Category: Disorders

Introduction

Eating disorders (EDs), including anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS), are serious mental illnesses associated with significant psychosocial and physiological morbidity, as well as a broad range of medical and psychiatric problems such as enhanced risk of mortality and poor health.

Indeed, it has been demonstrated through research that anorexia nervosa has the highest mortality rate of any psychiatric disorder, not mentioning that bulimia nervosa and EDNOS are fundamentally associated with health instability (Fursland et al., 2012).

But although extant literature demonstrates the prevalence rate of EDs to be less than 5 percent of the general population (Berg et al., 2012), a serious challenge arises from the fact that many people are reluctant to seek treatment due to lack of information which is critical in making informed decisions (Allen et al., 2011).

The present paper aims to counter this challenge by providing relevant information about EDs, which could then be used by patients not only to assess their status, but also dispel various misconceptions that continue to hinder help-seeking behavior.

Assessing the Eating Disorders according to DSM-IV-TR

As observed by Berg et al (2012), the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) identifies two approved eating disorders, namely anorexia nervosa and bulimia nervosa; however, the diagnostic manual makes mention of binge-eating disorder as a relatively new syndrome though still categorized under bulimia (Bowers & Andersen, 2007), and groups other syndromes under eating disorders not otherwise specified (Fursland et al., 2012).

According to Berg et al (2012), the criteria for anorexia nervosa as outlined in the DSM-IV-TR include &minimal body weight for age, gender, and height; fear of weight gain; at least one cognitive symptom (i.e., overevaluation of shape and weight, body image disturbance, or a denial of the seriousness of being at a low body weight); and amenorrhea (p. 263).

Amenorrhea is thought to occur when a woman misses three successive menstrual cycles, or when her periods occur only after administering a hormone such as estrogen (Keel et al., 2011). In addition, the diagnostic manual identifies two subgroups of anorexia nervosa, namely restricting and binge-eating/purging. In the former subgroup, patients rarely engage in binge eating or purging due to their overstated fear of gaining weight, but they routinely engage in any or all of these behaviors in the latter subgroup (Keel et al., 2011).

The DSM-IV-TR criteria for Bulimia nervosa, according to Berg et al (2012), &include binge eating, defined as the consumption of an unusually large amount of food coupled with a subjective sense of loss of control, and compensatory behaviors occurring at least twice per week for the previous 3 months and overevaluation of shape and weight (p. 263).

The compensatory behavior most exercised by individuals with this mental condition include self-induced vomiting after taking huge quantities of food, abuse of laxatives or diuretics, excessive physical exercise or fasting for prolonged periods of time (Keel et al., 2011).

As is the case with anorexia, the diagnostic manual specifies two main subgroups of bulimia nervosa, namely (1) purging subgroup (individuals regularly engage in self-induced vomiting and/or abuse laxatives and diuretics), and (2) non-purging subgroup (individuals engage in extreme exercises and/or fasting to keep in form, but do not engage in purging behaviors such as self-induced vomiting) (Berg et al., 2012; Allen et al., 2011).

The third category of EDs in the DSM-IV-TR encompasses eating disorders not otherwise specified (EDNOS), and is often allocated to people who demonstrate clinically significant disorder but nevertheless fail to successfully satisfy the assessment criteria for either anorexia nervosa or bulimia nervosa (Berg et al., 2012).

Examples of EDNOS, as cited by these authors, include &purging without binge eating, binge eating without the use of compensatory behaviors (i.e., binge eating disorder), and meeting all criteria for anorexia, except amenorrhea (p. 263). Attempts are at an advanced stage to formally classify various disorders that are presently categorized under EDNOS (Keel et al., 2011).

Indeed, The DSM-V, which is yet to be formally released, has attempted to minimize the prevalence of EDNOS by instituting a broad range of measures, including abolishing the amenorrhea prerequisite for anorexia nervosa as well as embracing binge eating disorder (BED) as a formal eating disorder diagnosis (Berg et al., 2012).

Available literature demonstrates that five in every ten people suffering from anorexia nervosa will transit into bulimia nervosa or EDNOS, and people with bulimia nervosa may also transit into EDNOS over time (Fursland et al., 2012).

However, epidemiological studies as well as validated clinical statistics show that prevalence rates of EDNOS are substantially elevated than those of either anorexia nervosa or bulimia nervosa (Allen et al., 2011), and that &the associated psychopathology, psychosocial impairment, treatment response, and medical/suicidal risk of EDNOS are comparable with those of anorexia and bulimia (Berg et al., 2012, p. 263).

Dispelling Misconceptions about Eating Disorders

Extant literature demonstrates that &although boys and men also experience eating disorders, they are greatly outnumbered by girls and women with eating-related problems (Schwitzer, 2012, p. 281).

At a global level, according to this author, EDs rank among the ten most common causes of psychological distress in young adult women of diverse racial and ethnic origins. But although this assertion is correct and valid, it should be noted that other research studies have found EDs to affect male populations with the same intensity as experienced in female populations.

