# data[].attributes.attachment_link.readable_text
Overview

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.

Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).
Bipolar disorder care at Mayo Clinic
Symptoms

There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.

Bipolar I disorder. You've had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).

Bipolar II disorder. You've had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode.

Cyclothymic disorder. You've had at least two years - or one year in children and teenagers - of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).

Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.

Mania and hypomania

Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.

Both a manic and a hypomanic episode include three or more of these symptoms:

Abnormally upbeat, jumpy or wired

Increased activity, energy or agitation

Exaggerated sense of well-being and self-confidence (euphoria)

Decreased need for sleep

Unusual talkativeness

Racing thoughts

Distractibility

Poor decision-making - for example, going on buying sprees, taking sexual risks or making foolish investments

Major depressive episode

A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:

Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)

Marked loss of interest or feeling no pleasure in all - or almost all - activities

Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)

Either insomnia or sleeping too much

Either restlessness or slowed behavior

Fatigue or loss of energy

Feelings of worthlessness or excessive or inappropriate guilt

Decreased ability to think or concentrate, or indecisiveness

Thinking about, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.

Symptoms in children and teens

Symptoms of bipolar disorder can be difficult to identify in children and teens. It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.

Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes.

The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.

When to see a doctor

Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones and don't get the treatment they need.

And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out - and perhaps in financial, legal or relationship trouble.

If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control.

When to get emergency help

Suicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

Causes

The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.

Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

Risk factors

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

Having a first-degree relative, such as a parent or sibling, with bipolar disorder

Periods of high stress, such as the death of a loved one or other traumatic event

Drug or alcohol abuse

Complications

Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as:

Problems related to drug and alcohol use

Suicide or suicide attempts

Legal or financial problems

Damaged relationships

Poor work or school performance

Co-occurring conditions

If you have bipolar disorder, you may also have another health condition that needs to be treated along with bipolar disorder. Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include:

Anxiety disorders

Eating disorders

Attention-deficit/hyperactivity disorder (ADHD)

Alcohol or drug problems

Physical health problems, such as heart disease, thyroid problems, headaches or obesity

Prevention

There's no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.

If you've been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:

Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you're falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.

Avoid drugs and alcohol. Using alcohol or recreational drugs can worsen your symptoms and make them more likely to come back.

Take your medications exactly as directed. You may be tempted to stop treatment - but don't. Stopping your medication or reducing your dose on your own may cause withdrawal effects or your symptoms may worsen or return.

# data[].attributes.attachment_link.description
Bipolar disorder causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

# data[].attributes.attachment_link.provider_name
National Institute of Mental Health (NIMH)

# data[].attributes.attachment_link.readable_text
What is anxiety?

Occasional anxiety is a normal part of life. Many people worry about things such as health, money, or family problems. But anxiety disorders involve more than temporary worry or fear. For people with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder, and various phobia-related disorders.

What are the signs and symptoms of anxiety?

What are the risk factors for anxiety?

How is anxiety treated?

How can I find a clinical trial for anxiety?

Where can I learn more about anxiety?

# data[].attributes.attachment_link.description
Learn about anxiety disorders, including signs and symptoms, types, risk factors, and potential treatments and therapies.

# data[].attributes.attachment_link.readable_text
Overview

Separation anxiety is a normal stage of development for infants and toddlers. Young children often experience a period of separation anxiety, but most children outgrow separation anxiety by about 3 years of age.

In some children, separation anxiety is a sign of a more serious condition known as separation anxiety disorder, starting as early as preschool age.

If your child's separation anxiety seems intense or prolonged - especially if it interferes with school or other daily activities or includes panic attacks or other problems - he or she may have separation anxiety disorder. Most frequently this relates to the child's anxiety about his or her parents, but it could relate to another close caregiver.

Less often, separation anxiety disorder can also occur in teenagers and adults, causing significant problems leaving home or going to work. But treatment can help.

Symptoms

Separation anxiety disorder is diagnosed when symptoms are excessive for the developmental age and cause significant distress in daily functioning. Symptoms may include:

Recurrent and excessive distress about anticipating or being away from home or loved ones

Constant, excessive worry about losing a parent or other loved one to an illness or a disaster

Constant worry that something bad will happen, such as being lost or kidnapped, causing separation from parents or other loved ones

Refusing to be away from home because of fear of separation

Not wanting to be home alone and without a parent or other loved one in the house

Reluctance or refusing to sleep away from home without a parent or other loved one nearby

Repeated nightmares about separation

Frequent complaints of headaches, stomachaches or other symptoms when separation from a parent or other loved one is anticipated

Separation anxiety disorder may be associated with panic disorder and panic attacks ― repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes.

When to see a doctor

Separation anxiety disorder usually won't go away without treatment and can lead to panic disorder and other anxiety disorders into adulthood.

If you have concerns about your child's separation anxiety, talk to your child's pediatrician or other health care provider.

Causes

Sometimes, separation anxiety disorder can be triggered by life stress that results in separation from a loved one. Genetics may also play a role in developing the disorder.

Risk factors

Separation anxiety disorder most often begins in childhood, but may continue into the teenage years and sometimes into adulthood.

Risk factors may include:

Life stresses or loss that result in separation, such as the illness or death of a loved one, loss of a beloved pet, divorce of parents, or moving or going away to school

Certain temperaments, which are more prone to anxiety disorders than others are

Family history, including blood relatives who have problems with anxiety or an anxiety disorder, indicating that those traits could be inherited

Environmental issues, such as experiencing some type of disaster that involves separation

Complications

Separation anxiety disorder causes major distress and problems functioning in social situations or at work or school.

Disorders that can accompany separation anxiety disorder include:

Other anxiety disorders, such as generalized anxiety disorder, panic attacks, phobias, social anxiety disorder or agoraphobia

Obsessive-compulsive disorder

Depression

Prevention

There's no sure way to prevent separation anxiety disorder in your child, but these recommendations may help.

Seek professional advice as soon as possible if you're concerned that your child's anxiety is much worse than a normal developmental stage. Early diagnosis and treatment can help reduce symptoms and prevent the disorder from getting worse.

Stick with the treatment plan to help prevent relapses or worsening of symptoms.

Seek professional treatment if you have anxiety, depression or other mental health concerns, so that you can model healthy coping skills for your child.

# data[].attributes.attachment_link.title
Separation anxiety disorder - Symptoms and causes

# data[].attributes.attachment_link.description
Separation anxiety is a normal stage of development for infants and toddlers. Young children often experience a period of separation anxiety, but most children outgrow separation anxiety by about 3 years of age. In some children, separation anxiety is a sign of a more serious condition known as separation anxiety disorder, starting as early as preschool age.

# data[].attributes.attachment_link.provider_name
National Institute of Mental Health (NIMH)

# data[].attributes.attachment_link.readable_text
Definition

Panic Disorder is an anxiety disorder characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. These episodes occur "out of the blue," not in conjunction with a known fear or stressor.

Additional information about panic disorder can be found on the NIMH Health Topics page on Anxiety Disorders.

Prevalence of Panic Disorder Among Adults

Based on diagnostic interview data from National Comorbidity Survey Replication (NCS-R), Figure 1 shows past year prevalence of panic disorder among U.S. adults aged 18 or older.¹

An estimated 2.7% of U.S. adults had panic disorder in the past year.

Past year prevalence of panic disorder among adults was higher for females (3.8%) than for males (1.6%).

An estimated 4.7% of U.S. adults experience panic disorder at some time in their lives.²

Figure 1

Panic Disorder with Impairment Among Adults

Of adults with panic disorder in the past year, degree of impairment ranged from mild to serious, as shown in Figure 2. Impairment was determined by scores on the Sheehan Disability Scale.³

Impairment was distributed evenly among adults with panic disorder. An estimated 44.8% had serious impairment, 29.5% had moderate impairment, and 25.7% had mild impairment.

Figure 2

Prevalence of Panic Disorder Among Adolescents

Based on diagnostic interview data from National Comorbidity Survey Adolescent Supplement (NCS-A), Figure 3 shows lifetime prevalence of panic disorder among U.S. adolescents aged 13-18.⁴

An estimated 2.3% of adolescents had panic disorder, and 2.3% had severe impairment. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria were used to determine impairment.

The prevalence of panic disorder among adolescents was higher for females (2.6%) than for males (2.0%).

Figure 3

Data Sources

References

1. Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 2: 12-month prevalence DSM-IV/WMH-CIDI disorders by sex and cohort.

2. Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 1: Lifetime prevalence DSM-IV/WMH-CIDI disorders by sex and cohort.

3. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):617-27. PMID: 15939839

4. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9. PMID: 20855043

Statistical Methods and Measurement Caveats

National Comorbidity Survey Replication (NCS-R)

Diagnostic Assessment and Population:

The NCS-R is a nationally representative, face-to-face, household survey conducted between February 2001 and April 2003 with a response rate of 70.9%. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured lay-administered diagnostic interview that generates both International Classification of Diseases, 10th Revision, and DSM-IV diagnoses. The DSM-IV criteria were used here. The Sheehan Disability Scale (SDS) assessed disability in work role performance, household maintenance, social life, and intimate relationships on a 0-10 scale. Participants for the main interview totaled 9,282 English-speaking, non-institutionalized, civilian respondents. Any anxiety disorder was assessed in a subsample of 5,692 adults. The NCS-R was led by Harvard University.

Unlike the DSM-IV criteria used in the NCS-R and NCS-A, the current DSM-5 no longer places post-traumatic stress disorder or obsessive compulsive disorder in the anxiety disorder category. They are listed in new DSM5 categories.

Survey Non-response:

In 2001-2002, non-response was 29.1% of primary respondents and 19.6% of secondary respondents.

Reasons for non-response to interviewing include: refusal to participate (7.3% of primary, 6.3% of secondary); respondent was reluctant- too busy but did not refuse (17.7% of primary, 11.6% of secondary); circumstantial, such as intellectual developmental disability or overseas work assignment (2.0% of primary, 1.7% of secondary); and household units that were never contacted (2.0).

For more information, see PMID: 15297905.

National Comorbidity Survey Adolescent Supplement (NCS-A)

Diagnostic Assessment and Population:

The NCS-A was carried out under a cooperative agreement sponsored by NIMH to meet a request from Congress to provide national data on the prevalence and correlates of mental disorders among U.S. youth. The NCS-A was a nationally representative, face-to-face survey of 10,123 adolescents aged 13 to 18 years in the continental United States. The survey was based on a dual-frame design that included 904 adolescent residents of the households that participated in the adult U.S. National Comorbidity Survey Replication and 9,244 adolescent students selected from a nationally representative sample of 320 schools. The survey was fielded between February 2001 and January 2004. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview.

Survey Non-response:

The overall adolescent non-response rate was 24.4%. This is made up of non-response rates of 14.1% in the household sample, 18.2% in the un-blinded school sample, and 77.7% in the blinded school sample. Non-response was largely due to refusal (21.3%), which in the household and un-blinded school samples came largely from parents rather than adolescents (72.3% and 81.0%, respectively). The refusals in the blinded school sample, in comparison, came almost entirely (98.1%) from parents failing to return the signed consent postcard.

For more information, see PMID: 19507169.

# data[].attributes.attachment_link.description
Panic Disorder is an anxiety disorder characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. These episodes occur "out of the blue," not in conjunction with a known fear or stressor.

