Category: Disorders

Many people around the world suffer from various eating disorders. The disorders are brought about by a number of factors. They involve psychological problems that affect individuals depending on the diets they take. Some of these issues involve excessive consumption of food accompanied by little or no physical exercise. People with these diseases tend to be affected socially, physically, and psychologically. Consequently, their productivity and quality of life are significantly reduced.

Affected persons have problems with their weight. The developments cause stress to them (Bulik, Sullivan, Wade & Kendler, 2000). It is also noted that individuals with these problems complain of depression and anxiety. In addition, they are at a high risk of engaging in substance abuse and other negative coping mechanisms. However, the problems can be treated through a number of medical procedures.

In this paper, the author is going to provide critical analysis of strategies used to control eating disorders. It is important to manage these problems as they compromise the physical health of the individual. To this end, the author will highlight the various types of eating disorders, as well as their control and treatment.

Types of Eating Disorders

There are various types of eating disorders. The different types are brought about by a combination of various factors. In addition, they have varying impacts on the physical health of the individual. Some of them are discussed below:

Anorexia Nervosa

The disorder is characterized by refusal to eat. As a result, individuals are unable to maintain a healthy body weight. They have a pathological fear of gaining weight and becoming obese. The fear is what compels them to reduce their food intake (Crow et al., 2009). It is noted that the problem can affect both children and adults. The disorder is especially common among women and girls in their early twenties. The reason is that these groups of individuals are conscious of their body image.

Persons suffering from anorexia nervosa are diagnosed with various mental disorders. The individuals are usually disturbed by the size and shape of their body. In most cases, they in denial of their current weight or size (Bulik et al., 2000). Another trait associated with the problem is amenorrhea.

The condition entails the absence of three consecutive menstrual cycles in a healthy individual. The interruption of these cycles is brought about by the unhealthy diet taken by the person. It is one of the indications of how this eating disorder can compromise the individuals physical health. Symptoms of the disorder include severe food restrictions, low body weight, and pale skin. The unhealthy color of the skin is brought about by lack of enough blood in the system.

The problem can be treated in the hospital if discovered on time. Medical intervention is necessary given that the condition is associated with various health complications (Crow et al., 2009). The complications include infertility, brain damage, osteopenia, and osteoporosis. Others entail organ failure, low blood pressure, and anemia. The latter is brought about by insufficient blood in the body. The eating disorder may also result in constipation and heart failure. If the condition is not well managed, it can lead to death.

Bulimia Nervosa

It is regarded as the opposite of anorexia. The condition is associated with bingeing and purging. The former involves consumption of quantities of food that are more than those consumed by normal people under similar circumstances (Wilson, Grilo & Vitousek, 2007). The binge and purging cycle can be repeated several times during the day (Godart et al., 2003). It is simply the consumption of excess food with complete disregard for portions.

People suffering from the problem lack control over the amount of food they take. It is noted that some of these individuals may wish to reduce their consumption. However, this may be impossible due to the routine formed.

The most common compensatory behavioral patterns reported by patients include excessive use of diuretics, compulsive physical exercise, fasting, and forced vomiting (Fairburn, Cooper & Shafran, 2003). Patients suffering from the disorder may be able to maintain healthy body weight. However, most of them are overweight. The increased weight may result in lowered self-esteem.

The eating disorder is associated with a wide range of symptoms. They include severe dehydration due to forced vomiting and electrolytic imbalances. The latter involves unhealthy levels of certain elements in the system.

The levels may be too low or too high. The minerals involved include, among others, potassium, sodium, and calcium. The erratic level of these compounds may lead to stroke or heart attack (Fairburn et al., 2003). Swollen salivary glands, intestinal distress, and irritation, as well as acid reflux, are other symptoms related to the disorder (Crow et al., 2009).

Binge-Eating Disorder

It is another common eating disorder. The problem is closely related to bulimia nervosa. The only difference between the two is that people affected by binge-eating have no control over their eating habits. In addition, episodes of compulsive eating are not followed by compensatory acts like fasting and forced vomiting. In addition, patients suffering from this disorder tend to consume food even when they are not physically hungry. As a result, the body is unable to burn all the calories.

Consequently, fat accumulates in the body (Godart et al., 2003). People with binge-eating disorder are usually overweight. Most of them are at risk of becoming obese. Other complications related to the problem include high blood pressure and heart failure. Fatigue is also a common indicator of the disorder.

Like the other eating disorders, binge-eating has a number of signs and symptoms. They include uncontrolled eating habits, excess weight gain, poor breathing due to the accumulation of fats in the respiratory system, sweating, fatigue, and discomfort. Patients suffering from the disease usually feel powerless and lack control over their eating habits (Jacobi, Hayward, Zwaan, Kraemer & Agras, 2004). The problem can be controlled through medical intervention.

Obesity

The condition is also associated with eating disorders. It is characterized by the accumulation of excess fat in the body (Crow et al., 2009). As a result, the person becomes overweight. The condition compromises the individuals physical health given that it is associated with various complications. Such issues include reduced life expectancy, heart attack, and diabetes.

Control and Treatment of Eating Disorders

People suffering from the disorders highlighted above can seek medical help to manage their condition. However, it is important to note that the control and treatment of these problems do not necessarily involve the use of drugs. On the contrary, patients may require psychotherapy or psychological counseling. Medical and nutritional needs can be addressed after counseling.

Counseling helps to deal with established bad eating habits (Striegel-Moore & Bulik, 2007). In addition, it allows the individuals to become aware of the long term effects the habits have on their lives. The reason is that most people are ignorant of these impacts.

A number of medical tests are carried out to establish whether a person is suffering from the disorders or not. Under normal circumstances, a complete blood count test can be conducted. A comprehensive metabolic profile to evaluate the distribution of minerals like sodium, potassium, and chloride can also be done. Serum magnesium, urinalysis, and thyroid screen tests are other clinical examinations that may be conducted. A medical specialist may also decide to conduct a physical exam (Wilson et al., 2007).

The physical examination is meant to rule out other medical issues that may result in eating habits. Psychological evaluations are also conducted on the individuals suffering from the disorder to establish their mental status. The assessments also provide information about their feelings and thoughts with regards to their eating habits.

Patients suffering from eating disorders may present a number of special needs. The treatment plan to be adopted usually depends on the needs identified. Medical care and monitoring may be one of the needs. Anti-depressants are recommended for the treatment of some of the disorders, such as bulimia nervosa.

