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Pediatricians are often the first health professionals to assess and raise suspicions of RAD in children with the disorder. The initial presentation varies according to the child's developmental and chronological age, although it always involves a disturbance in social interaction. Infants up to about 18–24 months "may" present with non-organic failure to thrive and display abnormal responsiveness to stimuli. Laboratory investigations will be unremarkable barring possible findings consistent with malnutrition or dehydration, while serum growth hormone levels will be normal or elevated.
The core feature is severely inappropriate social relating by affected children. This can manifest itself in two ways:
1. Indiscriminate and excessive attempts to receive comfort and affection from any available adult, even relative strangers (older children and adolescents may also aim attempts at peers).
2. Extreme reluctance to initiate or accept comfort and affection, even from familiar adults, especially when distressed.
While RAD is likely to occur in relation to neglectful and abusive treatment, automatic diagnoses on this basis alone cannot be made, as children can form stable attachments and social relationships despite marked abuse and neglect.
The name of the disorder emphasizes problems with attachment but the criteria includes symptoms such as failure to thrive, a lack of developmentally appropriate social responsiveness, apathy, and onset before 8 months.
Reactive attachment disorder (RAD) is described in clinical literature as a severe and relatively uncommon disorder that can affect children. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited form". Due to recent revision in the DSM-5 the "disinhibited form" is now considered a separate diagnosis named "Disinhibited attachment disorder".
RAD arises from a failure to form normal attachments to primary caregivers in early childhood. Such a failure could result from severe early experiences of neglect, abuse, abrupt separation from caregivers between the ages of six months and three years, frequent change of caregivers, or a lack of caregiver responsiveness to a child's communicative efforts. Not all, or even a majority of such experiences, result in the disorder. It is differentiated from pervasive developmental disorder or developmental delay and from possibly comorbid conditions such as intellectual disability, all of which can affect attachment behavior. The criteria for a diagnosis of a reactive attachment "disorder" are very different from the criteria used in assessment or categorization of attachment "styles" such as insecure or disorganized attachment.
Children with RAD are presumed to have grossly disturbed internal working models of relationships that may lead to interpersonal and behavioral difficulties in later life. There are few studies of long-term effects, and there is a lack of clarity about the presentation of the disorder beyond the age of five years. However, the opening of orphanages in Eastern Europe following the end of the Cold War in the early-1990s provided opportunities for research on infants and toddlers brought up in very deprived conditions. Such research broadened the understanding of the prevalence, causes, mechanism and assessment of disorders of attachment and led to efforts from the late-1990s onwards to develop treatment and prevention programs and better methods of assessment. Mainstream theorists in the field have proposed that a broader range of conditions arising from problems with attachment should be defined beyond current classifications.
Mainstream treatment and prevention programs that target RAD and other problematic early attachment behaviors are based on attachment theory and concentrate on increasing the responsiveness and sensitivity of the caregiver, or if that is not possible, placing the child with a different caregiver. Most such strategies are in the process of being evaluated. Mainstream practitioners and theorists have presented significant criticism of the diagnosis and treatment of alleged reactive attachment disorder or the theoretically baseless "attachment disorder" within the controversial form of psychotherapy commonly known as attachment therapy. Attachment therapy has a scientifically unsupported theoretical base and uses diagnostic criteria or symptom lists markedly different to criteria under ICD-10 or DSM-IV-TR, or to attachment behaviors. A range of treatment approaches are used in attachment "therapy", some of which are physically and psychologically coercive, and considered to be to attachment "theory". Many constitute abuse.
The diagnosis of PTSD was originally developed for adults who had suffered from a single event trauma, such as rape, or a traumatic experience during a war. However, the situation for many children is quite different. Children can suffer chronic trauma such as maltreatment, family violence, and a disruption in attachment to their primary caregiver. In many cases, it is the child's caregiver who caused the trauma. The diagnosis of PTSD does not take into account how the developmental stages of children may affect their symptoms and how trauma can affect a child’s development.
The term developmental trauma disorder (DTD) has also been suggested. This developmental form of trauma places children at risk for developing psychiatric and medical disorders. Bessel van der Kolk explains DTD as numerous encounters with interpersonal trauma such as physical assault, sexual assault, violence or death. It can also be characterized by subjective events like betrayal, defeat or shame.