# data[].attributes.attachment_link.readable_text
DSM-5 and Eating Disorders

The advent of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5) is a great opportunity to mark where we are as specialists in understanding eating disorders. It is also a moment to contemplate and applaud most of the changes in the diagnostic nomenclature, as they should aid significantly in the clinician's ability to "officially" diagnose and label, provide earlier clinical intervention, and (hopefully) be reimbursed for these increasingly prevalent and debilitating diseases.

There are important changes for many psychiatric diagnoses in DSM-5, including several comorbid diagnoses frequently associated with eating disorders. However, my goal in this limited discourse is to highlight the logical and clinically relevant evolution of the DSM section on eating disorders. But I would be remiss in the area of clinical utility if I did not take a moment to briefly discuss the rationale for thinking diagnostically, as well as the benefit of considering comorbidity. In attempting to understand and treat eating disorders, there are many benefits for our patients in doing so.

My frame of reference is that of a treating and supervising psychiatrist who has specialized in treating eating disorders with more than 20 years in both inpatient and outpatient settings. I have been fortunate enough to work with hundreds of patients across the severity spectrum-from those ambulatory to those prostrate with life-threatening medical complications; from the neophyte beginning to experiment with eating disordered behaviors to those, unfortunately, chronically ill.

Overall considerations for DSM-5

Elimination of the Multi-Axial System

The MAS has been eliminated in DSM-5. The non-axial listing was previously an option in DSM-IV, but now this will become the norm. The clinician simply lists diagnoses, starting with the primary diagnosis (main reason for treatment), followed by other relevant psychiatric and medical conditions (formerly DSM-IV Axis I, II, and III diagnoses). (In the interest of brevity, the reader is referred to the Introduction section of the Manual as to the rationale for this change.)

Diagnoses are not designated by axis, and there is no listing of formerly Axis IV (Psychosocial Problems) and V (Assessment of Functioning) characteristics.

Elimination of "Not Otherwise Specified"

In DSM-5, the diagnostic category "Not Otherwise Specified" (NOS) has been replaced by two designations: (1) "Other Specified" and (2) "Unspecified." This change applies to all psychiatric diagnoses, including eating disorders. If one is unable to specify one of the established listed diagnoses, such as Anorexia Nervosa, for example, one may diagnose by preceding the general category with (1) or (2) above. In this case, a clinician might choose "Other Specified Feeding and Eating Disorder" or "Unspecified FED" (see example below).

Eating Disorders in DSM-5: General Features

From ED to FED

The most obvious change from DSM-IV to DSM-5 is the change in the name of the specialty itself from "Eating Disorders" to "Feeding and Eating Disorders." In the past year, I have been to several presentations on DSM-5 but have not heard highlighted the obvious pun in the acronym FED. In indulging my compulsion to do so here, I implore all eating disorder specialists to revel in our uniqueness; we are likely the only medical or psychiatric specialty for which the secret to a successful therapeutic outcome is revealed in the simple abbreviation of its name!

From Three to Eight

Equally of note, the number of eating disorder diagnoses in DSM-5 has increased from three to eight. These include six specific diagnoses: (1) Pica, (2) Rumination Disorder (RD), (3) Avoidant/Restrictive Food Intake Disorder (ARFID), (4) Anorexia Nervosa (AN), (5) Bulimia Nervosa (BN), and (6) Binge Eating Disorder (BED). They also include two "umbrella" diagnoses: (7) Other Specified Feeding or Eating Disorder (OSFED) and (8) Unspecified Feeding or Eating Disorder (UFED). To review the complete criteria for these diagnoses, the reader is again referred to the DSM-5 text (as well as elsewhere in this catalog).

DIAGNOSTIC CHANGES AND CLINICAL RELEVANCE

Pica, Rumination Disorder and Avoidant/Restrictive Food Intake Disorder

The diagnoses Pica and Rumination Disorder were both transferred from the previous DSM-IV section of "Disorders Usually First Diagnosed in Infancy, Early Childhood, or Adolescence" (now eliminated). Also in the same section, the diagnosis "Feeding Disorder in Infancy or Early Childhood", (FDIEC), has been expanded and transferred to the new general category of Feeding and Eating Disorders. In this transformation, the name changes to "Avoidant/Restrictive Food Intake Disorder" or by its acronym, ARFID. Unlike FDIEC, ARFID can be diagnosed past age 6.

Given that the essential feature of Pica involves the repeated eating of non-nutritive, non-food substances, and given the mutually exclusive classification scheme for DSM-5 eating disorders, it is the only Feeding and Eating Disorder which can be diagnosed simultaneously with another eating disorder.

Rumination behavior, which involves the regurgitation of food which is then either re-chewed, re-swallowed or spit out, may exist as part of active AN or BN or as a sole diagnosis, Rumination Disorder. It may remain as a residual problem after apparent recovery from another eating disorder and may go undetected unless it is suspected and inquired about, since patients may not be forthcoming about its existence. This may give the practitioner a flawed complacency that the patient is in full recovery. A recent patient of mine illustrates this point:
M.D., a 44 year old mother of three in remission from restricting and over-exercising AN had a stable healthy weight for three years, even though she continued to express body dissatisfaction. During one meeting in response to more pointed questioning, she revealed that for years she had been and was still engaging in regurgitating and spitting out her food. She had previously not revealed this information, citing profound guilt and shame.
ARFID, a diagnostic category, encompasses a broad set of eating disordered behaviors e.g., from feeding problems of infancy to restrictive eating in a young adult afraid of choking. The reason for including these behaviors in the same diagnostic category may seem obscure initially. But the common feature here is that in these cases the eating refusal (and eventual negative medical consequences), do not stem from physical limitations; it is psychological but not based on distorted body image or weight concerns.

Many patients with the type of ARFID related to a desire to avoid aversive consequences (e.g., choking or vomiting) would have been diagnosed as EDNOS using DSM-IV. This often resulted in such problems as patients erroneously being confused as atypical anorexics or having trouble with third party reimbursement. This problem should now be rectified as these patients are placed into a specific diagnostic category with descriptive criteria.

Anorexia Nervosa

a) 85% is not a Marker. While there are no major conceptual developments, there are significant welcome changes to the criteria for Anorexia Nervosa. One clinically relevant difference is the use of the phrase " significantly low body weight" in Criterion A to replace the phrase " body weight less than 85% of that expected ". Significantly low weight is defined as less than minimally normal (adults) and less than minimally expected (children and adolescents) in the context of age, sex development and physical health. This new phrasing allows the clinician's judgment to enter the picture as opposed to adhering to a rigid percentage of ideal or expected body weight as a criterion.

The irony here is that the abbreviation " e.g.," (for the Latin term exempli gratia), meaning for example, was often confused by even the most erudite among us with "i.e.", (short for Latin id est) which means that is. Therefore "for example 85%" converted in many minds to, "that is 85%" and this became gospel for diagnosing AN not only by clinicians and some patients who used it to deny their illness, but also insurance companies in denial of reimbursement.

So in DSM-5, the diagnosis of AN can be made above the 85% mark. In DSM IV, many cases meeting all criteria for AN but were 85 or higher percentage of IBW were diagnosed as Eating Disorder Not Otherwise specified (EDNOS). The perception of undue vagueness in utilizing the new criteria can be avoided by specifying severity according to a suggested scale as follows: Mild (BMI >or =17), Moderate (16-16.99), Severe (15-15.99) and Extreme (< 15). DSM-5 chose the starting point of BMI of 17 because of the World Health Organization's standard. (The use of BMI for this scale will be controversial for some, as it does not account for differences in body type, bone structure, and muscle vs. fat differential. Further discussion is beyond the scope of this article).

b) Focus on Behavior. Criterion B also undergoes clinically relevant modification. To the relatively subjective designation of "intense fear of gaining weight or becoming fat" is added "persistent behavior that interferes with weight gain." The emphasis here is not only on the patient's mental attitude (which may be hidden by denial or even at times by a resistant patient's desire to evade diagnosis and treatment) but also on behavior, which is more easily observed and measured.

c) Amenorrhea is absent. Perhaps the most obvious and clinically relevant development is the removal of amenorrhea from the diagnostic criteria for females. This eliminates a false "diagnostic imbalance" between males and females. It also allows official inclusion of the small percentage of females who manage to retain menstrual functioning despite extreme weight loss and malnutrition, and eliminates diagnostic concern over whether a client on hormonal replacement to induce menses is truly has amenorrhea.

With previous criteria in DSM-IV some patients who had not lost their menses but otherwise had AN behaviors and weight loss, could argue that they did not have the diagnosis. Many clinicians have thought that amenorrhea was best considered a medical complication of weight loss in anorexic females, rather than being a diagnostic criterion, e.g. similar to bradycardia or lanugo.

All of these changes help to create a diagnostic environment where a patient's specific and sometimes objectively quantifiable behavior, as well as illness mindset, becomes the diagnostic focus. Utilizing DSM-5 clinicians should be able to utilize diagnostic guidelines and their clinical judgment to diagnose AN and intervene earlier in the course of illness, potentially reducing morbidity and chronicity.

Bulimia Nervosa

a) Fewer Episodes Required. The essential change in the diagnostic criteria for BN is the decrease in frequency of binge episodes and compensatory behaviors required to make the diagnosis. In DSM-IV one needed two or more episodes per week of binge eating and compensatory behaviors over a 3-month period to qualify for the diagnosis. In DSM-5, only one episode per week is required over the same time frame. Similar to AN, a severity specifier for the compensatory behaviors allows the clinician a more precise qualification: Mild (an average of 1-3 episodes of inappropriate compensatory behaviors per week), Moderate (4-7), Severe (8-13) and Extreme (>or =14).

Again the trend here is towards earlier official diagnosis by decreasing the frequency of behaviors required. Qualitatively is there a significant difference in clinical urgency between one who purges once vs. twice a week? Given evidence that most destructive potentially addictive behaviors are more responsive to treatment earlier in their course, any action, which allows sooner recognition and intervention, is welcome.

Binge Eating Disorder

a) Into the Mainstream. Having been lifted from the Appendix section of DSM-IV, BED is now an official psychiatric diagnosis in DSM-5. The rationale for this move was that following extensive research the "clinical utility and validity" of this condition were documented.

In addition, in moving from a research diagnosis, to a clinical one, the frequency of binge episodes required is reduced from a minimum of 2 days of binge episodes per week for 6 months, to one episode weekly for 3 months. Similar to AN and BN a severity specifier scale is offered, with the frequency of binges for each level being the same as the compensatory behaviors for BN: Mild (1-3 binge-eating episodes per week), Moderate (4-7), Severe (8-13) and Extreme (>0r= 14).

Under DSM-IV BED sufferers were usually given the diagnosis of EDNOS. The theme of inclusion and the clinician's ability to diagnose earlier after the onset of symptoms, continue with the DSM-5 addition of BED as an official Feeding and Eating Disorders Diagnosis.

Other Specified Feeding or Eating Disorder and Unspecified Feeding or Eating Disorder

a) EDNOS Splits Up. As mentioned above it has been replaced in DSM-5 with OSFED and UFED. One of these diagnoses should be used in cases where distressful and impairing symptoms of an eating disorder are present, but the full criteria for one of the other FED's are not met. The difference between the two is that in OSFED the specific reason is stated, but in UFED it is not. In the latter case it may be that not enough information is available to decide what type of FED is present.