Nutritional counseling may also be conducted to teach the patients on proper eating. The clients are made aware of what they need to eat to maintain a balanced and healthy diet (Wilson et al., 2007). Individual or family physiotherapy can also be adapted to deal with the disorder.

Conclusion

Eating disorders are harmful to the physical health of individuals. Persons suffering from these problems should seek medical and psychiatric help promptly. The right way to manage the disorders is to regulate the intake of food. In addition, individuals should adopt healthy eating habits. Today, many children are affected by the problem. Consequently, controlled intake of food will help in protecting the health of the young generation.

References

Bulik, C., Sullivan, P., Wade, T., & Kendler, K. (2000). Twin studies of eating disorders: A review. International Journal of Eating Disorders, 27(1), 1-20.

Crow, S., Peterson, C., Swanson, S., Raymond, N., Specker, S., Eckert, E., & Mitchell, J. (2009). Increased mortality in bulimia nervosa and other eating disorders. The American Journal of Psychiatry, 166(12), 1342-1346.

Fairburn, C., Cooper, Z., & Shafran, R. (2003). Cognitive behavior therapy for eating disorders: A transdiagnostic theory and treatment. Behavior Research and Therapy, 41(5), 509-528.

Godart, N., Flament, M., Curt, F., Perdereau, F., Lang, F., Venisse, J., & Fermanian, J. (2003). Anxiety disorders in subjects seeking treatment for eating disorders: A DSM-IV controlled study. Psychiatry Research, 117(3), 245-258.

Jacobi, C., Hayward, C., Zwaan, M., Kraemer, H., & Agras, W. (2004). Coming to terms with risk factors for eating disorders: Application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin,130(1), 19.

Striegel-Moore, R., & Bulik, C. (2007). Risk factors for eating disorders. American Psychologist, 62(3), 181.

Wilson, G., Grilo, C., & Vitousek, K. (2007). Psychological treatment of eating disorders. American Psychologist, 62(3), 199.

Introduction

Scientists recommend adequate and uninterrupted sleep for a healthy life. Sleep disorder is an intricate physiological phenomenon that medical professionals and researchers are in the course of looking for its remedy. Espie (2007) alleges, About 40 million people in the United States suffer from chronic long-term sleep disorders each year (p. 217). Sleep disorders are classified into three groups, which are insomnia, narcolepsy, and sleep apnea.

Sleep disorder has no particular remedy. However, it can be controlled once it is correctly diagnosed. According to Roehrs, Zorick, Sicklesteel, Wittig and Roth (2008), insomnia is the most prevalent sleep disorder. Insomnia is common among the elderly and women. Chemical variations in the blood and brain influence the sleeping pattern. Apart from the chemical variations, some drugs and foods also affect the sleeping pattern of individuals.

For instance, caffeine, which is found in tea, coffee and colas, causes insomnia (Bryant, Trinder & Curtis, 2009). Medical professionals do not have a clear explanation on why we require adequate sleep. Nevertheless, research has shown that enough sleep boosts the immune system.

Research Question

Scientists allege that sleep disorders have adverse effects on the immune system. Consequently, the research question for this paper is: what are the consequences of sleep disorder on the immune system?

Hypotheses

Sleep disorders inhibit normal functioning of the immune system and prevent the body from fighting illnesses. Also, sleep disorders hamper the development of the nervous system and cell growth.

Methodology

Data collection

The research will be carried out in a healthcare facility, and it will involve patients suffering from sleep disorders like insomnia and apnea. The researcher will liaise with healthcare providers to obtain permission to interview patients. The study will cover patients from different age groups. The participants will be aged between 10 and 50 years. The research will focus on both male and female patients who have been suffering from sleep disorder for at least six months.

Focusing on different age groups will enable the researcher to come up with a comprehensive and general conclusion of the effects of sleep disorder on the immune system. The researcher will select a sample of 100 participants from a pool of 350 patients. The members will be chosen through stratified random sampling technique.

The patients will be separated into mutually exclusive strata or groups, and the members picked randomly from each cluster. Stratified random sampling will guarantee that all the patients have equal chances of participating in the study. Also, the sampling technique will enable the researcher to arrive at an accurate data for the entire population. The primary objective of using stratified random sampling is to avoid human bias that might compromise the accuracy of the findings.

Measures

The primary goal of the study is to determine the effects of sleep disorder on the immune system. Therefore, the study will treat the immune system as a dependent variable. The health status of all participants will be assessed based on the form of sleep disorder that disturbs them.

The immune system will be treated as the dependent variable because the researchers objective is determine how it responds to varied sleep disorders. On the other hand, the study will treat insomnia, apnea and narcolepsy as the independent variables. These are the variables that influence the immune system of a patient. Their variations have impacts on the immune system of a patient.

References

Bryant, P., Trinder, J., & Curtis, N. (2009). Sick and tired: Does sleep have a vital role in the immune system? Nature Reviews Immunology, 4(1), 457-467.

Espie, C. (2007). Insomnia: Conceptual issues in the development, persistence, and treatment of sleep disorder in adults. Annual Review of Psychology, 53(1), 215-243.

Roehrs, T., Zorick, F., Sicklesteel, J., Wittig, R., & Roth, T. (2008). Age-related sleep-wake disorders at a sleep disorder center. Journal of the American Geriatrics Society, 31(6), 364-370.

Somatic Symptom and Related Disorders and Dissociative Disorders

The understanding of the somatic symptoms and ability to diagnose it may prevent the dire consequences that disorders may have on human health. I succeeded in understanding how the following criteria connected to the somatic system disorders, namely the health-related anxiety and dominant thoughts about the symptoms, excessive health concern. There are not many studies that characterize the mental disorders of the population in Saudi Arabia. However, according to recent researches, 14% of students aged 14 to 19 have somatic symptoms (Koenig et al. 116).

The given statistic concerning the illness anxiety disorders prove the significance of problem-solving as every person of any age group can be affected by such type of disorders. The major symptoms are considered to be the following, namely the high level of health concern, repeated checks in different hospitals, and the big amount of doctors appointments.

I would like to state that the major reason for the illness anxiety disorders can be stressful events in life, the illness history within the family, or other psychological factors. The treatment can occur through the education and support in the mild cases, however, cognitive-behavioral, and stress-reduction treatment should also be provided to eliminate the progress of the disorder.