Repeated traumatization during childhood leads to symptoms that differ from those described for PTSD. Cook and others describe symptoms and behavioural characteristics in seven domains:
- "Attachment" – "problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to others' emotional states"
- "Biology" – "sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems"
- "Affect or emotional regulation" – "poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes"
- "Dissociation" – "amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events"
- "Behavioural control" – "problems with impulse control, aggression, pathological self-soothing, and sleep problems"
- "Cognition" – "difficulty regulating attention, problems with a variety of 'executive functions' such as planning, judgement, initiation, use of materials, and self-monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with 'cause-effect' thinking, and language developmental problems such as a gap between receptive and expressive communication abilities."
- "Self-concept" – "fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self".
Attachment disorder is a broad term intended to describe disorders of mood, behavior, and social relationships arising from a failure to form normal attachments to primary care giving figures in early childhood. Such a failure would result from unusual early experiences of neglect, abuse, abrupt separation from caregivers between 6 months and three years of age, frequent change or excessive numbers of caregivers, or lack of caregiver responsiveness to child communicative efforts resulting in a lack of basic trust. A problematic history of social relationships occurring after about age three may be distressing to a child, but does not result in attachment disorder.
The term attachment disorder is used to describe emotional and behavioral problems of young children, and also applied to school-age children, teenagers and adults. The specific difficulties implied depend on the age of the individual being assessed, and a child's attachment-related behaviors may be very different with one familiar adult than with another, suggesting that the disorder is within the relationship and interactions of the two people rather than an aspect of one or the other personality. No list of symptoms can legitimately be presented but generally the term attachment disorder refers to the absence or distortion of age appropriate social behaviors with adults. For example, in a toddler, attachment-disordered behavior could include a failure to stay near familiar adults in a strange environment or to be comforted by contact with a familiar person, whereas in a six-year-old attachment-disordered behavior might involve excessive friendliness and inappropriate approaches to strangers.
There are currently two main areas of theory and practice relating to the definition and diagnosis of attachment disorder, and considerable discussion about a broader definition altogether. The first main area is based on scientific enquiry, is found in academic journals and books and pays close attention to attachment theory. It is described in ICD-10 as reactive attachment disorder, or "RAD" for the inhibited form, and disinhibited attachment disorder, or "DAD" for the disinhibited form. In DSM-IV-TR both comparable inhibited and disinhibited types are called reactive attachment disorder or "RAD".
The second area is controversial and considered pseudoscientific. It is found in clinical practice, on websites and in books and publications, but has little or no evidence base. It makes controversial claims relating to a basis in attachment theory. The use of these controversial diagnoses of attachment disorder is linked to the use of pseudoscientific attachment therapies to treat them.
Some authors have suggested that attachment, as an aspect of emotional development, is better assessed along a spectrum than considered to fall into two non-overlapping categories. This spectrum would have at one end the characteristics called secure attachment; midway along the range of disturbance would be insecure or other undesirable attachment styles; at the other extreme would be
non-attachment. Agreement has not yet been reached with respect to diagnostic criteria.
Finally, the term is also sometimes used to cover difficulties arising in relation to various attachment styles which may not be disorders in the clinical sense.
Adults with C-PTSD have sometimes experienced prolonged interpersonal traumatization as children as well as prolonged trauma as adults. This early injury interrupts the development of a robust sense of self and of others. Because physical and emotional pain or neglect was often inflicted by attachment figures such as caregivers or older siblings, these individuals may develop a sense that they are fundamentally flawed and that others cannot be relied upon.
This can become a pervasive way of relating to others in adult life described as insecure attachment. The diagnosis of dissociative disorder and PTSD in the current DSM-5 (2013) do not include insecure attachment as a symptom. Individuals with Complex PTSD also demonstrate lasting personality disturbances with a significant risk of revictimization.
Six clusters of symptoms have been suggested for diagnosis of C-PTSD:
- alterations in regulation of affect and impulses;
- alterations in attention or consciousness;
- alterations in self-perception;
- alterations in relations with others;
- somatization;
- alterations in systems of meaning.
Experiences in these areas may include:
- Difficulties regulating emotions, including symptoms such as persistent dysphoria, chronic suicidal preoccupation, self injury, explosive or extremely inhibited anger (may alternate), or compulsive or extremely inhibited sexuality (may alternate).
- Variations in consciousness, including forgetting traumatic events (i.e., psychogenic amnesia), reliving experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation), or having episodes of dissociation.