An OSFED example could be a patient who started out at a high body weight who then lost significantly via an anorexic restricting pattern who has body image distortion, fear of weight gain, but whose current weight is still normal. It might be listed as "Other Specified Feeding or Eating Disorder: Anorexia Nervosa Currently at Normal Weight". A UFED example could be a normal weight patient who admits to binging and purging "once or twice" in the last 3 months (suspected of more), has undue concerns with body weight and shape, and uses no other compensatory behaviors. It would simply be listed as "Unspecified Feeding or Eating Disorder".
SUMMARY OF CHANGES AND POSSIBLE SIGNIFICANCE
In scrutinizing the new developments in Feeding and Eating Disorders in DSM-5 one is impressed with two main trends, i.e., inclusivity and lowering of criteria for diagnosing some illnesses. Rumination Disorder, Avoidant/Restrictive Food Intake Disorder and Binge Eating Disorder have now been added as official diagnoses. Criteria have changed for AN and BN allowing diagnosis for less severe symptom use and earlier in the illness course. In AN, objective behavior that interferes with weight gain can replace the subjective and potentially reticent criterion of fear of weight gain. All these modifications should result in less use of the former EDNOS (now OSFED and UFED). Though clearly unintended, the use of EDNOS often had the erroneous effect of minimizing the seriousness of eating disorders. In some situations third party payers balked at reimbursing for the EDNOS diagnosis. The DSM-5 changes should promote earlier diagnosis and clinical intervention, could help potentially lower morbidity and chronicity, and ideally, improve reimbursement.

DIAGNOSIS AND COMORBIDITY: FOOD FOR THOUGHT

With DSM-5, mental health clinicians in general and eating disorders clinicians in particular, have at their disposal the most researched and deliberated diagnostic manual in Psychiatry's history. Why do we need such a manual? By learning the diagnostic nomenclature, it helps clinicians speak a common language and communicate with each other about our patients. Thinking diagnostically about patients encourages us to generally organize our thinking about their illness, allows us to make some hopefully valid assumptions about associated features (including psychosocial aspects), which usually accompany a diagnosis. But perhaps most importantly, making a diagnostic formulation helps to inform treatment, increasingly so as evidenced based treatments become the norm.

Once diagnostic formulations are made, they should be regularly reviewed, by those who made them as well as clinicians who inherit a patient with a particular diagnosis. They should be assessed both for accuracy and agreement amongst clinicians as well as being up to date. Accurate diagnosing of FED utilizing DSM-5 criteria should not pose major challenges for the average clinician. Well-honed interviewing skills and an ability to match historical data to the criteria obtained from a thorough interview and appropriate physical assessment will usually produce accurate diagnoses.

Astute clinicians cannot think diagnostically about the main condition that brings the patient to treatment, without pondering deeply what other clinical features or syndromes might also be influencing the development, course and potential treatment of the primary problem. One must also consider comorbidity. Unlike DSM-IV, DSM-5 has a "Comorbidity" section for each of the FED diagnoses. Even though not extensively discussed, many of the other common psychiatric diagnoses associated with the particular eating disorder diagnosis are mentioned. E.g., "Bipolar, depressive and anxiety disorders commonly co-occur with anorexia nervosa. Many individuals with anorexia nervosa report the presence of either an anxiety disorder or symptoms prior to onset of their eating disorder..."

As a clinician beginning to specialize in eating disorders almost 25 years ago I was soon surprised by how many patients appeared to have mood and anxiety disorders in addition to severe eating disturbance and how these conditions frequently persisted after stabilization of the eating disorder. Working with children and adolescents, pre-morbid histories could often be obtained showing pre-existing anxiety and mood disturbances before any eating disordered behavior emerged. Furthermore there was likely to be family history of anxiety, mood or substance use disorders. Over the years my clinical experience has continued to witness this pattern, and some of the most successful and lasting interventions for the eating disorder, have not come until stabilization of the comorbid disorder. However I continue to see patients with eating disorders who have had previous treatment for whom there has been no mention or significant discussion of the comorbid diagnosis, even in a few instances where the latter condition was more exigent than the eating disorder.

Eating disorders are psychiatric disturbances where likely a confluence of dysfunctional brain mechanisms influenced by environmental factors result in abnormal feeding and eating behavior. This leads to physical changes and medical complications in those afflicted, as well as further mental changes. It is likely that comorbid psychiatric disorders strongly influence the dysfunctional brain mechanisms (for example leading to altered perceptions, greater impulsivity or compulsivity) thereby predisposing to eating disordered behavior. (It is also possible that comorbid disturbances are perhaps manifestations themselves of the same brain dysfunction.)

Whether comorbid conditions help to "drive" eating disordered cognitions and behavior or whether they arise as expressions of the same brain deregulation, it would seem that with greater comorbidity, eating disorders become more difficult to treat and have higher degree of chronicity. For example, a bulimic patient suffering from untreated Bipolar Disorder, which places her in a more highly "reactive" or deregulated state, will be more likely to binge and purge when confronted with triggers.

Comorbid factors influence not only manifestations of the eating disorder, but also response to treatment. An adolescent suffering from unrecognized or untreated PTSD, when feeling "trapped" might experience unmanageable fright and terror from any treatment intervention perceived as coercive whether in a hospital treatment program or family (home) based setting.

In co-occurring situations, the treatment of one disorder can exacerbate or complicate the treatment of the other. For example a bulimic patient who is failing CBT and DBT treatment and who refuses potentially effective medication for her mood disorder due to fear of weight gain side effects, risks continued decrease in impulse control and poor response to other modalities. This results in continued debilitation from both illnesses.

Comorbid conditions combined with an eating disorder result in poorer quality of life than an eating disorder alone. The panic level anxiety felt by a child with ARFID at mealtimes is also likely to have been experienced by him through other diagnosable anxiety spectrum disorders, such as separation anxiety, school phobia or OCD. Successful therapeutic attention to his anxiety disorder can result not only in resolution of the eating disturbance and subsequent medical complications, but also improved functioning in other areas of his life as well.

With co-occurring disorders an increased likelihood of chronicity exists for both conditions if either is not adequately managed. There is potential mutual exacerbation since the cognitions and behaviors from the comorbid disorder often intensify disordered eating and the latter, through the effect of nutritional derangement on brain chemistry, worsen the comorbid disorder.

There is lack of clarity sometimes as to whether certain comorbid traits reach the threshold of a diagnosable condition. There has been general debate in the field and often confusion in a particular case, whether a comorbid diagnosable condition precedes and/or is causative to an eating disorder or results from it. But just as it is important to consider cognitive and behavioral changes caused by malnutrition and starvation, it is incumbent to recognize those, which might precede and exacerbate FED. Comorbidities may be hidden because of focus on the more visible physical changes of the FED, and threat of medical consequences. But to always assume these changes result from FED presents a risk of incomplete treatment, continued morbidity, poor life quality and higher risk of FED relapse. Clinical experience and judgment are necessary, along with wise use of consultation.

The argument over whether or when to treat a patient who is malnourished, for an apparent mood or anxiety disorder which may be interfering with FED treatment is legitimate. The picture is tilted by the fact that when medications are being considered in an eating disordered patient, there is currently only one FDA-approved medication for any eating disorder: fluoxetine for bulimia. And yet despite potentially undesirable side effects, medications have been increasingly used over the last several years as part of the overall management of FED's. As mentioned earlier I have witnessed cases where the results of ameliorating comorbid illnesses with medications have had dramatic positive benefit in recovery from an ED. Nevertheless I would hope that the current trend is due to a desire to target comorbidity and the recognition that treating co-occurring conditions can be a significant facilitator to successful overall treatment of FED, rather than a naively sought clinical coup de grace.

Finally, in this brief discussion on comorbidity I have been focusing mainly on psychiatric conditions that stand alone as diagnoses often requiring treatment or may coexist with other maladies such as FED. These diagnostic "connections" are recognized in DSM-5 and point to a common biogenetic substrate and psychosocial underpinnings in the final pathway to the development of serious psychiatric disturbances whether eating or other disorders. They also summon into action a variety of analytic and therapeutic skills whether present in an individual clinician, or spread across different professionals comprising a treatment "team". However I want to make sure that despite the focus on comorbidities that are diagnosable entities with strong biological determinants, eating disorders according to my experience, clearly are not solely brain-based disorders. Despite recent trends by the profession to emphasize biogenetic factors in causation, FED are paramount examples of biopsychosocial illnesses. As often as I have seen the missing piece to the recovery puzzle in eating disorders be the elimination of another comorbid psychiatric disorder, I have also seen it be the resolution of a psychosocial "comorbidity". Eating disorders are richly complex, multi-determined illnesses. It is this phenomenon that has stimulated, humbled and held me captive as a clinician for the last 22 years.

by KennethW.Willis, MD, Medical Director, Eating Disorder Treatment of NY-Monte Nido Manhattan

# data[].attributes.attachment_link.title
DSM-5 and Eating Disorders - Eating Disorders Catalogue

# data[].attributes.attachment_link.description
DSM-5 and Eating Disorders The advent of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5) is a great opportunity to mark where we are as specialists in understanding eating disorders. It is also a moment to contemplate and applaud most of the changes in the diagnostic nomenclature, as they should aid significantly in [...]

# data[].attributes.attachment_link.readable_text
Overview

Anorexia (an-o-REK-see-uh) nervosa - often simply called anorexia - is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives.

To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain.

Anorexia isn't really about food. It's an extremely unhealthy and sometimes life-threatening way to try to cope with emotional problems. When you have anorexia, you often equate thinness with self-worth.

Anorexia, like other eating disorders, can take over your life and can be very difficult to overcome. But with treatment, you can gain a better sense of who you are, return to healthier eating habits and reverse some of anorexia's serious complications.

Products & Services

Symptoms

The physical signs and symptoms of anorexia nervosa are related to starvation. Anorexia also includes emotional and behavioral issues involving an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.

It may be difficult to notice signs and symptoms because what is considered a low body weight is different for each person, and some individuals may not appear extremely thin. Also, people with anorexia often disguise their thinness, eating habits or physical problems.

Physical symptoms

Physical signs and symptoms of anorexia may include:

Extreme weight loss or not making expected developmental weight gains

Thin appearance

Abnormal blood counts

Fatigue

Insomnia

Dizziness or fainting

Bluish discoloration of the fingers

Hair that thins, breaks or falls out

Soft, downy hair covering the body

Absence of menstruation

Constipation and abdominal pain

Dry or yellowish skin

Intolerance of cold

Irregular heart rhythms

Low blood pressure

Dehydration

Swelling of arms or legs

Eroded teeth and calluses on the knuckles from induced vomiting

Some people who have anorexia binge and purge, similar to individuals who have bulimia. But people with anorexia generally struggle with an abnormally low body weight, while individuals with bulimia typically are normal to above normal weight.

Emotional and behavioral symptoms

Behavioral symptoms of anorexia may include attempts to lose weight by:

Severely restricting food intake through dieting or fasting

Exercising excessively

Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products

Emotional and behavioral signs and symptoms may include:

Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them

Frequently skipping meals or refusing to eat

Denial of hunger or making excuses for not eating

Eating only a few certain "safe" foods, usually those low in fat and calories

Adopting rigid meal or eating rituals, such as spitting food out after chewing

Not wanting to eat in public

Lying about how much food has been eaten

Fear of gaining weight that may include repeated weighing or measuring the body

Frequent checking in the mirror for perceived flaws

Complaining about being fat or having parts of the body that are fat

Covering up in layers of clothing

Flat mood (lack of emotion)

Social withdrawal

Irritability

Insomnia

Reduced interest in sex

When to see a doctor

Unfortunately, many people with anorexia don't want treatment, at least initially. Their desire to remain thin overrides concerns about their health. If you have a loved one you're worried about, urge her or him to talk to a doctor.

