Category: Disorders

Many people and their families are affected by antisocial personality disorder (ASPD). Such a condition may be described as a manifestation of chronic maladaptive personality types that impair a persons functioning (Bobadilla et al., 2017). In addition, people who are diagnosed with ASPD are not able to fulfill their social duties and may engage in criminal behavior (Bobadilla et al., 2017). To describe the characteristics of ASPD, this paper focuses on the controversy, strategies, and legal considerations of the disorder by using scientific research and personal beliefs.

Controversy

Most of the controversy that surrounds ASPD focuses on the etiology of the disorder. According to research, the primary cause of the disorder is adverse childhood experiences (DeLisi et al., 2019). However, some experts argue that harmful personality traits primarily originate from childhood psychopathology (DeLisi et al., 2019). A number of studies have been conducted to investigate the links between unpleasant childhood events and ASPD, with various degrees of success (DeLisi et al., 2019). However, the findings do not provide a clear explanation for the origins of ASPD, leaving open the question of whether the condition is produced by experience or by physiological abnormalities.

Personal Beliefs

In my opinion, the disorder requires further research and more scientific data. I believe that people with ASPD struggle to adhere to social standards and should not be diagnosed in patients younger than 18 years old. Accordingly, diagnostic manuals suggest that to be eligible for a diagnosis, a persons age must reach 18 years, and they must provide evidence of the conduct disorder (American Psychiatric Association, 2013, as cited in DeLisi et al., 2019). Additionally, I believe that common traits of ASPD may include aggression and lawful behavior. According to research, ASPD is often defined as a failure to follow cultural standards of lawful conduct (DeLisi et al., 2019). Furthermore, the disorder is frequently associated with a lack of remorse. (Bobadilla et al., 2017). Therefore, the research findings serve as the foundation of my views on ASPD.

Therapeutic Relationship

An effective strategy for maintaining the therapeutic relationship with a patient should involve open discussions and adhering to medication prescriptions. For patients with ASPD, therapies that rely on the creation of a strong therapeutic connection are less successful (Bobadilla et al., 2017). Therefore, therapy of diagnosed people should not be based on personal relationships. Instead, therapists should utilize strict measures that guarantee prolonged medication. Such strategies may include creating a plan with timelines and obtaining official written consent. Patients can create a healthier and more successful bond with their physician by actively addressing relevant actions and measures.

Legal and Ethical Considerations

Legal and ethical issues should also be considered during therapeutic practice. Since personality disorder is a comorbid illness, finding direct causes is difficult, which leads to less approval by the legal system (Johnson & Elbogen, 2022). In addition, within the judicial system, ASPD too closely resembles a generic understanding of crime (Johnson & Elbogen, 2022). From an ethical perspective, people with personality disorders are often considered to be able to make a free choice (Johnson & Elbogen, 2022). It is critical to approach the disease with such considerations since treatment approaches frequently result in legal difficulties and lawsuits.

To comprehend ASPD, specialists should thoroughly evaluate all of the significant elements associated with the condition. The causes of the disorder often result in discussions and debates. Personal beliefs should also constitute a part of a successful analysis of the disorder. Therapeutic relationships should be based on professionalism and appropriate measures. Furthermore, physicians should consider the legal aspects of the problem to respond to any potential complications.

References

Bobadilla, L., Kurkoske, M., & Taylor, J. (2017). Antisocial and narcissistic personality disorder. Reference Module in Neuroscience and Biobehavioral Psychology. Web.

DeLisi, M., Drury, A. J., & Elbert, M. J. (2019). The etiology of antisocial personality disorder: The differential roles of adverse childhood experiences and childhood psychopathology. Comprehensive Psychiatry, 92, 16. Web.

Johnson, S. C., & Elbogen, E. B. (2022). Personality disorders at the interface of psychiatry and the law: Legal use and clinical classification.Dialogues in Clinical Neuroscience, (15)2, 203-211. Web.

Practice Problem

Depressive disorders are quite common diseases, affecting 10-15% of the worlds population each year (Park & Zarate, 2019). Despite advances in the development of psychopharmacology and the identification of individual biomarkers of depression, only 60-70% of patients with depression who respond to treatment respond positively to antidepressant therapy (Park & Zarate, 2019). A number of studies on the satisfaction of life of patients with depression show that in addition to receiving antidepressant therapy, they also need additional psychosocial measures to achieve complete remission.

The reason for the increased difficulties in early diagnosis of depression among young adults between 18-40 y/o in primary care practice in recent decades can rightfully be called the replacement of a consistent, strictly structured analysis of the state on the basis of a medical conversation. It was replaced by a simplified procedure for operational diagnostics based on a particular set of criteria.

In itself, the principle of diagnostics based on certain criteria is an undeniable achievement. It is assumed that it should prevent unreasonable freedom in the formulation and justification of the diagnosis and ensure its reproducibility (Park & Zarate, 2019). However, this principle does not take into account the patterns of the formation of the syndrome and the general clinical, biological and compensatory psychological elements of the state.

In addition, it should be considered that the authors of the relevant criteria themselves did not always follow the rules of evidence when forming one or another of their compositions, which is formally sufficient to establish a definite diagnosis. So, in modern DSM-V classifications, the operational diagnosis of depression uses the following as equivalent alternative signs (Park & Zarate, 2019). This is a decrease or increase in appetite, a decrease or increase in body weight, insomnia, or hypersomnia. If each of the first signs of these binary combinations is typical for a depressive syndrome, then the second indicates an atypical structure of depression. Such a broad interpretation is suitable for a population study but not for a differentiated, individualized diagnosis of an affective disorder.

Practice Change

Early diagnosis of depression is a complex process that requires increased effort on the part of both the physician and the patient. It is important to maintain a therapeutic alliance with the patient and almost permanent psycho-educational activities (Davey & McGorry, 2019). Patients with the suspected depressive disorder should share their inner experiences with the doctor and be able to freely ask any questions related to risk factors for depression, lifestyle changes, more effective treatment options for depression, duration of treatment, the severity of side effects, as well as suicidal thoughts and aggressive behavior.

The doctor, in turn, should discuss with the patient the issue of adherence to treatment and the impact of comorbidities (such as cardiovascular disease, cancer, thyroid disease, and eating disorders). Moreover, the interaction between antidepressants and other drugs, possible manifestations of future relapses of depression, and factors of increased vulnerability to it should be discussed (Park & Zarate, 2019). It is important to inform the patient that ignoring the symptoms of depression predicts a worse long-term outcome while achieving a state of certainty is associated with a more favorable course of the disease.

Moreover, there is a necessity to develop an appropriate treatment strategy for young adults who might have resistant depression at the early stages of diagnosis. There is no single standard approach to treating depression-resistant depression, so a patient with this condition needs an individualized treatment plan that may take time and effort. Therefore, the following principles should be followed when treating patients with therapy-resistant depression. It is necessary to determine the exact diagnosis, including the subtype of depression, and assess concomitant mental and physical illnesses. It is recommended to determine the applicability of the strategy of prescribing Aripiprazole, a dopamine system stabilizer that is pharmacologically different from other antipsychotics, acting as a partial agonist of dopamine D2 and D3 receptors, serotonin 5-HT1A receptors, and serotonin 5 antagonists (Taylor et al., 2019).

Population

Population for the practice change involves patients of age 1840 years who are classified as young adults. Inclusion criteria are compliance with the clinical picture of non-psychotic depressive disorder with one of the following diagnostic headings. Among them are depressive episodes of mild, moderate degree; dysthymia; mixed anxiety and depressive disorder; adjustment disorder. Exclusion criteria are organic mental disorders, schizophrenia and schizophrenia spectrum disorders, psychopathy, and mental retardation.

Intervention

The primary aspect of intervention will be the shift towards the approach to early diagnosing of depression among young adults in primary care practice. As mentioned above, there is the issue of over-reliance on specified criteria during this process. The section on practice change suggests appealing to individualized and even improvised diagnosing of depression within the scope of the theme. It will be crucial to develop as the open and complex conversation with the patients as possible. Then, at the initial stages, the necessary analyses in the framework of defining the appropriacy of prescription of Aripiprazole in case of resistant depression should be made.

Comparison

The main difference between the suggested practice change to the prevalent practices in this vein will be the adherence to the approach of individualized and improvised discussion with the patient on his or her state and risk factors related to the presence of depression. However, here, it can be noted that the application of DSM-V may be used as well  if the physician considers such an option relevant at the early diagnosing stages. Then, the significance of Aripiprazole should be explored and shown too. The study showed the effectiveness of Aripiprazole in the treatment of resistant depression (McDermott & Dozois, 2019). The authors showed that patients who received this drug as adjunctive therapy showed a better therapeutic response compared to placebo and achieved remission.