It should be stated that it is significantly important to understand the diagnostic criteria for dissociative amnesia. The dissociative amnesia is characterized by the inability of the individual to remember the autobiographical information (Sar et al. 487). The major cause is the stressful events that happened in life. It should be highlighted that the disturbance is usually not connected to physiological issues, such as alcohol or drug addiction. The discussed table concerning dissociative amnesia and cognitive disorders provided a deeper understanding of distinguishing the two types of disturbance.

I learned that dissociative identity disorder is rooted in childhood and can turn out to a chronic course. The main causes are abusive behavior during childhood and brain damage. Knowing the criteria of diagnosis is not enough as the treatment plays a significant role. I succeeded in understanding that hypnosis and visualization can be considered as the perfect treatment for dissociative identity disorder.

Neurodevelopmental Disorders

The surroundings influence the overall health of the human being in a significant way. It should be stated that neurodevelopmental disorders, attention deficit, specific learning disorders, autism, and intellectual disability are characterized by some problems with brain development that consequently lead to behavioral and mental disorders. I learned that some conditions, namely undernourishment, parental impacts, and genetic disorders, can influence the mental functioning and cause autism and schizophrenia (Millan 2).

The criteria for attention deficit and hyperactivity disorder are significant for the diagnosis. The attention disorders and hyperactivity are characterized by hostility, aggressive behavior, challenges in performing the needed tasks, impossibility to concentrate, and lack of attention (Barkley 12). The stated above criteria may have a great influence on academic activities and the social environment. The discussed statistics of the attention deficit disorders provided a deeper understanding of the issue.

The learning disorders influence academic success, and that is, should be diagnosed while an early stage to avoid severe consequences. Difficulties while reading, struggling with the understanding of what is read, bad spelling and failures in mathematical reasoning are the first symptoms of the learning disorders and should be noticed as quickly as possible. I would like to state that in diagnosing such types of disorders, the attention of the teacher plays a significant role (Koolwijk et al. 592).

The Islamic religion is against any racial or social discrimination; however, during the pre-Islam period, the Arab society used to socially and culturally isolate people with certain disabilities that prevented them from normal life. I managed to see the connection between psychological factors, religion, and culture concerning learning or attention disabilities (Al-Jadid 456).

The Relationship between Suicide and Depression

Depression is considered to be one of the most widespread health issues across the globe. According to recent researches, almost 15% of people experience depression characterized by sadness, guilt, and lack of interest in favorite activities every year (Thapar 1056). Depression may occur because of stressful life events.

The statistic proves that women tend to be more depressed than men; however, males usually do not go to the doctor even though they have symptoms of depression. The depression can have mild or severe forms that can be the reason for suicidal thoughts. Diagnosed people are usually facing alcohol or drug addiction, anxiety, and behavioral disorders. Depressive thoughts may influence the overall mood of an individual that will consequently lead to suicide if the medical treatment does not occur.

The Difference between Feeling Sad and Depressed

Every person can sometimes feel sad or depressed, and it is significant to understand the difference. The criteria for major depressive disorder comprise the following, namely depressed mood, irritation, insomnia, fatigue, suicidality, feeling if worthlessness, guilt, and loss of interest towards the favorite activities.

Sadness is usually related to a certain circumstance and cannot exist for a long time. The sad periodical feelings are typical for the human being; however, the long-lasting stated above symptoms can be diagnosed as a mental disorder, and that is, should be treated appropriately not to transform to severe forms of depression or, even, suicide.

Works Cited

Al-Jadid, Maher. Disability in Saudi Arabia. Saudi Med 34.5 (2013): 453-460. Print.

Barkley, Russell A. Hyperactive Children: Handbook for Diagnosis and Treatment. 4th ed. New York: Guilford Publications, 2014. Print.

Koenig, Harold G., Faten Al Zaben, Mohammad Gamal Sehlo, Doaa Ahmed Khalifa, Mahmoud Shaheen Al Ahwal, Naseem Akhtar Qureshi, and Abdulhameed Abdullah Al-Habeeb. Mental Health Care in Saudi Arabia: Past, Present and Future. Open Journal of Psychiatry OJPsych 4.2 (2014): 113-130. Print.

Koolwijk, Irene, David S. Stein, Eugenia Chan, Christine Powell, Katherine Driscoll, and William J. Barbaresi. Complex Attention-Deficit Hyperactivity Disorder, More Norm Than Exception? Diagnoses and Comorbidities in a Developmental Clinic. Journal of Developmental & Behavioral Pediatrics 35.9 (2014): 591-597. Print.

Millan, Mark J. An Epigenetic Framework for Neurodevelopmental Disorders: From Pathogenesis to Potential Therapy. Neuropharmacology 68.1 (2012): 2-82. Print.

Sar, Vedat, Firdevs Alioglu, Gamze Akyuz, and Sercan Karabulut. Dissociative Amnesia in Dissociative Disorders and Borderline Personality Disorder: Self-Rating Assessment in a College Population. Journal of Trauma & Dissociation 15.4 (2014): 477-493. Print.

Thapar, Anita. Depression in Adolescence. The Lancet 379.9820 (2012): 1056-1067. Print.

The International Classification of Disorders (ICD) is traditionally viewed as the foundation for determining the problem that a patient might be having, diagnosing a specific disease and, therefore, designing the treatment strategy that will eventually lead to a fast recovery. However, in a range of instances, specialized classification terminologies (SCT) are preferred to ICD despite its comprehensiveness (Cardillo 6), which begs the question whether the use of the technologies above is justified. Although ICD permits a quick location of a problem and its further identification, it typically relies on the standard interpretation of symptoms, thus, dismissing the probability of the patient displaying unique ones; thus, the introduction of the SCT in the process of diagnosing is justified.

The limitations of the current ICD are linked directly to its key properties, i.e., its comprehensiveness. For instance, the lack of the theoretical understanding of a certain problem and the tendency to base the analysis thereof on a specific practical experience, which is typically characteristic of ICD, inhibits the identification of the specific characteristics of a certain case and sends a false message to the therapist (Chapter 3. Specialized Terminologies 2).

For instance, the use of SCT in the healthcare setting should be considered as a necessity in the setting that involves data coordination between EHRs (electronic health records) and PHRs (personal health records) (Healthcare Terminologies and Classifications: Essential Keys to Interoperability 1). To be more exact, the adoption of the SCT tools allows for transferring the information retrieved with the help of tests from one format to another. Despite the fact that issues have been raised concerning the need to keep the patient informed on the updates of or changes to their healthcare records, to date, the SCT tools are viewed as the most efficient way of getting essential details across from one healthcare service member to another so that the information could be encrypted in the e-format (Hovenga 106). Seeing that the SCT tools provide ample opportunities for saving time with precise terminology and a sparing use of words, it is by far the most adequate tool for managing the patients records and updating the latter on a regular basis.