If you're experiencing any of the problems listed above, or if you think you may have an eating disorder, get help. If you're hiding your anorexia from loved ones, try to find a person you trust to talk to about what's going on.

Causes

The exact cause of anorexia is unknown. As with many diseases, it's probably a combination of biological, psychological and environmental factors.

Biological. Although it's not yet clear which genes are involved, there may be genetic changes that make some people at higher risk of developing anorexia. Some people may have a genetic tendency toward perfectionism, sensitivity and perseverance - all traits associated with anorexia.

Psychological. Some people with anorexia may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, which causes them to think they're never thin enough. And they may have high levels of anxiety and engage in restrictive eating to reduce it.

Environmental. Modern Western culture emphasizes thinness. Success and worth are often equated with being thin. Peer pressure may help fuel the desire to be thin, particularly among young girls.

Risk factors

Anorexia is more common in girls and women. However, boys and men have increasingly developed eating disorders, possibly related to growing social pressures.

Anorexia is also more common among teenagers. Still, people of any age can develop this eating disorder, though it's rare in those over 40. Teens may be more at risk because of all the changes their bodies go through during puberty. They may also face increased peer pressure and be more sensitive to criticism or even casual comments about weight or body shape.

Certain factors increase the risk of anorexia, including:

Genetics. Changes in specific genes may put certain people at higher risk of anorexia. Those with a first-degree relative - a parent, sibling or child - who had the disorder have a much higher risk of anorexia.

Dieting and starvation. Dieting is a risk factor for developing an eating disorder. There is strong evidence that many of the symptoms of anorexia are actually symptoms of starvation. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.

Transitions. Whether it's a new school, home or job; a relationship breakup; or the death or illness of a loved one, change can bring emotional stress and increase the risk of anorexia.

Complications

Anorexia can have numerous complications. At its most severe, it can be fatal. Death may occur suddenly - even when someone is not severely underweight. This may result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes - minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body.

Other complications of anorexia include:

Anemia

Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart failure

Bone loss (osteoporosis), increasing the risk of fractures

Loss of muscle

In females, absence of a period

In males, decreased testosterone

Gastrointestinal problems, such as constipation, bloating or nausea

Electrolyte abnormalities, such as low blood potassium, sodium and chloride

Kidney problems

If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control.

In addition to the host of physical complications, people with anorexia also commonly have other mental health disorders as well. They may include:

Depression, anxiety and other mood disorders

Personality disorders

Obsessive-compulsive disorders

Alcohol and substance misuse

Self-injury, suicidal thoughts or suicide attempts

Prevention

There's no guaranteed way to prevent anorexia nervosa. Primary care physicians (pediatricians, family physicians and internists) may be in a good position to identify early indicators of anorexia and prevent the development of full-blown illness. For instance, they can ask questions about eating habits and satisfaction with appearance during routine medical appointments.

If you notice that a family member or friend has low self-esteem, severe dieting habits and dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent an eating disorder from developing, you can talk about healthier behavior or treatment options.

# data[].attributes.attachment_link.description
Anorexia is an eating disorder characterized by an abnormally low body weight, intense fear of gaining weight and a distorted perception of body weight.

# data[].attributes.attachment_link.description
With bulimia, a serious eating disorder, you eat large amounts of food and then purge to get rid of extra calories. Learn about symptoms and treatment.

# data[].attributes.attachment_link.readable_text
Overview

Binge-eating disorder is a serious eating disorder in which you frequently consume unusually large amounts of food and feel unable to stop eating.

Almost everyone overeats on occasion, such as having seconds or thirds of a holiday meal. But for some people, excessive overeating that feels out of control and becomes a regular occurrence crosses the line to binge-eating disorder.

When you have binge-eating disorder, you may be embarrassed about overeating and vow to stop. But you feel such a compulsion that you can't resist the urges and continue binge eating. If you have binge-eating disorder, treatment can help.

Symptoms

Most people with binge-eating disorder are overweight or obese, but you may be at a normal weight. Behavioral and emotional signs and symptoms of binge-eating disorder include:

Eating unusually large amounts of food in a specific amount of time, such as over a two-hour period

Feeling that your eating behavior is out of control

Eating even when you're full or not hungry

Eating rapidly during binge episodes

Eating until you're uncomfortably full

Frequently eating alone or in secret

Feeling depressed, disgusted, ashamed, guilty or upset about your eating

Frequently dieting, possibly without weight loss

Unlike a person with bulimia, after a binge, you don't regularly compensate for extra calories eaten by vomiting, using laxatives or exercising excessively. You may try to diet or eat normal meals. But restricting your diet may simply lead to more binge eating.

The severity of binge-eating disorder is determined by how often episodes of bingeing occur during a week.

When to see a doctor

If you have any symptoms of binge-eating disorder, seek medical help as soon as possible. Binge-eating problems can vary in their course from short-lived to recurrent or they may persist for years if left untreated.

Talk to your medical care provider or a mental health professional about your binge-eating symptoms and feelings. If you're reluctant to seek treatment, talk to someone you trust about what you're going through. A friend, loved one, teacher or faith leader can help you take the first steps to successful treatment of binge-eating disorder.

Helping a loved one who has symptoms

A person with binge-eating disorder may become an expert at hiding behavior, making it hard for others to detect the problem. If you have a loved one you think may have symptoms of binge-eating disorder, have an open and honest discussion about your concerns.

Provide encouragement and support. Offer to help your loved one find a qualified medical care provider or mental health professional and make an appointment. You might even offer to go along.

Causes

The causes of binge-eating disorder are unknown. But genetics, biological factors, long-term dieting and psychological issues increase your risk.

Risk factors

Binge-eating disorder is more common in women than in men. Although people of any age can have binge-eating disorder, it often begins in the late teens or early 20s.

Factors that can increase your risk of developing binge-eating disorder include:

Family history. You're much more likely to have an eating disorder if your parents or siblings have (or had) an eating disorder. This may indicate that inherited genes increase the risk of developing an eating disorder.

Dieting. Many people with binge-eating disorder have a history of dieting. Dieting or restricting calories during the day may trigger an urge to binge eat, especially if you have symptoms of depression.

Psychological issues. Many people who have binge-eating disorder feel negatively about themselves and their skills and accomplishments. Triggers for bingeing can include stress, poor body self-image and the availability of preferred binge foods.

Complications

You may develop psychological and physical problems related to binge eating.

Complications that may be caused by binge-eating disorder include:

Poor quality of life

Problems functioning at work, with your personal life or in social situations

Social isolation

Obesity

Medical conditions related to obesity, such as joint problems, heart disease, type 2 diabetes, gastroesophageal reflux disease (GERD) and some sleep-related breathing disorders

Psychiatric disorders that are often linked with binge-eating disorder include:

Depression

Bipolar disorder

Anxiety

Substance use disorders

Prevention

Although there's no sure way to prevent binge-eating disorder, if you have symptoms of binge eating, seek professional help. Your medical care provider can advise you on where to get help.

If you think a friend or loved one has a binge-eating problem, steer her or him toward healthier behavior and professional treatment before the situation worsens. If you have a child:

Foster and reinforce a healthy body image, regardless of body shape or size

Discuss any concerns with your child's primary care provider, who may be in a good position to identify early indicators of an eating disorder and help prevent its development

The Mayo Clinic experience and patient stories

Our patients tell us that the quality of their interactions, our attention to detail and the efficiency of their visits mean health care like they've never experienced. See the stories of satisfied Mayo Clinic patients.

# data[].attributes.attachment_link.title
Binge-eating disorder - Symptoms and causes

# data[].attributes.attachment_link.description
Binge-eating disorder is a serious eating disorder in which you frequently consume unusually large amounts of food and feel unable to stop eating. Almost everyone overeats on occasion, such as having seconds or thirds of a holiday meal. But for some people, excessive overeating that feels out of control and becomes a regular occurrence crosses the line to binge-eating disorder.

# data[].attributes.attachment_link.description
Feeding disorders are characterized by extreme food selectivity by type, texture, brand, shape or color.

# data[].attributes.attachment_link.title
Eating Disorders and Teens: How to Talk About It

# data[].attributes.attachment_link.description
As a parent, you want nothing more than happiness and health for your teen. That's why it's so terrifying when you notice your daughter skipping breakfast or your son retreating to the bathroom immediately after dinner. Over one-half of teenage girls and nearly one-third of teenage boys practice unhealthy weight control behaviors, like: Those are scary statistics.

# data[].attributes.attachment_link.title
What’s Bipolar Disorder? How Do I Know If I Have It?

# data[].attributes.attachment_link.description
Bipolar disorder, formerly manic depression, causes extreme mood shifts ranging from mania to depression. Learn symptoms, diagnosis, treatment, and more.

# data[].attributes.attachment_link.readable_text
Bipolar disorder, also known as manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior.

People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling very sad, hopeless, and sluggish. In between those periods, they usually feel normal. You can think of the highs and the lows as two "poles" of mood, which is why it's called "bipolar" disorder.

The word "manic" describes the times when someone with bipolar disorder feels overly excited and confident. These feelings can also involve irritability and impulsive or reckless decision-making. About half of people during mania can also have delusions (believing things that aren't true and that they can't be talked out of) or hallucinations (seeing or hearing things that aren't there).

" Hypomania" describes milder symptoms of mania, in which someone does not have delusions or hallucinations, and their high symptoms do not interfere with their everyday life.

The word "depressive" describes the times when the person feels very sad or depressed. Those symptoms are the same as those described in major depressive disorder or "clinical depression," a condition in which someone never has manic or hypomanic episodes.

Most people with bipolar disorder spend more time with depressive symptoms than manic or hypomanic symptoms.

What Are the Symptoms of Bipolar Disorder?

In bipolar disorder, the dramatic episodes of high and low moods do not follow a set pattern. Someone may feel the same mood state (depressed or manic) several times before switching to the opposite mood. These episodes can happen over a period of weeks, months, and sometimes even years.

How severe it gets differs from person to person and can also change over time, becoming more or less severe.

Symptoms of mania ("the highs"):

Excessive happiness, hopefulness, and excitement

Sudden changes from being joyful to being irritable, angry, and hostile

Restlessness

Rapid speech and poor concentration

Increased energy and less need for sleep

Unusually high sex drive

Making grand and unrealistic plans

Showing poor judgment

Drug and alcohol abuse

Becoming more impulsive

During depressive periods ("the lows"), a person with bipolar disorder may have:

Sadness

Loss of energy

Feelings of hopelessness or worthlessness

Not enjoying things they once liked

Trouble concentrating

Uncontrollable crying

Trouble making decisions

Irritability

Needing more sleep

Appetite changes that make them lose or gain weight

Thoughts of death or suicide

Attempting suicide

Continued

Who Gets Bipolar Disorder?

When someone develops bipolar disorder, it usually starts when they're in late adolescence or young adulthood. Rarely, it can happen earlier in childhood. Bipolar disorder can run in families.