Although it has traditionally been assumed that only one in ten cases of eating disorders occur in a male, this perspective has been changed by a recent study of over 10,000 adolescents, ages 13 to 18, which &found equal numbers of males and females with anorexia (Fursland, 2012, p. 319). This finding dispels the misconception that EDs are gender-specific, but also demonstrates the likelihood that many male ED cases repeatedly go unnoticed or undiagnosed, making exact approximation of prevalence difficult.

Historically, EDs were thought to be a psychiatric problem limited to Caucasian females from rich family backgrounds (Berg et al., 2012), but recent epidemiological research has discounted this perspective by finding extremely few variations in disordered eating indications among African American, Latina, and European American women in institutions of higher learning (Schwitzer, 2012).

Consequently, the idea that EDs can only affect girls and women of European American descent cannot be supported by research; on the contrary, consecutive studies reveal that EDs are becoming increasingly widespread in broader age ranges, both genders, and diverse ethnic groupings (Berg et al., 2012).

Extant literature demonstrates that &anorexia tends to develop in adolescence, with peaks in onset at ages 14 and 18, whereas bulimia tends to develop in later adolescence or early adulthood (Fursland et al., 2012, p. 319).

While this knowledge is objective and valid in as far as EDs are concerned, it has rendered many parents to believe that these disabilities do not affect young children, hence not only making estimates of prevalence difficult but also hindering attempts toward care and management.

Parents need to be acquainted with the knowledge that EDs can also present in young children, some as young as four years, and develop or endure into late adulthood (Fursland et al., 2012; Schwitzer, 2012).

The last misconception relates to risk factors involved in the development of an eating disorder. To date, many people believe that EDs are caused by factors that are innate to the body, such as hormonal imbalances, poor digestive systems and poor food transformation (Berg et al., 2012). However, extant literature demonstrates that gender and social-cultural factors, including the media and Western culture, evidently play the biggest part in the progression of these disorders (Fursland et al., 2012).

As noted by these authors, &repeated exposure to fashion magazines (which often use technology to modify images) has been found to predict increases in ED symptoms among adolescent girls valuing a thin ideal (p. 319). Other studies demonstrate that factors such as low self-esteem, early childhood feeding and gastrointestinal problems, stressful life events, and high weight and shape concern, considerably enhance the risk of EDs (Allen et al., 2011; Fursland et al, 2012).

Conclusion

The present paper has not only illuminated assessment criteria for EDs under the DSM-IV-TR, but also taken time to provide useful insights into a number of misconceptions related to the disorders.

It is believed that for effective treatment and management of these disorders, individuals and health professionals need to have sufficient knowledge on how the disorders present as well as their assessment criteria. Additionally, people need to be provided with the correct information regarding the disorders, thus the need to dispel misconceptions that continue to adversely affect help-seeking behavior among the populations most at risk of developing eating disorders.

References

Allen, K.L., Fursland, A., Watson, H., & Byrne, S. (2011). Eating disorder diagnoses in general practice settings: Comparison with structured clinical interview and self-report questionnaires. Journal of Mental Health, 20(3), 270-280.

Berg, K.C., Peterson, C.B., & Frazier, P. (2012). Assessment and diagnosis of eating disorders: A guide for professional counselors. Journal of Counseling & Development, 90(3), 262-269.

Bowers, W.A., & Andersen, A.E. (2007). Cognitive-behavior therapy with eating disorders: The role of medications in treatment. Journal of Cognitive Psychotherapy: An International Quarterly, 21(1), 16-27.

Fursland, A., Byrne, S., Watson, H., La Puma, M., Allen, K., & Byrne, S. (2012). Enhanced cognitive behavior therapy: A single treatment for all eating disorders. Journal of Counseling & Development, 90(3), 319-329.

Keel, P.K., Brown, T.A., Holm-Denoma, J., & Bodell, L.P. (2011). Comparison of DSM-IV versus proposed DSM-5 diagnostic criteria for eating disorders: Reduction of eating disorder not otherwise specified and validity. International Journal of Eating Disorders, 44(6), 553-560.

Schwitzer, A.M. (2012). Diagnosing, conceptualizing, and treating eating disorders not otherwise specified: A comprehensive practice model. Journal of Counseling & Development, 90(3), 281-289.

Rationale (what did you see that supports the diagnosis?)

The client is a mature (thirty-eight years old) woman with a fear of elevators. The patient is currently unemployed. She failed one of her job interviews approximately two years ago as she could not manage to overcome her elevator fear in the building of a company that had vacancies at that moment. Moreover, she avoids using elevators in everyday life because there is a possibility of panic attacks that might occur when dealing with lifting mechanisms. The issue described above first appeared at the college that the patient attended for two years but did not manage to graduate. Also, the clients heartbeat increases, and it becomes harder for her to breathe when she is obliged to take an elevator. Agoraphobia is an appropriate diagnosis in this case as it implies fears of various social situations that are usually followed by panic-attacks and other symptoms that can occur in nervous individuals.

Developmental Disorder(s): No diagnosis

Rationale (what did you see that supports the diagnosis?)

There were no developmental issues as this woman entered an educational institution, which means that she passed all the necessary exams. Moreover, she has a good appetite. Therefore, no mental or physical developmental issues can be considered in the given case.

Personality Disorder(s): F60.3 Borderline Personality Disorder

Rationale (what did you see that supports the diagnosis?)