Moreover, the introduction of the SCT tools into the framework of the therapists operations can be viewed as positive when considering the case of an injury that was caused by an undetermined object and the effects of which cannot be determined to a full extent (Maffulli et al. 242). In the given scenario, the necessity to apply the principles of SCT is obvious as the patients life hinges on the accuracy of the diagnosis and the appropriateness of the treatment suggested (Komenda et al. 76). Therefore, the need to work with the health issue the causes of which have not been fully identified can be viewed as another example of an active use of the SCT tools.

With all respect to the all-embracive properties of the ICD, it is still very broad and, thus, can offer only generalized descriptions of the existing disorders; consequently, to make sure that a patient-centered therapy could be provided, one must consider SCT. Seeing that the latter set the stage for a detailed and in-depth analysis of a specific case, they must be viewed as an integral part of high-quality healthcare services. As the cases provided above show, the use of the approach under analysis can be applied to both efficient information management and the services quality improvement areas of healthcare. Thus, the premises for patient-centered care can be created.

Works Cited

Cardillo, Elena 2015, Medical Terminologies for Patients. Web.

Chapter 3. Specialized Terminologies. 2011. Web.

Healthcare Terminologies and Classifications: Essential Keys to Interoperability. 2013. Web.

Hovenga, Evelyn J. S. Health Informatics: An Overview. Washington, DC: IOS Press, 2010. Print.

Komenda, Martin , Daniel Schwarz, Jan `vancara, Christos Vaitsis, and Nabil Zary. Practical Use of Medical Terminology in Curriculum Mapping. Computers in Biology and Medicine 63.1 (2013): 74-82. Print.

Maffulli,Nicola, Francesco Oliva, Antonio Frizziero, Gianni Nanni, Michele Barazzuol, Alessio Giai Via, Carlo Ramponi, Paola Brancaccio, Gianfranco Lisitano, Diego Rizzo, Marco Freschi, Stefano Galletti, Gianluca Melegati, Giulio Pasta, Vittorino Testa, Alessandro Valent, and Angelo Del Buono. ISMuLT Guidelines for Muscle Injuries. Muscles, Ligaments and Tendons Journal 3.4 (2013): 241-249. Print.

Introduction

The mental issue under analysis is stereotypic movement disorder (SMD), which is a motor disorder resulted in a purposeless and repetitive movement of a body part. This issue is important today, as these spontaneous movements can interfere with normal activities, thereby making a person suffering from it partially disabled, and can result in bodily injuries. Besides, this disorder is difficult to cure, therefore, it is important to study it in detail and find out what causes it in order to provide a comprehensive and effective treatment (Wijemanne & Jankovic, 2017).

Analysis of Stereotypic Movement Disorder

History

The history of SMD dates back to the beginning of the twentieth century when it was first diagnosed. During that time, all the symptoms of SMD were referred to as a psychiatric disorder. Thus, since that time, these symptoms have been considered both a neurological and psychological issue. Until recently, this disorder was completely incurable. However, by now, with the development of technologies, there has been some progress regarding the research and treatment of this disorder. In 2013, the DSM-5 was published, and SMD was added to its list, particularly to a new sub-category of neurodevelopmental disorders devoted to various motor disorders (Stein & Woods, 2014).

Clinical Picture and Statistics

The basic symptoms of SMD include arm-waving, rhythmic and rock movements, hand trembling, self-hitting and self-biting, headbanging, trichotillomania, abnormal skipping or running, nail-biting, bruxism, and thumb-sucking. In general, stereotypic movements are peculiar to toddlers and infants who are less than three years old. They demonstrate approximately 15-20% of various repetitive movements. Usually, children with SMD show 80% of symptoms when they are less than two years old, 12% when they are two or three years, and 8% when they are more than three years old. However, sometimes, the symptoms of SMD can occur at any age but are easily identified only in adolescence.

SMD can be caused by intellectual disabilities, autism, head trauma, sensory deprivation, blindness or deafness, drug abuse, brain diseases from infections or seizures, obsessive-compulsive disorder, or major psychiatric disorders. Statistics show that approximately 5-10% of people with intellectual disabilities and 15-20% of people with severe intellectual disabilities suffer from SMD. The risk factors include physiological, genetic, and environmental. Social isolation can cause self-stimulation, which, in turn, results in self-injury. Low cognitive functioning is associated with an elevated risk for the development of stereotypic behaviors and a slow response to interventions. Additionally, fear and environmental stressors are also a major risk factor (Wijemanne & Jankovic, 2017).

Treatment

Currently, there are two principal types of treatment for SMD, namely pharmacological therapy and behavioral therapy. The latter is the primary option, as it is more effective than the former. In behavioral therapy, differential reinforcement is used to reverse the acquired habits. Basically, people learn how to identify their stimuli and develop a response to these stereotypic movements. This therapy also includes self-monitoring, biofeedback, nocturnal control, negative practice, reinforcement, the use of repugnant-tasting substances for nail biting and thumb sucking, and competing responses. This therapy is, in most cases, effective, particularly for infants and toddlers.

However, in some cases, the use of medication is required. In terms of pharmacological therapy, Naltrexone is used to suppress euphoria from the stereotypic movements, and Clomipramine helps inhibit the serotonin reuptake. The prognosis mostly depends on the cause of the disorder and on its severity (Ricketts et al., 2013).

Additional Literature

Source 1

In their research, Houdayer et al. (2014) focus on various dysfunctions in the cerebral activity that cause SMD in children. Admittedly, the underlying mechanism that causes complex motor stereotypes is unknown. Movement-related cortical potentials (MRCPs) which represent the activation of those cerebral areas that are responsible for generating movements accompany and precede voluntary movements.

The purpose of this research was to make a comparison between cerebral activities that are associated with voluntary movements and those associated with motor stereotypes. The authors analyzed the data obtained from an EEG of ten children with primary motor stereotypes. According to the results, no MRCP was observed before motor stereotypes appeared. In comparison with voluntary movements, motor stereotypes do not follow MRCPs.

This shows that the premotor areas do not influence the appearance of these movements and indicates that motor stereotypes are not initiated by the mechanisms responsible for voluntary movements. Additionally, the authors claim that further research is required in order to analyze the findings that would be found in people with secondary stereotypes.

