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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Money disorders are the maladaptive patterns of financial beliefs and behaviors that lead to clinically significant distress, impairment in social or occupational functioning, due to financial strain or an inability to appropriately enjoy one’s financial resources. With the exception of pathological gambling and compulsive buying, psychology and the mental health fields have largely neglected dysfunctional money disorders. The term is contentious among mental health professionals and as of 2017, money disorder is not a clinical diagnosis in either the DSM or ICD medical classifications of diseases and medical disorders.
Types of behaviors, or “scripts”, related to money disorders include money avoidance, money worship, money status and money vigilance. Some mental health practitioners say that those afflicted with money disorders or who have problematic money beliefs can seek financial therapy. With financial therapy, financial planners and relationship therapists work together to provide comprehensive treatment to clients experiencing financial distress.
Codependency is a type of dysfunctional helping relationship where one person supports or enables another person's drug addiction, alcoholism, gambling addiction, poor mental health, immaturity, irresponsibility, or under-achievement. Among the core characteristics of codependency, the most common theme is an excessive reliance on other people for approval and a sense of identity.
Given its grassroots origin, the precise definition of codependency varies based on the source but can be generally characterized as a subclinical and situational or episodic behavior similar to that of dependent personality disorder. In its broadest definition, a codependent is someone who cannot function from their innate self and whose thinking and behavior is instead organized around another person, or even a process, or substance. In this context, people who are addicted to a substance, like drugs, or a process, like gambling or sex, can also be considered codependent. In its most narrow definition, it requires one person to be physically or psychologically addicted, such as to heroin, and the second person to be psychologically dependent on that behavior. Some users of the codependency concept use the word as an alternative to using the concept of dysfunctional families, without statements that classify it as a disease.
Codependency does not refer to all caring behavior or feelings, but only those that are excessive to an unhealthy degree. One of the distinctions is that healthy empathy and caregiving is motivated by conscious choice; whereas for codependents, their actions are compulsive, and they usually aren't able to weigh in the consequences of them or their own needs that they're sacrificing. Some scholars and treatment providers feel that codependency is an overresponsibility and that overresponsibility needs to be understood as a positive impulse gone awry. Responsibility for relationships with others needs to coexist with responsibility to self.
Codependency has been referred to as the disease of a lost self. Codependent relationships are marked by intimacy problems, dependency, control (including caretaking) denial, dysfunctional communication and boundaries, and high reactivity. Often, there is imbalance, so one person is abusive or in control or supports or enables another person's addiction, poor mental health, immaturity, irresponsibility, or under-achievement. Some codependents often find themselves in relationships where their primary role is that of rescuer, supporter, and confidante. These helper types are often dependent on the other person's poor functioning to satisfy their own emotional needs. Many codependents place a lower priority on their own needs, while being excessively preoccupied with the needs of others. Codependency can occur in any type of relationship, including family, work, friendship, and also romantic, peer or community relationships.
Commonly cited symptoms of codependency are:
- intense and unstable interpersonal relationships
- inability to tolerate being alone, accompanied by frantic efforts to avoid being alone
- chronic feelings of boredom and emptiness
- subordinating one's own needs to those of the person with whom one is involved
- overwhelming desire for acceptance and affection
- perfectionism
- over-controlling
- external referencing
- dishonesty and denial
- manipulation
- lack of trust
- low self-worth.
Warning signs of the disorder include:
- A child who has one or more medical problems that do not respond to treatment or that follow an unusual course that is persistent, puzzling, and unexplained.
- Physical or laboratory findings that are highly unusual, discrepant with patient's presentation or history, or physically or clinically impossible.
- A parent who appears medically knowledgeable, fascinated with medical details and hospital gossip, appears to enjoy the hospital environment and expresses interest in the details of other patients' problems.
- A highly attentive parent who is reluctant to leave their child's side and who themselves seem to require constant attention.
- A parent who appears unusually calm in the face of serious difficulties in their child's medical course while being highly supportive and encouraging of the physician, or one who is angry, devalues staff and demands further intervention, more procedures, second opinions, and transfers to other more sophisticated facilities.