When the client is obliged to take an elevator, her behavior becomes unstable and abnormal. Moreover, she cannot control her emotions when dealing with elevators. Nevertheless, her uncontrolled actions might cause harm to the surrounding people. Also, the patient ended her relationships because she thought she was a burden on her ex-boyfriend. Sometimes, she regrets hastily decisions she made before. However, the client is not a confident person as she thinks negative about her body, temperament, and behavior.

Medical Disorder(s): No diagnosis

Rationale (what did you see that supports the diagnosis?)

Although there are no major complaints, the patient is allergic to something as she takes appropriate medicine on a daily basis. As it was mentioned above, her appetite is good. Moreover, she has never had any problems with drugs or alcohol before.

Client Strengths:

1. The client is not alcohol addicted, which is very beneficial for her emotional condition and physical health in general.
2. The client is not drug addicted, which means that she is not a weak person because the patient has many stresses every day.
3. The client does not have any mental issues that usually influence people who are afraid of staying in a confined space for an extended period.
4. The client has a good appetite and sticks to a healthy diet to remain strong and to prevent vitamin deficiency, which is essential for people who experience many stresses.
5. The client does not have insomnia or other illnesses that might influence her night rests. When people sleep well, they feel more energized and active.
6. The client does not think about committing suicide. Although the patient has a tough situation in her life, she does not want to give up because of her elevator fears.
7. She has sympathy for people who surround her and does not want to burden them with her problems and personal concerns.
8. The woman is calm in everyday life. However, panic attacks might occur in the client if she has to deal with her elevator fears.

Comments/Differential Diagnosis. (Did you consider any other possible diagnoses? Identify them here, and discuss your rationale for not selecting them. You can also use this section to discuss additional observations which helped you with your diagnostic decision making.

Another diagnosis that might be considered in this case is the major depressive disorder because the client is lonely and does not want to socialize (American Psychiatric Association, 2013). She does not have friends, is not in a relationship, and feels awkward in public places due to her elevator fears. However, it is not necessary to be a professional psychologist to tell that the patient is in depression because her sullen mood and glum face can describe the persons attitude towards her life.

Reference

American Psychiatric Association. (Ed.). (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Publishing.

Rationale (what did you see that supports the diagnosis?)

The client is a female (fifty-one years old) who says that she is concerned about the robbery in her house that happened three weeks ago. A strange man (perhaps, a burglar) broke into her house to rob it. He wanted to take only valuable things to sell them afterward. When the patient entered her house, she was shocked and scared because of what she saw. Fortunately, the stranger did not cause any harm to the woman. However, today she does not feel safe and always recalls the moment described above, which makes her nervous and stressed. Moreover, the woman does not feel brave anymore and cannot relax as she thinks that the same situation can happen again. All of the factors mentioned above meet the criteria for specific phobia.

Developmental Disorder(s): No diagnosis

Rationale (what did you see that supports the diagnosis?)

The client does not have any developmental disorders. Her parents would always make her complete all the homework perfectly, which says that this person was smart and was able to accomplish logical and theoretical tasks. Moreover, the client loved going to school when she was a child because she did well in all of her classes. Also, the woman has a good job that cannot be acquired by an individual with particular developmental disorders.

Personality Disorder(s): Paranoid Personality Disorder

Rationale (what did you see that supports the diagnosis?)

The client does not trust people who surround her as much as she did before the incident with a burglar in her house. She also has insomnia because of her permanent fear of facing the same situation again. Moreover, she could not go to work or leave the house as she was afraid that something could happen to it while she was gone. The client feels scared all the time and is always afraid that strangers can cause harm to her and her family. When a person is obsessed with a certain thought or has continuous fears about something, one is likely to have paranoid personality disorder.

Medical Disorder(s): No diagnosis

Rationale (what did you see that supports the diagnosis?)

Although the patient does not have any medical issues at the present moment, there are some interventions in her body. For instance, she underwent a medical operation to repair her tendon.

Client Strengths:

1. The client is a very clever person because she has two higher education degrees (Bachelors and Masters). She also loved going to school as all the disciplines were easy and interesting for the patient.
2. The client has a strong marriage and supportive parents.
3. The client said that she was a happy person until the incident with a burglar occurred in her dwelling. This meant that the person did not have many stresses and emotional issues before.
4. The client is very ambitious and active as she has a good job. Moreover, the patient is a very independent person who can take care of herself in any life situation.
5. The client is very intelligent and follows the basic rules of ethics at work. This quality was developed by her parents because they made her complete all the homework as well as she could. Therefore, she is a responsible person today.

Comments/Differential Diagnosis. (Did you consider any other possible diagnoses? Identify them here, and discuss your rationale for not selecting them. You can also use this section to discuss additional observations which helped you with your diagnostic decision making.

Although the main diagnoses are described above, it would be proper to consider other disorders contributed to the given case. The client does not sleep well because of her fears of facing the house robbery again. Moreover, the patient has continuous nightmares that remind her of that day when she met a burglar in her dwelling who wanted to steal all the valuable things. Therefore, insomnia is a possible diagnosis in the given situation (American Psychiatric Association, 2013). Also, such diagnosis as schizophrenia can be considered in the given situation, which can be prevented by specific treatment.