Outcome

It is expected that the described approach will benefit the related practices to a great extent. In particular, there may be an increased number of timely diagnoses of depression among young adults in primary care practice. The individualized strategy will take into account vital aspects that specified diagnostic criteria can miss at times. Moreover, the activities in the framework of Aripiprazole prescription can significantly reduce the cases of severe resistant depression.

Timing

It might be assumed that the practice of non-adherence to the established and generally accepted diagnosing criteria cannot be implemented promptly and without preparations. In particular, the development of the related recommendations on how to conduct the individualized conversation with the patients will take from one to two months. Then, in order to create significant practical experience and knowledge, such a strategy should be realized among the reputable and recognized facilities and professionals, which will take at least six months. After the scientific approbation of the results  from one to two months  the practice change may become a generally accepted approach.

Feasibility

Despite the fact that the practice change is likely to bring many benefits, its implementation involves many resources  starting from primary care facilities and ending with healthcare professionals. Prior to the practices realization, a considerable degree of work should be done. Particularly, patterns for individualized conversations with the patients are to be developed by respected mental specialists and agreed with the facilities that will potentially use them. Then, the efficiency of this shift

References

Davey, C. G., & McGorry, P. D. (2019). Early intervention for depression in young people: A blind spot in mental health care. The Lancet: Psychiatry, 6(3), 267272.

McDermott, R., & Dozois, D. J. A. (2019). A randomized controlled trial of Internet-delivered CBT and attention bias modification for early intervention of depression.Journal of Experimental Psychopathology. Web.

Park, L. T., & Zarate, C. A. (2019). Depression in the primary care setting. The New England Journal of Medicine, 380(1), 559568.

Taylor, R. W., Marwood, L., Greer, B., Strawbridge, R., & Cleare, A. J. (2019). Predictors of response to augmentation treatment in patients with treatment-resistant depression: A systematic review. Journal of Psychopharmacology, 33(11), 13231339.

IEP stand for individualized education program. Individualized education program consists of a statement describing an education program for students with disabilities. This program gets termed individualized because it deals with disabled students individually.

Individual statement describing each students education program exists. The main purpose of individualized education program is to ensure that needs of students with disabilities get addressed (Barrera et al., 2003). IEP provides each student with an education plan designed to meet the students special needs.

Orthopedic impairment can be defined as a severe impairment that affects the childs educational performance. Some of these impairments results from diseases such as poliomyelitis or bone tuberculosis.

A child with limb deficiency requires specialized education program because he or she lacks some parts of the body. This orthopedic disorder may result to a student with one or more limbs malfunctioning or missing. In a case where the child has only one limb malfunctioning or missing, it gets easy to handle their case.

For example, if only one arm is malfunctioning the child can be trained to rely on the other arm. Some of individualized education program goals for such students include; ensuring that the child attains the best in education (Barrera et al., 2003). This is made possible by their teachers who modify the learning environment to accommodate the needs of the child with limb deficiencies.

Another goal is to ensure that the child acquires and retains a positive attitude in life. This helps curve situations where children lose hope or develop negative attitudes towards their conditions. They feel unwanted because they do not look like the rest and at times they lack motivation or the urge to live more.

Limb deficiency involves any number of skeletal problems, which may result to a child missing one or more limbs. The disorder may result from illness whereby a child gets affected by diseases such as poliomyelitis or bone tuberculosis. These complications result to malfunctioning of limbs hence making it difficult for the child to play or make move around normally.

In some cases, children get born without some limbs hence making it impossible for them to be independent. This happens before birth. Therefore, such children need to attend to schools where special education teachers handle them accordingly (Adams et al., 2002).

On the other hand, some children may have some limbs fully functioning with others malfunctioning or missing. For example, there may be a case where the child has both arms normal and active and both legs paralyzed. Limb deficiencies can happen in any order, and each case need to be analyzed and handled with care in order to give the affected child his or her right. These rights include right to proper education and the right to life.

Loss of limbs or malfunctioning is a resultant of several problems; therefore, it has few associated problems. However, the greatest problem can be an increase in sedentary lifestyle related complications. This happens because movement remains limited hence reducing activities for the affected person.

It is healthy for the human body to be active because, it helps burn fats that might cause cholesterol related illnesses such as heart attack. If the deficiency is due to amputation, residual limb pains may be experienced by the child hence causing trauma and discomfort (Adams et al., 2002).

The other complication associated with this disorder is skin diseases resulting from the use of prosthesis. Whenever these complications appear the child get advised to see a medical doctor for treatment. This remains encouraged because any abnormal development in the human body can be fatal. Therefore, proper medication needs to be administered by a qualified medical practitioner.

Financial assistance is essential in an education system where individual needs of children have to be addressed. Without adequate financing, education facilities may not be able to employ all required specialist to handle special students. Schools with disabled students need special teaching equipment, and other positioning equipment to be used by students.

For example, in a school with students with limb deficiencies, equipment such as wheel chairs must be purchased to enhance movement of students. This is an expensive exercise because some students may need manual wheel chairs according to ability of their arms (Gorman- Smith et al., 2000).

If their arms are weak to push the manual wheel chair, electrical wheelchairs get used. Therefore, financial assistance is vital in these education systems to make sure that needs of disabled students get addressed in the most appropriate manner possible. In fact, all equipment necessary for achievement of IEP goals must be available for the teacher to help students to his or her best.

Many of limb deficiencies conditions cannot be treated. However, some of the associated conditions can be treated with options such as surgery whereby surgeons can carry out operations on the patient to correct deformities and minimize deficiencies.

For example, they can improve movements of arms hence enabling the child to handle some minor tasks. In cases of limb length discrepancies action such as shoe raises can be taken to enhance smooth movements. This happens when one limb is shorter than the other. A raised shoe is designed for the victim, and this helps him or her walk easily hence reducing deficiency.

Rehabilitation takes place in cases where patients undergo a specialized treatment. For example, if a patient has fixators affixed in his or her fractured bones rehabilitation is noteworthy because close attention is vital. During rehabilitation, a patient follows a schedule of activities comprising of physical and occupational therapy.

All these remain aimed at helping the affected limbs regain normal operations. The patients remain monitored closely by their care givers to ensure that they do not get infections on their limbs. Patients also interact with psychologists during rehabilitation. They get counseled on how to accept their status.

Government officials have to come up with legislation guiding how education should be administered to children with disabilities. A friendly teaching environment is crucial to take care of needs of students with disabilities (Achenbach and Rescoria, 2001).

There should be a curriculum made to accommodate their needs in terms of sports and all aspects inclusive. This will ensure that students with unique needs get appreciated and enjoy being in school just like the other children.

The teacher must make sure he or she understands the disorders exceptionally clearly. When dealing with students with spinal problems, the teacher must make sure the child is in the right condition al, the time (Gorman- Smith et al., 2000).

They should also ensure that they communicate with the child in case they need any help such as going to the toilet. Teachers have responsibilities of assisting children whenever they want to move around, and showing them how to operate some of the supporting equipment such as electrical wheel chairs. They should also make sure that they learn as much as possible by assessing them in person and individually to note on their weak points.

References

Achenbach, T.M., & Rescorla, L.A. (2001). Manual for ASEBA school-aged forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.

Adams, C.D., Streisand, R.M., Zawacki, T., & Joseph, K.A. (2002). Living with a Chronic illness: A measure of social functioning for children and adolescents. Journal of Pediatric Psychology, 27(7), 593-605.

Barrera, M., Wayland, L., DAgostino, N., Gibson, J., Weksberg, R., & Malkin, D. (2003). Developmental differences in psychological adjustment and health related quality of life in pediatric cancer patients. Childrens Health Care, 32(3), 215-232.

Gorman-Smith, D., Tolan, P.H., Henry, D.B., & Florsheim, P. (2000). Patterns of family Functioning and adolescent outcomes among urban African American and Mexican American families. Journal of Family Psychology, 14(3), 436-457.

Eating Disorder Prevention Programs is an article written by Eric Stice and Heather Shaw. Through the article, Stice and Shaw evaluated the current information on eating disorders based on risks and maintenance aspects rather than on a particular analysis.

Based on the available data, Stice suggested that risks and maintenance factors could not be distinguished from diagnosis consequences without adequate information (Stice & Shaw, 2002)

. In general, the article illustrates meta-analytic procedures, the existing intervention programs, and their effects.

