An assessment is the process of collecting symptoms and seeing what causes them. A diagnosis is a label for a number of symptoms that often occur together.
There are modern methods for diagnosing. Assessment techniques must be valid and reliable. In addition, they must be standardized.
To say that a test is valid: the test must actually measure that for which it was designed. The validity for testing psychological disorders is not very large, because there are no good objective methods for determining these.
There are different types of validity:
The reliability is the certainty that the outcome of the measurement remains the same. Different types of reliability:
To prove validity and reliability, you can standardize the data collected of a test, so that there is no variation between tests in how this is done.
A lot of information for an assessment comes from an interview, which often includes an investigation into the mental status.
There are five types of information:
Clinicians increasingly use structured interviews: a series of questions about the symptoms.
In order to quickly determine what the symptoms are, a symptom questionnaire can be filled out. A frequently used questionnaire is the Beck Depression Inventory (BDI): here you have to judge for yourself which description best suits how you felt during the past week.
Personality inventories are questionnaires that look at the typical way of thinking, feeling and behaving of a person. An example is the Minnesota Multiphasic Personality Inventory (MMPI): the patient must indicate whether a statement is correct, incorrect or that they can not be assessed. The questionnaire is empirically developed, which means that the questions were asked first to healthy subjects and then to people with mental health problems. The items on which the answers differed were included in the Inventory.
There are also validity scales that check whether a person completes the test fairly.
A disadvantage of the MMPI is that this questionnaire was developed in America and may therefore not be representative of the rest of the world. No good, representative sample was used.
Behavioral observation and self-monitoring
Clinicians often use behavioral observations to see how patients approach situations. They look at specific behavior and cause that behavior to be caused. An advantage is that you look at 'natural' behavior and not at a self-report of the behavior by the patient. A disadvantage is that people know that they are observed and behave differently, this is called reactivity. Moreover, this method is not objective. That is why the situation must be standardized.
People can also apply self-monitoring, while keeping track of how often they perform a certain action per day and in which circumstances this happens. The advantage of self-observation is that people do not change their behavior because of the presence of another person (reactivity).
Tests measure the intellectual strength of an individual. These tests are used in schools, in the army and in job applications. The WAIS (for adults) and WISC (for children) measure the basic intelligence capacity. However, we still do not know exactly what intelligence means, there is no good definition.
There is also a bias in the test: the test was developed for and by Western countries and this can influence the result when the test is taken from someone who comes from a non-Western country.
A neuropsychological test is used when clinicians suspect a neurological disorder, such as memory problems. An example of this is the Bender-Gestalt Test. The therapist assesses the sensorimotor skills of the patient by having him draw nine pictures. People with brain damage can not reproduce the drawings.
Brain-imaging (brain imaging) is often used to detect brain damage and to search for possible brain tumours. We look at differences in structures of the brain.
Possible methods are:
One of the biggest challenges in diagnosing is when an individual refuses to give information. Someone can refuse to give information because that person does not want to be assessed and / or treated. Often people have a certain interest in the outcome of the test and therefore give information that is in their 'advantage' (bias). This arises, for example, when assessments are part of a lawsuit, for example when parents fight for the custody of their children. Challenges can arise when children or people from different cultures are evaluated.
A conversation with a sad, stressed child often does not go as it should, you often do not get a real answer to your question. Children can not describe their feelings about certain things in the same way as adults, certainly not in connection with a certain event. Clinicians must therefore rely on others, parents for example. They are often asked about changes in behavior in recent times. Unfortunately, parents are not always accurate and often they are biased. Sometimes parents bring their children to psychologists, while in fact they would benefit more from treatment themselves. In addition, parents can also be the cause of the child's problems. Teachers can also give information about children, they often see first that a child has problems.
Evaluating individuals in different cultures
People who emigrated to another country often do not speak the same language as their new compatriots, or do not speak the language well enough. This can ensure that someone is under or over diagnosed. A translator can be used, but often gives an interpretation to the questions and answers and is not literally in his translations. In this way misunderstandings can arise and the therapist can not make the correct diagnosis.