- The suspected parent may work in the health care field themselves or profess an interest in a health-related job.
- The signs and symptoms of a child's illness may lessen or simply vanish in the parent's absence (hospitalization and careful monitoring may be necessary to establish this causal relationship).
- A family history of similar or unexplained illness or death in a sibling.
- A parent with symptoms similar to their child's own medical problems or an illness history that itself is puzzling and unusual.
- A suspected emotionally distant relationship between parents; the spouse often fails to visit the patient and has little contact with physicians even when the child is hospitalized with a serious illness.
- A parent who reports dramatic, negative events, such as house fires, burglaries, or car accidents, that affect them and their family while their child is undergoing treatment.
- A parent who seems to have an insatiable need for adulation or who makes self-serving efforts for public acknowledgment of their abilities.
- A patient who inexplicably deteriorates whenever discharge is planned.
An addictive personality refers to a particular set of personality traits that make an individual predisposed to developing addictions. This hypothesis states that there may be common personality traits observable in people suffering from addiction. Alan R. Lang of Florida State University, author of an addiction study prepared for the United States National Academy of Sciences, said, "If we can better identify the personality factors, they can help us devise better treatment and can open up new strategies to intervene and break the patterns of addiction."
The main observed symptoms of OCPD are (1) preoccupation with remembering past events, (2) paying attention to minor details, (3) excessive compliance with existing social customs, rules or regulations, (4) unwarranted compulsion to note-taking, or making lists and schedules, and (5) rigidity of one's own beliefs, or (6) showing unreasonable degree of perfectionism that could eventually interfere with completing the task at hand.
OCPD's symptoms may cause varying level of distress for varying length of time (transient, acute, or chronic), and may interfere with the patient's occupational, social, and romantic life.
In factitious disorder imposed on another, a caregiver makes a dependent person appear mentally or physically ill in order to gain attention. To perpetuate the medical relationship, the caregiver systematically misrepresents symptoms, fabricates signs, manipulates laboratory tests, or even purposely harms the dependent (e.g. by poisoning, suffocation, infection, physical injury). Studies have shown a mortality rate of between 6% and 10%, making it perhaps the most lethal form of abuse.
At the time of diagnosis, the average age of the persons affected was 4 years. Slightly over 50% were aged 24 months or younger, and 75% were under 6 years old. The average duration from onset of symptoms to diagnosis was 22 months. By the time of diagnosis, 6% of the affected persons were dead, mostly from apnea (a common result of smothering) or starvation, and 7% suffered long-term or permanent injury. About half of the affected had siblings; 25% of the known siblings were dead, and 61% of siblings had symptoms similar to the affected or that was otherwise suspicious. The mother was the perpetrator in 76.5% of the cases, the father in 6.7%.
Most present about 3 medical problems in some combination of the 103 different reported symptoms. The most frequently reported problems are apnea (26.8% of cases), anorexia / feeding problems (24.6% of cases), diarrhea (20%), seizures (17.5%), cyanosis (blue skin) (11.7%), behavior (10.4%), asthma (9.5%), allergy (9.3%), and fevers (8.6%). Other symptoms include failure to thrive, vomiting, bleeding, rash and infections. Many of these symptoms are easy to fake because they are subjective. A parent reporting that their child had a fever in the past 24 hours is making a claim that is impossible to prove or disprove. The number and variety of presented symptoms contribute to the difficulty in reaching a proper MSbP diagnosis.
Aside from the motive (which is to gain attention or sympathy), another feature that differentiates MSbP from "typical" physical child abuse is the degree of premeditation involved. Whereas most physical abuse entails lashing out at a child in response to some behavior (e.g., crying, bedwetting, spilling food), assaults on the MSbP victim tend to be unprovoked and planned.