To understand the effects of intervention moderators, the authors assessed several eating disorder programs. Moderators were chosen on a theoretical basis.

From all the programs evaluated, 53% of the intervention strategies led to a reduction on risk factors associated with eating disorders. Alternatively, 25% of intervention strategies led to a significant drop in eating disorders (Stice & Shaw, 2002).

After an extensive research, Stice and Shaw discovered that some intervention strategies led to a reduction on both risk factors and eating disorders. With these findings, Stice believed that they had accomplished innovative developments in food pathology (Stice & Shaw, 2002).

In my opinion, the authors findings were too insignificant to be regarded as developments. Correspondingly, various intervention effects were evaluated and found to be varying.

For instance, some intervention procedures generated effects on all outcomes while others failed (Stice & Shaw, 2002). In turn, the authors should have examined several aspects that restrained the effect sizes portrayed by interventions.

Thereafter, the authors compared moderator effect sizes and average- intervention effect sizes. For effective evaluation, the approximated mean random effect sizes for all outcomes were recorded and tabulated (Stice & Shaw, 2002).

The mean effect sizes varied from 11 to 38 at the finishing. Whereas the mean effect sizes at the follow-ups varied from 0.05 to 0.29. Stice noted that among the average effect sizes recorded, one effect size was below zero (Stice & Shaw, 2002).

Contrary to the previous findings, the average effect sizes recorded by Stice and Shaw were smaller in magnitudes. This illustrates that implementation of the program will result in reduction on risk factors associated with eating disorders.

In this regard, Stice and Shaws efforts have been acknowledged numerously in several texts. However, it should be noted that their findings on average sizes were relatively small.

For instance, if the intervention program is implemented on 10 million girls, 60 thousand girls will respond to the program (Stice & Shaw, 2002). This implies that the program effectiveness is quite small.

After analyzing the article, I identified that the review provides a superior methodology. I do believe that, the program has several implications on eating disorders.

If supplemented with other protective factors, there will be a significant decrease in cases of eating disorders (Davison & Neale, 2001). On the other hand, I noted that the program proposed was characterized by practical discrepancy.

As such, the program will always be a challenge to implement due to its complexity. For effective eating disorder programs, food pathologists should carry out more research rather than relying on the current programs (Maj, 2003).

While doing so, these experts should focus more on addressing theoretical, practical, and arithmetical limitations illustrated by Stice and Shaw.

Similarly, the experts should contrast current and past programs. By doing so, they would identify the most promising intervention approach for further investigations.

References

Davison, G. C., & Neale, J. M. (2001). Abnormal psychology (8th ed.). New York. John , Wiley.

Maj, M. (2003). Eating disorders. Chichester, England: John Wiley.

Stice, E., & Shaw, H. (2002, June 4). Eating Disorder Prevention Programs: A Met Analytic Review. Psychological Bulletin . Retrieved from homepage.psy.utexas.edu/homepage/group/sticelab/reprints/SticeShawPB04.pdf

Introduction

Eating disorder among adolescent girls is a health issue that has become very common in the United States over the last decades. According to Golden et al (2003), this disorder arises when adolescents deliberately eat an amount of food that is below the standard levels based on the requirements of the body.

As Field et al. state, although the prevalence of overweight and obesity is increasing, the desire to be thin or to have well-defined or toned muscles is still very widespread (2003, p. 900). For a human body to function properly there is a specific amount of food intake that should be observed on a daily basis. This will help in the normal running of bodily organs.

When this amount is not met, the body will be forced to work with lesser amount of energy. This leads to malnourishment among those who are suffering from this complication. The most common sign among people with this disorder is a thin body. This condition may occur when an individual lacks enough food to make them healthy.

However, it is a worrying trend that girls at their adolescent consider being thin as a sign of beauty. For this reason, they starve themselves in the name of fighting excessive fat. They deliberately avoid taking some means, and when they have to eat, and then their diet is always lean, with lots of water.

The problem is so contagious that majority of the American adolescent girls currently suffer from this health complication. These adolescents want to be noticed. Peer pressure and the press have convinced them that the only way through which they can be noticed is when they have a thin body (American Psychiatric Association, 2000).

Slim has been considered as a sign of beauty, and adolescent girls are willing to go an extra mile with their diet in order to achieve this. The result has been massive malnutrition that brings other health complications.

Discussion from the Interview

In order to get more insight into the causes, effect, the prevalence and solution to eating disorders among the adolescent girls in this country, the researcher interviewed Paul Marcus who is a psychologist who works in private practice with adolescents, especially girls with eating disorders. According to this psychologist, eating disorder starts among the adolescent aged between 12-14 years.

However, their condition escalates when they reach between the ages of 15-20. It is at this stage that these girls seek much attention and are very concerned of their appearance. Some of the risk factors that would make girls of this age develop this disorder include dysfunctional family dynamics, being in a culture where being thin is highly valued, peer and media pressure on the beauty of being thin.

Girls of this age are always under pressure and anxiety to look presentable in order to gain acceptance among peers. They let their anxiety control them. Unstable families where parents are not in control of the behavior of their teenage children are always more likely to have children suffering from eating disorders than those with stability where parents are in control of the welfare of their children.

Children exposed to abuse at home, either physically or psychologically are also more likely to develop this disorder. This is because they will always be looking for comfort outside their homes, and this can only be achieved when they look presentable.

According to this psychologist, it is possible to detect early signs of eating disorders before the negative impact is manifested on the victim. Some of the most common signs include avoidance of meals either at school or at home, visiting the washroom immediately after meals, a lot of time dedicated to looking self on the mirror, obsession with nutrition, vomiting without just cause, anemia, and over-exercising.

The above are some of the symptoms that an individual is taking the ideas of being thin very seriously. This psychologist also states that eating disorders are always combined with other psychological disorders. Because this is a type of anxiety disorder, it is always accompanied with other psychological disorders such as GAD, OCD, depression or even substance abuse.

Depending on the level of anxiety and dissatisfaction with the current body weight, an individual can develop a series of other psychological disorders as she tries to push herself beyond limits in order to reduce weight to levels she considers acceptable among her peers.

Marcus says that there are a number of effects of eating disorder. One such effect is weight loss. Patients suffering from eating disorder always lose weight at terrific rates, especially when they push themselves very hard on the need to lose weight.

These are some medical consequences that are related to this weight loss such as ulcers, infections in the throat, stomach and intestines, heart complication due to lack of enough energy, mood disorders among others. The family will also be affected as such an individual will tend to be an introvert, especially when the weight loss is not coming at the anticipated rate. Some girls are also vulnerable to stomach infections and infertility.

Paul Marcus says that in order to treat this disorder, it is important to start by appreciating that this is a psychological disorder and can only be treated from the psychological perspective. One of the most common ways of treating this disorder is through cognitive behavioral therapy.

This will involve making them appreciate their body the way they are and dispelling the idea that only thinness is a sign of beauty. This therapy will also dispel the perfectionist notion that these adolescents always develop. Another approach will be family therapy. In this case, the family will be involved in making the victim recover from this condition.

The family will be demanded to show love and care to the victim, and make her feel valued by the family members irrespective of her weight. The family members will also monitor the diet of the victim closely to ensure that she takes enough food every day.

Marcus says that there are a number of ways of determining if an individual has met the DSM IV criteria for bulimia or anorexia nervosa. Blatant refusal to maintain body weight at or above minimally acceptable weight for age and height is one such indication.

Intense fear of any slight body gain and being at peace with a skinny body is another indication. Others are in constant denial that their weight is below the minimally accepted level, while others engage in inappropriate compensatory measures whenever they feel that they had taken excess meals at one time. Fasting and excessive exercise, misuse of laxatives and diuretics is another indication.

Marcus admits that treating eating disorder patients is an extremely challenging. This is because they are not easily convinced that weight loss can be dangerous to their health. Because this is a psychological problem, if the patients fail to internalize the importance of having a normal body weight, they cannot accept the treatment offered.

They also need close family supervision. This psychologist summarizes by saying that adolescent girls at puberty who are concerned with the emerging cultures in this society should be observed very closely to ensure that they do not get this disorder in the name of looking for beauty.

Supportive Literature

The issue of eating disorder among the adolescent girls in this country has raised a lot of questions among the policy makers, parents and other stakeholders. According to Killen et al (2006), eating disorders among the adolescent girls has been on the rise. When they reach puberty, girls realize that they should look beautiful and presentable among their peers.