There are also cultural prejudices (bias): people speak the same language, but have a different cultural background. Symptoms may be slightly more severe. This is because people in other cultures often think differently.
A diagnosis is a label that we give to symptoms that occur more often together. A set of symptoms is called a syndrome, which is an observable manifestation of an underlying biological disorder. We have to pay attention to behavior that can be a symptom and also how often that behavior is repeated.
Often, symptoms overlap between different syndromes. Therefore, you have to have different symptoms to be diagnosed with a certain syndrome. A classification system contains all known syndromes and gives clear rules to be able to establish them with the patient. Classifying is therefore the classification of problems of individuals in certain groups.
Hippocrates was the first to establish syndromes. His syndromes were: mania, melancholy, paranoid and epilepsy.
Now we have the DSM: Diagnostic and Statistical Manual of Mental Disorders. This contains all syndromes and disorders with the associated symptoms to be able to give a correct diagnosis.
Diagnostic and Statistical Manual of Mental Disorders
The DSM was developed in America. The first DSM came out in 1952, containing all known psychological disorders of that time. The criteria for diagnosing were also given. The criteria were then vague descriptions, which were heavily influenced by the psychoanalytic theory. The reliability of DSM-I and also DSM-II was therefore very low.
The DSM-IV differs very little from the DSM-III, they are both more reliable than the first DSMs. There are specific and concrete criteria for the diagnosis: these are often well observable and measurable behaviours and feelings. Usually a person must have at least a certain number of possible symptoms to get a diagnosis. It must be known how long the symptoms are already present and daily life must be influenced by the symptoms in a negative way.
The reliability of the DSM-III was reasonably good, about 70%. The fact that the reliability was still not really high was due to several factors, but the most important is that the focus was on observable symptoms and not on the underlying factors.
The DSM-IV is more reliable because the criteria are tested in a clinical and research environment.
The DSM-III and DSM-IV have 5 axes (or dimensions). The first two are the only ones that reflect the actual disorders, together with the criteria required for the diagnosis. The other three are mainly meant to provide information about the physical condition, which can influence the mental state.
Axis 1: clinical disorders. On this axis, the clinician records which major disorders the patient qualifies, with the exception of mental retardation and personality disorders. Furthermore, it is noted whether these disorders are chronic or acute.
Axis 2: personality disorders and mental retardation. In general, the disorders on this axis are lifelong.
Axis 3: general medical conditions. On this axis all medical and physical conditions are recorded that a patient has. Although not all of these conditions need to affect psychological conditions, it is important that the clinician is aware of it, as well as the medication that the patient may be taking.
Axis 4: psychological problems and problems in the environment. Psychological stressors can influence the mental disorder. Again, these stressors have nothing to do with the disorder, but the clinician must be aware of it.
Axis 5: global assessment of functioning. On this axis, the clinician assesses the level at which the patient functions in daily life. This helps to determine to what extent the disorder affects the life of the patient.
An important change in the DSM-V compared to the earlier versions of the DSM is that the DSM-V no longer works with this system of axles. In this way it is brought more into line with the International Classification System of Diseases (ICD). Axis I, II and III have been returned to a general diagnostic scheme in the DSM-V. Separate notations for important psychosocial and contextual factors (previously as IV) and disabilities (formerly as V), are made by the clinician.
Continuous concerns about the DSM (possible points for improvement)
Consider the continuum: there is a clear distinction between normal and abnormal behavior in DSM-IV. Many psychologists argue for a diagnostic system that sees disorders as extremes of normal behavior, rather than as qualitatively different from normal functioning.
It is difficult to properly distinguish between mental disorders by using the DSM-IV. Many symptoms are associated with multiple syndromes and this can cause confusion. It may be good to develop better distinctive criteria. On the other hand, there is a lot of overlap present between disorders, the natural occurrence of problems in mood, behavior and thoughts. The DSM-V deals more with the underlying dimension of the disorder but fails to properly distinguish among them.