Also unique to this form of abuse is the role that health care providers play by actively, albeit unintentionally, enabling the abuse. By reacting to the concerns and demands of perpetrators, medical professionals are manipulated into a partnership of child maltreatment. Challenging cases that defy simple medical explanations may prompt health care providers to pursue unusual or rare diagnoses, thus allocating, even more, time to the child and the abuser. Even without prompting, medical professionals may be easily seduced into prescribing diagnostic tests and therapies that are at best uncomfortable and costly, and at worst potentially injurious to the child. If the health practitioner instead resists ordering further tests, drugs, procedures, surgeries, or specialists, the MSbP abuser makes the medical system appear negligent for refusing to help a poor sick child and their selfless parent. Like those with Munchausen syndrome, MSbP perpetrators are known to switch medical providers frequently until they find one that is willing to meet their level of need; this practice is known as "doctor shopping" or "hospital hopping".
The perpetrator continues the abuse because maintaining the child in the role of patient satisfies the abuser's needs. The cure for the victim is to separate the child completely from the abuser. When parental visits are allowed, sometimes there is a disastrous outcome for the child. Even when the child is removed, the perpetrator may then abuse another child: a sibling or other child in the family.
Factitious disorder imposed on another can have many long-term emotional effects on a child. Depending on their experience of medical interventions, a percentage of children may learn that they are most likely to receive the positive maternal attention they crave when they are playing the sick role in front of health care providers. Several case reports describe Munchausen syndrome patients suspected of themselves having been MSbP victims. Seeking personal gratification through illness can thus become a lifelong and multi-generational disorder in some cases. In stark contrast, other reports suggest survivors of MSbP develop an avoidance of medical treatment with post-traumatic responses to it. This variation possibly reflects broad statistics on survivors of child abuse in general, where around 30% go on to also become abusers even though a significant percentage do not.
The adult care provider who has abused the child often seems comfortable and not upset over the child's hospitalization. While the child is hospitalized, medical professionals must monitor the caregiver's visits to prevent an attempt to worsen the child's condition. In addition, in many jurisdictions, medical professionals have a duty to report such abuse to legal authorities.
Experts describe the spectrum of behaviors designated as addictive in terms of five interrelated concepts: patterns, habits, compulsions, impulse control disorders, and physical addiction.
Obsessive–compulsive personality disorder (OCPD) is a personality disorder characterized by a general pattern of concern with orderliness, perfectionism, excessive attention to details, mental and interpersonal control, and a need for control over one's environment, at the expense of flexibility, openness to experience, and efficiency. Workaholism and miserliness are also seen often in those with this personality disorder. Persons affected with this disorder may find it hard to relax, always feeling that time is running out for their activities, and that more effort is needed to achieve their goals. They may plan their activities down to the minute—a manifestation of the compulsive tendency to keep control over their environment and to dislike unpredictable things as things they cannot control.
The cause of OCPD is unknown. This is a distinct disorder from obsessive–compulsive disorder (OCD), and the relation between the two is contentious. Some (but not all) studies have found high comorbidity rates between the two disorders, and both may share outside similaritiesrigid and ritual-like behaviors, for example. Hoarding, orderliness, and a need for symmetry and organization are often seen in people with either disorder. Attitudes toward these behaviors differ between people affected with either of the disorders: for people with OCD, these behaviors are unwanted and seen as unhealthy, being the product of anxiety-inducing and involuntary thoughts, while for people with OCPD they are egosyntonic (that is, they are perceived by the subject as rational and desirable), being the result of, for example, a strong adherence to routines, a natural inclination towards cautiousness, or a desire to achieve perfection.
OCPD occurs in about 2–8% of the general population and 8–9% of psychiatric outpatients. The disorder occurs more often in men.
People who demonstrate factitious disorders often claim to have physical ailments or be recovering from the consequences of stalking, victimization, harassment, and sexual abuse. Several behaviors present themselves to suggest factors beyond genuine problems. After studying 21 cases of deception, Feldman listed the following common behavior patterns in people who exhibited Munchausen by Internet:
- Medical literature from websites or textbooks is often duplicated or discussed in great detail.
- The length and severity of purported physical ailments conflicts with user behavior. Feldman uses the example of someone posting in considerable detail about being in septic shock, when such a possibility is extremely unlikely.
- Symptoms of ailments may be exaggerated as they correspond to a user's misunderstanding of the nature of an illness.