Reference

American Psychiatric Association. (Ed.). (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Publishing.

Introduction

The development of symptoms of eating disorders is a cause for concern since this health problem can become a serious risk factor. The article by Crawford and Brandt (2018) tells about the dangers of such a problem and why public authorities should pay more attention to the issue of control over the populations eating habits. As the evidence of the relevance of the issue raised, it can be noted that the physiological outcomes of misbalance in the digestive system are fraught with dangerous consequences. Therefore, relevant interventions can be useful, and the positions of the stakeholders deserve at least a discussion.

Justification of the Need to Resolve the Issue

The opinion on the need to take urgent measures to address health problems caused by eating disorders has a theoretical and statistical justification. For example, according to Crawford and Brandt (2018), eating disorders are the third most common chronic illness in adolescents (para. 14). As a consequence, a number of appeals to the countrys authorities were held. The initiators made a petition to the representatives of the Senate and also appealed to the former head of the Center for Disease Control and Prevention. Nevertheless, the statements of the activists did not have sufficient influence on the officials, and no significant measures were taken even after providing the substantiation of the danger of the problem. However, the issue raised by the initiators should be considered since, judging by their assurances, the situation regularly deteriorates, and every 62 minutes, someone dies as a direct result of an eating disorder (Crawford & Brandt, 2018, para. 19). Therefore, the discussion of the intervention should be started as soon as possible to stop the problem.

Causes of Disagreements

The primary reason for the disagreement was that the position of the authorities did not coincide with the opinion of the supporters of urgent interventions. According to the healthcare representative, eating disorders cannot be considered such a dangerous problem to take many efforts, and therefore, this ailment was excluded from the list of potentially dangerous ones. Nevertheless, as the authors note, over the past two years since the signing of this law, the changes have taken a toll, and the need for intervention is obvious (Crawford & Brandt, 2018). Moreover, the statistics provided by researchers demonstrates the urgent need for information dissemination among the population and psychological assistance to those in need. However, judging by the words of official representatives, all the data on the indicated problem can be found in free access on various online platforms. Such an approach to protecting the population can hardly be considered successful since the decision to take appropriate measures and group all available information in one place for conducting a complex intervention would be a more sensible solution. It is these disagreements that have become the cause of the contradictions, and the position of supporters of taking urgent measures looks convincing enough.

Conclusion

Thus, the problem of eating disorders is relevant and significant, and the discussion of ideas can be considered not only at the local but also at the state level. The elimination of the indicated problem from the list of potentially dangerous diseases has led to gaps in this area, and the ailment itself did not disappear. Comprehensive assistance to those in need can help to improve the situation in the country.

Reference

Crawford, S. F., & Brandt, H. A. (2018). 30 million people will experience eating disorders  The CDC needs to help. The Hill. Web.

Rationale (what did you see that supports the diagnosis?)

A client is a 50-year-old female who lives with her husband and claims that she does some research. From her behavior, it is seen that she is hyperactive and is hardly paying attention to what is told to her concentrating only on her thoughts and feelings. The clients husband made her go to a counselor for the recommendations regarding her condition. Other symptoms include talking too much, changing topics in a conversation, distracting, having thoughts of being followed by the CIA, and having conversations with god.

Thus, she is probably has Delusional Disorder according to the following criteria. Criterion A: the client claims that many people want to have sex with her, which is the main symptom of the delusional disorder of erotomanic type. Criterion B: the client states that she has a special relationship with god and has the secret of the universe. She also thinks that many people want to write a book about her, as she thinks that she is brilliant. All these symptoms are peculiar to the delusional disorder of grandiose type. Criterion C: the client feels that the CIA has framed her and stolen her thoughts. In addition, she claims that doctors are bad, as they have given her medications that she did not like. These symptoms are peculiar to the delusional disorder of persecutory type.

Developmental Disorder(s): F22.0 Delusional disorder, mixed type

Rationale (what did you see that supports the diagnosis?)

The client has been probably having Delusional Disorder since her childhood but in a milder form. According to her husband, she was treated in a psychiatric hospital when she was a teenager. He also says that she had been there three times before the age of eighteen. Evidently, she was cured at that time, and her condition has been normal until recently.

Personality Disorder(s): Schizotypal Personality Disorder

Rationale (what did you see that supports the diagnosis?)

The main symptom that characterizes Schizotypal Personality Disorder is the distortion of events that happen in reality. Thus, the client claims that she is the smartest and the most brilliant person, that she has the cure for cancer, that leaves are speaking and singing songs to her, that Google is talking to her, and that she spoke with the Pope.

Medical Disorder(s): No diagnosis

Rationale (what did you see that supports the diagnosis?)

There are no particular diseases mentioned in the clients medical history.

Client Strengths

1. The client has no medical disorders.
2. The client has a family that looks after her.
3. The client does not abuse any substances.
4. The client has lived for a long time without her disorder meaning that it can be treated once again.
5. The client loves her husband though she thinks that he is not smart enough.
6. The client regularly visits a counselor though she does not like these sessions.
7. The client has a lot of energy.
8. The client listens to her husband, which makes it easier to make her begin the treatment.

