion

Both Acute Stress Disorder and Post-traumatic Stress Disorder are very debilitating conditions. They can affect a person’s life to such a level that they might give up their jobs, shut off contact with others and even consider taking their own life. However, understanding how such a condition can start can help you cope with it and take the necessary actions.

If you or someone you know is experiencing this disorder, I would advise you to seek professional help. Do not take your mental health lightly!

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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.

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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.

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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.
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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.
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Brain Health Psychiatric Disorders

Psychoeducation: Understanding Your Addiction

Addiction to chemical substances is not a comfortable condition. According to a study, 2.2% of people in the world have a problem with drugs or alcohol. 1.5% of people have an alcohol use disorder, compared to 0.8% of people with all substance use disorders put together (0.32% had a cannabis use disorder, 0.29% had an opioid use disorder, and 0.1 % had an amphetamine use disorder).

There are four major concepts that are central to addiction. These major concepts are expanded upon briefly in the DSM V TR. In this written piece of psychoeducation, I will attempt to unpack substance addiction and open a framework by which you can control it.

The four major concepts of addiction are:

  • Habits
  • Compulsivity
  • Personality factors
  • Physiological effects (tolerance and withdrawal)

These aspects can and are, in fact, present in many addictions, not just those related to chemical substances. For example, gambling disorder also is characterized by compulsions, habits and certain personality factors. One prominent aspect, however, which is a core feature of substance addiction are the physiological effects of tolerance and withdrawal.

So, without further ado, let us dive into the experience of addiction, factor by factor.

Habits

According to some researchers, addiction can be explained as an adapted habit. An adapted habit is a complex of behaviors that an individual seeks to adapt to, due to the reinforcing aspects of the behaviors. There are three major elements of such a habit:

  • Initial capture
  • Development of behavioral action schemata
  • Cognitive expectancies concerning the habit
Initial Capture

The word capture here is used in the invasiveness of the habit, due to its desirability and reinforcement. Individuals who are addicted to substances often talk about a drug capturing their state of mind. The initial capture is often when the action has already been performed and the reinforcement has already been significantly experienced.

What then happens is that this action is associated with a desirable outcome (e.g euphoria, stimulation, more relaxed social interactions etc.). Adapted habit theory of addiction – and scientific research – put forward the notion that drugs actually become a primary reinforcer. This means that they are on the same level as a reward for person as food is.

This is how the habit captures a person.

Action Schemata

Action schemata or behavioral action schemata are a thought based conceptualization of one’s plan to perform the habit. Schemata refer to many ideas about a particular thing being grouped together in order.

So, behavioral action schemata refer to the addicted individual’s conceptualized plan of how they will follow their addiction further. For example, a person addicted to pain killers will have an entire action sequence in mind where they acquire the pain killer and use it.

This is the result of a habit.

Expectations

For one to have motivation to perform a habit, there have to be some expectations of what they hope to achieve. Since the substance(s) can become a primary reinforcer, this shows that one’s expectations for the substance use is far reaching.

Mind altering substances can provide an individual with psychological and physiological relief. Conversely, some substances can energize an individual.

Regardless, these effects usually make one’s expectations for the drug use stronger and more mentally intrusive.

Compulsivity

Compulsions are constant urges to perform an action. Compulsivity is the lack of control of one’s behavior over acting against these urges. Substance use disorders also feature the element of compulsivity, much like obsessive compulsive disorder.

There are two ways by which compulsivity plays a role in addiction. The first way is by the way of carrying on a learned and reinforced habit. An individual could thus have compulsions regarding performing a habit again and again because it is rewarding.

The second way compulsions have a major part in addictions is that one’s urge to consume drugs is fueled by their urge to get rid of a bad experience or event. This is most notable in individuals engage in substance abuse and who have higher levels of stress. The substance provides them with relief from an aversive state.