Cultural differences: Different cultures have different ways to conceptualize mental disorders and some disorders from the DSM-IV do not occur in other cultures at all. In DSM-V, researchers try to map out cultural variation in the expression and characterization of disorders.
There are many benefits when someone has received a diagnosis, but people also have many disadvantages. Szasz claims that we quickly label people who do not fit within society. Someone with a label is then treated differently, because he is abnormal according to our standards.
Rosenhan had 12 colleagues in different mental hospitals, saying that they heard voices in their heads say 'hollow', 'empty' and 'thud' (hollow, empty and broken). Actually there was nothing wrong with them, but they were indeed recorded and treated. Once they were recorded, they said that they no longer heard voices and, moreover, they wrote their experiences every day on a notepad. Some other patients had previously learned that the researchers did not actually have a mental disorder, but the institutions themselves did not find out after 19 days on average.
The label 'abnormal' is even more dangerous for children. Here is an example of an investigation with a group of boys, some of whom had a behavioral problem. The boys had to work together in pairs. On one occasion, the boys received background information about the other person, namely that the boy they worked with had a behavioral problem, the other time this did not happen. Afterwards the boys had to say how they found the cooperation. The boys who knew that their partner had a behavioral problem were less friendly and less interactive and did not like the cooperation so well. These results show that if abnormal labelling of a child can have strong effects on the behavior of other children towards this child, even when there is no reason for the child to get such a label.
What does abnormality mean? - Chapter 1 (Abnormal Psychology)Abnormal psychology, frequently called psychopathology, is the study of people suffering from mental, emotional and often physical pain. Although people with psychopathological problems can have unusual experiences, most of the time these experiences are same in nature to other people's experiences but taken to an extreme degree (e.g. sadness turning into depression).
Some behaviours that seem abnormal to us are normal in other cultures or situations. When we determine whether something is normal, we have to look at the context or circumstances in which the behavior occurs. In addition to context, there are a number of criteria that must be taken into account when determining whether certain behavior is abnormal.
Cultural relativism theory states that there are no universal standards or rules to judge a behavior as abnormal. Instead, behavior can only be abnormal according to the prevailing cultural norms. Therefore, definitions of abnormality differ between cultures.
Opponents of cultural relativism believe that it can be dangerous if cultural norms dictate what is normal and abnormal. For example, throughout history, different societies have labelled certain individuals and groups as abnormal to provide justification for controlling those groups. Think of what Hitler did to the Jews. Also, such abuse often took place when slavery was legal. For example, slaves who tried to escape were diagnosed with drapetomania, a disease that caused them to desire freedom.
Gender also affects whether something is labelled as abnormal. For example, men who show sadness or fear, or who choose to stay at home with children while their wife works, are often seen as abnormal. Women who are aggressive or who do not want children are also viewed as abnormal. On the other hand, aggression in men and chronic anxiety in women are seen as normal, because these behaviours are in line with societal expectations based on sex.
In any case, it is clear that culture and gender influence the expression of abnormal behavior and the way such behavior is viewed. Furthermore, culture and gender can have an impact on determining which types of treatment for abnormal behaviours are acceptable.
Another approach of assessing abnormality is to think of how unusual the behaviour is. Behavior that is deviant or unusual is seen as abnormal, while typical or standard behavior is considered normal. In a sense, such attitude is linked to the relativistic criterion, because the unusual nature of behavior is partly dependent on cultural norms of that behavior.
The relativistic criterion has some shortcomings. For example, how unusual a behavior has to be to call it abnormal? Is a behavior abnormal if less than 10% of the population displays it, or if less than 1% displays it? In addition, plenty of rare behaviours are positive for the individual and society, making it strange to call such behaviours abnormal. People who exhibit such rare but positive behaviours are often called eccentric.
According to the distress criterion a behavior can be seen as abnormal if it causes a feeling of distress
.....read more Which theories and treatments of abnormality exist? - Chapter 2 (Abnormal Psychology)A theory is a set of ideas that provide a framework. Based on this framework, questions can be asked about a particular phenomenon and information collected and interpreted about this phenomenon. A therapy is a treatment, often based on a theory about a disorder, that deals with the factors that cause the disorder according to the theory.