Comments/Differential Diagnosis. (Did you consider any other possible diagnoses? Identify them here, and discuss your rationale for not selecting them. You can also use this section to discuss additional observations which helped you with your diagnostic decision making.

Due to the abundance of symptoms the client has, it is possible to think that she has some another illness. Thus, one of the possible diagnoses is Paranoid Personality Disorder. The main symptoms of this disorder that the client has are the suspiciousness and concerns about the conspiracy against her. However, this disorder also includes such symptoms as sensitivity and bearing grudges which are not reported by the client. Another possible diagnosis is schizophrenia.

In this respect, the client expresses unusual beliefs with a great force, has thought and mood disorders, and has a distorted perception of reality (Mental Health, 2016). Regarding schizophrenia, a patient usually has severe hallucinations that can completely separate them from reality and cannot act normally. Therefore, the client does not fit these criteria either.

Reference

Mental Health and Delusional Disorder. (2016). Web.

Client Diagnosis

Major Psychiatric Disorder(s): F25.9 Schizoaffective Disorder, Unspecified

Rationale (what did you see that supports the diagnosis?)

The client meets Criterion A (the presence of the major manic episode that is related to Criterion A of schizophrenia) for the schizoaffective disorder because she reported being extremely excited or genius during a certain period. She was agitated by the necessity to resolve the puzzle that was associated with the received secret message about Edgar Allan Poe. In addition, the client did not need to sleep for several days. However, it is important to note that no depressive moods or suicidal ideations were reported. The client also meets Criterion B (delusions or hallucinations) because she reported receiving secret messages and having many brilliant ideas. The client also meets Criterion C (the duration of symptoms) as Susie reported being genius and active during a long period, and she called these periods genius phases. It is also possible to state that the client meets Criterion D (no medication abuse) as she did not report consuming any drugs, but she wanted to take some drugs to become even more genius.

Developmental Disorder(s): No diagnosis.

Rationale (what did you see that supports the diagnosis?)

The client did not report having any disorders diagnosed while being a child, including autism or attention deficit hyperactivity disorder. Therefore, it is impossible to claim that the client has some developmental disorder that affects her mental state and behavior.

Personality Disorder(s): F60.6 Avoidant Personality Disorder

Rationale (what did you see that supports the diagnosis?)

The client can meet Criterion A (avoiding interpersonal contacts) because she discussed interactions with other people and her thoughts regarding having a husband. The clients ideas about her family and husband can be associated with Criterion B of this disorder because she seems to be unwilling to become involved in interactions with other people or strangers.

Medical Disorder(s): G47.00 Insomnia

Rationale (what did you see that supports the diagnosis?)

The client seems to meet the majority of criteria for insomnia, but an additional conversation is required to examine her sleep patterns in detail. The problem is that the client does not sleep for several days, and this aspect needs to be examined as her mental disorder can cause such problems. Furthermore, specific sleep patterns associated with the chronic type of insomnia can also provoke some of the symptoms reported by the client. As a result, the symptoms associated with the clients mental disorder can worsen because of problems with her sleep patterns.

Client Strengths

1. The client has positive relationships with her daughter.
2. The client can be motivated to follow some treatment.
3. The client has no suicidal ideations.
4. The client denies the presence of any other mental disorders.
5. The clients home environment is stable.
6. The client receives her daughters assistance and support.
7. The client can be described as clever and self-confident.
8. The client reads a lot and she can memorize some poems.

Comments/Differential Diagnosis. (Did you consider any other possible diagnoses? Identify them here, and discuss your rationale for not selecting them. You can also use this section to discuss additional observations that helped you with your diagnostic decision making

In addition to the schizoaffective disorder associated with the clients state, it is possible to diagnose schizophrenia or bipolar disorder. However, not all criteria for schizophrenia are met, and to diagnose bipolar disorder, it is important to note that the client has an extremely accentuated manic phase without discussing significant symptoms for the depressive phase. Currently, it is impossible to specify the clients disorder as of the bipolar type because of the lack of information regarding the clients manic and depressive episodes, but the bipolar type is assumed (ICD 10, 2017). The client also has such symptoms of schizoaffective disorder as psychosis, mania, disorganized and rapid speech, and the impossibility to focus on one idea at a time.

Reference

ICD 10. (2017). 2017/18 ICD-10-CM diagnosis code F25.9. Web.

Rationale (what did you see that supports the diagnosis?)

Client is a 29-year old female who is obsessively concerned about her safety. She meets diagnostic criterion A due to the presence of recurring thoughts. The client believes she is being constantly watched by people. The thoughts are distressing for Debra; therefore, she attempts to suppress them by performing compulsions. The womans compulsions take the form of regularly checking locks and light switches.

The behaviors are not realistically connected to the anxiety that the client tries to alleviate. Debra meets criterion B because her compulsions take more than one hour per day (APA, 2013). Furthermore, the presence of obsessions and compulsions leads to a substantial distress in her social and occupational functioning (APA, 2013). For example, the compulsive rituals interfere with her work and limit her social interactions. The woman meets criterion C because she does not have any underlying medical conditions and substance abuse issues (APA, 2013). The clients symptoms cannot be attributed to another mental disorder (Criterion D). Debra does not recognize that the delusional beliefs are not true.