Men and women are equally likely to get it. Women are somewhat more likely than men to go through "rapid cycling," which is having four or more distinct mood episodes within a year. Women also tend to spend more time depressed than men with bipolar disorder.

Many people with the condition abuse alcohol or other drugs when manic or depressed. People with bipolar disorder are more likely to have seasonal depression, co-existing anxiety disorders, post-traumatic stress disorder, and obsessive-compulsive disorder.

What Causes Bipolar Disorder?

There is no single cause. Genes, brain changes, and stress can all play a role.

Researchers are studying how these factors may contribute to the development of bipolar disorder.

How Is Bipolar Disorder Diagnosed?

If you or someone you know has symptoms of bipolar disorder, talk to your family doctor or a psychiatrist. They will ask questions about mental illnesses that you, or the person you're concerned about, have had, and any mental illnesses that run in the family. The person will also get a complete psychiatric evaluation to tell if they have likely bipolar disorder or another mental health condition."

Diagnosing bipolar disorder is all about the person's symptoms and determining whether they may be the result of another cause (such as low thyroid, or mood symptoms caused by drug or alcohol abuse). How severe are they? How long have they lasted? How often do they happen?

The most telling symptoms are those that involve highs or lows in mood, along with changes in sleep, energy, thinking, and behavior.

Talking to close friends and family of the person can often help the doctor distinguish bipolar disorder from major depressive (unipolar) disorder or other psychiatric disorders that can involve changes in mood, thinking, and behavior.

What Are the Treatments for Bipolar Disorder?

Bipolar disorder can be treated. It's a long-term condition that needs ongoing care.

Medication is the main treatment, usually involving "mood stabilizers" such as carbamazepine ( Tegretol), lamotrigine ( Lamictal), lithium, or valproate ( Depakote). Sometimes antipsychotic drugs are also used such as olanzapine ( Zyprexa), quetiapine ( Seroquel), lurasidone ( Latuda) and cariprazine (Vraylar)), as well as antidepressants. Combinations of medicines are often used. Psychotherapy, or "talk therapy," is often recommended, too.

People who have four or more mood episodes in a year, or who also have drug or alcohol problems, can have forms of the illness that are much harder to treat.

Continued

What Can I Expect After Bipolar Disorder Treatment?

For most people, a good treatment program can stabilize moods and provide symptom relief.

Ongoing treatment is more effective than dealing with problems as they come up. People who also have a substance abuse problem may need more specialized treatment.

Bipolar Disorder and Suicide

Some people who have bipolar disorder may become suicidal.

Learn the warning signs and seek immediate medical help for them:

Depression (changes in eating, sleeping, activities)

Isolating yourself

Talking about suicide, hopelessness, or helplessness

Acting recklessly

Taking more risks

Having more accidents

Abusing alcohol or other drugs

Focusing on morbid and negative themes

Talking about death and dying

Crying more, or becoming less emotionally expressive

Giving away possessions

# data[].attributes.attachment_link.description
Bipolar disorder, also known as manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior. People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling very sad, hopeless, and sluggish.

# data[].attributes.attachment_link.readable_text
Seasonal affective disorder (SAD) is a type of depression that's related to changes in seasons - seasonal affective disorder (SAD) begins and ends at about the same times every year. If you're like most people with , your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. These symptoms often resolve during the spring and summer months. Less often, causes depression in the spring or early summer and resolves during the fall or winter months.

Treatment for may include light therapy (phototherapy), psychotherapy and medications.

Don't brush off that yearly feeling as simply a case of the "winter blues" or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.

In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. Less commonly, people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses.

Signs and symptoms of may include:

Feeling listless, sad or down most of the day, nearly every day

Losing interest in activities you once enjoyed

Having low energy and feeling sluggish

Having problems with sleeping too much

Experiencing carbohydrate cravings, overeating and weight gain

Having difficulty concentrating

Feeling hopeless, worthless or guilty

Having thoughts of not wanting to live

Fall and winter SAD

Symptoms specific to winter-onset , sometimes called winter depression, may include:

Oversleeping

Appetite changes, especially a craving for foods high in carbohydrates

Weight gain

Tiredness or low energy

Spring and summer SAD

Symptoms specific to summer-onset seasonal affective disorder, sometimes called summer depression, may include:

Trouble sleeping (insomnia)

Poor appetite

Weight loss

Agitation or anxiety

Increased irritability

Seasonal changes and bipolar disorder

People who have bipolar disorder are at increased risk of seasonal affective disorder. In some people with bipolar disorder, episodes of mania may be linked to a specific season. For example, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania), anxiety, agitation and irritability. They may also experience depression during the fall and winter months.

It's normal to have some days when you feel down. But if you feel down for days at a time and you can't get motivated to do activities you normally enjoy, see your health care provider. This is especially important if your sleep patterns and appetite have changed, you turn to alcohol for comfort or relaxation, or you feel hopeless or think about suicide.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include:

Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset . This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression.

Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in . Reduced sunlight can cause a drop in serotonin that may trigger depression.

Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood.

Seasonal affective disorder is diagnosed more often in women than in men. And occurs more frequently in younger adults than in older adults.

Factors that may increase your risk of seasonal affective disorder include:

Family history. People with may be more likely to have blood relatives with or another form of depression.

Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions.

Living far from the equator. appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.

Low level of vitamin D. Some vitamin D is produced in the skin when it's exposed to sunlight. Vitamin D can help to boost serotonin activity. Less sunlight and not getting enough vitamin D from foods and other sources may result in low levels of vitamin D in the body.

Take signs and symptoms of seasonal affective disorder seriously. As with other types of depression, can get worse and lead to problems if it's not treated. These can include:

Social withdrawal

School or work problems

Substance abuse

Other mental health disorders such as anxiety or eating disorders

Suicidal thoughts or behavior

There's no known way to prevent the development of seasonal affective disorder. However, if you take steps early on to manage symptoms, you may be able to prevent them from getting worse over time. You may be able to head off serious changes in mood, appetite and energy levels, as you can predict the time of the year in which these symptoms may start. Treatment can help prevent complications, especially if is diagnosed and treated before symptoms get bad.

Some people find it helpful to begin treatment before symptoms would normally start in the fall or winter, and then continue treatment past the time symptoms would normally go away. Other people need continuous treatment to prevent symptoms from returning.

1. Specifiers for depressive disorders: With seasonal pattern. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed July 15, 2021.

2. Seasonal affective disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder/. Accessed July 15, 2021.

3. Seasonal affective disorder (SAD). American Psychiatric Association. https://www.psychiatry.org/patients-families/depression/seasonal-affective-disorder. Accessed July 15, 2021.

4. Seasonal affective disorder: More than the winter blues. American Psychological Association. https://www.apa.org/topics/depression/seasonal-affective-disorder. Accessed July 15, 2021.

5. Major depressive disorder with a seasonal pattern. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression/Major-Depressive-Disorder-with-a-Seasonal-Pattern. Accessed July 15, 2021.

6. Galima SV, et al. Seasonal affective disorder: Common questions and answers. American Family Physician. 2020;102:668.

7. Haller H, et al. Complementary therapies for clinical depression: An overview of systematic reviews. BMJ Open. 2019; doi:10.1136/bmjopen-2018-028527.

8. Light therapy. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed July 15, 2021.

9. Seasonal affective disorder and complementary health approaches: What the science says. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/providers/digest/seasonal-affective-disorder-and-complementary-health-approaches-science. Accessed July 15, 2021.

10. Safe use of complementary health products and practices. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/safety. Accessed July 19, 2021.

11. Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression/. Accessed July 19, 2021.

12. Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/depression/. Accessed July 19, 2021.

13. Rosenthal SJ, et al. Seasonal effects on bipolar disorder: A closer look. Neuroscience and Biobehavioral Reviews. 2020; doi:10.1016/j.neubiorev.2020.05.017.

14. Gitlin MJ. Antidepressants in bipolar depression: An enduring controversy. International Journal of Bipolar Disorders. 2018; doi:10.1186/s40345-018-0133-9.

15. Sawchuk CN (expert opinion). Mayo Clinic. Sept. 2, 2021.

# data[].attributes.attachment_link.title
Steps to keep your mood and motivation steady throughout the year-Seasonal affective disorder (SAD) - Symptoms & causes - Mayo Clinic

# data[].attributes.attachment_link.description
This type of depression is related to changes in seasons and begins and ends at about the same times every year.

# data[].attributes.attachment_link.readable_text
SOURCES:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5, American Psychiatric Publishing, 2013.

National Institute of Mental Health: "What is Depression?" "What is Bipolar Disorder?" and "Brain Stimulation Therapies."

National Alliance on Mental Illness: "Depression: Treatment, Services, and Support."

Cleveland Clinic: "Seasonal Depression."

University of Michigan Depression Center: "Premenstrual Dysphoric Disorder (PMDD)."

Agency for Healthcare Research and Quality: "Efficacy and Safety of Screening for Postpartum Depression."

American Academy of Family Physicians. "Depression: How Electroconvulsive Therapy Works."

CDC: "The Burden of Mental Illness."

Morbidity and Mortality Weekly Report, Jan. 6, 2012.

Epperson, C.N The American Journal of Psychiatry, May 2012.

Goldberg, J. Current Psychiatry, May 2014.

National Alliance on Mental Illness: "Criteria for Major Depressive Episode: DSM-5," "Psychotic Depression."

Parker, G. The American Journal of Psychiatry, September 2002.

Rothschild, A. Schizophrenia Bulletin, April 2013.

Severus, E. International Journal of Bipolar Disorders, 2013.

Anxiety and Depression Association of America: "Depression."

# data[].attributes.attachment_link.description
SOURCES: American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5, American Psychiatric Publishing, 2013. National Institute of Mental Health: "What is Depression?" "What is Bipolar Disorder?" and "Brain Stimulation Therapies." National Alliance on Mental Illness: "Depression: Treatment, Services, and Support." Cleveland Clinic: "Seasonal Depression."

# data[].attributes.attachment_link.readable_text
Psychotic depression is a subtype of major depression that occurs when a severe depressive illness includes some form of psychosis. The psychosis could be hallucinations (such as hearing a voice telling you that you are no good or worthless), delusions (such as, intense feelings of worthlessness, failure, or having committed a sin) or some other break with reality. Psychotic depression affects roughly one out of every four people admitted to the hospital for depression.

What Are the Symptoms of Psychotic Depression?

Common symptoms for patients who have psychotic depression include:

Agitation

Anxiety

Constipation

Hypochondria

Intellectual impairment

Physical immobility

Delusions or hallucinations

How Is Psychotic Depression Treated?

Usually, treatment for psychotic depression is given in a hospital setting. That way, the patient has close monitoring by mental health professionals. Different medications are used to stabilize the person's mood, typically including combinations of antidepressants and antipsychotic medications.

Antipsychotic drugs affect neurotransmitters that allow communication between nerve cells in areas of the brain that regulate our ability to perceive and organize information about the world around us. There are a number of antipsychotic, or neuroleptic, medications commonly used today. These include aripiprazole ( Abilify), asenapine ( Saphris), cariprazine ( Vraylar), olanzapine ( Zyprexa), quetiapine ( Seroquel), and risperidone ( Risperdal). Each drug has unique side effects and may differ in its clinical efficacy profile. Usually, though, these drugs are better tolerated than earlier antipsychotics.

Does Treatment for Psychotic Depression Always Work?