Source 2

In their research, Mehanna and Jankovic (2013) considered SMD as a consequence of various neurological disorders, particularly cerebrovascular diseases. They state that SMD can occur as a genetic or idiopathic disease as a secondary disease, including multiple systemic and neurological diseases, or as a manifestation of certain neurodegenerative disorders. Particularly, cerebrovascular diseases constitute approximately 20% of all secondary movement disorders, and after approximately 5% of strokes, involuntary movements appear that can result in Parkinsonism and various kinds of hyperkinetic movement disorders.

Additionally, the authors claim that controlling stroke risk factors is crucial in decreasing the chance of the appearance of SMD related to cerebrovascular disease. Symptomatic therapies can significantly improve the quality of life of patients who suffer from post-stroke SMDs.

Source 3

In their research, Kurian and Dale (2016) focus on various factors that cause SMDs in children. The purpose of their research is to provide an overview of SMDs that occur in childhood, discuss SMDs main clinical features, and analyze strategies for its prevention and treatment. The authors state that SMDs in childhood comprise a broad range of both acquired and genetic diseases, beginning from slight self-limiting conditions and ending with more virulent cases associated with considerable morbidity and the increase in mortality.

The explanation of the cause of SMD is achieved through the clinical examination, accurate history, laboratory and neuroimaging investigations, and analysis of video footage. Additionally, the authors claim that advances in cell biology and genetic technologies made a great contribution to explaining the reasons for the appearance of SMD in children. Early correct diagnosis can significantly improve the efficaciousness of the existing SMD management strategies.

Conclusion

In conclusion, it can be mentioned that although SMD is difficult to cure, there have been many advances in its treatment recently. The first mentioning of SMD dates back to the beginning of the twentieth century. However, it was only included in the DSM-5 that was released in 2013. The risk factors for SMD consist of three aspects: physiological, genetic, and environmental. SMD is common for all children who are less than two years old, but in the majority of cases, all these involuntary movements disappear after the age of three. SMD includes various unpleasant symptoms such as head banging, hand trembling, or thumb-sucking that can cause other problems.

The treatment for SMD consists of two types. The first type is a behavioral therapy that helps people take control of their spontaneous movements. The second type is pharmacological therapy, which is used when behavioral therapy is not enough to achieve positive results.

References

Houdayer, E., Walthall, J., Belluscio, B. A., Vorbach, S., Singer, H. S., & Hallett, M. (2014). Absent movementrelated cortical potentials in children with primary motor stereotypies. Movement Disorders, 29(9), 1134-1140.

Kurian, M. A., & Dale, R. C. (2016). Movement disorders presenting in childhood. CONTINUUM: Lifelong Learning in Neurology, 22(4), 1159-1185.

Mehanna, R., & Jankovic, J. (2013). Movement disorders in cerebrovascular disease. The Lancet Neurology, 12(6), 597-608.

Ricketts, E. J., Bauer, C. C., Van der Fluit, F., Capriotti, M. R., Espil, F. M., Snorrason, I.,& Woods, D. W. (2013). Behavior therapy for stereotypic movement disorder in typically developing children: A clinical case series. Cognitive and Behavioral Practice, 20(4), 544-555.

Stein, D. J., & Woods, D. W. (2014). Stereotyped movement disorder in ICD-11. Revista Brasileira de Psiquiatria, 36(1), 65-68.

Wijemanne, S., & Jankovic, J. (2017). Stereotypies. Movement Disorders Curricula, 407-414.

Introduction to the DSM-5

Pros and Cons of Eliminating the Multiaxial System

The main pro of eliminating the multiaxial system is the fact that it allows clinicians and organizations more flexibility in how to organize diagnostic information (Peele, Goldstein, & Crowell, 2013, p.15). This means that clinicians are in a position to present the diagnostic information in an organized and presentable manner. However, the con of eliminating the multiaxial system is that it results in limited standardization of the diagnosis information. This means that eliminating the multiaxial system is similar to removing the coding that provides a common language for communicating diagnostic information (Peele et al. 2013, p.11).

In my opinion, it is not fair to totally eliminate the multiaxial system since the environmental and any psychological attributes in diagnosis can be recorded in the most proactive way. Therefore, eliminating the multiaxial system may be detrimental in erasing other conditions that are part and parcel of the clinical attention in processing diagnosis information. Therefore, eliminating the multiaxial system should be done when other alternatives such as pseudo-multiaxial systems are adopted.

Changes from the DSM-5-TR to the DSM-5

The phrase mental retardation was replaced by intellectual disability. The rationale for the change can be attributed to the fact that intellectual disability has been classified as a challenge in the cognitive capacity as development in the diagnostic criteria advanced (Peele et al. 2013). The second change was made in the criterion for the diagnosis of schizophrenia. The special attribution was erased as a result of the fact that the symptoms for the condition are nonspecific.

The third change is that criterion A for manic and hypomanic episodes now includes an emphasis on changes in activity and energy as well as mood (Peele et al. 2013, p.17). This change was made to facilitate and enhance detection and diagnosis in any clinical environment. The fourth change is the inclusion of new depressive disorders. This change was made to address fears of possible overtreatment or overdiagnosis of the condition, especially among children suffering from bipolar disorder. The last change made in the diagnosis of anxiety disorders by erasing obsessive-compulsive disorder, posttraumatic stress disorder, and acute stress disorder (Peele et al. 2013, p.13). The changes were made to minimize the phobic response during diagnosis.

Diagnostic Reliability of the DSM-5

Diagnostic reliability

This is the scale for measuring the degree of accuracy in the tests and symptoms when carrying out a diagnosis for a disease.

Intraclass kappa

This is basically the scale for measuring the reliability of different raters for measurements to determine the consistency and absolute agreement with the predetermined scale.

Good range of reliability

Schizophrenia Spectrum

The diagnosis involved classifying the type of schizophrenia a patient is suffering from through the use of the predetermined diagnostic information that had a range of effect, that is, from mild to acute (Regier, Mitter, Zwick, Bazinet, Cummings, & Kawahara, 2013).

Hypothesis

The diagnosis was followed by tests that were measured against predetermined results for each stage of the disease to ensure that it had good reliability.

Clinical benefit

The clinical benefit of having very good reliability is to guarantee accurate diagnosis and proper recording of the diagnosis information.

Questionable score

Bipolar diagnosis

It was unclear on the degree of bipolar condition since the results were confusing for different tests (Regier et al. 2013).