Developmental Disorder(s): No diagnosis

Rationale (what did you see that supports the diagnosis?)

The client has a BA degree and is gainfully employed, which is evidenced by her lack of financial concerns. Debra was able to name both the current and past presidents. She was alert during the interview.

Personality Disorder(s): No diagnosis

Rationale (what did you see that supports the diagnosis?)

The clients symptoms fall under four diagnostic criteria for obsessive-compulsive disorder. Debra shows no signs of other personality disorders.

Medical Disorder(s): No diagnosis

Rationale (what did you see that supports the diagnosis?)

Debra regularly exercises and does not have an eating disorder. She adheres to her diet and eats well. The client states that she does not have medical issues and does not take medications. Therefore, it is not possible to diagnose any underlying medical disorders.

Client Strengths

1. Debra is alert, young woman who has successfully pursued a bachelors degree.
2. The clients mother is extremely supportive and shows considerable concern over her wellbeing.
3. The woman reports engaging in a regular exercise, which is a considerable strength since purposeful physical activities are associated with a lower risk of developing chronic illnesses. Furthermore, regular exercise is a source of stress relief. Another mental benefit of physical activities is anxiety alleviation.
4. Debra is willing to build a social life.
5. The woman had a normal childhood.
6. The client is an active member of a church, which can provide her with additional support.
7. Debra maintains a healthy diet, thereby avoiding weight disorders.
8. The client is gainfully employed, which reduces her exposure to unexpected financial challenges.
9. Debra does not report experiencing suicidal thoughts.
10. The woman is not concerned about her physical appearance.

Comments/Differential Diagnosis. (Did you consider any other possible diagnoses? Identify them here, and discuss your rationale for not selecting them. You can also use this section to discuss additional observations which helped you with your diagnostic decision making

General anxiety disorder has been considered as a differential diagnosis. However, the diagnosis was discarded because the patient does not meet key criteria such as fatigue, muscle tension, and sleep disturbance (APA, 2013). Avoidant personality disorder is also not applicable to the case because the client reported seeking social interactions. In addition, Debra regularly visits a church and does not regard herself as being personally unappealing.

Obsessive-compulsive disorder can be misdiagnosed as anxiety; therefore, she was assessed with regard to the accuracy of her convictions (Grant, 2014). The absent insight in the presence of delusional beliefs helped to distinguish obsessive-compulsive disorder from other anxiety disorders. The woman might have experienced physical abuse from her former boyfriend, which is a stressful event that can contribute to the development of the disorder (APA, 2013).

References

APA. (2013). Diagnostic and statistical manual of mental disorders (5^th ed.). Washington, DC: American Psychiatric Publishing.

Grant, J. (2014). Obsessive-compulsive disorder. The New England Journal of Medicine, 371(1), 646-653.

Humans spend approximately one-third of their life for sleeping. However, the full role of this process remains unknown. It was determined that sleep is essential for cell division, body growth and reparation, memory formation and unnecessary memory files removal, protein synthesis, immunocompetence maintenance, and metabolism regulation (Silber et al. 8). Thus, it could be stated that sleeping disorders can lead to serious health problems. Insomnia and narcolepsy are two different types of sleeping disorders. Insomnia is characterized by the reduction of quantity or quality of sleep, while narcolepsy means excessive daily sleepiness.

Insomnia

According to the American Academy of Sleep Medicine, insomnia could be defined as a nightly complaint of an insufficient amount of sleep or not feeling rested after the habitual sleep episode (23). The definition also includes adverse daytime consequences of the sleeping disorder (Sateia and Buysse 3). The problem with the definition is that there are no accepted objective criteria that could be used for the disorder diagnosis. The level of distress and, therefore, the severity of insomnia depend on the individual characteristics of a patient. Besides, it was established that people with insomnia are inclined to overestimate the negative effect of sleeping disorder and underestimate the total time of sleep. Despite all the difficulties, nowadays, the clinical diagnosis of insomnia is based on the patients complaints and description (Sateia and Buysse 3-5).

It was stated that insomnia affected up to 30% of American citizens (Silber et al. 184). Reasons for insomnia could be various: environmental factors that prevent healthy sleep, the irregular sleep-wake cycle and unhealthy, sedentary lifestyle, stress, a wide range of physiological, neurological, and psychiatric diseases, and others (Silber et al. 185-194). It is important to determine the cause of the sleeping disorder to provide efficient therapy. For the insomnia treatment, pharmaceutical and non-pharmaceutical approaches are used. It is required to optimize the sleep environment and regime. Cognitive-behavioral therapy is also considered to be an effective method to overcome insomnia. For pharmaceutical therapy, sedative, and hypnotic medications such as benzodiazepines, nonbenzodiazepine benzodiazepine-receptors agonists, melatonin agonists, and antidepressants are used in clinical practice (Silber et al. 200-206).

Narcolepsy

Narcolepsy could be defined as excessive sleepiness that typically is associated with cataplexy and other REM-sleep phenomena, such as sleep paralysis and hypnagogic hallucinations (American Academy of Sleep Medicine 38). All people who suffer from narcolepsy complain of daytime sleepiness which interferes with their activities. This disorder can lead to different accidents, difficulties with employment, and various social problems (Silber et al. 68).