Treatment for psychotic depression is very effective. People are able to recover, usually within several months. But continual medical follow-up may be necessary. If the medications do not work to end the psychosis and depression, sometimes electroconvulsive therapy (ECT) is used. It's important for the patient to work with the doctor to find the most effective drugs with the least side effects. Because psychotic depression is quite serious, the risk of suicide is also great.

How Is Psychotic Depression Different From Major or Clinical Nonpsychotic Depression?

According to the National Institute of Mental Health, a person who is psychotic is out of touch with reality. People with psychosis may hear "voices." Or they may have strange and illogical ideas. For example, they may think that others can hear their thoughts or are trying to harm them. Or they might think they are possessed by the devil or are wanted by the police for having committed a crime that they really did not commit.

People with psychotic depression may get angry for no apparent reason. Or they may spend a lot of time by themselves or in bed, sleeping during the day and staying awake at night. A person with psychotic depression may neglect appearance by not bathing or changing clothes. Or that person may be hard to talk to. Perhaps they barely talk or else says things that make no sense.

People with other mental illnesses, such as schizophrenia, also experience psychosis. But those with psychotic depression usually have delusions or hallucinations that are consistent with themes about depression (such as worthlessness or failure), whereas psychotic symptoms in schizophrenia are more often bizarre or implausible and have no obvious connection to a mood state (for example, thinking strangers are following them for no reason other than to harass them). People with psychotic depression also may be humiliated or ashamed of the thoughts and try to hide them. Doing so makes this type of depression very difficult to diagnose.

But diagnosis is important. Its treatment is different than for nonpsychotic depression. Also, having one episode of psychotic depression increases the chance of bipolar disorder with recurring episodes of psychotic depression, mania, and even suicide.

# data[].attributes.attachment_link.description
Psychotic depression is a subtype of major depression that occurs when a severe depressive illness includes some form of psychosis. The psychosis could be hallucinations (such as hearing a voice telling you that you are no good or worthless), delusions (such as, intense feelings of worthlessness, failure, or having committed a sin) or some other break with reality.

# data[].attributes.attachment_link.title
Diagnostic and Statistical Manual of Mental Disorders

# data[].attributes.attachment_link.description
Please read the entire Privacy Policy and Terms of Use. By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies.

# data[].attributes.attachment_link.provider_name
National Institute of Mental Health (NIMH)

# data[].attributes.attachment_link.readable_text
What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms:

Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.

Hyperactivity means a person may seem to move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks. In adults, hyperactivity may mean extreme restlessness or talking too much.

Impulsivity means a person may act without thinking or have difficulty with self-control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.

What are the signs and symptoms of ADHD?

What are the risk factors of ADHD?

How is ADHD treated?

How can I find a clinical trial for ADHD?

Where can I learn more about ADHD?

# data[].attributes.attachment_link.description
Learn about attention-deficit/hyperactivity disorder, including signs and symptoms, risk factors, treatments, and tips for staying organized with ADHD.

# data[].attributes.attachment_link.provider_name
Individuals with Disabilities Education Act

# data[].attributes.attachment_link.title
Individuals with Disabilities Education Act (IDEA)

# data[].attributes.attachment_link.description
The U.S. Department of Education’s Individuals with Disabilities Education Act website brings together department and grantee IDEA information and resources. The IDEA makes available a free appropriate public education to and ensures special education and related services to eligible children with disabilities.

# data[].attributes.attachment_link.title
ASCA Ethical Standards for School Counselors - American School Counselor Association (ASCA)

# data[].attributes.attachment_link.readable_text
What Symptoms Should Parents Look for?

There are four basic types of behavior that characterize conduct disorder:

Physical aggression (such as cruelty toward animals, assault or rape).

Violating others' rights (such as theft or vandalism).

Lying or manipulation.

Delinquent behaviors (such as truancy or running away from home).

Conduct disorder is characterized by aggression toward others and a callous disregard for their rights and needs. Adolescents and teens with conduct disorder can find acts of aggression, deceit and coercion to be gratifying. Your child may meet the criteria for conduct disorder if you find them engaging in several of the below behaviors:

Many young people with conduct disorder will have trouble:

Feeling and expressing empathy or remorse.

Showing emotion toward others.

Performing well in the school or community and blaming others for poor performance.

They often misinterpret the actions of others as being hostile or aggressive. They respond by escalating the situation into verbal or physical conflict.

In adolescents and teens, conduct disorder may be associated with other difficulties, including:

In younger children, it can be more of a challenge to distinguish signs of conduct disorder from more typical "acting out".

At times, these same symptoms can be seen in children without the disorder. The difference is frequency, intensity, and duration, as well as to what extent it impacts their functioning. In children with conduct disorder, these behaviors happen much more frequently.

# data[].attributes.attachment_link.description
There are four basic types of behavior that characterize conduct disorder: Physical aggression (such as cruelty toward animals, assault or rape). Violating others' rights (such as theft or vandalism). Lying or manipulation. Delinquent behaviors (such as truancy or running away from home).

# data[].attributes.attachment_link.readable_text
What Is OCD?

Obsessive-compulsive disorder (OCD) causes upsetting thoughts called obsessions. It also causes the urge to do behaviors called compulsions (also called rituals). Kids and teens with OCD get stuck in a stressful cycle of these thoughts, anxiety, and rituals.

If you think your child has OCD, start with a visit to your child's doctor or mental health provider. They can check for OCD or for other problems that could be the cause of your child's symptoms.

How Is OCD Treated?

Treatment for OCD is a type of cognitive behavioral therapy (CBT). In therapy, kids learn coping and calming skills for anxiety. They learn how to safely face fears without doing rituals.

Along with therapy, doctors may give medicines for OCD to some kids. For kids who need medicines, doctors give SSRIs (selective serotonin reuptake inhibitors). These include Zoloft®, Prozac®, and Luvox®.

Treatment works best when a parent or caregiver goes to therapy with their child. That way, they can learn how to coach their child through OCD symptoms, help their child practice skills they learn in therapy, and offer daily support.

What Signs Might Parents Notice?

Obsessions

These are stressful thoughts that come to mind over and over. A child with OCD doesn't want to think about these things. But they feel they can't stop.

Parents may notice obsessions as intense fears or worries. Kids with OCD may feel unusually upset about:

germs, dirt, illness, injury, or harm

whether someone could get sick, hurt, or die

things that seem wrong, or out of place

whether bad thoughts might come true

things that are not straight, even, or arranged "just right"

Compulsions (Rituals)

These are behaviors a child will do, trying to feel better. To the child, rituals seem like the way to stop thoughts and relieve fears. They seem like a way to keep bad things from happening.

Parents may notice that kids:

touch, tap, or step in unusual ways

arrange things over and over

repeat words, phrases, or questions

have many doubts, and trouble making choices

wash or clean more than needed

take a long time to do things - like get dressed, shower, eat, do homework

Kids may involve parents in rituals. And at first, parents may not realize that something is a ritual. For example, a child with OCD might ask for reassurance over and over. Or a child may insist a parent say or do something a set number of times, or in a set way.

Kids and teens with OCD can have obsessions, compulsions, or both.

Feelings

OCD symptoms are hard on kids. Rituals may seem to give them some relief at first. But rituals multiply. They start to take more time and energy. Kids have little left for things they enjoy. OCD thoughts, feelings, and rituals become a stressful cycle. This can make it hard to focus in school, have fun with friends, get to sleep, or relax.

Kids may seem:

anxious, worried

frustrated, irritable

sad, tired

upset when they can't do a ritual

to need constant reassurance from a parent that things are OK

Some kids may not let parents know about the thoughts, fears, and behaviors OCD causes. They may feel confused or ashamed about their fear and keep it to themselves. They may try to hide rituals they do. Some kids may have OCD symptoms for a while before their parents realize it.

How Can I Help My Child?

If you think your child may have OCD:

Talk with your child about what you've noticed. Talk in a supportive way, listen, and show love. Say something that works for your child's situation like, "I notice you fixing your socks a lot, trying to get them even. Getting them to feel right causes you a lot of stress."

Say that something called OCD might be causing the worry and the fixing. Tell your child that a checkup with a doctor can find out if this is what's going on. Let your child know that this can get better, and that you want to help.

Make an appointment with a child psychiatrist or psychologist. Your child's doctor can help you find the right person. To diagnose OCD, they will spend time talking with you and your child. They will ask questions about your child's symptoms that help point them to signs of OCD. If they diagnose OCD, they can explain the treatment.

Take part in your child's therapy. Part of treatment is coaching parents on how to respond to their child's OCD symptoms. Learn all you can about ways you can help. Learn how to support your child's progress without giving in to rituals.

Be patient. Overcoming OCD is a process. There will be many therapy visits. Be sure to go to them all. Help your child practice the things the therapist shows you. Praise your child's effort. Show how proud you feel. Remind them that OCD is not their fault.

Get support, and give it. There are lots of resources and support for families dealing with OCD. The International OCD Foundation is a good place to start. Knowing that you're not alone can help you cope. Sharing success stories with other parents can give you hope and confidence.

# data[].attributes.attachment_link.description
OCD causes upsetting thoughts (obsessions) and the urge to do "ritual" behaviors (compulsions). Kids and teens get stuck in a stressful cycle of these thoughts, anxiety, and rituals. OCD can get better with the right attention and care.

# data[].attributes.attachment_link.provider_name
National Institute of Mental Health (NIMH)

# data[].attributes.attachment_link.description
Learn about schizophrenia, including onset & symptoms, risk factors, treatments and therapies, how to help a loved one, & resources for more information.

# data[].attributes.attachment_link.readable_text
Overview

What is delusional disorder?

Delusional disorder is a type of psychotic disorder. Its main symptom is the presence of one or more delusions.

A delusion is an unshakable belief in something that's untrue. The belief isn't a part of the person's culture or subculture, and almost everyone else knows this belief to be false.

People with delusional disorder often experience non-bizarre delusions. Non-bizarre delusions involve situations that could possibly occur in real life, such as being followed, deceived or loved from a distance. These delusions usually involve the misinterpretation of perceptions or experiences. In reality, these situations are either untrue or are highly exaggerated.

Non-bizarre delusions are different from bizarre delusions, which include beliefs that are impossible in our reality, such as believing someone has removed an organ from your body without any physical evidence of the procedure.

People with delusional disorder often continue to socialize and function well, apart from the subject of their delusion. Generally, they don't behave in an odd or unusual manner. This is unlike people with other psychotic disorders, who might also have delusions as a symptom. In some cases, however, people with delusional disorder might become so preoccupied with their delusions that their lives are disrupted.

What are the types of delusional disorder?

There are different types of delusional disorder, which are determined based on the main theme of the delusions the person experiences. The types of delusional disorder include:

Erotomanic: People with this type of delusional disorder believe that another person, often someone important or famous, is in love with them. They may attempt to contact the person of the delusion and engage in stalking behavior.

Grandiose: People with this type of delusional disorder have an overinflated sense of self-worth, power, knowledge or identity. They may believe they have a great talent or have made an important discovery.

Jealous: People with this type of delusional disorder believe that their spouse or sexual partner is unfaithful without any concrete evidence.

Persecutory: People with this type of delusional disorder believe someone or something is mistreating, spying on or attempting to harm them (or someone close to them). People with this type of delusional disorder may make repeated complaints to legal authorities.