At this stage, they do not have to struggle looking for the information of what makes a lady beautiful and presentable. This message is all over in the media, among the peers and the articles they read. They realize that the solution is to reduce their body weight. According to Graham (2010), the problem starts when they realize that the weight loss is not coming at the desired rate.

This makes them push themselves beyond their limits. This scholar says that the message that teenagers get from their peers and from the media has massive influence on their behavior. For instance, it is common to find a situation where those who are considered as overweight being rebuked by their peers. In such instances, the victim or a witness of these abuses will try to avoid such scenario.

To achieve this, they try to regulate their eating habits in order to gain the weight that their peers would consider admirable. The media also plays a massive role in influencing adolescent girls to regulate their eating habits. According to Fritz (2008), media has successfully convinced the adolescent girls that beauty can only be achieved when one is beautiful.

The models are women who are skinny, and this makes young girls admire being thin. The process of weight loss always starts by avoiding some kind of foods which are considered to contain excessive fat. This is a good move towards healthy eating. However, this gets worse when these youngsters get pressure of increased weight loss within the shortest time possible.

They lower their food intake to the levels where the body gets malnourished. What is worrying is that when they become malnourished, they consider themselves slim enough to earn acceptance and admiration among peers. It is at this stage that one would be considered to be suffering from eating disorder.

As Golden et al (2003) observe, this disorder may have serious negative impact on an individual. For this reason, it is important for all the stakeholders to advise the adolescent girls on the dangers of this eating disorder. They should be made to appreciate their condition.

Conclusion

The discussion above has clearly demonstrated that eating disorder in adolescent girls is an issue that is on the rise within this country. The gravity of this issue shows that no adolescent girl is safe from this disorder as long as they are exposed to the wrong impression from media and their peers that beauty can only be achieved when one is slim. Parents must be responsible for their families and convince their adolescent girls that they are beautiful the way they are.

References

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4^th Ed.). New York, NY: American Psychiatric Association.

Field, A.E., Austin, S. B., Taylor, C. B., Malspeis, S, Rosner, B., Rockett, H.R., Gillman, M.W., & Colditz, G.A. (2003). Relation Between Dieting and Weight Change Among Preadolescents and Adolescents. Pediatrics, 112(4), 900  906. DOI: 10.1542/peds.112.4.900.

Fritz, R. (2008). The power of a positive attitude: Discovering the key to success. New York: AMACOM.

Golden, N., Katzman, D.K., Kreipe, R.E., Stevens, S.L., Sawyer, S.M., Rees, J., Nicholls, D., Rome, E.S & Society For Adolescent Medicine. (2003). Eating disorders in Adolescents: Position Paper of the Society for Adolescent Medicine. Journal of Adolescent Health, 33(1), 496-503.

Graham, J. (2010). Critical thinking in consumer behavior: Cases and experiential exercises. Prentice Hall: Pearson.

Killen, D., Hayward, T.C., Wilson, D. M., Haydel, K.F., Hammer, L.D., Simmonds, B., Robinson, T. N., Litt, I. Varady, A. & Kraemer, H. (2006). Pursuit of thinness and onset of symptoms in a community sample of adolescent girls: A three year prospective analysis. International journal of eating disorders, 16(3), 227-238.

Juliet Bourke on Flexibility

Evaluation of strategic threats and opportunities is important for an organisation in execution of strategic plans and decision making when managing labour during economic downturn. Companys success and productivity depend on organisation of the human resource management, and how the same relate to flexibility.

Reflectively, labour as a factor of production, determines the gross output, performance, and goal achievement at optimal resource use. In implementing flexibility policy, it is important to consider budget constraint.

As opined by Juliet, this is no longer the case. For instance, following the short term need for restructuring and remaining solvent, companies have over relied on these short term counteractive strategies in managing labour, and are often characterized by overwork since the numbers of employees are reduced.

Secondly, the modern human resource management has remained fairly irresponsive to sudden swings and very sensitive to changes in work condition. Due to the shift in flexibility, employees have suffered heavily, since the communication system for implementing changes seems to target interests of the company.

In the end, the limited flexibility may give way to redundancy, lack of performance evaluation processes, poor employee testing, and unhealthy work culture. Flexibility is often compromised in companies facing uncertainty. In real sense, there should be a balancing system that is critical in improving leadership skills, evaluation skills, promoting creativity, and rewarding outstanding achievements.

Therefore, the basis for flexibility implementation should function on a comprehensive analysis of how employers facilitate work-life balance during an economic downturn. Therefore, the concept should remain relevant even during economic downturn.

Sharing the same sentiments with Juliet, it is apparent that human resource may end up seriously underdeveloped despite the fact that labour determines total output. Despite the fact that economic downturn is short term, fresh initiatives for correcting previous mistakes put in structures by management are not enough.

In agreement with Juliet, the modern flexibility practices have not adopted an inclusive career development plan. Instead, it works on assumptions that the labour force is fully developed and well trained. Besides, the modern flexibility system lacks aspect of innovation, skills, and motivation evaluation as part of work-life balance.

Magnitude of change is quantum because changes involving culture, structure and strategy of the company are required. This form of change is necessary in the cases of companies attempting to restructure their human resource component during the economic downturn.

However, sharing same sentiments with Juliet, modern flexibility plans lack leadership responsibility, performance efficiency, and continuous motivational policies which facilitate responsive management.

Implications of Excessive Working Hours on Employees and Managers

In any organisation, there is always a laid down structure formulated in order to keep its staff in healthy and stable mind in their duty of serving companys interest. A stable mind performs optimally with little or no supervision. In nearly all formal and informal organisation(s), there always exists work related stress. If not streamlined, its effects can be catastrophic both to the organisation and the staff.

In addition, unhealthy workforce in the medium and long term is inversely proportional to goal achievement. Therefore, excessive working hours might reduce the effectiveness and sustainability of counter strategies implemented throughout various company departments or structures aimed at noticing and influencing right behavior at all levels; a key factor in addressing redundancy and healthcare issues.

Since all the working class adults in most organisations spend most of their waking hours at the work place, employers are given a unique opportunity to establish and monitor a desirable culture to improve and maintain a healthy workforce.

These may be in form of psychological trainings, sharing common experience, value and beliefs, attitudes, and group interests. However, excessive working hours alter these and may have a negative result on ways of interaction, commitment at work and confidence of the employees.

Excessive working hours make the work environment less holistic and socially friendly to management and other staff. Besides, it limits structural goals developed in the norms, expectations of specific behavior display, and appropriate guideline controlling interaction with one another.

In addition, excessive working hours reduce response to stimulus as it is aligned to negative organisational values characterized by inconsistent operations, emotional imbalance, and poor health.

Moreover, excessive working hours break the informal rule of engagement, expected behavior, and repercussions for misconduct as little time is allocated for personal development. Consequently, when people feel overworked, they will naturally give their least towards achieving goals of such an organisation.

Organisations apply human relation management system alongside stressing on rationality and autonomy of staff that perform at optimal levels when constantly motivated. For any outstanding achievement, one is given a reward, and/or promotion as a way of earning their loyalty.

As human nature dictates, an enticement that is offered from time to time may lead to a deep attachment with the object over which such a motivation is given. Motivation can be expressed in the form of salary review and increment, recognition for a well performed duty, equality, and fair treatment.

Whenever there is a strong professional relationship nurtured in the values of appreciation and respect, hidden talents are easily displayable and are needed for organisational sustainability. However, excessive working hours may hinder the display of these special talents among the staff members.

Workplace stress is a depression resulting from an interaction of a person with his/her work environment leading to an inability to balance work with other aspects of life. Thus, it attracts systematic buildup of negative emotional response in the person.

Causes of stress, thus referred to as stressors, are elements or circumstances leading a person to anticipate a feeling of exceeding psychological and physical demands on the ability to comfortably cope up with a situation.

Though difficult to explain a definite cause, stressors mostly are associated with long working hours and poor balance between work and rest.

As the bucket model theory asserts, stress matures up upon complete drainage of a persons bank of personal resilience as a result of work conflicts, unfavorable working conditions, and emotionally straining assignments outweighing supportive relationships, interesting works, rest and good health. Unfortunately, excessive working hours is a primary contributor to the above ailments.

Ways of facilitating Work-Life Balance during Economic Downturn

To handle effectively work place related disorders, as a result of imbalance between Life and Work, it is vital for an employer to concentrate on establishing a good work place ethics as a security strategy for confidential sharing of work related hiccups with the employer or a trusted staff mate. Through this, the company will be in a position to draw a practical and satisfactory flexibility plan for its staff.