- Changes in self-perception, such as a chronic and pervasive sense of helplessness, paralysis of initiative, shame, guilt, self-blame, a sense of defilement or stigma, and a sense of being completely different from other human beings.
- Varied changes in the perception of the perpetrator, such as attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge, idealization or paradoxical gratitude, seeking approval from the perpetrator, a sense of a special relationship with the perpetrator or acceptance of the perpetrator's belief system or rationalizations.
- Alterations in relations with others, including isolation and withdrawal, persistent distrust, anger and hostility, a repeated search for a rescuer, disruption in intimate relationships and repeated failures of self-protection.
- Loss of, or changes in, one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair.
- Disconnection from surroundings accompanied by feelings of terror and confusion.
Emotional dysregulation in children can be associated with externalizing behaviors including
- exhibiting more extreme emotions
- difficulty identifying emotional cues
- difficulty recognizing their own emotions
- focusing on the negative
- difficulty controlling their attention
- being impulsive
- difficulty decreasing their negative emotions
- difficulty calming down when upset
Emotional dysregulation in children can be associated with internalizing behaviors including
- exhibiting emotions too intense for a situation
- difficulty calming down when upset
- difficulty decreasing negative emotions
- being less able to calm themselves
- difficulty understanding emotional experiences
- becoming avoidant or aggressive when dealing with negative emotions
- experiencing more negative emotions
Avoidant individuals often choose jobs of isolation so that they do not have to interact with the public regularly, due to their anxiety and fear of embarrassing themselves in front of others. Some with this disorder may fantasize about idealized, accepting, and affectionate relationships, due to their desire to belong. Individuals with the disorder tend to describe themselves as uneasy, anxious, lonely, unwanted and isolated from others. They often feel themselves unworthy of the relationships they desire, so they shame themselves from ever attempting to begin them.
People with avoidant personality disorder are preoccupied with their own shortcomings and form relationships with others only if they believe they will not be rejected. Loss and social rejection are so painful that these individuals will choose to be alone rather than risk trying to connect with others (see rejection sensitivity). They often view themselves with contempt, while showing an increased inability to identify traits within themselves that are generally considered as positive within their societies.
- Hypersensitivity to rejection and criticism
- Self-imposed social isolation
- Extreme shyness or anxiety in social situations, though the person feels a strong desire for close relationships
- Avoids physical contact because it has been associated with an unpleasant or painful stimulus
- Feelings of inadequacy
- Drastically reduced or absent self-esteem
- Self-loathing, autophobia or self-harm
- Mistrust of others or oneself; exhibits heightened self-doubt
- Emotional distancing related to intimacy
- Highly self-conscious
- Self-critical about their problems relating to others
- Heightened attachment-related anxiety, which may include a fear of abandonment
- Problems in occupational functioning
- Lonely self-perception, although others may find the relationship with them meaningful
- Feeling inferior to others
- Substance abuse and/or dependence
- In some extreme cases, agoraphobia
- Uses fantasy as a form of escapism to interrupt painful thoughts
ICD-10 describes Reactive Attachment Disorder of Childhood, known as RAD, and Disinhibited Disorder of Childhood, less well known as DAD. DSM-IV-TR also describes Reactive Attachment Disorder of Infancy or Early Childhood. It divides this into two subtypes, Inhibited Type and Disinhibited Type, both known as RAD. The two classifications are similar and both include:
- markedly disturbed and developmentally inappropriate social relatedness in most contexts,
- the disturbance is not accounted for solely by developmental delay and does not meet the criteria for Pervasive Developmental Disorder,
- onset before 5 years of age,
- requires a history of significant neglect, and
- implicit lack of identifiable, preferred attachment figure.
ICD-10 includes in its diagnosis psychological and physical abuse and injury in addition to neglect. This is somewhat controversial, being a "commission" rather than "omission" and because abuse in and of itself does not lead to attachment disorder.
The inhibited form is described as "a failure to initiate or respond...to most social interactions, as manifest by excessively inhibited responses" and such infants do not seek and accept comfort at times of threat, alarm or distress, thus failing to maintain 'proximity', an essential element of attachment behavior. The disinhibited form shows "indiscriminate sociability...excessive familiarity with relative strangers" (DSM-IV-TR) and therefore a lack of 'specificity', the second basic element of attachment behavior. The ICD-10 descriptions are comparable. 'Disinhibited' and 'inhibited' are not opposites in terms of attachment disorder and can co-exist in the same child. The inhibited form has a greater tendency to ameliorate with an appropriate caregiver whilst the disinhibited form is more enduring.