- Grave situations and increasingly critical prognoses are interspersed with "miraculous" recoveries.
- A user's posts eventually reveal contradictory information or claims that are implausible: for example, other users of a forum may find that a user has been divulging contradictory information about occurrence or length of hospital visits.
- When attention and sympathy decreases to focus on other members of the group, a user may announce that other dire events have transpired, including the illness or death of a close family member.
- When faced with insufficient expressions of attention or sympathy, a forum member claims this as a cause that symptoms worsen or do not improve.
- A user resists contact beyond the Internet, such as by telephone or personal visit, often claiming bizarre reasons for not being able to accept such contact.
- Further emergencies are described with inappropriate happiness, designed to garner immediate reactions.
- The posts of other forum members exhibit identical writing styles, spelling errors, and language idiosyncrasies, suggesting that the user has created fictitious identities to move the conversation in their direction.
Children with persistent GID are characterized by more extreme gender dysphoria in childhood than children with desisting gender dysphoria. Some (but not all) gender diverse / gender independent / gender fluid youth will want or need to transition, which may involve social transition (changing dress, name, pronoun), and, for older youth and adolescents, medical transition (hormonal and surgical intervention). Treatment may take the form of puberty blockers such as Lupron Depot or Leuprolide Acetate, or cross-sex hormones (i.e., administering estrogen to an assigned male at birth or testosterone to an assigned female at birth), or surgery (i.e., mastectomies, salphingo-oophorectomies/hysterectomy, the creation of a neophallus in female-to-male transsexuals, orchiectomies, breast augmentation, facial feminization surgery, the creation of a neovagina in male-to-female transsexuals), with the aim of bringing one’s physical body in line with their felt gender. The ability to transition (socially and medically) are sometimes needed in the treatment of gender dysphoria.
The Endocrine Society does not recommend endocrine treatment of prepubertal children because clinical experience suggests that GID can be reliably assessed only after the first signs of puberty. It recommends treating transsexual adolescents by suppressing puberty with puberty blockers until age 16 years old, after which cross-sex hormones may be given.
The University of Washington is leading the largest study of transgender youth ever conducted. The study, known as the Transgender Youth Project, looks at 300 transgender kids between the ages of 3 and 12. Researchers hope to follow the children for 20 years.
CBD is frequently comorbid with mood, anxiety, substance abuse and eating disorders. People who score highly on compulsive buying scales tend to understand their feelings poorly and have low tolerance for unpleasant psychological states such as bad moods. Onset of CBD occurs in the late teens and early twenties and is generally chronic. CBD is similar to, but distinguished from, OCD hoarding and mania. Compulsive buying is not limited to people who spend beyond their means; it also includes people who spend an inordinate amount of time shopping or who chronically think about buying things but never purchase them. Promising treatments for CBD include medication such as selective serotonin reuptake inhibitors (SSRIs), and support groups such as Debtors Anonymous.
Munchausen by Internet is a pattern of behavior akin to Munchausen syndrome (renamed factitious disorder imposed on self), a psychiatric disorder, wherein those affected feign disease, illness, or psychological trauma to draw attention, sympathy, or reassurance to themselves. In Munchausen by internet, users seek attention by feigning illnesses in online venues such as chat rooms, message boards, and Internet Relay Chat (IRC). It has been described in medical literature as a manifestation of factitious disorder imposed on self, or if claiming illness of a child or other family member, factitious disorder imposed on another. Reports of users who deceive Internet forum participants by portraying themselves as gravely ill or as victims of violence first appeared in the 1990s due to the relative newness of Internet communications. The pattern was identified in 1998 by psychiatrist Marc Feldman, who created the term "Münchausen by Internet" in 2000. It is not included in the fifth revision of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5).
The development of factitious disorders in online venues is made easier by the availability of medical literature on the Internet, the anonymous and malleable nature of online identities, and the existence of communication forums established for the sole purpose of giving support to members facing significant health or psychological problems. Several high-profile cases have demonstrated behavior patterns which are common among those who pose as gravely ill or as victims of violence, or whose deaths are announced to online forums. The virtual communities that were created to give support, as well as general non-medical communities, often express genuine sympathy and grief for the purported victims. When fabrications are suspected or confirmed, the ensuing discussion can create schisms in online communities, destroying some and altering the trusting nature of individual members in others.