Somatic: People with this type of delusional disorder believe that they have a physical issue or medical problem, such as a parasite or a bad odor.

Mixed: People with this type of delusional disorder have two or more of the types of delusions listed above.

What is the difference between delusional disorder and schizophrenia?

Schizophrenia is a spectrum (or range) of conditions that involve psychotic symptoms, which include:

Disorganized speech or behavior.

Negative symptoms (a decrease in emotion in a person's facial expressions and motivation).

Delusional disorder is different from schizophrenia because there aren't any other psychotic symptoms other than delusions.

In addition, in contrast to schizophrenia, delusional disorder is relatively rare, and daily functioning isn't as impaired as it is in schizophrenia.

Who does delusional disorder affect?

Delusional disorder most often occurs in middle to late life, with the average age of onset being 40 years.

The persecutory and jealous types of delusional disorder are more common in people assigned male at birth (AMAB), and the erotomanic type is more common in people assigned female at birth (AFAB).

People who tend to be socially isolated are more likely to develop delusional disorder. These populations include:

Immigrants who have language barriers.

People who are deaf.

People who are visually impaired.

Elderly people.

How common is delusional disorder?

Although delusions might be a symptom of more common disorders, such as schizophrenia, delusional disorder itself is rather rare. Approximately 0.05% to 0.1% of the adult population has delusional disorder.

What is the most common type of delusional disorder?

The most common type of delusional disorder is the persecutory type - when someone believes others are out to harm them despite evidence to the contrary.

Symptoms and Causes

What are the signs and symptoms of delusional disorder?

The presence of delusions is the most obvious sign of delusional disorder, which vary based on the type.

Another characteristic of this condition is that the person often lacks self-awareness that their delusions are problematic. They're unable to accept that their delusions are irrational or inaccurate, even if they recognize that other people would describe their delusions this way.

Anger and violent behavior may be present if someone is experiencing persecutory, jealous or erotomanic delusions.

People with delusional disorder may also develop anxiety and/or depression as a result of the delusions.

Early symptoms of delusional disorder may include:

Feelings of being exploited.

Preoccupation with the loyalty or trustworthiness of friends.

A tendency to read threatening meanings into benign remarks or events.

Persistently holding grudges.

A readiness to respond and react to perceived slights.

What causes delusional disorder?

As with many other psychotic disorders, researchers don't yet know the exact cause of delusional disorder. Researchers are, however, looking at the role of various factors that may contribute to the development of the condition, including:

Genetic factors: The fact that delusional disorder is more common in people who have family members with delusional disorder or schizophrenia suggests there might be a genetic factor involved. Researchers believe that, as with other mental disorders, a tendency to develop delusional disorder might be passed on from parents to their biological children.

Biological factors: Researchers are studying how abnormalities of certain areas of your brain might be involved in the development of delusional disorder. An imbalance of certain chemicals in your brain, called neurotransmitters, has been linked to the formation of delusional symptoms.

Environmental and psychological factors: Evidence suggests that delusional disorder can be triggered by stress. Alcohol use disorder and substance use disorder might contribute to the condition. Hypersensitivity and ego defense mechanisms like reaction formation, projection and denial are some psychodynamic theories for the development of delusional disorder. Social isolation, envy, distrust, suspicion and low self-esteem are also some psychological factors that may lead to a person seeking an explanation for these feelings and, thus, forming a delusion as a solution.

Diagnosis and Tests

How is delusional disorder diagnosed?

Healthcare providers - mainly mental health professionals - diagnose delusional disorder when a person has one or more delusions for one month or more that can't be explained by any other condition. The person must also not have the characteristic symptoms of other psychotic disorders, such as schizophrenia.

If someone is experiencing signs and symptoms of delusional disorder, a healthcare provider will perform a complete medical history and physical examination. Although there aren't any laboratory tests to diagnose delusional disorder, their healthcare provider might use various diagnostic tests - such as imaging tests, a urine drug screen and blood tests - to rule out any physical conditions, medications or substances that could be causing the symptoms.

If their healthcare provider finds no physical reason for the symptoms, a consultation with a psychiatrist or psychologist will likely be made. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a psychotic disorder. They'll ask questions about the delusions and assess the person's mental status.

The psychiatrist or psychologist may also interview family members and friends so they can provide further details about the person's delusions and a timeline of the symptoms.

As other mental health conditions can cause delusions, mental health professionals carefully assess the person for other symptoms. Delusional disorder can be misdiagnosed as any of the following conditions:

Management and Treatment

How is delusional disorder treated?

Treatment for delusional disorder most often includes psychotherapy (talk therapy) and medication, but delusional disorder is highly resistant to treatment with medication alone.

People with delusional disorder often don't seek treatment for the condition on their own because most people with delusional disorder don't realize their delusions are problematic or incorrect. It's more likely they'll seek help due to other mental health conditions such as depression or anxiety.

People with severe symptoms or who are at risk of hurting themselves or others might need to be admitted to the hospital until the condition is stabilized.

Psychotherapy for delusional disorder

Psychotherapy is a term for a variety of treatment techniques that aim to help people identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to the person and their family.

Through therapy, people with delusional disorder can learn to manage their symptoms, identify early warning signs of relapse and develop relapse prevention plans. Types of psychotherapy include:

Individual psychotherapy: This type of therapy can help a person recognize and correct the underlying thinking that has become distorted.

Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. A mental health professional helps people take a close look at their thoughts and emotions. They'll come to understand how their thoughts affect their actions. Through CBT, they can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.

Family-focused therapy: This therapy can help people with delusional disorder and their families. This treatment involves psychoeducation regarding delusional disorder, communication improvement training and problem-solving skills training.

Medications for delusional disorder

The primary medications used to help treat delusional disorder are called antipsychotics (neuroleptics). Medications include the following:

First-generation ("typical") antipsychotics: Healthcare providers have used these medications to treat mental health conditions since the mid-1950s. These medicines work by blocking dopamine receptors in your brain. Dopamine is a neurotransmitter believed to be involved in the development of delusions. First-generation antipsychotics include chlorpromazine (Thorazine®), fluphenazine (Prolixin®), haloperidol (Haldol®), thiothixene (Navane®), trifluoperazine (Stelazine®), perphenazine (Trilafon®) and thioridazine (Mellaril®).

Second-generation ("atypical") antipsychotics: These newer antipsychotics are also effective in treating the symptoms of delusional disorder. They work by blocking dopamine and serotonin receptors in your brain. These drugs include risperidone (Risperdal®), clozapine (Clozaril®), quetiapine (Seroquel®), ziprasidone (Geodon®) and olanzapine (Zyprexa®). These medications are usually better tolerated than first-generation antipsychotics.

Other medications that healthcare providers might prescribe to treat delusional disorder include anxiolytics and antidepressants. Anxiolytics might help if the person has a very high level of anxiety and/or problems sleeping. Antidepressants can help treat depression, which often occurs in people with delusional disorder.

Prevention

Can delusional disorder be prevented?

There's no known way to prevent delusional disorder. However, early diagnosis and treatment can help decrease the disruption to the person's life, family and friendships.

Outlook / Prognosis

What is the prognosis (outlook) for delusional disorder?

The prognosis (outlook) for people with delusional disorder varies depending on a few factors, including:

The type of delusional disorder.

The severity of the delusions.

The person's life circumstances, including the availability of support and a willingness to stick with treatment.

Delusional disorder doesn't usually significantly affect a person's daily functioning, but the severity of the delusion may gradually get worse. Most people with delusional disorder can remain employed as long as their work doesn't involve things related to their delusions.

The prognosis of delusional disorder is better if the person sticks to their treatment plan. Almost 50% of people have a full recovery, more than 20% of people report a decrease in symptoms and less than 20% of people report minimal to no change in symptoms.

Unfortunately, many people with this condition don't seek help. It's often difficult for people with mental health conditions to recognize they're not well. They also might be too embarrassed or afraid to seek treatment. Without treatment, delusional disorder can be a life-long condition.

What are the possible complications of delusional disorder?

If left untreated, delusional disorder might lead to:

Depression, often as a consequence of difficulties associated with the delusions.

Social isolation.

Legal issues - for example, stalking or harassing the person involved with the delusion could lead to arrest.

Self-harm or harm to others. This is more common in the jealous and persecutory types.

Living With

How can I help someone with delusional disorder?

If you know someone with delusional disorder, you can help by providing support and encouragement for them to seek help and treatment.

People with delusional disorder who feel pressured or repeatedly criticized by others will likely experience stress, which may worsen their symptoms. Because of this, a positive approach may be more helpful and effective.

The friends and family members of people with delusional disorder often experience stress, depression, grief and isolation. It's important to take care of your mental health and seek help if you're experiencing these symptoms.
A note from Cleveland Clinic
It's important to remember that delusional disorder is a mental health condition. As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to life. Mental health professionals can offer treatment plans that can help manage thoughts and behaviors.

# data[].attributes.attachment_link.title
Delusional Disorder: Causes, Symptoms, Types & Treatment

# data[].attributes.attachment_link.description
Delusional disorder is a type of psychotic disorder. Its main symptom is the presence of one or more delusions. A delusion is an unshakable belief in something that's untrue. The belief isn't a part of the person's culture or subculture, and almost everyone else knows this belief to be false.

# data[].attributes.attachment_link.readable_text
A 7-year-old states that she is vegetarian because she loves animals, and begins to eat a more restricted diet. A 10-year-old is concerned about starvation in the world and begins to feel guilty about their abundance of food, and slowly begins to eat fewer food choices. An 8-year-old eats less in response to stressful family dynamic and begins to lose weight.

Eating disorders are dangerous at any age, but when the symptoms go unnoticed in a child, it can be catastrophic. Children have lower percentage of body fat, and small amounts of weight loss can be medically detrimental to growth and physical health. Bodies and brains are continually developing at this age and eating disorders can affect development through limiting growth potential and damaging vital organs [1, 5].

Margaret Kelly, a clinical nurse manager at Children's Hospital Denver, states that their program has had to reduce the admittance requirements to age 9 for eating disorders. She states that the increase in males has gone up in the last decade, as well [1].

5 percent of adolescents are affected by an eating disorder, and at least 10 percent of adults first showed clear symptoms prior to age 10. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), 60 percent of elementary and middle school teachers report eating disorders are a problem.

Further statistics from the National Eating Disorders Association (NEDA) stated that 41 percent of children in first through third grade report they want to be thinner, and 81 percent of 10-year-olds are afraid of becoming fat. A further 51 percent of 9 and 10-year-olds say they would feel better about themself if they were on a diet.

Risk Factors for Children

Children are more vulnerable to eating disorders due to culture and personality traits [1, 3]. Common traits are high levels of anxiety, perfectionism, obsessive-compulsive tendencies, depression, and addiction. Children also have genetic risks that can compound when mixed with personality traits.

Cultural pressures, including messages at school around healthy eating and exercise, can be misheard and misperceived by many children. Magazine ads, commercials, and unhealthy family expectations and pressures all add to the vulnerability of the development of an eating disorder in children.

Sports can also play a role in the development of an eating disorder. Children are participating at a much younger age than before, and involved in competitive levels and/or on various levels of teams. Team uniforms and sports that have a higher emphasis on appearance can also increase the risk of an eating disorder.

Another factor is puberty. This can be a trigger due to rapid growth spurts and weight gain as their bodies change. Both boys and girls may have a wider body prior to the growth spurt, which may result in bullying by peers.