While RAD is likely to occur following neglectful and abusive childcare, there should be no automatic diagnosis on this basis alone as children can form stable attachments and social relationships despite marked abuse and neglect. Abuse can occur alongside the required factors but on its own does not explain attachment disorder. Experiences of abuse are associated with the development of disorganised attachment, in which the child prefers a familiar caregiver, but responds to that person in an unpredictable and somewhat bizarre way. Within official classifications, attachment disorganization is a risk factor but not in itself an attachment disorder. Further although attachment disorders tend to occur in the context of some institutions, repeated changes of primary caregiver or extremely neglectful identifiable primary caregivers who show persistent disregard for the child's basic attachment needs, not all children raised in these conditions develop an attachment disorder.
According to Michael First of the DSM-5 working committee the focus of a relational disorder, in contrast to other DSM-IV disorders, "is on the relationship rather than on any one individual in the relationship".
Relational disorders involve two or more individuals and a disordered "juncture", whereas typical Axis I psychopathology describes a disorder at the individual level. An additional criterion for a relational disorder is that the disorder cannot be due solely to a problem in one member of the relationship, but requires pathological interaction from each of the individuals involved in the relationship.
For example, if a parent is withdrawn from one child but not another, the could be attributed to a relational disorder. In contrast, if a parent is withdrawn from both children, the dysfunction may be more appropriately attributable to a disorder at the individual level.
First states that "relational disorders share many elements in common with other disorders: there are distinctive features for classification; they can cause clinically significant impairment; there are recognizable clinical courses and patterns of comorbidity; they respond to specific treatments; and they can be prevented with early interventions. Specific tasks in a proposed research agenda: develop assessment modules; determine the clinical utility of relational disorders; determine the role of relational disorders in the etiology and maintenance of individual disorders; and consider aspects of relational disorders that might be modulated by individual disorders."
The proposed new diagnosis defines a relational disorder as "persistent and painful patterns of feelings, behaviors, and perceptions" among two or more people in an important personal relationship, such a husband and wife, or a parent and children.
According to psychiatrist Darrel Regier, MD, some psychiatrists and other therapists involved in couples and marital counseling have recommended that the new diagnosis be considered for possible incorporation into the Diagnostic and Statistical Manual of Mental Disorders (DSM IV).
People with HPD are usually high-functioning, both socially and professionally. They usually have good social skills, despite tending to use them to manipulate others into making them the center of attention. HPD may also affect a person's social and/or romantic relationships, as well as their ability to cope with losses or failures. They may seek treatment for clinical depression when romantic (or other close personal) relationships end.
Individuals with HPD often fail to see their own personal situation realistically, instead dramatizing and exaggerating their difficulties. They may go through frequent job changes, as they become easily bored and may prefer withdrawing from frustration (instead of facing it). Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to greater risk of developing clinical depression.
Additional characteristics may include:
- Exhibitionist behavior
- Constant seeking of reassurance or approval
- Excessive sensitivity to criticism or disapproval
- Pride of own personality and unwillingness to change, viewing any change as a threat
- Inappropriately seductive appearance or behavior of a sexual nature
- Using somatic symptoms (of physical illness) to garner attention
- A need to be the center of attention
- Low tolerance for frustration or delayed gratification
- Rapidly shifting emotional states that may appear superficial or exaggerated to others
- Tendency to believe that relationships are more intimate than they actually are
- Making rash decisions
- Blaming personal failures or disappointments on others
- Being easily influenced by others, especially those who treat them approvingly
- Being overly dramatic and emotional
Some people with histrionic traits or personality disorder change their seduction technique into a more maternal or paternal style as they age.
A mnemonic that can be used to remember the characteristics of histrionic personality disorder is shortened as "PRAISE ME":
- Provocative (or seductive) behavior
- Relationships are considered more intimate than they actually are
- Attention-seeking
- Influenced easily by others or circumstances
- Speech (style) wants to impress; lacks detail
- Emotional lability; shallowness
- Make-up; physical appearance is used to draw attention to self
- Exaggerated emotions; theatrical
In psychology, relationship obsessive–compulsive disorder (ROCD) is a form of obsessive-compulsive disorder focusing on intimate relationships (whether romantic or non-romantic). Such obsessions can become extremely distressing and debilitating, having negative impacts on relationships functioning.