Internet addiction disorder, more commonly called problematic Internet use (PIU), refers to excessive Internet use that interferes with daily life.
Gender dysphoria in children or gender identity disorder in children (GIDC) is a formal diagnosis used by psychologists and physicians to describe children who experience significant discontent (gender dysphoria) with their biological sex, assigned gender, or both.
GIDC was formalized in the third revision of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-III) in 1980 and primarily referenced gender non-conforming behaviors. GIDC remained in the DSM from 1980 to 2013, when it was replaced with the diagnosis of "gender dysphoria" in the fifth revision (DSM-5), in an effort to diminish the stigma attached to gender variance while maintaining a diagnostic route to gender affirming medical interventions such as hormone therapy and surgery.
Controversy surrounding the pathologization and treatment of cross-gender identity and behaviors, particularly in children, has been evident in the literature since the 1980s. Proponents of more widespread GIDC diagnoses argue that therapeutic intervention helps children be more comfortable in their bodies and can prevent adult gender identity disorder. Opponents say that the equivalent therapeutic interventions with gays and lesbians (titled conversion or reparative therapy) have been strongly questioned or declared unethical by the American Psychological Association, American Psychiatric Association, American Association of Social Workers and American Academy of Pediatrics. The World Professional Association for Transgender Health (WPATH) states that treatment aimed at trying to change a person's gender identity and expression to become more congruent with sex assigned at birth "is no longer considered ethical." Critics also argue that the GIDC diagnosis and associated therapeutic interventions rely on the assumption that an adult transsexual identity is undesirable, challenging this assumption along with the lack of clinical data to support outcomes and efficacy.
Gender identity disorder in children is more heavily linked with adult homosexuality than adult transsexualism. According to limited studies, the majority of children diagnosed with GID cease to desire to be the other sex by puberty, with most growing up to identify as gay or lesbian with or without therapeutic intervention.
The terms compulsive shopping, compulsive buying, and compulsive spending are often used interchangeably, but the behaviors they represent are in fact distinct. (Nataraajan and Goff 1992) One may buy without shopping, and certainly shop without buying: of compulsive shoppers, some 30% described the act of buying itself as providing a buzz, irrespective of the goods purchased.
Courtship disorder is a theoretical construct in sexology in which a certain set of paraphilias are seen as specific instances of anomalous courtship instincts in men. The specific paraphilias are biastophilia (paraphilic rape), exhibitionism, frotteurism, telephone scatologia, and voyeurism. According to the "courtship disorder hypothesis", there is a species-typical courtship process in human males consisting of four phases, and anomalies in different phases result in one of these paraphilic sexual interests. That is, instead of being independent paraphilias, this theory sees these sexual interests as individual symptoms of a single underlying disorder.
Attraction to disability or devotism is a sexualised interest in the appearance, sensation and experience of disability. It may extend from normal human sexuality into a type of sexual fetishism. Sexologically, the pathological end of the attraction tends to be classified as a paraphilia. (Note, however, that the very concept "paraphilia" continues to elude satisfactory definition and remains a subject of ongoing debate in both professional and lay communities) Other researchers have approached it as a form of identity disorder. The most common interests are towards amputations, prosthesis, and crutches.
Shopping addiction is defined as the deficiency of impulse control which appears as the eagerness for constantly making new purchases of unnecessary or superfluous things. It is a concept similar to "compulsive buying disorder" and "oniomania", although these terms usually have a more clinical approach, related to a psychological individual disorder of impulse control. The phrase “shopping addiction” usually has a more psychosocial perspective . or it is placed among drug-free addictions like the addiction to gambling, Internet, or video-games.
Trichotillomania is classified as compulsive picking of hair of the body. It can be from any place on the body that has hair. This picking results in bald spots. Most people who have mild Trichotillomania can overcome it via concentration and more self-awareness.
