AVOIDANT PERSONALITY DISORDER
Avoidant Personality Disorder is characterized by a pervasive pattern of:
- social inhibition
- feelings of inadequacy
- hypersensitivity to negative evaluation, as indicated by at least four characteristic symptoms, e.g. -
- avoids work activities involving interpersonal contact due to a fear of criticism, rejection, or disapproval;
- is unwilling to get involved with people unless certain of being liked;
- is preoccupied with concerns about being criticized or rejected;
- views self as socially inept, inferior, or unappealing to others.
BIPOLAR II DISORDER
A diagnosis of Bipolar II Disorder requires at least one hypomanic episode and at least one major depressive episode.
A hypomanic episode lasts for at least four consecutive days and involves at least three symptoms that are also associated with a manic episode but are not severe enough to cause marked impairment in social or occupational functioning or require hospitalization.
A major depressive episode lasts for at least two weeks and involves at least five characteristic symptoms, at least one of which must be a depressed mood or a loss of interest or pleasure.
DEPENDENT PERSONALITY DISORDER
Dependent Personality Disorder involves a pervasive and excessive need to be taken care of, which leads to submissive, clinging behavior and a fear of separation as manifested by at least five characteristic symptoms - e.g.,
- has difficulty making decisions without advice and reassurances from others;
- fears disagreeing with others because it might lead to a loss of support;
- has difficulty initiating projects on his/her own;
- goes to great lengths to gain nurturance and support from others;
- is unrealistically preoccupied with fears of being left to care for him/herself.
GENITO-PELVIC PAIN/PENETRATION DISORDER
This disorder is diagnosed in the presence of persistent difficulties involving at least one of the following:
- vaginal penetration during intercourse;
- genito-pelvic pain during intercourse or penetration attempts;
- anxiety about genito-pelvic pain before, during, or as a result of vaginal penetration;
- tensing of pelvic floor muscles during attempted vaginal penetration.
Symptoms have persisted for, at a minimum, about six months and cause clinically significant distress.
Insomnia Disorder is characterized by dissatisfaction with sleep quality or quantity that is associated with at least one characteristic symptom -
- difficulty initiating sleep;
- difficulty maintaining sleep;
- early-morning awakening with an inability to return to sleep.
The sleep disturbance occurs at least three nights each week, has been present for at least three months, occurs despite sufficient opportunities for sleep, and causes significant distress or impaired functioning.
Acculturation refers to the extent to which an individual from one cultural group has adopted the beliefs, attitudes, values, and other characteristics of another cultural group and can be conceptualized in terms of four categories:
ACUTE STRESS DISORDER
Acute Stress Disorder involves exposure to actual or threatened death. severe injury, or sexual violation in at least one of four ways:
- direct experience of the event;
- witnessing the event in person as it happened to others;
- learning that the event occurred to a close family member or friend;
- repeated or extreme exposure to aversive details of the event
plus at least nine symptoms from any of five categories —
- negative mood,
- dissociative symptoms,
- avoidance symptoms,
- arousal symptoms.
Symptoms have a duration of three days to one month and cause clinically significant distress or impaired functioning.
The Adjustment Disorders involve the development of emotional or behavioral symptoms in response to one or more identifiable psychosocial stressors within three months of the onset of the stressors.
Symptoms must be clinically significant as evidenced by the presence of marked distress that is not proportional to the severity of the stressor and/or significant impairment in functioning, and they must remit within six months after termination of the stressor or its consequences.
A diagnosis of Agoraphobia requires the presence of marked fear or anxiety about at least two of five situations
- using public transportation,
- being in open spaces,
- being in enclosed spaces,
- standing in line or being part of a crowd,
- and being outside the home alone.
The individual fears or avoids these situations due to a concern that escape might be difficult or help will be unavailable in case he/she develops incapacitating or embarrassing symptoms; and the situations nearly always provoke fear or anxiety and are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.
The fear or anxiety is persistent, is not proportional to the threat posed by the situations, and causes clinically signiﬁcant distress or impaired functioning.
The essential features of Anorexia Nervosa are
- a restriction of energy intake that leads to a significantly low body weight;
- an intense fear of gaining weight or becoming fat or behavior that interferes with weight gain: and
- a disturbance in the way the person experiences his or her body weight or shape or a persistent lack of recognition of the seriousness of his/her low body weight.