Hypothesis

The diagnosis was not followed by tests measured against predetermined results for each stage of the disease.

Clinical benefits

There were no clinical benefits since the variance between different test results was uneven (Regier et al. 2013).

References

Peele, R., Goldstein, G., & Crowell, R. (2013). DSM-5: What It Will Mean to Your Practice. Psychiatric Times, 3(4), 7-21. Web.

Regier, J. C., Mitter, C., Zwick, A., Bazinet, A. L., Cummings, M. P., & Kawahara, Y. (2013). DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses. PLoS ONE, 8(3), 23-39. Web.

Introduction

Thalassemia is a genetic disorder impacting the formation of hemoglobin synthesis. Management of thalassemia usually includes regular immunizations, diet modification, and exercise. The purpose of the project is to study the effectiveness of the proposed management approaches and determine the mechanisms responsible for the effect. The topic was chosen to determine the feasibility of non-intrusive management options for thalassemia management programs. The significance of the topic stems from its ability to improve the understanding of the issue.

Description

Thalassemia is an umbrella term that covers a range of blood disorders. The condition is genetic in origin and is thus inheritable. The central mechanism behind the disorder is the inability of the organism to produce hemoglobin, a protein responsible for the delivery of oxygen by red blood cells. The exact type of thalassemia is determined by the specificities of the deficiency of hemoglobin production. The most widespread type is beta-thalassemia, which impacts the synthesis of normal adult hemoglobin, generated by the human body throughout its life cycle (Karimi et al. 586). Depending on the severity of the condition, the disorder can be categorized as thalassemia minor and thalassemia major. The former is a relatively harmless form of the disorder, which does not constitute a major health issue. In extreme cases, people with thalassemia minor are subject to symptoms resembling mild anemia, which is sometimes interpreted as the deficiency of blood iron. The second subtype, thalassemia major, is a clinically significant disorder that has major implications for the impacted persons development. The effects of thalassemia major become noticeable in early childhood and persist throughout life.

Treatment Options

As was mentioned above, beta-thalassemia is an inheritable condition, which means it cannot be prevented. However, a variety of treatment options are available to the impacted population. The most common treatments of thalassemia major include bone marrow transplant and blood transfusion. In less severe cases, it can be controlled with pharmacological interventions. Finally, in certain cases, a surgery, such as a splenectomy, may be required (Vichinsky 197). Finally, a range of supportive measures can be included in the treatment plan, such as folic acid replacement. The condition of the sufferers is often monitored to detect and address possible complications, such as heart failure, osteoporosis, and hypertension. The described measures are applicable predominantly to thalassemia major, which has clinically significant effects on patient health. The treatment of thalassemia minor and mild forms of thalassemia major is limited to monitoring and, in some cases, lifestyle modifications.

Management

Immunization

Regardless of the necessity for treatment, thalassemia has a noticeable effect on the individuals quality of life. Immunizations are among the most important aspects of thalassemia management. Regular pediatric immunizations, as well as adult immunization against hepatitis A and B, are essential for health protection, especially for patients who undergo blood transfusions (Musallam et al. 67).

Diet

In addition, the current knowledge on the subject suggests nutritional adjustments for patients with thalassemia minor and mild cases of thalassemia major. The rationale for the recommendation is the controlled intake of certain elements, such as folate, calcium, vitamin D, and a number of trace minerals. The exact contents of the diet in question are developed by a dietician based on nutritional history, results of annual dietary evaluations, the current state of the disorder, and, in the case of pediatric thalassemia, a childs growth status. Importantly, the intake of iron-rich foods, including meat, fish, fortified cereals, and certain juices. This aspect of the diet is especially important since thalassemia minor exhibits a number of similarities with conditions related to iron deficiency. As a result, the patients may be tempted to include some of the listed foods as a result of misdiagnosis or misguided independent research.

Another important component of the diet is calcium-rich foods. Thalassemia-impacted patients often experience secondary health problems with bone formation, which puts them at an increased risk of fractures and related injuries (Cao and Kan 9). From this perspective, calcium-rich foods provide the necessary supply of nutrients to strengthen the musculoskeletal system.

Exercise

Finally, physical activity is often included in thalassemia management recommendations. The rationale behind the suggestion is the general tendency among patients with thalassemia to prefer a sedentary lifestyle and ignore physical activity. In the majority of cases, this behavior can be attributed to the feeling of weakness as one of the symptoms of the disorder. In severe cases, patients may experience pain that discourages them from exercising regularly. Finally, exercise is known to improve general wellbeing and strengthen both the cardiac and musculoskeletal system (Cao and Kan 11). Importantly, due to health limitations, thalassemia sufferers are advised to consult with their healthcare providers regarding the recommended intensity and frequency of the exercise to avoid adverse effects.

Conclusion

As can be seen, each of the recommended approaches is consistent with the current understanding of the mechanisms associated with the condition. The dietary modification is expected to address deficiencies observed in the impacted population and mitigate the most common risks created by thalassemia. Exercise, which is another popular option, has a twofold effect of increasing general wellbeing and improving patients wellbeing while at the same time addressing physical activity deficiencies common among the impacted population. It is reasonable to conclude that the current approach to management is feasible and can be included in treatment plans due to its overall beneficial effect.

Works Cited

Cao, Antonio, and Yuet Wai Kan. The Prevention of Thalassemia. Cold Spring Harbor Perspectives in Medicine, vol. 3, no. 2, 2013, pp. 1-16.

Karimi, Mehran, et al. Guidelines for Diagnosis and Management of Beta-Thalassemia Intermedia. Pediatric Hematology and Oncology, vol. 31, no. 7, 2014, pp. 583-596.

Musallam, Khaled M., et al. Cross-Talk between Available Guidelines for the Management of Patients with Beta-Thalassemia Major. Acta Haematologica, vol. 130, no. 2, 2013, pp. 64-73.

Vichinsky, Elliott. Non-Transfusion-Dependent Thalassemia and Thalassemia Intermedia: Epidemiology, Complications, and Management. Current Medical Research and Opinion, vol. 32, no. 1, 2016, pp. 191-204.

Screening for Treatment or Referral

The situation is very complicated, however, because our agency deals with mental disorders and has a child evaluation specialist and a child psychiatrist, it can address the needs of Julia in a short-term period. Having the ability to provide specific treatment, our agency is going to serve the patient with particular care. One of the main aspects which are going to be considered is the screening of a girl for an eating disorder. Therefore, being able to define the specific nature of the problem by the DSM IV, the agency will be able to take further steps. It is essential to know the nature of the disorder and only then refer to treatment. Bullying at school is one of the reasons, however, it is not enough for concluding. A depressive disorder is the main aspect of treatment that is going to be addressed. Eating disorder is the effect of depression, which is a result of personal dissatisfaction.