There are different approaches for explaining psychological complaints. For example, when it comes to anxiety, the biological approach symptoms suggests that the symptoms can be caused by a genetic predisposition to anxiety. The psychological approach seeks the explanation in a person's beliefs, life experience and relationships. The sociocultural approach looks at the cultural values or social environment of a person. These different approaches are often seen as incompatible. People seek either a biological explanation or a socio-cultural explanation. This is also called the nature-nurture debate : is the explanation in someone's nature, or in education (or environment).
Although it is tempting to look for a single explanation, theoreticians often start from the biopsychosocial approach, which recognizes that it is often a combination of biological, psychological and socio-cultural factors. Vulnerability to a disorder can also lie with each of these factors and therefore does not always have to be genetic. Only vulnerability is not enough to develop a disorder, only when another trigger occurs (e.g. stress), the disorder could really develop.
Treatments have also been developed for each approach. The biological approach mainly requires medication, from the psychological and sociocultural approach it usually concerns psychotherapy. Both types of treatment have proved effective and are often used together, in an integrated approach.
The famous story of Phineas Gage describes how this man, one day through an accident at work, received a thick iron rod through his skull and brain. Miraculously, he survived this accident and he recovered completely physically. His personality, however, had changed completely: from a responsible, friendly and intelligent man, he had suddenly changed into a capricious person who had no respect for social norms. His sense of responsibility was completely gone.
Later research showed that Gage mainly suffered damage to the frontal lobe. People who have damage to this part of the brain often have trouble taking rational decisions in social situations and have trouble processing information about emotions. They can still solve logic and abstract problems, just like Gage still could.
Brain dysfunction is only one of the three possible biological causes of abnormality. The other two are biochemical imbalances and genetic abnormalities. These three causes can also influence each other. For example, brain dysfunction can be the result of genetic factors and this can cause biochemical imbalance.
The brain can be subdivided into three main areas: the hindbrain, midbrain and forebrain. The back brains contain the medulla (controls breathing and reflexes), punch (important for attention and timing of sleep), reticular formation (controls arousal and attention to stimuli) and cerebellum (is involved
.....read more How can you assess and diagnose abnormality? - Chapter 3 (Abnormal Psychology)An assessment is the process of collecting symptoms and seeing what causes them. A diagnosis is a label for a number of symptoms that often occur together.
There are modern methods for diagnosing. Assessment techniques must be valid and reliable. In addition, they must be standardized.
To say that a test is valid: the test must actually measure that for which it was designed. The validity for testing psychological disorders is not very large, because there are no good objective methods for determining these.
There are different types of validity:
The reliability is the certainty that the outcome of the measurement remains the same. Different types of reliability:
To prove validity and reliability, you can standardize the data collected of a test, so that there is no variation between tests in how this is done.
A lot of information for an assessment comes from an interview, which often includes an investigation into the mental status.
There are five types of information:
Clinicians increasingly use structured interviews: a series of questions about the symptoms.
In order to quickly determine what the symptoms are, a symptom questionnaire can be filled out. A frequently used questionnaire is the Beck Depression Inventory (BDI): here you have to judge for yourself which description best suits how you felt during the past
.....read more Which anxiety disorders exist? - Chapter 4 (Abnormal Psychology) Due to evolution, humans and animals have an automatic reaction to danger: the fight or flight response (fight or flight). The psychological changes that arise during this response are due to the activation of two systems: the autonomic nervous system and the adrenal cortical system.
The hypothalamus activates the sympathetic part of the autonomic nervous system, which prepares to fight or flight by releasing energy. The hypothalamus also activates the adrenal cortical system by releasing CRF (corticotrophin-releasing hormone), which releases the adrenocorticotropic hormone (ACTH). This hormone causes the cortisol level to rise. Cortisol in the blood and urine is an indicator of stress. We then experience the emotions that come with danger, after which we either confront the danger (fight) or run from it(flight).
People with anxiety disorders follow the same pattern, but with them there is no actual objective danger but rather a more subjective, psychological one.