In addition, especially during economic downturn, an employer should concentrate on preventive policy of creating informal inter-group meetings where the staff is given an opportunity to share experiences and encourage each other, while owning the option of accepting or rejecting extensive working hours beyond the regular ones.

Besides, it is vital to create an interesting, peaceful, and comfortable working environment where employees will be motivated to be part of the seriously needed restructuring.

The employer should create a short-term and properly structure appraisal procedure which encompasses and reflects the actual performance by the staff members. Therefore, actual performance of the department during crisis should not be appropriate for making comparison with the forecasts.

The best way to motivate employees is to give them responsibilities for achieving something. Through this approach, employees will be empowered and they will feel trusted and valued by the management personnel.

Naturally, employees will be motivated by mutual consent and internalized empowerment and appreciation. Empowerment unleashes plenty of energy and motivation.

Reflectively, the motivational and energy aspects of appreciation function simultaneously at micro and macro levels to facilitate optimal functionality or productivity even during the crisis. In real sense, there should be a balancing system that is critical in improving leadership skills, evaluation skills, promoting creativity, and rewarding outstanding achievements.

Conclusively, participatory integration of alterations within the workforce is vital in executing flexibility exercises especially during economic downturn. As noted in the Company Virgin Blue, which has been struggling with a human resource management problem, is as a result of financial constraints during economic meltdown.

Irrespective of the consequences of a change element, the dynamic essence of change proponent would not facilitate any state of quagmire as the unnecessary pressure associated with change would be integrated within the flexibility matrix.

Introduction

In the article Wellness, Emotion Regulation, and Relapse during Substance Use Disorder Treatment, Clarke, Lewis, Myers, Henson, and Hill (2020) focus on the role of managing emotions in substance use relapse prevention. The researchers were interested in exploring various relationships between emotion regulation, reappraisal, suppression, and others. In order to introduce the target topic, the authors began with a brief literature review, stating that the previous literature points to the link between lifestyles, wellbeing, and relapses. The research question was not explicitly formulated by Clarke et al. (2020), yet the article allows understanding that the inquiry refers to the mediating role of emotion regulation and healthy lifestyles on substance use disorder management.

Main Questions

The hypothesis that was made by the identified authors was associated with the existence of the negative correlation between problems in emotion regulation and wellness factors, the quantity of relapse days, and emotional suppression. At the same time, it was expected to discover the statistically significant positive correlation between such variables as reappraisal emotion regulation and wellness dimensions. Another hypothesis was associated with the predictive role of emotions and wellbeing on the number of relapses. The ability of emotion regulation to mediate the link between the number of relapse days and total wellness was also hypothesized in this study.

To make the identified hypotheses, the authors scrutinized the recent academic literature, referring to empirical research and providing proper citations. Since the reference list is given at the end of the article, the readers have the opportunity to access the sources used and better understand the topic of interest. The purpose of formulating these hypotheses was to address the gap existing in the modern literature that is concentrated on treating substance use disorder.

The critical review of the given article shows that the convenience sampling method was used to recruit the participants of the study. The organizations specializing in drug and alcohol treatment and located in the southeastern United States were contacted. The patients receiving outpatient treatment or partial hospitalization programs were offered to contribute to this study. The inclusion characteristics were the enrollment in the mentioned program within one year and 18 years of age.

The exclusion criteria were the participation in the program for more than one year and the current opioid maintenance therapy. Of 194 research packets, 179 were completed, which allows for claiming that the response rate achieved 92.3 percent. Speaking of the demographic characteristics, one should note that the age of the participants was 19-67 years; the majority of them were unemployed; the high school was the highest education. There was an almost equal distribution of males and females; and African-Americans (43.0 percent) and Caucasians (42.5 percent) participants. The diversity in these characteristics seems to promote more accurate results.

The authors verified each of the hypotheses within a separate test, where the relapse of substance use disorder was regarded as the dependent variable. The emotional regulation and wellness factors were taken as the independent variables that can impact the dependent variable. More to the point, depending on the hypothesis being tested, the changes in the dependent and independent variables were made. Among the predictor variables, there also were reappraisal, suppression, and difficulties in coping with emotions. These variables were operationalized by the use of specific clarifications on what exactly the authors planned to measure.

Speaking of the methodology, the study clearly outlines the procedures, instruments, and participants. First of all, the authors received the approval from institutional review boards (IRBs) of the involved organizations. The cooperation with treatment coordinators allowed recruiting participants with the help of software that estimated that 130 people would be sufficient for the sample. Second, the demographic data of participants was analyzed, and their medical data was also taken into account to consider it while interpreting the results. The section related to the instruments contains the discussion of the three questionnaires.

The demographic questionnaire was applied to measure the social and demographic characteristics of respondents. The Five-Factor Wellness Inventory aimed to evaluate the component-specific wellness of participants, and the Emotion Regulation Questionnaire helped to assess reappraisal and suppression issues. The participants completed these questionnaires by using Likerts scale and clarifying their agreement with the given statements.

The results of the study demonstrate that hypothesis 1 was verified: there is the correlation between difficulties in emotion regulation and total wellness. Hypothesis 2 was not confirmed since the authors discovered that creative self-wellness was the strong anticipator of the number of relapse days. The next strongest predictive factor was reappraisal that included a range of coping skills. As for hypothesis 3, it was supported partially: the indirect effects on the number of relapse days were noted in the connection between wellness factors and emotional regulation. In particular, coping self and essential self as well as reappraisal and difficulties in emotion regulation can be noted as the correlating factors.

The data collected by the authors was tested for validity and reliability on the sample of graduate students. The satisfactory correlations with the associated measures allowed reflecting the validity of questionnaires. No threats to validity can be observed in this study; indeed, it seems that the authors minimized it. In general, this research article properly discussed all the integral points of the study, making it possible for others to repeat it, which means that their experiment is consistent.

The fact that the authors used the scholarly literature to identify the hypotheses is another issue that makes this study appropriate. The well-structured presentation of methodology and results allows for following the authors ideas and evaluating their interpretations. It seems that this article lacks a more comprehensive discussion that could integrate knowledge from previous research. The convenience sampling and a retrospective nature of the study can also be mentioned as the limitations. In further research, one can recommend focusing on a prospective design and purposeful sampling.

Conclusion

The implications for counselors were associated with the practical steps that they can to better understand their patients. For instance, by helping a patient to develop his or her coping skills and regulation strategies, it is possible to enhance the overall wellbeing. At the same time, the advancements in wellness can enhance the emotional regulation of a patient. The awareness of these specific links between the identified variables can equip counselors with valuable and feasible strategies.

In addition, the practitioners may be interested in the detailed exploration of one or several factors that impact a particular patient to a greater extent, and the findings of this article can serve as guideline. Based on this study, the scholars suggest that future research can explore different ways to measure relapse or discuss addiction severity indicators. This study was based on a single experiment, which provides another opportunity to design multi-experiment research in the future.

Reference

Clarke, P. B., Lewis, T. F., Myers, J. E., Henson, R. A., & Hill, B. (2020). Wellness, emotion regulation, and relapse during substance use disorder treatment. Journal of Counseling & Development, 98(1), 17-28.

The lack of proper parenting is one of the key premises that contribute to the initiation and substance use disorder (SUD) development in adolescents. In families where communication between parents and their children is poor, substance abuse is likely to be unnoticed and uncontrolled extensively. In this connection, a family check-up (FCU) intervention can be utilized to enhance parenting strategies and prevent SUD.

Examining the FCU Intervention

The FCU represents a set of strategies designed to assist parents in monitoring their children and identifying their substance use cases. The pivotal idea of the given intervention is to focus on the protective mechanisms of families, including communication, relationship building, and skill orientation. These family-based preventive interventions are based on motivational interviewing (MI) and immediate feedback. Hernandez, Rodriguez, and Spirito (2015) state that FCU is effective in encouraging behavioral changes in adolescents, which is proven by several research studies. In particular, the article by Connell et al. demonstrates that children aged 7 to 17 years shown lower tobacco, alcohol, and marijuana use compared to their peers whose parents received no intervention (Hernandez et al., 2015). In their turn, Das, Salam, Arshad, Finkelstein, and Bhutta (2016), who systematically reviewed 46 recently published studies, report that family-related interventions are beneficial to reduce tobacco smoking and other substance use means, which resulted from family functioning improvement. In a long-term period, these adolescents tend to quit or minimize substance use in their adulthood.