Personality Factors

Personality is a pattern of multiple complexes of behaviors that seem to be constant through age and context. It is based on environmental and genetic predispositions, with both of them contributing simultaneously. To say that one is born an addict would be unscientific and untrue. However, if a young individual has a higher affinity towards seeking excitement, it reflects a predisposition towards addiction. Excitement seeking is actually a facet of trait extraversion of the five factor model of personality.

Other important personality traits that can contribute to addiction are of neuroticism and conscientiousness.

Neuroticism is a personality trait that signifies emotional instability. Thus, one could see this as playing a major role in compulsivity. Furthermore, neuroticism also includes being impulsive. Impulsivity is the failure to control one’s actions in the context of a momentary urge. Unsurprisingly, individuals that have addictions are also often impulsive.

On the other hand, conscientiousness, which is a trait that relates to one’s ambitiousness and orderliness, can have a negative impact on addiction. In fact, if an individual has higher levels of conscientiousness, there is a greater possibility that they can recover from addiction more effectively. Conscientious individuals want their life to be in order and they usually have high ambitions and desire to achieve more. So, they might see their addiction as a major hindrance that they eventually have to overcome

It is important to remember, however, that psychiatric conditions are not just a product of the environment or genetics as a whole. Rather, both of these factors contribute significantly. Personality traits are much the same.

So, by understanding one’s behaviors and working towards goals which offer pleasure but stability can have a major effect on the person’s addictions.

Physiological Effects

Substance addiction can majorly change our body’s physiological condition. While some of the physical effects are indirect (for example, weight loss), the substance can directly affect the way chemicals in our brain act.

Many of these substances, by binding with chemical receptors in the synapses of our brains increase the duration the ‘happy chemicals’ stay out in the synapse.

This is usually what causes the euphoria one might feel. This also produces the relaxing effects.

Since this change is not what our body is used to, our body tries to adapt to it. Our brain might gradually stop releasing its own ‘happy chemicals’. Or our blood vessels might remain dilated for longer times.

As our body adapts to the drug, we might start to feel as if the effects of the drug are lesser. So, one could start taking more drugs to help them get the same feeling. Their body has developed a tolerance to the effects of the drug. This is what can greatly increase one’s substance use.

Another important point to remember is that these changes that I talked about earlier, only adapt our bodies to the time when we are using the drug. When one suddenly stops using the drug, for some time, their body doesn’t just go back to normal. It is adapted to the effects of the drug.

The happy chemicals do not release at the same rate they did before. In fact, many other effects, such as slowing down of the heart rate in alcohol, do not return to normal initially after the addiction is dropped. This is our body’s way of withdrawal from the effects of the drug.

Unfortunately, in cases of potent drugs such as methamphetamine and heroine, the withdrawals can endanger life. This is because many of the physiological functions of the body are no longer being performed as correctly as before.

This is why medications are often used to treat withdrawal symptoms. They do not lead to the same euphoria, but they allow the body to return to normal through a controlled and safer dosage.

Conclusion

Substance abuse and addiction is a psychiatric condition. If it is severe, it can cause long lasting social and psychological trauma. In fact, withdrawal symptoms and overdoses can be fatal. This is why it is necessary to treat them appropriately. Not every kind of drug is fatal though. However, habits that cause harm to oneself and others are rarely sustainable.

If you or anyone you know might have a substance problem, it is probably good to seek help.

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
Dark Personality Psychology Psychiatric Disorders

5 Red Flags of Pathological Lying

In the current digital sphere, communication has diversified. No longer does one have to speak to each other directly. While this has greatly increased the convenience of communication, it has also increased the convenience for pathological lying.

Yes, this did just escalate quickly.

Pathological lying is a pattern of behavior of distorting or hiding information that is not really needed in the context. So, a pathological liar would be a person who lies ‘without much thought’, even in situations where he or she is not being harmed. One could connect pathological lying to psychopathy, Machiavellianism and/or narcissism.

However, compared to these large traits, pathological lying is one specific behavior. One study of 1,000 young offenders found excessive lying among 15% of males and 26% of females.