We refer to anxiety disorder when people are continuously living with fear and normal functioning is thereby impeded. When this happens, people tend to realize the unreal nature of the disorder and suffers from it.
Fear consists of four different types of symptoms.
1. somatic symptoms: physical responses such as sweating and increased blood pressure
2. emotional symptoms: feelings of anxiety and vigilance
3. cognitive symptoms: unrealistic worries such as the feeling that something bad is going to happen
4. behavioral symptoms: such as avoidant or flight behaviours.
Posttraumatic stress disorder and acute stress disorder both occur as a result of an experience of extreme stress. For example, many people developed a stress disorder in America as a result of the 11th of September attacks. Furthermore, it is estimated that 7% of the people experience stress during their lifetime as a result of a traumatic experience.
For a diagnosis of PTSD, from all the symptoms in the DSM, at least the following four are necessary:
Many people with PTSD experience symptoms of dissociation, a process in which parts of the identity, memories or consciousness lose contact with each other. These people can be diagnosed with the subtype PTSD with prominent dissociative symptoms.
An acute stress disorder occurs in traumas that resemble PTSD, only the symptoms of acute stress disorder develop within a month. Dissociative symptoms are common in ASD: stiffening, less awareness of the environment, experiencing the world as a dream. People with ASD have an increased risk of developing PTSD.
.....read more Which somatic symptom disturbances and dissociative disorders do exist? – Chapter 5 (Abnormal Psychology)In this chapter, the somatic symptom disturbances and the dissociative disorders will be discussed. In somatic symptom disorders , people have physical complaints, without an organic cause. Often the pain comes through painful emotions, thoughts or memories. In dissociative disorders , people develop several independent personalities, as a result of which they suffer from memory loss. This is because some personalities do not communicate with each other, as it were.
Somatic symptom disorders symptom disturbances
The problem with somatic is that it is difficult to determine whether the symptoms have an organic or psychological cause. Often people’s symptoms do not correspond to a physiological process associated with these symptoms. If this is the case, it is assumed that psychological factors are of influence. Another possibility is that people do have a physical illness, but that they still must be discovered or simply can not be found.
The people who have this disorder really feel the pain. It is not that they can influence or control their symptoms.
5 types of somatic symptom disorders are distinguished:
Somatic symptom disorder and Illness Anxiety Disorder
Someone with a somatic symptom disorder has one or more physical symptoms that he or she worries about, and the person spends a lot of time thinking about these symptoms and looking for medical care. It can be pain symptoms, neurological symptoms, gastrointestinal symptoms or symptoms that affect any part of the body. People with somatic symptom disorder have concerns about their health that are excessive given their current physical health. The concerns also continue to exist when they have evidence that they are healthy and interfere with their daily functioning. When they experience a certain symptom, they immediately think the worst, for example that they have cancer.
Illness anxiety disorder is very similar to somatic symptom disorder. The primary distinction in the DSM-V between these two disorders is that people with a somatic symptom disorder actually seek help while people with illness anxiety disorder are afraid that they will get a serious illness, but they do not always experience serious physical symptoms. . When they experience physical symptoms, these people are very concerned, and seek medical help before.
People with somatic symptom disorder or illness anxiety disorder often experience periods of anxiety and depression. They can express their stress in physical symptoms or mask the stress with alcohol abuse or antisocial behavior. Their symptoms and health concerns become their identity. When they are anxious or depressed, they report more physical complaints and then worry when they are not anxious or depressed.
Cognitive factors play a major role in somatic symptom disorder and illness anxiety disorder. People with these disorders have convicted dysfunctional about diseases. They assume that serious illnesses are
.....read more What is the relationship between mood disorders and suicide? - Chapter 6 (Abnormal Psychology)Two different mood disorders are discussed below. Bipolar disorder is a disorder with periods of mania and periods of depression. Someone with a unipolar disorder only suffers from depression (not mania). Furthermore suicide is treated, or suicide.
People with depression are completely confiscated by the disorder; depression affects the emotions, body functions, behaviours and thoughts of man.