To conduct the FCU for adolescents having SUD, it is essential to have two phases. During the first of the phases, the initial family assessment should be performed to specify the challenges and strengths that it has and also determine its interactional style (Véronneau, Dishion, Connell, & Kavanagh, 2016). After that, MI is anticipated to be used to empower parents with the tools and ways to improve their current positive impact on an adolescent and change potential negative behaviors. For example, if previously a mother or father used conflicts and shouting to prohibit substance use, it is better to recommend them applying more constructive means of communication, such as an open dialogue or advice (Véronneau et al., 2016). Parents should be instructed to provide the presentation of SUDs social, physical, and emotional consequences so that children can understand the effects of their actions.

The care providers should be educated on the nature of MI and FCU to offer their services to parents. More to the point, they should have knowledge and skills of proper communication, conflict management, and leadership (Hernandez et al., 2015). In their turn, parents need training regarding the strategies of overcoming their childs resistance to change, motivation, and other parenting practices that can be used to manage difficult situations. The discussed intervention may be evaluated towards the improvement of such indicators as parenting self-efficacy, the reduction of SUD in adolescents, relationship building, and respect to the family members.

Conclusion

To conclude, the family check-up intervention is a feasible and relevant strategy to combat and prevent SUD in adolescents. This family-oriented approach includes the evaluation of problems and strengths existing in a particular family to improve communication and parent monitoring via motivational interviewing and feedback. The evidence shows that the FCU allows for enhancing parent-child interaction, preventing SUD escalation, and strengthening family bonds. Care provider and parent training are essential to succeed in the implementation of the examined intervention.

References

Das, J. K., Salam, R. A., Arshad, A., Finkelstein, Y., & Bhutta, Z. A. (2016). Interventions for adolescent substance abuse: An overview of systematic reviews. Journal of Adolescent Health, 59(4), 61-75.

Hernandez, L., Rodriguez, A. M., & Spirito, A. (2015). Brief family-based intervention for substance-abusing adolescents. Child and Adolescent Psychiatric Clinics, 24(3), 585-599.

Véronneau, M. H., Dishion, T. J., Connell, A. M., & Kavanagh, K. (2016). A randomized, controlled trial of the family check-up model in public secondary schools: Examining links between parent engagement and substance use progressions from early adolescence to adulthood. Journal of Consulting and Clinical Psychology, 84(6), 526-543.

Introduction

There are quite a number of research studies that have explored the association between mental illness on the one hand, and violence, on the other hand (for example, Paterson et al 2004; Friedman, 2006; Sirotich 2008). Even then, there those amongst the scholars who are of the opinion that such studies are often flawed, when it comes to selection criteria of the study subjects (Friedman, 2006). As such, an intense and controversial debate appears to surround the issue of the link between mental illness and violent behavior. Nevertheless, a majority of the researchers and scholars alike are in agreement that by and large, patients with psychiatric disorders are more likely to be violent, when compared to the general population (Bourget, el-Guebaly & Atkinson, 2002).

This assertion is further compounded by a study whose findings revealed that mental health professionals and psychiatrists were more likely to be assaulted by their patients, when compared with other workers (Crime Times, 2007). Furthermore there are certain mental illnesses that have since been shown to have an impact on the criminal behavior of mental patients, and these include delirium, anxiety disorder, impulse control disorders, mood disorders, schizophrenia, substance abuse and dependence (Shaw et al, 2006). This should not however, lead to a conclusion that by and large, all mentally ill individuals tend to be violent. On the contrary, even non-mentally ill individuals are also capable of committing acts of violence. This could be exacerbated by such factors as the socio-demographic elements of a population (for instance, racial disparities), and drugs, like alcohol.

Association of mental disorder and criminogenic behavior

The probable link between on the one hand, mental disorder and on the other hand, criminogenic behavior, has elicited extensive controversy and debate amongst scholars. As such, this is an area that has over the years attracted a lot of extensive research. For more than 15 years now, publications by scholars that seek to explore the relationships between crime and mental disorders, appears to have grown exponentially. A majority of the psychiatrists, especially those working in acute or emergency care settings have narrated encounters of violent behavior from patient under their care that are mentally ill (Modestin, 1998).

In Canada for instance, where violence amongst the member of the population is reportedly lesser in comparison with a majority of the other nations, most of the psychiatrists here are usually involved in treating and managing patients manifesting violent behavior. Additionally, about 50 percent of the psychiatrists talk of at least one violent encounter, with a patient (Bourget, el-Guebaly & Atkinson, 2002). On the other hand, it is important to note that violent experience at a clinical setting dos not fully symbolize the actual behavior of most of the individuals that are mentally ill. Thanks to social changes in as far as psychiatric practice is concerned, this has in effect ensured that just the patients characterized by an elevated risk of violence gains access to clinical treatment. As such, we can already see a serious limitation of the clinical association of violence with criminal behavior; such studies tends to lay more emphasis on the mentally ill as well as the mental illnesses, at the expense of contextual and social factors whose interaction results in the kind of violent behavior that patients exhibits at a clinical setting.

Separately, an article by Jeremy Coid that appeared on an April 1996 issue of Archives of General Psychiatry reported a strong association between crime and mental illness (Crime Times, 2007). The author, while noting that a majority of the individuals often diagnosed with a mental illness may not be criminal after all, nevertheless asserts that most of them tend to exhibit violent behavior. As Coid ahs noted, In the last decade, the evidence showing a link between violence, crime, and mental illness has mounted. It cannot be dismissed; it should not be ignored. (Crime Times, 2007).

Another study that sought to explore a possible association between criminal behavior and mental illness was a study that was carried out in Denmark by Sheilagh Hodgins and other researchers. In this study, followed a group of Danes that were born between 1944 (January 1) and 1947 (December 31), by using registries of population of the country. The subjects in this cohort study were followed for a period of 43 years. The researchers then sought to explore the hospitalization records of individuals, for psychiatric illnesses, vis-à-vis the individuals criminal records. According to the findings of this research study, individuals with a history of psychiatric hospitalization were more likely to have been convicted of a criminal offence than persons with no history of psychiatric hospitalization, (Crime Times, 2007).

These findings were true for women and men alike. On the basis of diagnostic categories and sex, those subjects that have a history of psychiatric hospitalization, according to this study, were found to be between three and eleven times more prone to having been convicted of a criminal offence, relative to their counterparts that were without any psychiatric hospitalization history. Researchers are of the opinion that the findings by Hodgins and colleagues (2000) are in agreement with two related Scandinavian research studies, as well as a study conducted in North America, that indicated elevated levels of significant mental disorders amongst offenders that had been incarcerated.

Are individuals diagnosed with mental disorders more likely to become criminally involved?

Friedman (2006) has reported the findings of a study dubbed, National Crime Victimization Survey that the United States Department of Justice conducted, between 1993 and 1999. According to theses findings, the rate of job-related, nonfatal, violent crime was found to be 12.6 percent pre annum, for every 1000 workers, from the various occupational settings. The crime victimization rating tended to be higher, amongst physicians, at 16.2 percent for every 1,000 workers. On the other hand, the number of assaults was even higher for the nurses, standing at 21.9 percent, for every 1,000 workers. For the mental health professionals and psychiatrists, this rate shot drastically upwards, to stand at 69 and 68 percent for every 1000 workers, respectively (Friedman, 2006). What these research findings appear to suggest is that there is as possibility that mental patients could be more violent, when compared with rest of the population. In addition, attacks of psychiatrists by psychotic patients have been on the increase of late.

Again, Friedman (2006) gives a classic example of a London-based forensic psychiatry, at the Redford Lodge Hospital, who was assaulted by a 19 year old male psychotic patient whom he was treating. According to the forensic psychiatry, I was talking with him in a room and telling him why he couldnt leave, when I was suddenly aware of a few blows to my head, recalled Tim Exworthy, the forensic psychiatry that was assaulted, The next thing I knew, I was at the nursing station wiping the blood off my face. I never saw this coming and hadnt anticipated that he would react like that. (Friedman, 2006). The increase in such attacks therefore begs the question: Are individuals diagnosed with mental disorders more likely to become criminally involved? If this is the case, there is a need to identify psychiatric illnesses that bear an association with violence, in addition to an assessment of the possible magnitude, on the basis of an elevated risk for violence.