Avoidant personality disorder (AvPD) is a Cluster C personality disorder. Those affected display a pattern of severe social anxiety, social inhibition, feelings of inadequacy and inferiority, extreme sensitivity to negative evaluation, and avoidance of social interaction despite a strong desire for intimacy. The behavior is usually noticed by early adulthood and occurs in most situations.
People with AvPD often consider themselves to be socially inept or personally unappealing and avoid social interaction for fear of being ridiculed, humiliated, rejected or disliked. They generally avoid becoming involved with others unless they are certain they will be liked. As the name suggests, the main coping mechanism of those with avoidant personality disorder is avoidance of feared stimuli. Both childhood emotional neglect (in particular, the rejection of a child by one or both parents) and peer group rejection are associated with an increased risk for its development; however, it is possible for AvPD to occur without any notable history of abuse or neglect.
While some scientists claim the exact causes for the disorder are unknown, others found that parents of avoidant children seemed to have difficulty with their own negative emotions. Some researchers have also theorized that certain cases of AvPD may occur when individuals with innately high sensory processing sensitivity (characterized by deeper processing of physical and emotional stimuli, alongside high levels of empathy) are raised in abusive, negligent or otherwise dysfunctional environments, which inhibits their ability to form secure bonds with others.
Mental retardation is coded on Axis II of the DSM-IV-TR. The diagnostic criteria necessary in order to diagnose intellectual disability consists of:
There are varying degrees of intellectual disability, which are identified by an IQ test.
Mental retardation, Severity Unspecified: This unspecified diagnosis is given when there is a strong assumption that the child is mentally retarded, but cannot be tested because the individual is too impaired, not willing to take the IQ test or is an infant.
The fourth revision of the "Diagnostic and Statistical Manual" (DSM-IV-TR) (now replaced by DSM-5) stated that the child must exhibit four out of the eight signs and symptoms to meet the diagnostic threshold for oppositional defiant disorder. Furthermore, they must be perpetuated for longer than six months and must be considered beyond normal child behavior to fit the diagnosis. Signs and symptoms were: actively refuses to comply with majority's requests or consensus-supported rules; performs actions deliberately to annoy others; is angry and resentful of others; argues often; blames others for their own mistakes; frequently loses temper; is spiteful or seeks revenge; and is touchy or easily annoyed.
These patterns of behavior result in impairment at school and/or other social venues.
Children with underlying medical or mental health problems may exhibit some of the symptoms. Indeed, where the difficulties are not predicated in the parental-child nexus, many loving parents may be judged as "spoiling" instead of affirmed. Speech or hearing disorders, and attention deficit disorder, may lead to children's failing to understand the limits set by parents. Children who have recently experienced a stressful event, such as the separation of the parents (divorce) or the birth or death of a close family relative, may also exhibit some or all of the symptoms. Children of parents who themselves have psychiatric disorders may manifest some of the symptoms, because the parents behave erratically, sometimes failing to perceive their children's behavior correctly, and thus fail to properly or consistently define limits of normal behavior for them.
Oppositional defiant disorder (ODD) is defined by the DSM-5 as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness". Unlike children with conduct disorder (CD), children with oppositional defiant disorder are not aggressive towards people or animals, do not destroy property, and do not show a pattern of theft or deceit. A diagnosis of ODD is also no longer applicable if the individual is diagnosed with reactive attachment disorder (RAD).
Disinhibited attachment disorder of childhood (DAD) according to the International Classification of Diseases (ICD-10), is defined as:
Disinhibited attachment disorder is a subtype of the ICD-10 category F94, "Disorders of social functioning with onset specific to childhood and adolescence". The other subtype of F94 is reactive attachment disorder of childhood (RAD – F94 .1).
Synonymous or similar disorders include Affectionless psychopathy and Institutional syndrome.
Within the ICD-10 category scheme, disinhibited attachment disorder specifically excludes Asperger syndrome (F84.5), hospitalism in children (F43.2), and hyperkinetic disorders (F90.-).