The most important emotional symptoms in someone with a unipolar disorder are the sadness and the loss of all interest in life, which is referred to by the term anhedonia.
Many have also in people with depression body functions changed. These are changes in appetite, sleep and activity. Some people with depression have very little appetite, whereas others, on the other hand, very much.
In their behavior , many depressed people show changes in their way of moving. For example, they move very slowly in everything they do. This is called psychomotor retardation . Many people feel that they have little energy and that they are constantly tired. A small part of the depressed people feels restless. These people have opposite symptoms: psychomotor agitation, in which people feel physically agitated, can not sit still and walk around aimlessly or fidget.
The cognitive symptoms of depression are all kinds of thoughts about, for example, hopelessness, shame and suicide. In serious cases, there are also delusions and hallucinations. Delusions are thoughts that have no basis in reality. Hallucinations are observations that someone has, who are not actually there.
Depression can take different forms. Major depressive disorder is a severe depression that lasts at least two weeks. The diagnosis requires that someone feels depressed or has a loss of interest in daily activities. In addition, at least four other symptoms of depression must be present. According to the DSM-IV, there are two types of unipolar depression: major depression and dysthymic disorder. The difference between these two disorders is that a major depression is of shorter duration, but very intense. Dysthymic disorder is a chronic form of depression, which lasts for at least one year in adolescents and two years in adults. This depression can be less severe a major depressive disorder. A person must have a depressed mood and his interest in life must be lost. In addition, there must be at least four other symptoms of depression for at least two weeks, involving a disruption of daily life. There are two types of major depressions: in the first type (major depression single occurrence) there is only one single depressive episode, while in the second type (major depression periodically) there are two or more episodes with at least two consecutive months without symptoms between the episodes. The DSM-V criteria contain the observation that a normal and expected depressive response to a negative event, such as a loss, should not be diagnosed as a major depressive disorder unless other symptoms such as worthlessness, suicidality and psychomotor retardation are present.
More chronic forms
.....read more What does the schizophrenic spectrum and related psychotic disorders look like? - Chapter 7 (Abnormal Psychology)A person suffers from psychosis if he has hallucinations and delusions and can not say with certainty whether his observations are real or not. A form of psychosis that often occurs is schizophrenia. People can sometimes think very clearly and function well, but also have moments when they can no longer take care of themselves.
Schizophrenia occurs in 1 to 2 percent of people in the United States and in 0.5 to 1 percent of all people around the world. Schizophrenia is more common in men than women and is more common in colored people than in whites. About 90% of people with schizophrenia seek help. The disorder often develops in youth or young adulthood.
Schizophrenia is a very complex disorder. A distinction is made between two categories of symptoms, the positive and the negative symptoms. The DSM-V refers to the schizophrenia spectrum, to show that there are five domains of symptoms that define psychotic disorders, and their number, severity and duration distinguish psychotic disorders from each other.
Positive symptoms
Positive symptoms, or Type I symptoms, are characterized by the presence of delusions, hallucinations, disorganized speech and thoughts and disorganized or catatonic behavior. These symptoms can also occur in other disorders, such as bipolar disorder, so that makes the diagnosis for schizophrenia difficult. It is also possible that the symptoms occur in people who actually have no problems. Think of people who hear voices and attribute this to their religion. There are also people who, due to the symptoms, have no control over reality: delusional disorder (delusions).
The rule is that if the positive symptoms only occur during a manic or depressive period, the diagnosis 'mood disorder with psychotic characteristics' is made. If the positive symptoms also occur outside the manic or depressive periods, the diagnosis is made schizophrenia.
Delusions are ideas that the patient thinks are true, while those ideas are very unlikely or even impossible. Many people sometimes have unlikely thoughts, but there are differences between these kinds of thoughts and delusions. When healthy people have unlikely thoughts, they are not completely unbelievable, while delusions are. People with delusions constantly think about it and seek evidence for their ideas, with which they try to convince others. In addition, people with delusions can not accept that their thoughts are not right.