Until a moment ago, a majority of the studies have tended to lay emphasis on mental illness rates of violence amongst those individuals that have been incarcerated, arrested, or convicted after committing violent crimes or, on the other hand, an assessment of the violent rates amongst those patients admitted to a psychiatric facility with a mental illness (Shaw, Hunt & Flynn, 2006). For instance, the findings of one national survey indicated that the risk of being diagnosed with schizophrenia, at least once in a lifetime, was 5 percent, for those individuals that had been found guilty of homicide (Swanson, Swartz & Essock, 2002). Clearly, such a prevalence is in fact way above the schizophrenic rates amongst members of the general population that have been published, thereby offering a suggestion that homicide convictions could bears an association with schizophrenia (Shaw et al, 2006).

Nonetheless, these studies have a limitation, in that they are biased when it comes to the selection of the participants. Those individuals that have been arrested, convicted, or even those that have been hospitalized with a psychiatric conditions, have a higher likelihood of either being very ill, or extremely violent and for this reason, these do not serve as a sound representation of the psychiatric patients that many be found within the general population. There is a need therefore, for researchers to undertake an assessment that is less biased and moiré accurate, with regard to the association of violence with patients that are mentally ill.

Researchers in favor of increased levels of criminal behavior amongst those individuals that have been diagnosed with mental illness have sounded a warning to the effect that a majority of the studies that seeks to address this topic are usually flawed when it comes to the issue of research methodology, research design and sampling (Sirotich, 2008; Paterson et al. 2004). There has been the argument that by and large, studies appears inaccurate and/or con-comparable as a result of variations with respect to the subjects that are being assessed, in addition to a lack of standardization on, inability to control the studys variables, as well as the absence of the right kind of techniques for exploring if mental disorder comes before criminality, or the other way round (Paterson et al. 2004; Sirotich, 2008).

What types of mental disorders are commonly associated with particular offences?

Practically any psychiatric symptom could very well be connected with criminal behavior. This is because symptoms have the potential to causes an impairment to an individuals judgment, thereby directly or indirectly infringing on those norms that are held in high regard by the society. For instance, a person characterized by insomnia and major depression could fall asleep at a time when he/she is driving, with the result that they end up causing death of a pedestrian. What this means is that such an individual stand being convicted of manslaughter. On the other hand, Brennan, Mednick and Hodgins (2000) Reports of a study that involved persons that had been diagnosed with psychotic disorders, and whose findings revealed that mental illness of the subjects was only responsible for a partly 5 percent of the total number of violent crimes committed.

However, there are still exceptional mental illnesses that have since been shown to have an impact on the criminal behavior of the patients that gets diagnosed with these. Some of the commonly diagnosed psychiatry disorders, and which are usually linked to criminal behavior, include delirium, anxiety disorder, impulse control disorders, mood disorders, schizophrenia, substance abuse and dependence. The above mentioned psychiatric disorders encompass the most important psychiatric illnesses often diagnosed amongst those individuals that are associated with the system that is criminal justice (Bourget et al, 2002).

Disorders that are identifiable by those behaviors that bears a more direct connection with criminality entails impulse control disorders (such would include kleptomania, pathological gambling, and intermittent explosive disorder), as well as paraphilias (for example, exhibitionism, pedophilia, voyeurism, and frotteuism). Nonetheless, persons that are diagnosed with such illnesses should not be regarded as criminals, on the basis of manifesting this disorder. Instead, persons exhibiting such disorders are regarded as more intimately associated with criminality, given that DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Forth Edition, Text Revision), diagnostic criteria for such disorders takes into account those symptoms which have a tendency to infringe on other peoples rights (Paterson et al, 2004).

Are non-mentally disordered individuals capable of violent behavior?

Even as a number of researchers (for example, Modestin, 1998; Paterson et al, 2004) have reported of a link between those persons diagnosed with a metal illness and a rise in terms of getting involved in violence and crime, this is in no way a suggestion that individuals that are free of a mental disorder, are not capable of violent behavior. By and large, the available literature appears to augment certain kinds of connections between violence and mental illness; on the other hand, such an argument has not been without its short comings. For example, the connection is usually significant, yet small in terms of scope.

In addition, the risk of individuals to becoming violent, thereby participating in criminal behavior, has been seen to increase with the increase in substance abuse by individuals. For this reason, someone under the influence of such a drug as alcohol may end up becoming violent, although from a psychological point of view, they are not mentally ill. Furthermore, social-demographic factors like racial segregation and disparities between the rich and the poor have also been seen to have an impact on the increase in the number of violent individuals (Patterson et al, 2004).

Conclusion

The issue of the relationship between mental illness and the act of violence is one that has elicited controversial debates amongst scholars and researchers alike. Even as a majority of such researchers concur that by and large, a many of these mentally ill patient tend to be by extension, also violent, nevertheless this should not lead us to conclude that by and large, all mentally ill patients are violent. There are also several scholars that have taken issue with the number of studies that have sought to address the link between mental illness and violent behavior (Sirotich, 2008; Paterson et al. 2004). These authors have argued that most of the studies are limited with respect to the selection criteria of their subjects, almost all of whom tend to be those who have been arrested or incarcerated for various crimes, or those already in a psychiatric facility. It is imperative therefore that future research studies embrace an all-inclusive criteria for the choice of subjects, to overcome such a limitation. This way, more conclusive research findings may be provided, in effect shedding more light on the true picture of the link between mental illness and violent behavior.

References

Bourget, D., el-Guebaly, N., & Atkinson, M.J. (2002). Assessing and managing violent patients. CPA Bull, 34, 2527.

Brennan, P. A., Mednick, S. A. & Hodgins, S. (2000) Major mental disorders and criminal violence in a Danishbirth cohort. Archives of General Psychiatry, 57, 494 -500.

CrimeTimes. (2007). Mental disorders and crime: the connection is real. Web.

Friedman R. A. (2006). Violence and Mental Illness  How Strong is the Link? The New England Journal of Medicine, 355, 20, 2064-2066.

Hodgins, S., & Müller-Isberner, R. (2000). Violence among the mentaly ill. Effective treatments and management strategies. Boston: Kluwer Academic.

Modestin, J. (1998). Criminal and violent behavior in schizophrenic patients: An overview. Psychiatry and Clinical Neurosciences, 52, 6, 547-554.

Paterson, B., Claughan, C. & McComish, S. (2004). New evidence or changing population?

Reviewing the evidence of a link between mental illness and violence. International Journal of Mental Health Nursing, 13, 1, 39-52.

Shaw, J., Hunt, I.M., & Flynn, S, et al. (2006). Rates of mental disorder in people convicted of homicide: national clinical survey. Br J Psychiatry, 188, 143-147.

Swanson, J.W., Swartz, M.S., & Essock, S.M, et al. (2002). The social-environmental context of violent behavior in persons treated for severe mental illness. Am J Public Health, 92, 1523-1531.

Sirotich, F. (2008). Correlates of crime and violence among persons with mental disorder: An evidence-based review. Brief Treatment and Crisis Intervention, 8, 2, 171-194.

Outline

When a child is growing up, it is expected that he grows up into a normal being and reflecting behavior according to their gender. Boys are expected to grow up into men and take up responsibilities accordingly. Girls are also expected to display the character of a lady and grow into responsible mothers. However this is not always the case, parents may start observing strange behaviors in their children that may cause an alarm. One of this behavior is what is referred to as gender identity disorder. If such a problem is not diagnosed and treatment administered in time, it may have adverse effects on the child when they grow.

Introduction

Gender identity disorder is a psychological condition in which the individual feels more of the opposite gender than they are. Such a person will enjoy the company of the opposite gender and to a large percentage behave like them. The only distinction here is that the physical make of the individual does not display what they feel. They usually have a strange feeling when they discover that they are behaving contrary to what they are supposed to be. The serious problem comes when they are in a social setting like schools where they are to play gender games (Peter, 2002). The individual may feel so much out of place as they find themselves not fitting anywhere. There is the pressure of them wanting to join the opposite gender and the peers will react if they do so.

Characteristics of Gender Identity Disorder

During their early stages of life, boys with gender identity disorder will reflect the characteristics of a girl. Unlike their normal counterparts, they prefer the company of girls and always want to play their games. They avoid rough games like football and prefer the softer girlish games. In acting childhood games, they prefer to take up female roles like mother and sister. They also feel comfortable when wearing girls clothes and girls on the other hand will behave like boys. They enjoy playing rough games and mostly associate with boys where they wear boys cloth and just wish they maintain their manhood when they grow up.