Narcolepsy is a less common sleeping disorder than insomnia. It was estimated that up to 67 per 100,000 persons (0.067% of a population) are suffering from this disease (Silber et al. 72). Narcolepsy can be genetically determined (approximately 90% of people with narcolepsy have HLA DQB1*0602 antigen (Goswami et al. 5)) or caused by several factors, including brain tumors, neurotransmitters regulation malfunctioning, and autoimmune diseases (Silber et al. 72-75). It is important to determine the reason for the disorder because it could be a symptom of a serious illness.

For the narcolepsy treatment, pharmaceutical and non-pharmaceutical approaches could be proposed. Regime normalization is the first step of the therapy. It is important to develop a regular sleep-wake regime, avoid night shifts, and enhance daily activities to overcome narcolepsy. A range of stimulant medications such as modafinil, sodium oxybate, methylphenidate, pitolisant, amphetamines, and mazindol is widely used for the pharmaceutical therapy of the disorder (Barateau et al. 370-372).

Conclusion

Two different types of sleeping disorders were reviewed: insomnia (the lack of sleeping) and narcolepsy (the excessive sleepiness). Both disorders negatively affect patients work and social activities and cause significant adverse consequences. The reasons for these diseases could be various, including external and internal factors. For the insomnia treatment, sedative medicaments are used, while narcolepsy requires therapy with stimulant medications. A healthy lifestyle and regular sleep-wake daily regime are also essential for recovery.

Works Cited

American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd ed., American Academy of Sleep Medicine, 2005.

Barateau, Lucie, et al. Treatment Options for Narcolepsy. CNS Drugs vol. 30, no. 5, 2016, pp. 369-379. Web.

Goswami, Meeta, et al., editors. Narcolepsy: A Clinical Guide. 2nd ed., Springer, 2016.

Sateia, Michael J., and Daniel Buysse, editors. Insomnia: Diagnosis and Treatment. 2nd ed., CRC Press, 2016.

Silber, Michael H., et al. Sleep Medicine in Clinical Practice. 2nd ed., CRC Press, 2016.

Client Diagnosis

Major Psychiatric Disorder(s): F45.1 Somatic Symptom Disorder, with predominant pain, severe

Rationale

The client is a 28-year old female who reports having numerous health issues that deprive her of the possibility to work and communicate easily. These are the major issues, as identified by Catherine: her legs hurt so much that she cannot walk, her backaches frequently, she lumps that she thought to be a sign of cancer, and she has allergies when she goes outside. In the middle of the interview, she coughs slightly and says that she has a terrible cough which she considers to be a sign of pneumonia.

The client meets several criteria for Somatic Symptom Disorder, as defined by DSM-5 (American Psychiatric Association, 2013):

1. Criterion A: Catherine has more than one somatic symptoms that are disturbing her daily life (pain in legs and back, a lump, the cough);
2. Criterion B: Catherine has excessive thoughts represented by constant thoughts about her symptoms, she has a high level of anxiety concerning her health, and she devotes excessive energy and time to her health concerns;
3. Criterion C: The state of being symptomatic lasts longer than 6 months (Catherine reports to have had such problems for nearly ten years).

The disorder is characterized as with predominant pain since the clients somatic symptoms principally incorporate pain (American Psychiatric Association, 2013, p. 311). It is severe since all three symptoms specified in Criterion B are present in the client, and somatic complaints are multiple.

Developmental Disorder(s): No developmental disorders diagnosed

Rationale

The clients language and motor skills are fine. She graduated from high school and entered college. Even though she did not finish it, she is trying to receive an education with the help of online courses.

Personality Disorder(s): No personality disorders diagnosed

Rationale

Although she reports having difficulty moving, Catherine says that she sometimes goes out with her friends. Her family and friends are supportive. She does not have a boyfriend, but this is not a sufficient reason to diagnose an antisocial or avoidant personality disorder.

Medical Disorder(s): No medical disorders diagnosed

Rationale

Despite the numerous complaints, the client has no outstanding medical conditions. She pays visits to doctors quite often, but they do not diagnose any illnesses.

Client Strengths

1. Clients parents are supportive; they take her to doctors when she complains about some health issues;
2. The client has some friends with whom she can socialize;
3. The client does not have any history of substance abuse;
4. The client is not suicidal or homicidal;
5. The client is willing to find out the reason for her problems;
6. The client agrees to make more sessions with the social worker;
7. The client has a high degree of aspiration; she wants to continue her education;
8. Other than somatic symptom disorder, the client does not have any psychiatric illnesses;
9. The client reports having good access to health care;
10. The client expresses a willingness to cope with anxiety and lead a normal lifestyle.

Comments/Differential Diagnosis. (Did you consider any other possible diagnoses? Identify them here, and discuss your rationale for not selecting them. You can also use this section to discuss additional observations that helped you with your diagnostic decision making

It was clear from the start that Catherine suffered from a Somatic Symptom Disorder. I diagnosed it because the client met all the criteria (A, B, and C). Such symptoms may also refer to Generalized Anxiety Disorder since the clients condition causes an impairment in occupational and social areas of functioning (American Psychiatric Association, 2013). However, frequent referrals to various health issues made me convinced that it was a Somatic Symptom Disorder. The client talked about several past and present issues. Even in the course of a conversation, she pretended to have a slight cough which she defined very severe and suggested that it could be pneumonia.