There are four kinds of delusions:
Which personality disorders exist? - Chapter 8 (Abnormal Psychology)Personality is the collection of characteristics that the person has or shows and that distinguishes him or her from others. It is the way we behave, think, believe and feel. These characteristics make us unique.
A personality trait is a complex pattern of behavior, thoughts and emotions that remain constant over a longer period of time, and in different situations.
The 'big five' theory states that there are five different factors of personality traits. Everyone satisfies every factor to a certain extent, and how strongly that per factor is the case determines our personality.
The big five:
Definition and diagnosis of personality disorder
A personality disorder is a long-term pattern of unadopted behavior, thoughts and feelings. Personality disorders usually begin in adolescence, or in early adulthood, and sustain a large part of life. To diagnose a personality disorder in a person under the age of eighteen, the personality pattern must be present for at least a year.
In the DSM-IV, personality disorders are on the second axis. This means that these disorders are seen differently from acute disorders. The disorders on the second axis are chronic and penetrating. The DSM-V has rejected this distinction between disorders on As-I and As-II. Personality disorders are therefore no longer on the second axis in the DSM-V. The DSM-V has divided ten personality disorders into three clusters, based on their similarities. The DSM-V admits that this system is limited, not well validated and does not explain the fact that people often have multiple personality disorders from different clusters. The three clusters of the DSM-V are as follows:
Odd-eccentric personality disorders
People with an odd-eccentric personality disorder (from cluster A) behave in ways that strongly suggest schizophrenia. Many scientists therefore believe that this disorder is a weakened version of schizophrenia, or that people with this disorder have a very high chance of developing schizophrenia. Some scientists believe that this disorder should fall under schizophrenia than under the personality disorders, precisely because it appears to be a mild version of schizophrenia.
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Which eating disorders exist? - Chapter 9 (Abnormal Psychology)Most individuals meet the criteria for two or more eating disorders at different times. Many people do not meet the criteria for an eating disorder, but do show behaviours and concerns that fit in an eating disorder. They are diagnosed with other specified feeding or eating disorder.
People with anorexia nervosa are hungry themselves, while they are already well under a healthy weight. They do this by not eating or eating for a long time. Although they are already very thin, they insist that they have to lose even more weight. People with anorexia refuse to maintain a healthy, normal weight. Although these people are very emaciated, they have an intense fear of weight gain or fat. They have a disturbed idea about their bodies and think they are fatter than they actually are and therefore have to lose weight.
The self-esteem of these people depends entirely on their body weight and the control over their eating behavior; they feel good when they lose weight and are guilty or worthless if they do not succeed. Due to the loss of weight, people with anorexia nervosa are often chronically fatigued. Despite this fatigue, they continue to draw up heavy training programs to lose weight.
Anorexia nervosa usually starts between 15 and 19 years. 90 to 95 percent of all cases with anorexia nervosa are women. Due to the weight loss, the menstrual cycle stops in girls and women with anorexia, this is called amenorrhea . In the DSM-V the criterion for amenorrhea has been removed from the diagnostic criteria, because many girls with anorexia nervosa still have menstrual activity. Anorexia is, in a physical sense, a dangerous disorder. Serious complications such as a very low heart rate or damage to the kidneys may be the result; 5 to 8 percent of people with anorexia will die of it.
There are two types of anorexia nervosa. People with the restricting type of anorexia nervosa refuse to eat, or eat very small amounts, to prevent them from gaining weight. Some do not eat anything for days. People with the restricting type of anorexia nervosa often have a feeling of distrust towards others and the tendency to deny their problems.
The other type is the binge / purge type of anorexia nervosa. These people have binge eating (binges) that alternate with actions to prevent weight gain (purge). This often happens through deliberate vomiting or use of laxatives. People with the binge / purge type of anorexia nervosa often have varying moods, problems with the control of their impulses, problems with alcohol and self-mutilation.
The binge / purge type of anorexia nervosa is very similar to bulimia. The difference is that people with the binge / purge type of anorexia nervosa do not have a healthy weight, while people with bulimia nervosa generally have a healthy weight or even a bit of overweight.
Just like in the DSM-IV,
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