Review of the Existing Evidence from the Literature

McDermott (2006) presents much useful information, however, the models for understanding eating disorders based on diagnostic criteria are the most effective ones. Using the Diagnostic and Statistical Manual of Mental Disorders as the guide for action, it is important to mention that obesity is not included in the model as according to DSM-IV it does not refer to behavioral or psychological problems. In this case, obesity is used as a consequence, which will be reduced after the root problem is considered. The strong point of this article is the combination of the eating disorders and behavioral aspects of the problem as the mixture of the possible reasons for the psychological problem. Therefore, the author refers to eating disorders as a result of depression.

Grange and Lock (2011) present the DSM-IV-TR diagnostic criteria for problem-solving. DSM-IV-TR is the strategic model which may assist in defining the reasons for the behavior connected with the situation under discussion. Moreover, following this model it is possible to consider the basic information devoted to the anorexia nervosa, bulimia nervosa, or another eating disorder problem as a result of depression. The authors are sure that having an eating disorder, a person suffers one of the mentioned above Nervosa, which is to be the main aspect in defining the treatment measures.

Haines, Ziyadeh, Franko, McDonald, Mond, and Austin (2011) are sure that screening high school students for eating disorders is to be the first step on the way to recovery. Having selected the specific method drawn from the National Eating Disorder Screening Program, the researchers used the Eating Attitudes Test with questions devoted to understanding the eating culture of high school students. The results are shocking as 12% of females and 3% of males reported vomiting to control their weight and 17% of females and 10% of males reported binge eating 1 or more times per month (Haines, Ziyadeh, Franko, McDonald, Mond, & Austin, 2011, p. 530). Such high rates of vomiting or binge eating are the results of the creation of the stereotype.

Trujillo (2012) supports this idea by writing about the role of media and society in the life of adolescents and their consideration of depression as the theme of the discussion. The report dwells upon the negative effect media, and social opinion plays on adolescents and their eating disorders as they create the illusion of an ideal man and an ideal woman, which are to be corresponded to. Such discussion makes adolescents follow the ideal people, which do not exist, therefore, it is impossible to do it. As a result, the depressive condition leads to various problems, in our case, it is the depressive thoughts about suicide and eating disorder as one of the reflections of personal discontent.

Linville, Stice, Gau, and & ONeil (2011) dwell upon the role of parents in creating an eating behavior of adolescents and the risk of depression formation. The results show that mothers may affect their daughters by personal example, the effect may be both positive and negative.

Heller (2003) speaks about body image supported by self-esteem. Much information is directed at the signs of the possible problems. Therefore, the information may help in understanding Julias depression and considering the measures which are going to assist her treatment.

Prioritizing Treatment Outcome Goals and Setting a Treatment Plan

The case under consideration points at Julias eating disorder with referencing to the psychological issues. The situation covers the problems at school, the inability of parents to deal with their daughter, and as a result misunderstanding and failure to notice the beginning of the problem. It is essential to understand that depression is the main reason for eating disorders. Therefore, simple knowledge about the eating disorder and the consequence of the issue may not result in a successful recovery. A girl is rather aggressive that creates additional barriers on the way to recovery. A depressive disorder is going to be solved in several steps. First, the assessment of the psychological condition is going to be conducted. Second, the connection between a patient and a therapist is going to be created to make sure that a girl trusts a therapist and he/she may help her. Antidepressant treatment is going to be completed along with psychotherapy. Physical activity is going to be offered in combination with a well-balanced diet, which is going to assist the recovery and eating disorder, which supports Julias depression. Social activity is to be used as one3 of the steps of treatment. Finally, meditation is to be considered. Speaking about prioritizing in the treatment plan, antidepressant treatment and psychotherapy are going to be the main goals on the way to Julias recovery.

The family is ready to assist in treatment, however, additional problems are created by the patients reluctance to negotiate goals. The main idea of selecting and defining the goals is to make sure that the treatment is conducted by specific rules and the priorities are put on the necessary purposes. It is important to enumerate all the necessary actions, which are to be accomplished in the direction of Julia and then stress on the most essential ones.

Treatment Evaluation

Having considered the steps of treatment, it may be concluded that the treatments strategy is rather effective. First of all, medical treatment is covered along with psychological assistance. It increases the chances for faster recovery. Moreover, meditation and social activity are included that make it possible for Julia to remain with herself and to participate in social life, which is a very important factor. Psychical activity is essential as having an eating disorder as the side effect of depression personal self-esteem may increase with the changes in the body.

Reference List

Grange, D. L., & Lock, J. (2011). Eating Disorders in Children and Adolescents: A Clinical Handbook. New York: Guilford Press.

Haines, J., Ziyadeh, N. J., Franko, D. L., McDonald, J., Mond, J. M., & Austin, S. B. (2011). Screening High School Students for Eating Disorders: Validity of Brief Behavioral and Attitudinal Measures. Journal of School Health, 81(9), 530-535.

Heller, T. (2003). Eating Disorders: A Handbook for Teens, Families, and Teachers. Jefferson: McFarland.

Linville, D., Stice, E., Gau, J., & ONeil, M. (2011). Predictive effects of mother and peer influences on increases in adolescent eating disorder risk factors and symptoms: A 3-year longitudinal study. International Journal of Eating Disorders, 44(8), 745-751.

McDermott, B. (2006). Eating Disorders in Children and Adolescents. Cambridge: Cambridge University Press.

Trujillo, A. E. (2012). Adolescents and Eating Disorders. Insights to a Changing World Journal, 3, 126-140.

Symptom and Reflection Paper

Everyone has moments of excitement, talkativeness episodes, generosity, or irritability. These moods normally stand out in a definite period. However, people suffering from mania have hyperbolic moods and thus they are isolated and locked out of conventional relationships; hence, such people are abnormal people. Mania is the DSM disorder symptom of my choice for this paper.