Reference

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed.). Arlington, VA: American Psychiatric Publishing.

The article An Invariant Dimensional Liability Model of Gender Differences in Mental Disorder Prevalence focuses on mental disorders and their differences in both men and women. Throughout this research article, the main research topic comes out clearly to be an impact of gender on diverse comorbid mental disorders. This happens due to the result of observed gender differences in mental disorders, where women are seen to have more effects to some extent compared to men. The existing gender differences in the prevalence rates of a number of mental disorders have been found in many research studies. In this respect, the article explains different theories and research studies along with their findings and conclusions on gender differences in specific disorders. Also, the mentioned article takes into account comorbidity (Harkness, Alavi, 2010).

The research problem investigated in the article is the fact that defines whether there exists gender difference in prevalence rate of disorders as reported by several epidemiological studies or not. Their study also wanted to find out if it was possible to make a reliable model to show how a specific gender affected mental disorders. From the study, it has been found that at first gender differences exist in mental disorders and have a great effect. Secondly, there are mood along with anxiety and disorders that are emotional commonly observed in females or women. Men are known to have a high rate of drug disorders. Women have higher internalizing level and men have higher externalizing level (Grant, & Weissman, 2007).

There are other studies that show that women are more influenced by such disorders as anxiety, dysthymia, social phobia, panic disorder, at high prevalence rates than men. On the other hand, men are associated with high rate of alcohol, drugs, and antisocial personality disorders. The researchers identified that these differences had also been identified in other research studies carried out before. It has been found that the social phobia and panic disorders are the internalizing dimensions that are at high prevalence rate in females. Contrary, the externalizing dimensions are mostly are as a result of with nicotine, drugs, and other disorders that are antisocially dependence (Leedy, & Ormrod, 2011).

1. Are there gender differences that exist in disorder prevalence rates?
2. Are disorders often comorbid?
3. Is it possible to develop a liability model to elaborate on the effect of gender on different mental disorders?
4. What are the patterns of disorder comorbidity?

When we try to find out the solution to the first question, we understand the existence of gender differences as far as mental disorders are concerned. Several researchers investigated the impact of gender on mental disorders but failed to consider the comorbidity. Making an attempt to answer the above question and basing the argument from the research findings, we understand the pattern of these disorders and gender impacts towards them and, thereby, solution of the research problem should be elaborated.

The research method employed in the research finding was experimental method, which helped the author find information on different causes of mental disorders of different genders, and therefore, makes specific conclusions about their effect. Laboratory experiment had to be conducted to come with the main cause and effect of mental disorders in men and women. The non-experimental methods include diagnostic interview schedule and clinical assessment, which cause the sufficient assistance to a great extent in finding issue of gender on mental disorders.

The data used in the study was gathered from a different participant from the initial wave. The studys design of NESARC was descriptive (Grant & Dawson, 2006), and was able to yield reliable results. There was a wave, which represented a sample of civilians, population that was not institutionalized in the United States of America. There was a sample of African Americans where women represented approximately a half of the population. The participants also selected race and ethnicity using the defined category of census. The sample population was well selected, and this helped to avoid biasness in the study.

Diagnosis was conducted using the schedule of alcohol use disorder. Interviews were also conducted to gather more information on mental disorders. The results clearly indicated that the underlying common mental disorder structure was gender variant. Gender differences expressed in many different levels. Externalizing and internalizing liabilities were the source of differences in gender in prevalence rate of different related mental disorders.

High rate of anxiety and moody were observed in female analysis. The result indicated high rate of internalizing in women and high rate of externalizing in men. The model was therefore, gender invariance, where gender difference was well indicated in preferences rates. Different theories from different scholars have come up with different views and understanding on gender differences in prevalence rates. Conclusion have however, been made that high rate of internalizing in women and high rate of externalizing in men exists (Krueger et al., 2002). In reference to the results of the experiment, this is correct. This clearly indicates that, although the research had some limitations, it is to a great extent reliable. In a nutshell, the results of the analyses data have a close relationship with different theoretical views of many scholars.

References

Grant, B. F., & Dawson, D. A. (2006). Introduction to the National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol Research & Health, 29, 7478.

Grant, B. F., & Weissman, M. M. (2007). Gender and the prevalence of psychiatric disorders. In W. E. Narrow, M. B. First, P. J. Sirovatka, & D. A. Regier (Eds.), Gender and age co nsiderations in diagnoses of psychiatric: A research agenda for DSM-V (pp. 3146). Washington, DC: American Psychiatric Association.

Harkness, K. L., Alavi, N., (2010). Gender differences on mental disorders: London, Oxford University Press.

Krueger, R. F., Hicks, B. M., Patrick, C. J., Carlson, S. R., Iacono, W. G., & McGue, M. (2002). Etiologic connections among substance dependence, antisocial behavior, and personality: Modeling the externalizing spectrum. Journal of Abnormal Psychology, 111, 411424. Web.

Leedy, P. D., & Ormrod, J. E. (2011). Practical research: Planning and design (10th ed.). Upper Saddle River, NJ: Pearson.