In this article, I will talk about 5 red flags that could give away someone who engages in pathological lying.

Let us begin!

1. Difficulty in Getting a Straightforward Answer

When one asks a simple question, a person who engages in pathological lying will respond with answers that are too vague. They might bring up some other topic or they might appear to connect the question to some other topic.

Not only that, you might feel as if you have to wrangle the answer out of them. This particle behavior is interesting because it directly relates to one aspect of a trait in the Five Factor Model of personality.

Straightforwardness is a major aspect of Agreeableness, a personality trait akin to being polite, honest and empathic.  Psychopaths, narcissists and Machiavellians, all generally score less on measures of straightforwardness.

2. The Behavior is Persistent across Age and Context

Scientists have also defined pathological lying as chronic lying behavior. A pathological liar would seem to lie almost indiscriminately, across multiple situations. So, one major identifier here is if you hang out with this person and he/she continues to fabricate information even when there is no real need to.

I would further argue here that a person who has had a habit of lying pathologically can also remain functional. It could be that they have learned how to lie differently in different contexts to escape being caught.

However, there is a high chance that if you are their friend, relative, family or any kind of long-term associate, you will detect small indications of missing and distorted information.

This relates to the next point.

3. Suspicious Friends, Family and Colleagues

Even if the point being lied about is not important, when we learn that something someone says is untrue and dishonest, we might not trust them. This then forms the basis of the turbulent relationships that a pathological liar would have.

In the case of people who engage in pathological lying, the social circle they have might be suspicious of them. They might say that the person is insincere. Because of that, their family members or friends and colleagues might find it difficult to confide in them.

Often this distrust could show up in behaviors like not leaving any valuables in the pathological liar’s custody. It could also show up in not including them in close-knit family gatherings.

A crucial point to remember here is that this exclusion from social gatherings further solidifies pathological lying.

So, it is not at all an attractive thing to any person, even if they pathologically lie about many things. In fact, excluding such people from these gatherings could lead to even more personal isolation, which could increase their levels of paranoia.

4. Very Frequent Contradictions in Narratives

We as humans are far from perfect. We make many of the same errors in judgment that many people around us make.

However, with respect to the majority of people, the contradictions in our speech or expressions are far lesser and in-between than in the case of a pathological liar. It could be that when recalling a memorable trip, the individual could distort multiple points of the story to make them look superior. Conversely, if they are narrating a story or some point, they might distort parts of the story to put down someone else that they might not found favorable.

Whichever route they take, pathological lying can be identified when the story that they tell seems to be fundamentally distorted, with various points excluded from it.

One could say here that this is because pathological liars lack insight.  

5. Confrontations Lead to Overreactions

No one really wants to be openly confronted about their lack of honesty. It makes us self-conscious about ourselves. However, we have enough wits about ourselves to realize genuine issues that we might have. When someone close to us tells us that we are being dishonest, we often make a goodwill attempt to understand what they mean.

Now, consider this in the context of an individual who does not realize that

  • they are being dishonest
  • being dishonest is a behavior that should be improved.

Such an individual would become defensive when they are confronted. Even in very private and personal settings. Since they do not consider you or anyone close to them trustworthy enough to tell the truth and be okay, they might see your or another friend’s advice as a challenge to their identity.

So, a pathological liar would view confrontations as open indication of antagonism.

And they would then reply according to this conception.

This could result in ‘fighting matches’ with their close associates. Further still, this could result in physical and violent confrontations.

Conclusion

While popular media portrays pathological liars as psychopaths with no distress, this is not the case. Pathological lying is one feature of many distressing psychological disorders. In fact, pathological lying is in itself considered to be a condition of its own, defined as pseudologia phantastica.

So, while pathological lying causes distress to others, it often originates from running from psychological distress in the individual. This makes it an uncomfortable condition for the person too.

If you feel as if you or someone around you has a behavior of lying pathologically, I would advise you to give this the proper time and care.

After all, wouldn’t it be great if we make our lives less distressing?