Those that suffer from compulsive skin picking have issues with picking, rubbing, digging, or scratching the skin. These activities are usually to get rid of unwanted blemishes or marks on the skin. These compulsions also tend to leave abrasions and irritation on the skin. This can lead to infection or other issues in healing. These acts tend to be prevalent in times of anxiety, boredom, or stress.
Compulsive behavior is defined as performing an act persistently and repetitively without it necessarily leading to an actual reward or pleasure. Compulsive behaviors could be an attempt to make obsessions go away. The act is usually a small, restricted and repetitive behavior, yet not disturbing in a pathological way. Compulsive behaviors are a need to reduce apprehension caused by internal feelings a person wants to abstain from or control. A major cause of the compulsive behaviors is said to be obsessive–compulsive disorder (OCD). "The main idea of compulsive behavior is that the likely excessive activity is not connected to the purpose to which it appears directed." Furthermore, there are many different types of compulsive behaviors including, shopping, hoarding, eating, gambling, trichotillomania and picking skin, checking, counting, washing, sex, and more. Also, there are cultural examples of compulsive behavior.
Until the 1990s, it tended to be described mostly as acrotomophilia, at the expense of other disabilities, or of the wish by some to pretend or acquire disability. Bruno (1997) systematised the attraction as factitious disability disorder. A decade on, others argue that erotic target location error is at play, classifying the attraction as an identity disorder. In the standard psychiatric reference "Diagnostic and Statistical Manual of Mental Disorders", text revision (DSM-IV-tr), the fetish falls under the general category of "Sexual and Gender Identity Disorders" and the more specific category of paraphilia, or sexual fetishes; this classification is preserved in DSM-5.
Animal hoarding is keeping a higher-than-usual number of animals as domestic pets without ability to properly house or care for them, while at the same time denying this inability. Compulsive hoarding can be characterized as a symptom of mental disorder rather than deliberate cruelty towards animals. Hoarders are deeply attached to their pets and find it extremely difficult to let the pets go. They typically cannot comprehend that they are harming their pets by failing to provide them with proper care. Hoarders tend to believe that they provide the right amount of care for them. The American Society for the Prevention of Cruelty to Animals provides a "Hoarding Prevention Team", which works with hoarders to help them attain a manageable and healthy number of pets.
Addiction is defined by Webster Dictionary as a "compulsive need for and use of a habit-forming substance characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly: persistent compulsive use of a substance known by the user to be harmful".
Problematic Internet use is also called compulsive Internet use (CIU), Internet overuse, problematic computer use, or pathological computer use (PCU), problematic Internet use (PIU), or Internet addiction disorder (IAD)). Another commonly associated pathology is video game addiction, or Internet gaming disorder (IGD).
Research by governments in Australia led to a universal definition for that country which appears to be the only research-based definition not to use diagnostic criteria: "Problem gambling is characterized by many difficulties in limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or for the community." The University of Maryland Medical Center defines pathological gambling as "being unable to resist impulses to gamble, which can lead to severe personal or social consequences".
Most other definitions of problem gambling can usually be simplified to any gambling that causes harm to the gambler or someone else in any way; however, these definitions are usually coupled with descriptions of the type of harm or the use of diagnostic criteria. The "DSM-V" has since reclassified pathological gambling as "gambling disorder" and has listed the disorder under substance-related and addictive disorders rather than impulse-control disorders. This is due to the symptomatology of the disorder resembling an addiction not dissimilar to that of substance-abuse. There are both environmental and genetic factors that can influence on gambler and cause some type of addiction. In order to be diagnosed, an individual must have at least four of the following symptoms in a 12-month period:
- Needs to gamble with increasing amounts of money in order to achieve the desired excitement
- Is restless or irritable when attempting to cut down or stop gambling
- Has made repeated unsuccessful efforts to control, cut back, or stop gambling
- Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble)
- Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed)
- After losing money gambling, often returns another day to get even ("chasing" one's losses)
- Lies to conceal the extent of involvement with gambling
- Has jeopardized or lost a significant relationship, job, education or career opportunity because of gambling
- Relies on others to provide money to relieve desperate financial situations caused by gambling