As they grow up, the boys will reflect characteristics that are common with girls like expressing the desire to bear children in the future as well as interest in the feminine stories. They use of makeups and other accessories, a desire to grow long hair, imitating the female voice and gestures and enjoy being referred to by female nicknames. The behavior may not be common in girls but the few cases reported in girls suggest that, they will show no interest in the company of girls and generally display the rough nature of boys through fighting around and behaving violently. (Ronald, 2009)

Although some of these behaviors may be experienced in most normal children when they are growing up, there is a distinction to what extent the behavior manifests. Parents should be able to make a distinction between the children with gender identity disorder and the normal activities that may be due to certain gender dominance. Some children may be forced to play games of the opposite sex, due to the dominance of such a gender in the surrounding. Those with the disorder will completely feel adamant to join in the activities of their gender even when the environment demands so.

During their puberty stage, boys with a gender identity disorder will tend to deny the changes happening to them. They will hide their genitals and wish they were cut. They also feel shy to speak out due to their deepened voice and try to smoothen it. The girls may prefer to keep short hair and wear clothes that will hide their physique. They will persist in keeping the male company and acquire the masculine walking style together with other behaviors. Most of these individuals have no regard for their secondary features and regard them as ugly.

Gender identity in adults takes a different route all together. It is a stage when the psychological clashes with the physical. It is a time when their physic is much developed and it becomes even harder for them to adjust. Some of the adults will go to the extreme of going for surgeries to change their physical features. The pressure becomes so much on them that, they resort to such means so that they can comfortably fit in their preferred group. At this stage, most males will display bisexual and homosexual behaviors.

Diagnosis

The diagnosis of this disorder can be done in children from the age of six years old. During early diagnosis, the children can be helped and treated. The first stages of this diagnosis are more physical than medical. A child can easily be noticed to have an identity disorder if they persistently display the opposite characters. The diagnosis is done by a mental health specialist who will take a critical study of the individuals history. The physician may however recommend biological tests in case the patient has a problem that may be contributing to the situation. The diagnosis may hence involve a physical examination of the external genitalia, the study of the sex chromatin, Chromosome analysis, and the medical history of the patient.

These tests are done to rule out any probability of the patient being hormonally imbalanced or behaving so due to the hormonal treatment that the mother may have gone through during pregnancy (Saralea, 2003). The historical background study of the child is mostly done with the reference to the father. This is because; it was revealed that normal identity in children is characterized by the fathers dominance. When the child is physically or mentally deprived of a father figure in the home, he is likely to develop an identity disorder.

Since the males were the most affected by this problem, several studies on the history of their families show that, to some extent, these boys lacked a male figure that should have instilled the characters in them. It was also discovered that the parents who nursed their children of this disorder, were once nursed of the same. This means that gender identity disorder may be hereditary.

Treatment for GID

Treatment for gender identity disorder can be administered to the patients once the cause of their behavior is established. If the cause has nothing to do with medical interventions, the patient is taken through therapy sessions to re-identify themself. The best treatment can be given to a patient during their childhood stages. This is mainly because; it is easier to change the pattern of a childs growth when they are still young rather than when they have matured. It will also be easier for the psychiatrist to influence the childs behavior and monitor them adjust to their normal self. The treatment of this disorder involves a series of stages that may take a number of years.

If these disorders are not taken care of when the child is still young, they are likely to develop into irreversible adulthood problems of homosexuality and transsexuals (Williams, 2003). The adult patient may also experience social problems that may lead to emotional pain. They may find it hard to associate with any of the genders which will bring a feeling of isolation. When the disorder is diagnosed early, the parents and other members of society will be involved in the treatment process.

There have been a number of cases where adults with such disorders go through periods of hormonal therapy so as to completely change their physical makeup. These therapies involve surgeries, where the males are administered with the estrogen hormone to display the female characteristics. This hormone will make them grow breasts, their body hair to disappear and reduce the size of their testes (Seligman, 2007). The females on the other hand are administered with the male hormone testosterone which reduces the size of their breasts, grows a beard, and make them develops a deeper voice.

The treatment process will begin by establishing the relationship between the patient and the parents. They are given some counseling on how they can be involved in the treatment process. After counseling, the patient is trained to change behavior patterns pertaining to gestures and speech. In this regard, the patient if he is a male will have to stay within the company of a male psychiatrist that will frequently expose him to male activities. The father is also required to be at the forefront during such activity. He is to develop a closer relationship with the child and influence him into behaving as a man. If the fathers are not available due to various reasons, the children are provided with male role models to help them out.

To be able to adequately treat the patient, the psychiatrist has to know the areas that need serious attention. This requires some time and it may involve a video record of the childs behavior both at school and at home. This will help the psychiatrist to transform the similar behavior to the opposite. The training is done in a psychological manner, where the psychiatrist will show disinterest when the patient displays characters of the opposite sex. Since he is the person with the patient for a longer period of time, he will learn to behave in accordance with the requirements of the psychiatrist and the father figure.

During this process, the mother is advised not to keep a close association with the boy and prevent him from playing with the female gender. This may be done by ensuring that the boy is close to the males during playtimes as much as possible. With such male dominance around the boy, he will have no other but to adapt to their ways. The teachers of the boy are also trained on how to help the child adjust in the school setting by training them how to counterattacks any of the abnormal behaviors displayed by him.

For such treatment to produce positive results, it requires maximum attention and supervision towards the patient. Unless the psychiatrist, teachers, and parents coordinate in observing these procedures, the problem may only be partially solved. If an adequate follow-up is not administered to the child, the same problem may reoccur at a future stage. However, such kind of treatment is not a hundred percent effective; the patients have only been helped to identify themselves with the sex but the behavior change has been difficult to completely eliminate.

There are no preventive measures to this condition and may continue recurring among the members of a similar family (Arthur, 2006). Gender identity disorder has been related to the major prevalence of homosexuality. The research conducted reveals that due to their psychological belief that victims belong to the opposite gender; the same will be reflected in their sexual behavior of homosexuality. Therefore, it has been suggested by various psychiatrists that, homosexuality can be viewed as a psychological disorder.

To be able to help the victims of gender identity disorder, it has been suggested that, the church and Christian ministries can be of great help. This can be done by using biblical principles on the roles that are required for males and females. With a continuous emphasis on this, the victims may be psychologically influenced into changing their behavior.

The other preventive precaution that can be observed to minimize the prevalence of such behavior especially in boys is that the fathers should make sure they are as close to their sons as possible during their early stages of development. This closeness should not only be physical but also psychological since they are required to be the greatest influence towards their boys. This may be done by playing with them and taking them out. They should also clearly define to them who they exactly are and what is required of them.

The absence of both parents in taking care of the children is mostly caused by conflicts in the homes. Such conflicts may either result in divorce or separation. The children are either divided between their parents or the responsibility left to a single parent. Such incidences make the child develop an attachment towards the gender of the parent. Since the mother can not provide fatherly attention to the child and vice versa, the child will grow up deprived of certain care. This may reflect on the general behavior of the child which will be in accordance with the gender of the parent. To eradicate such an issue, couples are advised to resort to better means of resolving their issues rather than divorce and separation.

The current trend in the society where there is no clear distinction between the roles of males and females has been related to this confusion. When the children are young, most of them are not trained to observe gender roles. Commitment to gender roles has become a norm of the past and one is now required to behave as it seems best for him. The children grow up seeing their mothers behave like males or females and with such a trend; they will also have no problem behaving so. Unless this issue is addressed and the genders behave accordingly, gender identity disorder will soon be regarded as a normal behavior just as homosexuality.

There is always help to assist the victims that identify such disorders in themselves or their relatives and are willing to change. Such people can seek the help of a psychiatrist who may describe a procedure that will help them change. Gender identity disorder is purely a psychological disorder that can be prevented through discipline and routine observance. The assistance of the psychologist alone may not be a solution to this order; after all, he may not always be there to monitor the patient. It is all a matter of willingness and determination of the affected to come out of it. Family members and friends are also advised to play a role in shaping the character of the affected victim.

References

Arthur E. (2006): The child psychotherapy treatment planner: John Wiley and Sons pp33-38.

Charles H. (2005): Handbook of infant mental health: Guilford Press pp22-27.

Peter K. (2002): Blackwell handbook of childhood social development: Wiley-Blackwell pp54-59.

Ronald J. (2009): Abnormal Psychology: worth Publishers pp34-30.

Saralea E. (2003): Simultaneous treatment of parent and child: Jessica Kingsley pp22-28.

Seligman L. (2007): Selecting Effective Treatments: John Wiley and Sons pp11-17.

Williams L. (2003): Psychiatric Nursing Made Incredibly Easy: Lippincott Williams pp24-29.