ANTISOCIAL PERSONALITY DISORDER
Antisocial Personality Disorder is characterized by a pattern of disregard for and violation of the rights of others that has occurred since age 15 and involves at least three characteristic symptoms — e.g..
- failure to conform to social norms with respect to lawful behavior;
- reckless disregard for the safety of self and others;
- lack of remorse.
The person must be at least 18 years old and have a history of Conduct Disorder before 15 years of age.
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)
ADHD is the appropriate diagnosis when the individual has at least six symptoms of inattention and/or six symptoms of hyperactivity-impulsivity and symptoms had an onset prior to 12 years of age. are present in at least two settings (e.g.. home and school, and interfere with social, academic, or occupational functioning.)
AUTISM SPECTRUM DISORDER
For a diagnosis of Autism Spectrum Disorder. the individual must exhibit
- persistent deficits in social communication and interaction across multiple contexts as manifested by deficits in social-emotional reciprocity, nonverbal communication, and the development, maintenance, and understanding of relationships;
- restricted, repetitive patterns of behavior, interests, and activities as manifested by at least two characteristic symptoms e.g.
- stereotyped or repetitive motor movements, use of objects or speech
- inflexible adherence to routines or ritualized patterns of behavior
- the presence of symptoms during the early developmental period
- impaired functioning as the result of symptoms.
BECK DEPRESSION INVENTORY — SECOND EDITION [BDI-II)
THE BDI-ll is used to assess the mood, cognitive, behavioral, and physical aspects of depression for individuals ages 13 to 86.
BORDERLINE PERSONALITY DISORDER
The essential feature of Borderline Personality Disorder is a pervasive pattern of instability in interpersonal relationships, self-image, and affect, and marked impulsivity.
At least five characteristic symptoms must be present - e.g.
- frantic efforts to avoid abandonment;
- pattern of unstable, intense interpersonal relationships that are marked by fluctuations between idealization and devaluation,
- an identity disturbance involving a persistent instability in self-image or sense of self
- recurrent suicide threats or gestures
- transient stress-related paranoid ideation or severe dissociative symptoms
BRIEF PSYCHOTIC DISORDER
Brief Psychotic Disorder is characterized by the presence of one or more of four characteristic symptoms
- disorganized speech,
- grossly disorganized or catatonic behavior
with at least one symptom being delusions, hallucinations, or disorganized speech.
Symptoms are present for at least one day but less than one month with an eventual return to full premorbid functioning.
Bulimia Nervosa is characterized by
- recurrent episodes of binge eating that are accompanied by a sense of a lack of control
- inappropriate compensatory behavior to prevent weight gain (e.g.. self-induced vomiting. excessive exercise): and
- self-evaluation that is unduly inﬂuenced by body shape and weight.
For the diagnosis, binges and compensatory behaviors must occur, on average, at least once a week for three months.
Clinical interviews are the most common method for collecting information about a client's history and current situation and are useful for obtaining information that is not available from other sources and for establishing and maintaining a good working relationship with the client.
There are three basic types of clinical internews:
- semi-structured, and
COLLATERAL SOURCES OF INFORMATION
Important information about a client can be obtained from family members, friends, physicians, previous therapists, social service agencies, teachers, employers, clergy, and other collateral sources.
lt may also be appropriate to refer a client to another professional or agency for a specialized evaluation - e.g.. to a physician, neurologist, psychiatrist, or psychologst.
The diagnosis of Conduct Disorder requires a persistent pattern of behavior that violates the basic rights of others and/or age-appropriate social norms or rules as evidenced by the presence of at least three characteristic symptoms during the past 12 months and at least one symptom in the past six months.
Symptoms are divided into four categories:
- aggression to people and animals
- destruction of property
- deceitfulness or theft
- serious violation of rules
Symptoms must cause signiﬁcant impairment in functioning, and the disorder cannot be assigned to individuals over age 18 who meet the criteria for Antisocial Personality Disorder.
Cyclothymic Disorder involves fluctuating hypomanic symptoms and numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode, with symptoms lasting for at least two years in adults or one year in children and adolescents. Symptoms cause significant distress or impairment in functioning.