I had invited friends to our home to watch a football match. They arrived early enough and we had normal conversations before the match. One of the teams was my favorite team playing against another minor team at the bottom of the league standing. My favorite team scored as expected, but I did not celebrate with my friends. It was difficult to act this part, but given that I had already premeditated on it, the acting was successful. My friends noticed that I was depressed, but they could not tell why I was depressed. When our team scored the second goal, I celebrated with my friends, but I exaggerated the celebrations. I celebrated for 30 seconds beyond my friends. At this point, they thought that I was going crazy and all they could do was to stare at me in bewilderment. After the match, I did not even ask my friends to share their thoughts concerning my behavior because they immediately demanded an explanation of my weird behavior and I gave an explanation.

After the game, I bid my friends farewell and continued to act this symptom, but this time in the family set-up. I expressed another symptom of mania by speaking rapidly and louder than normal when conversing with a family member. However, I made sure that I maintained a normal personality and outlook during my one-hour ordeal during dinner. I had chosen to express this symptom during dinner for we share the same table and I was certain that my family members would notice my behavior. My behavior was strange to them for I had never acted that way before.

My mother would occasionally inquire, Are you okay? and because I maintained a normal outlook, I would answer in the affirmative. Why then are you talking that way? At this point, I would pretend to be unaware of the existence of any strange behavior on my part. My dad also noticed the strange behavior in my speech, but he did not say anything hopefully looking forward to getting an answer to incase I responded to my mums questions. My two younger siblings as well noticed the strangeness, but they merely enjoyed it and would occasionally burst into sudden laughter. After the episode, I explained to my mum because I knew that she would understand and explain to the rest of the family members that it was a psychological academic practical.

The experience of acting mania symptoms when with my friends and family taught me that people who know us even when we are not aware of it recognize our behaviors. When we deviate from our normal behaviors, the people around us quickly notice the differences and respond differently about the relationship we have with them. Normal behavior free of DSM disorders is significant in society and plays a major role in how people act. DSM disorder symptoms invoke emotional reactions among individuals close to the person exhibiting the behavior.

Introduction

This essay focuses on the personality disorders with specific reference to the case of Hilde, who had Histrionic Personality Disorder (HPD). Personality disorders are chronic, persistent, and rigid forms of perceived responses to situations, which are adequately maladaptive to create a distraction in the functioning and environmentally created subjective distress. Personality disorders are common. People with these conditions tend not to show concerns with their situations.

On the other hand, their relatives and friends tend to be concerned about their behaviors. In most cases, people with personality conditions tend to consider their personality characteristics as ego-syntonic. In other words, individuals consider their personality traits as consistent with their self-perceptions. This implies that people with personality disorders are not likely to seek help from professionals by themselves. Instead, other people may seek such help for them. Some major characteristics of these disorders include traits that appear odd or eccentric, dramatic, emotional or erratic, and anxious or fearful.

A brief overview of Hildes case

Hilde was a 42-year-old homemaker who had several complications, including headaches, marital issues, and gentle depression (Meyer, Chapman & Weaver, 2009). Initially, the family physician used reassurance and Valium to control the case of Hilde, but they did not work.

Hilde never referred to her condition in personal terms but placed that responsibility on other people. She claimed that her husband was uncaring and noted that a secretary could have seduced him. These conditions and stress contributed to her headaches and depression.

Hildes husband claimed that he had become tired of dealing with her. Steve married Hilde for her social status and physical attractiveness. Hilde maintained that her children were wonderful, while Steve noted that the children were spoilt and had a poor performance in school.

Hilde was from a wealthy family and a highly valued child. Hildes parents never rewarded her adequately for her academic achievements, but they made fun of intellectual snobs. During her adolescence stage, Hilde had a wide circle of friends but failed to create deep relationships with her friends. Although Hilde acquired a reputation of being loose sexually, this was not reflected in her actual behaviors. She considered junior high and high school as the happiest moments of her life.

However, college years were different for Hilde because she had to work harder than previously to attain average grades. Hilde dated many people but never developed any deep and meaningful relationships or sexual experiences.

Steve and Hilde dated for few months and were married, and none of the family members objected. The courtship was in a whirlwind manner. Steve became highly occupied with his practice as Hilde was engaged in social activities. The couples life became dull as they rarely did anything meaningful together.

Biological, emotional, cognitive, and behavioral components of Hildes case

Biological factors were responsible for the case of Hilde. However, Hilde learned most of these disorder patterns from her parents and refined them with age to cope with her prevailing environments and social activities. Hildes upbringing contributed to her Histrionic Personality Disorder. Hildes mother only used her for social events as an object to show off at parties, but without much caring. Generally, she lacked good maternal attention but strived for her fathers attention.

Emotionally, Hilde developed a wide circle of relationships but failed to create any deep, long-lasting emotional bonds. Hilde focused on social activities but failed to share personal challenges and vulnerabilities. Her parents also hid their marital problems. Hence, denial was rampant in the case of Hilde.

Initially, Hilde displayed good academic performance, cognitive development, and intellectual competence. Unfortunately, these analytic capabilities deteriorated as she progressed through high school to college. Moreover, her family did not provide any meaningful reinforcement. Hilde focused on her physical attractiveness and social skills rather than developing her intellectual skills.

Behavioral aspects of Hilde reflected histrionic personalities. She was categorical on social class and tended to elicit new relationships without developing deep contacts. She placed the blame on others because of her condition. Hilde was emotionally insensitive to others, and she did not understand her own behaviors. She displayed signs of being antisocial (Millon, 2004). Hilde had a mild case of attempted suicide in order to manipulate her husbands decision of marrying another wife.

Conclusion

This essay has covered the personality disorders with specific reference to the case of Hilde, who had Histrionic Personality Disorder (HPD). Biological and genetic factors could have contributed to the case of Hilde because her mother did not develop any deep relationships with her while her father was a patriarch. However, the highly demanding social environment shaped these personality traits in Hilde.

Hilde showed intense emotional expression to gain favors but failed to develop any deep relationships with others. She did not understand her emotions. Hilde was intelligent, but her family failed to reinforce her academic achievements. Consequently, she declined in performance through her college years. Hilde showed a mild case of suicide to manipulate her husband as their relationship declined.

Hildes treatment required rewards, assertive behaviors, avoidance of special treatment, and effective group therapies (Hansell & Damour, 2008).

References

Hansell, J., & Damour, L. (2008). Abnormal psychology (2nd ed.). Hoboken, NJ: John Wiley & Sons, Inc.

Meyer, R., Chapman, L. K., & Weaver, C. M. (2009). Case studies in abnormal behavior (8th ed.). Boston, MA: Allyn & Bacon/Person Education Inc.

Millon, T. (2004). Personality Disorders in Modern Life. Hoboken, NJ: John Wiley & Sons, Inc.