Types of Eating Disorders and Symptoms in Children

In children, eating disorders can overlap [2]. Some children may alternate between periods of anorexia, bulimia, and binge eating.

Children often struggle with feelings of distress around weight gain or mealtime situations, may feel helplessness around the disorder, and struggle with low self-esteem. Developing unhealthy eating habits may seem like an option to tweens to control their feelings or situation.

Physical issues are common with those who have an eating disorder and can lead to serious, sometimes fatal, medical complications.

Early symptoms to look out for in children are:

Skipping meals or making excuses to eat in secret

Excessive focus on food or healthy eating

Persistent worry or complaints of being fat

Frequent body checking

Repeatedly eating large amounts of sweets or high-fat foods

Regularly going to the bathroom after eating

Eating more than considered normal for a meal or snack

Expressing depression, disgust, shame, or guilt about eating habits [3].

Anorexia symptoms can include being thin or emaciated yet wanting to diet, being underweight but having an intense fear of becoming fat, menstruation that is infrequent or stops altogether, rapid weight loss, and strange eating habits.

Damage to major organs, such as brain, heart, and kidneys, can occur with significant weight loss. Irregular heartbeat or slowed heart rhythm, lowered blood pressure, pulse, and temperature, sensitivity to cold, and thinning of bones are all common results of weight loss.

The most common causes of death in children with anorexia are cardiac arrest, electrolyte imbalance, and suicide [2, 4].

Tweens can often struggle with fear of weight gain and feelings of distress around body shape and size. Often with eating disorder overlap, a child may overeat and feel a sense of lack of control. This leads to vomiting, laxative use, diet pills, diuretics, or enema use to rid the body of food consumed. Typically, purging behaviors bring a sense of relief to the child, reinforcing the eating disorder. Many times the purging behaviors are done in secret.

Symptoms of bulimia in children can include increased anxiety, binging on large amounts of food or food missing from cabinets and refrigerator, eating in secret, or noticing unusual eating habits.

Excessive exercise with sport, or practicing outside of scheduled games or practices, is also a sign. Some children will excessively play or fidget, as well, after mealtimes. Physical complications include damage and erosion of tooth enamel, inflammation of the esophagus, swelling of salivary glands in cheeks where they look puffy, and lower blood levels of potassium, which can lead to abnormal heart rhythms [2, 4].

Binge eating is similar to bulimia but without the purging aspect. It includes chronic, out-of-control eating of large amounts of food in a short period of time. It often brings discomfort physically to the child and causes guilt, shame, and distress. Typically a binge will occur in secret, is chaotic, and is done in a 2-hour period or less with an out-of-control feeling and inability to stop.

Children who binge eat are often overweight due to consumption of large amount of foods and non-compensating behaviors. These individuals may struggle with managing emotions, such as anger, worry, stress, sadness, or boredom. Depression and anxiety are also common with binge eating. Health problems include heart disease, high blood pressure, high cholesterol, and type 2 diabetes [2, 4].

Treatment of Eating Disorders

The first step in eating disorder treatment is often to have the child assessed by a coordinator of a hospital or higher level of care treatment facility. Once the assessment is complete, the determination of which treatment option is best will be decided and the child admitted to the program.

The primary goal, at first, is to restore weight and healthy eating patterns. If malnutrition is severe, or a concern, the child will be first admitted to hospital for refeeding until medically stable. In these cases, a feeding tube may be required for weight restoration. Psychological treatment may include medication treatment for co-occurring mood disorders, behavioral therapy, group support, psychotherapy and nutritional counseling.

Treatment for bulimia in children is multi-fold. The first step is to reduce and cease the binge-purge cycle. Treatment options may include hospitalization, depending on severity of cycles. It is also important to have the child evaluated by a medical physician who specializes in pediatric eating disorders. Further treatment can include medication for mood disorders, behavior modification, individual, family, and group therapy, and nutritional counseling.

Treatment for binge eating in tweens includes behavioral therapy, such as cognitive behavioral to address negative thinking and unhealthy behaviors, medication treatment, and psychotherapy, as well as nutritional counseling to establish healthy eating habits and cease binging behaviors.

In conclusion, with comprehensive treatment, children and teens can manage eating disorder symptoms and reach full recovery.

It is important to get an assessment and treatment for a child who is struggling. Treatment often includes the family, as both individual and group practices are highly effective. Research shows that early identification and treatment lead to successful results [5].
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies. References:
[1] Renkl, M. (n.d.). The scary trend of tweens with anorexia. Retrieved March, 2017, from http://www.cnn.com/2011/HEALTH/08/08/tweens.anorexia.parenting/index.htmlKam, K. (n.d.). Eating Disorders in Children and Teens. Retrieved March, 2017, from http://www.webmd.com/mental-health/eating-disorders/features/eating-disorders-children-teens#1Teen eating disorders: Tips to protect your teen. (2015, June 02). Retrieved March, 2017, from http://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-depth/teen-eating-disorders/art-20044635https://www.nationaleatingdisorders.org/sites/default/files/Toolkits/ParentToolkit.pdf
[2] [3]
[4] (n.d.) Retrieved March 2017, from
[5] A. (n.d.). Retrieved March, 2017, from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_families_Pages/Teenagers_With_Eating_Disorders_02.aspx

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals. We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on May 4, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on May 3, 2017.
Published on EatingDisorderHope.com

# data[].attributes.attachment_link.title
Tweens with Eating Disorders: Warning Signs and Treatment Options

# data[].attributes.attachment_link.description
A 7-year-old states that she is vegetarian because she loves animals, and begins to eat a more restricted diet. A 10-year-old is concerned about starvation in the world and begins to feel guilty about their abundance of food, and slowly begins to eat fewer food choices.

# data[].attributes.headline
Educators and Working with Students with Psychological Disabilities

# data[].attributes.subject
Educators and Working with Students with Psychological Disabilities

# data[].attributes.attachment_link.readable_text
The needs of students with psychological disabilities can vary widely and may change with the changing course of their disability. The most important way faculty can support these students is by being supportive and flexible.

Functional Limitations

The following functional limitations related to psychiatric disabilities may affect academic performance and may require accommodations (Center for Psychiatric Rehabilitation, 1997).

Difficulty with medication side effects: side-effects of psychiatric medications that affect academic performance include drowsiness, fatigue, dry mouth and thirst, blurred vision, hand tremors, slowed response time, and difficulty initiating interpersonal contact.

Screening out environmental stimuli: an inability to block out sounds, sights, or odors that interfere with focusing on tasks. Limited ability to tolerate noise and crowds.

Sustaining concentration: restlessness, shortened attention span, distraction, and difficulty understanding or remembering verbal directions.

Maintaining stamina: difficulty sustaining enough energy to spend a whole day on campus attending classes; combating drowsiness due to medications.

Handling time pressures and multiple tasks: difficulty managing assignments, prioritizing tasks, and meeting deadlines. Inability to participate in multi-task work.

Interacting with others: difficulty getting along, fitting in, contributing to group work, and reading social cues.

Fear of authority figures: difficulty approaching instructors or TAs.

Responding to negative feedback: difficulty understanding and correctly interpreting criticism or poor grades. May not be able to separate person from task (personalization or defensiveness due to low self-esteem).

Responding to change: difficulty coping with unexpected changes in coursework, such as changes in the assignments, due dates or instructors. Limited ability to tolerate interruptions.

Severe test anxiety: the individual is rendered emotionally and physically unable to take an exam.

Instructional Strategies

Students with a psychological disability can be intelligent, sensitive, creative, and interesting. You can employ strategies that will promote their success in your class. For example:

Address a variety of learning styles (e.g. auditory, visual, kinesthetic, experiential, or a combination of styles).

Incorporate experiential learning activities.

Be prepared to set behavioral expectations for all students in your class.

Embrace diversity to include people with psychiatric disabilities.

Accommodations

Some students with a psychological disability may require accommodations to allow them equal access to classes, programs, and coursework. An accommodation is the removal of a barrier to full participation and learning. The emphasis is on access, not outcome. This is done by providing the student with a disability equal access to the content and activities of a course, but not necessarily assuring their success.

The following are typical classroom, exam, and assignment accommodations that may be approved by SSD for a student with a psychological disability.

Classroom Accommodations

Preferential seating, especially near the door to allow leaving class for breaks.

Prearranged or frequent breaks

Permission to audio record lectures

Copy of notes from a volunteer notetaker

Permission to use a laptop for taking notes in class

Access to powerpoints or overheads shown in class

Student will raise hand to participate in class and/or will work with instructor to determine how participation will be assessed. Student should not be called upon at random

Permission to approach instructor to discuss flexible deadlines. Final determination will be made by instructor based on the structure of the course.

Attendance may be an issue

Examination Accommodations

Extended time for test taking.

Test location in a reduced distraction environment

Not all requested accommodations are "reasonable." An accommodation is not reasonable if:

Making the accommodation or having the individual involved in the activity poses a direct threat to the health or safety of others.

Making the accommodation means making a substantial change in an essential element of the curriculum.

Making the accommodation would require a substantial alteration in the manner in which educational opportunities are provided, such as the course objectives being altered.

Making the accommodation would impose an undue financial or administrative burden to the institution.

References

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed). Washington, DC: Author.

Center for Psychiatric Rehabilitation. (1997). How does mental illness affect the way I function at school? Boston University. https://cpr.bu.edu/resources/reasonable-accommodations/jobschool/how-does-mental-illness-affect-my-school-performance/

Additional Resources

DO-IT has created a collection of videos that can be freely viewed at www.uw.edu/doit/Video/. Of particular relevance are the following titles: Building the Team: Faculty, Staff and Students Working Together, Equal Access: Universal Design of Instruction, and Invisible Disabilities and Postsecondary Education. You may also find the following resources useful as you explore this topic further.

The Center for Universal Design in Education
www.uw.edu/doit/CUDE/

About DO-IT

DO-IT (Disabilities, Opportunities, Internetworking, and Technology) serves to increase the successful participation of individuals with disabilities in challenging academic programs such as those in science, engineering, mathematics, and technology. Primary funding for DO-IT is provided by the National Science Foundation, the State of Washington, and the U.S. Department of Education. DO-IT is a collaboration of UW Information Technology and the Colleges of Engineering and Education at the University of Washington.

Acknowledgment

This publication was developed under a grant from the U.S. Department of Education, #P33A990042. However, these contents do not necessarily represent the policy of the U.S. Department of Education, and you should not assume endorsement by the federal government.

Copyright © 2012, 2009, 2008, 2006, 2001, University of Washington. Permission is granted to copy these materials for educational, noncommercial purposes provided the source is acknowledged.
Academic Accommodations for Students with Psychiatric Disabilities
For more general information about Psychological Disabilities, please click here.

# data[].attributes.attachment_link.title
Tips for Working with Students with Psychological Disabilities - Disability and Access

# data[].attributes.attachment_link.description
The needs of students with psychological disabilities can vary widely and may change with the changing course of their disability. The most important way faculty can support these students is by being supportive and flexible. Functional Limitations The following functional limitations related to psychiatric disabilities may affect academic performance and...

# data[].attributes.attachment_link.description
Impulse control disorders (ICDs) are a class of psychiatric disorders characterized by difficulties controlling aggressive or antisocial impulses. Because they can involve physical violence, theft, or destruction of property, the disorders often have harmful effects on both the person with the disor…