A diagnosis of Delirium requires
- a disturbance in attention and awareness that develops over a short period of time (ordinarily hours to a few days), represents a change from baseline functioning, and tends to fluctuate in severity over the course of a day and
- an additional disturbance in cognition, e.g..
- impaired memory
- impaired language
- deﬁcits in visualspatial ability
- perceptual distortions
Symptoms must not be due to another Neurocognitive Disorder and must not occur during a severely reduced level of arousal (e.g. during a coma), and there must be evidence that symptoms are not the direct physiological consequence of a medical condition, substance intoxication or withdrawal, and/or exposure to a toxin.
A diagnosis of Dissociative Amnesia requires an inability to recall important personal information that cannot be attributed to ordinary forgetfullness and causes clinically significant distress or impaired functioning.
It is often related to exposure to one or more traumatic events.
Enuresis involves repeated voiding of urine into the bed or clothes at least twice a week for three or more consecutive months. Urination is usually involuntary but can be intentional and is not due to substance use or a medical condition.
Enuresis is diagnosed only when the individual is at least five years old or the equivalent developmental level.
A diagnosis of Erectile Disorder requires the presence of at least one of three symptoms
- marked difficulty in obtaining an erection during sexual activity
- marked difficulty in maintaining an erection until completion of sexual activity
- marked decrease in erectile rigidity
on all or almost all occasions of sexual activity. Symptoms have persisted for at least six months and cause clinically significant distress.
Individuals with Factitious Disorder imposed on Self falsify physical or psychological symptoms that are associated with their deception, present themselves to others as being ill or impaired, and engage in the deceptive behavior even in the absence of an obvious external reward for doing so.
Individuals with Factitious Disorder imposed on Another falsify physical or psychological symptoms in another person, present that person to others as being ill or impaired, and engage in the deceptive behavior even in the absence of an external reward.
For both types of Factitious Disorder, falsification of symptoms can involve feigning, exaggeration, simulation, or induction [e.g. by ingestion of a substance or self-injury).
FAMILY LIFE CYCLE STAGES
McGoldrick, Carter, and Garcia-Preto's (2011) family life cycle distinguishes between seven predictable stages
- leaving home
- forming a couple
- families with young children
- families with adolescents
- launching children and moving into midlife
- families in late middle age
- families nearing the end of life
and identifies the developmental tasks that families face during the transition to each stage. Inadequate accomplishment of any task can lead to crisis and disequilibrium.
For Gender Dysphoria in Children, the diagnostic criteria are a marked incongruence between assigned gender at birth and experienced or expressed gender as evidenced by a strong desire to be the opposite sex and at least five symptoms — e.g.
- strong preference for wearing clothes of the other gender;
- strong preference for cross-gender roles during play:
- strong preference for toys and activities typically used or engaged in by the other gender;
- strong preference for playmates of the opposite gender;
- strong desire for primary and/or secondary sex characteristics of one's experienced gender.
For Gender Dysphoria in Adolescents and Adults, the marked incongruence between assigned gender and experienced or expressed gender must be manifested by at least two symptoms — e.g,
- marked mcongruence between one's primary and/or secondary sex characteristics and one's experienced or expressed gender
- strong desire for the primary and/or secondary sex characteristics of the opposite gender
- strong desire to be of the opposite gender
- strong conviction that one has the feelings and reactions that are characteristic of the opposite ....
GENERALIZED ANXIETY DISORDER (GAD)
GAD involves excessive anxiety and worry about multiple events or activities, which are relatively constant for at least six months, the person finds difficult to control, and cause clinically significant distress or impairments in functioning.
Anxiety and worry must include at least three characteristic symptoms for adults and at least one symptom for children —
- restlessness or feeling keyed up or on edge
- being easily fatigued
- difficulty concentrating
- muscle tension
- sleep disturbance.
GRAPHIC ASSESSMENT TECHNIQUES
Graphic assessment techniques include the genogram and ecomap.
The genogram depicts family relationships over several generations and provides information on significant life events, family structure and roles. etc.
The ecomap provides information on the strength and nature of relationships between family members and people, institutions, and agencies in the social environment.