Compulsive hoarding, also known as hoarding disorder, is a pattern of behavior that is characterized by excessive acquisition and an inability or unwillingness to discard large quantities of objects that cover the living areas of the home and cause significant distress or impairment. Compulsive hoarding behavior has been associated with health risks, impaired functioning, economic burden, and adverse effects on friends and family members. When clinically significant enough to impair functioning, hoarding can prevent typical uses of space, enough so that it can limit activities such as cooking, cleaning, moving through the house, and sleeping. It can also put the individual and others at risk of fires, falling, poor sanitation, and other health concerns. Compulsive hoarders may be aware of their irrational behavior, but the emotional attachment to the hoarded objects far exceeds the motive to discard the items.
Researchers have only recently begun to study hoarding, and it was first defined as a mental disorder in the 5th edition of the DSM in 2013. It was not clear whether compulsive hoarding is a separate, isolated disorder, or rather a symptom of another condition, such as OCD, but the current DSM lists hoarding disorder as both a mental disability and a possible symptom for OCD. Prevalence rates have been estimated at 2% to 5% in adults, though the condition typically manifests in childhood with symptoms worsening in advanced age, at which point collected items have grown excessive and family members who would otherwise help to maintain and control the levels of clutter have either died or moved away. Hoarding appears to be more common in people with psychological disorders such as depression, anxiety and attention deficit hyperactivity disorder (ADHD). Other factors often associated with hoarding include alcohol dependence, paranoid schizotypal and avoidance traits.
In 2008, a study was conducted to determine if there is a significant link between hoarding and interference in occupational and social functioning. Hoarding behavior is often severe because hoarders do not recognize it as a problem. It is much harder for behavioral therapy to successfully treat compulsive hoarders with poor insight about their disorder. Results show that hoarders were significantly less likely to see a problem in a hoarding situation than a friend or a relative might. This is independent of OCD symptoms, as people with OCD are often very aware of their disorder, which suggests a possible association with OCPD where the behavior are ego-syntonic. The opposite condition is compulsive decluttering.
Obsessive-compulsive disorder comprises thoughts, images or urges that are unwanted, distressing, interfere with a person's life and that are commonly experienced as contradicting a persons' beliefs and values. Such intrusive thoughts are frequently followed by compulsive behaviors aimed at "neutralizing" the feared consequence of the intrusions and temporarily relieve the anxiety caused by the obsessions. Attempts to suppress or "neutralize" obsessions increase rather than decrease the frequency and distress caused by the obsessions.
Common obsessive themes include fear of contamination, fears about being responsible for harming the self or others, doubts, and orderliness. However, people with OCD can also have religious and sexual obsessions. Some people with OCD may experience obsessions relating to the way they feel in an ongoing relationship or the way they felt in past relationships (ROCD). Repetitive thought about a person's feelings in intimate relationships may occur in the natural course of the relationship development; however, in ROCD such preoccupations are unwanted, intrusive, chronic and disabling.
According to Shear et al. (2011):
- The person has been bereaved (i.e. experienced the death of a loved one) for at least six months
- At least one of the following symptoms of persistent, intense, acute grief has been present for a period longer than is expected by others in the person’s social (or cultural) environment:
- Persistent intense yearning or longing for the person who died
- Frequent intense feelings of loneliness, or that life is empty or meaningless without the person who died
- Recurrent thoughts that it is unfair, meaningless or unbearable to live when a loved one has died, or a recurrent urge to die in order to find (or join) the deceased
- Frequent preoccupying thoughts about the person who died; e.g. thoughts or images of the person intrude on activities or interfere with functioning
- At least two of the following symptoms are present for at least one month:
- Frequent, troubling rumination about the circumstances (or consequences) of the death (concerns about how or why the person died, about not being able to manage without their loved one, thoughts of having let the deceased person down, etc.)
- Recurrent feeling of disbelief or inability to accept the death
- Persistent feeling of shock; feeling stunned, dazed or emotionally numb since the death
- Recurrent feelings of anger or bitterness related to the death
- Persistent difficulty trusting or caring about other people, or envy of others who have not experienced a similar loss
- Frequently experiencing pain (or other symptoms) that the deceased person had, hearing the voice of (or seeing) the deceased person
- Experiencing intense emotional or physiological reactivity to memories of the person who died or to reminders of the loss
- Changes in behavior due to avoidance (or its opposite, excessive proximity-seeking—refraining from going places, doing things, or having contact with things that are reminders of the loss; feeling drawn to reminders of the person—wanting to see, touch, hear or smell things to feel close to the person who died). Both symptoms may coexist in the same individual.
- Duration of symptoms and impairment of at least one month
- Symptoms cause clinically significant distress or impairment in social, occupational or other major areas of functioning, where impairment is not explicable as a culturally appropriate response
Compulsive hoarding in its worst forms can cause fires, unsanitary conditions (such as rat and roach infestations), and other health and safety hazards.
Listed below are possible symptoms hoarders may experience:
- They hold onto a large number of items that most people would consider useless or worthless, such as:
- Junk mail, old catalogs, magazines, and newspapers
- Worn out cooking equipment
- Things that might be useful for making crafts
- Clothes that might be worn one day
- Broken things or trash
- "Freebies" or other promotional products
- Their home is cluttered to the point where many parts are inaccessible and can no longer be used for intended purposes. For example:
- Beds that cannot be slept in
- Kitchens that cannot be used for food preparation
- Tables, chairs, or sofas that cannot be used for dining or sitting
- Unsanitary bathrooms
- Tubs, showers, and sinks filled with items and can no longer be used for washing or bathing.
- Their clutter and mess is at a point where it can cause illness, distress, and impairment. As a result, they:
- Do not allow visitors in, such as family and friends, or repair and maintenance professionals, because the clutter embarrasses them
- Are reluctant or unable to return borrowed items
- Keep the shades drawn so that no one can look inside
- Get into a lot of arguments with family members regarding the clutter
- Are at risk of fire, falling, infestation, or eviction
- Often feel depressed or anxious due to the clutter
Dissociative disorders (DD) are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception. People with dissociative disorders use dissociation, as a defence mechanism, pathologically and involuntarily. Dissociative disorders are sometimes triggered by psychological trauma, but may be preceded only by stress, psychoactive substances, or no identifiable trigger at all.
The dissociative disorders listed in the American Psychiatric Association's DSM-5 are as follows:
- Dissociative identity disorder (formerly multiple personality disorder): the alternation of two or more distinct personality states with impaired recall among personality states. In extreme cases, the host personality is unaware of the other, alternating personalities; however, the alternate personalities can be aware of all the existing personalities. This category now includes the old derealization disorder category.
- Dissociative amnesia (formerly psychogenic amnesia): the temporary loss of recall memory, specifically episodic memory, due to a traumatic or stressful event. It is considered the most common dissociative disorder amongst those documented. This disorder can occur abruptly or gradually and may last minutes to years depending on the severity of the trauma and the patient.
- Dissociative fugue (formerly psychogenic fugue) is now subsumed under the dissociative amnesia category. It is described as reversible amnesia for personal identity, usually involving unplanned travel or wandering, sometimes accompanied by the establishment of a new identity. This state is typically associated with stressful life circumstances and can be short or lengthy.
- Depersonalization disorder: periods of detachment from self or surrounding which may be experienced as "unreal" (lacking in control of or "outside" self) while retaining awareness that this is only a feeling and not a reality.
- The old category of dissociative disorder not otherwise specified is now split into two: Other specified dissociative disorder, and unspecified dissociative disorder. These categories are used for forms of pathological dissociation that do not fully meet the criteria of the other specified dissociative disorders, or if the correct category has not been determined.
Both dissociative amnesia and dissociative fugue usually emerge in adulthood and rarely occur after the age of 50. The ICD-10 classifies conversion disorder as a dissociative disorder while the DSM-IV classifies it as a somatoform disorder.
Richard Weaver, in his work "Ideas Have Consequences", introduced the term “spoiled child psychology” in 1948. In 1989, Bruce McIntosh coined the term the "spoiled child syndrome". The syndrome is characterized by "excessive, self-centered, and immature behavior". It includes lack of consideration for other people, recurrent temper tantrums, an inability to handle the delay of gratification, demands for having one's own way, obstructiveness, and manipulation to get their way. McIntosh attributed the syndrome to "the failure of parents to enforce consistent, age-appropriate limits", but others, such as Aylward, note that temperament is probably a contributory factor. It is important to note that the temper tantrums are "recurrent". McIntosh observes that "many of the problem behaviors that cause parental concern are unrelated to spoiling as properly understood". Children may have occasional temper tantrums without them falling under the umbrella of "spoiled". Extreme cases of spoiled child syndrome, in contrast, will involve "frequent" temper tantrums, physical aggression, defiance, destructive behavior, and refusal to comply with even the simple demands of daily tasks. This can be similar to the profile of children diagnosed with Pathological Demand Avoidance, which is part of the autism spectrum.