Category Archives: Senior News

Men Tend To Crave Alcohol More Than Women

Men tend to respond to stress very differently and tend to have different types of stress-related disorders according to a new study. According to this research, men have a tendency to have greater rates of alcohol use disorders than women and women seem to have greater rates of depression and some types of anxiety disorders. This new study linking emotions to alcohol craving responses and stress, has found that men have a tendency to crave alcohol when becoming upset more frequently than women.

Tara M. Chaplin, associate research scientist at Yale University School of Medicine and the first author to the study reported, “We know that women and men respond to stress differently,” and continued by stating, “For example, following a stressful experience, women are more likely than men to say that they feel sad or anxious, which may lead to risk for depression and anxiety disorders. Some studies have found that men are more likely to drink alcohol following stress than women. If this becomes a pattern, it could lead to alcohol use disorders.”

As a part of a larger study, 54 healthy adult social drinkers (27 women, 27 men) were exposed to three different types of imagery scripts-stressful, alcohol-related, and neutral/relaxing in random order on separate days. Researchers then assessed participant’s subjective emotions, behavioral/bodily responses, heart rate and blood pressure and self-reported alcohol craving.

Chaplin stated, “After listening to the stressful story, women reported more sadness and anxiety than men,” and went on to say, “as well as greater behavioral arousal. But, for the men….emotional arousal was linked to increases in alcohol craving. In other words, when men are upset, they are more likely to want alcohol.”

Researchers concluded that based upon these findings in addition to the fact that men have a tendency to drink more than women on average, and seem to have more experience with alcohol, that perhaps they have a tendency to turn to alcohol as a way of coping with the stress. Chaplin commented “Men’s tendency to crave alcohol when upset may be a learned behavior or may be related to known gender differences in reward pathways in the brain.” Chaplin then continued that “And this tendency may contribute to risk for alcohol-use disorders.”

Researchers concluded that there seems to be a greater acceptance of “emotionality”, particularly anxiety and sadness in women than men. Chaplin commented “Women are more likely than men to focus on negative emotional aspects of stressful circumstances, for example, they tend to ‘ruminate’ or think over and over again about their negative emotional state,” she said. “Men, in contrast, are more likely to distract themselves from negative emotions, to try not to think about these emotions. Our finding that men had greater blood pressure response to stress, but did not report greater sadness and anxiety, may reflect that they are more likely to try to distract themselves from their physiological arousal, possibly through the use of alcohol.”

Information adapted from:
Kwangik Hong, Keri Bergquist, and Rajita Sinha of the Department of Psychiatry at the Yale University School of Medicine. Gender Differences in Response to Emotional Stress: An Assessment across Subjective, Behavioral and Physiological Domains and Relations to Alcohol Craving. Alcoholism: Clinical & Experimental Research. July 2008.

Online at ScienceDaily (May 12, 2008): Men Are More Likely Than Women To Crave Alcohol When They Feel Negative Emotions
Additional Information and webpage by Paul Susic Ph.D Licensed Psychologist  (Health and Geriatric Psychologist)

Prescription Medication: The Do’s and Don’ts

Prescription Medication: The Do’s and Don’ts

When taking prescription medications, your senior should do the following:
Frequent a pharmacist who keeps a “drug profile” for customers and who will alert you to any prescription medication interaction problems. Also, continue comparing prices at other pharmacies as your pharmacist may match a cheaper price at another drugstore if you’re a regular customer.

Ask your doctor to write the purpose of the medication on the prescription so that the pharmacist can then type it on the label, helping to reduce the chance of accidental mix-ups. Most pharmacists will also write the expiration date of the prescription medication if asked to.

Ask the pharmacist for easy open caps, large print labels, and sometimes oversize bottles may be necessary. Check your prescription medications before leaving the pharmacy. Make sure that the correct patient’s name is on the bottle and the directions are consistent with what the doctor told you. Ask the pharmacist if your pill box or pill organizer will affect the stability of the prescription medication. You should also talk with your doctor and pharmacist about whether crushing pills or putting them in liquid or applesauce affects the medication, making them less effective.

Always read the medicine container before each dose. Always take all medications as prescribed. A recent report found that nearly 25% of all admissions to nursing homes were due to elders not following the prescribed medication therapeutic regimen.

Things your loved ones should not do when taking prescription medications: Never put drugs in different bottles then what they were originally prescribed in. When medications are in different bottles, it’s hard to remember what they are for or how they should be taken. Also, the original bottles are tinted or opaque to keep out damaging sunlight.

Split medications in advance. When the doctor has approved taking half a pill, ask the pharmacist whether splitting medications in advance will have an effect on the drug. (Most large pharmacies sell tablet cutters for splitting pills). Chew or break pills unless directed. You should never take anyone else’s prescription medication. Never drive when there’s a warning on the medications saying that it may cause drowsiness or fatigue. Never modify the dosage without consulting your physician.

Never discontinue medications even if you feel better. This is especially true for antibiotics. Quitting before the pills are taken completely may cause an increase in antibiotic resistant strains of bacteria. Also, abrupt discontinuation of medications may cause unpleasant and possibly dangerous withdrawal symptoms. Your physician always needs be notified when medications are discontinued before the prescribed time.

Do not accumulate old prescription medications. Unused medicines make the proper management of medications more difficult. The best way to dispose of prescription medications is by flushing them down the toilet, which will ensure that children, pets or others will not find them in the trash and be harmed by them in any way.
These recommendations should help to make yourself or family member safer and healthier.

Some information from Eldercare for Dummies by Rachelle Zukerman

Additional information and webpage by Paul Susic Ph.D. Licensed Psychologist (Health and Geriatric Psychologist)

Trazodone medication: Is this medicine safe and effective?

Brand-name: Desyrel

Generic name: Trazodone hydrochloride

Trazodone medication: Why is this medication prescribed?

Trazodone medication is prescribed for treatment of depression. In addition to its antidepressant properties, sometimes it is also prescribed to assist people with their sleep.

Trazodone medication: What are some important things for me to know?

Trazodone medication does not give immediate relief, but may take up to four weeks before you actually begin to feel better. Most patients notice some improvement within approximately 2 weeks however.

When should trazodone medication not be prescribed?

If you’ve ever been sensitive or allergic to trazodone or similar medications, you should probably not take this antidepressant. You should always make sure that your doctor is aware of any drug reactions you experience when on this or any medications.

What if I am pregnant or breast-feeding?

The effects of trazodone medication have not been adequately studied during pregnancy. If you’re pregnant or planning on becoming pregnant in the near future, you should talk to your physician immediately. This medicine may appear in breast milk. If trazodone medication is absolutely essential to your health, your doctor may recommend that you discontinue breast-feeding your baby until your treatment with trazodone medication is complete.

Trazodone side effects: An overview

Trazodone side effects usually cannot be anticipated. If you notice any Trazodone side effects however, you should notify your physician immediately. Along with the benefits of any medicine, there are almost always some unwanted effects. While many or most of these effects may not occur, if they do you should call your physician or get medical attention immediately.

Trazodone side effects that require immediate attention:


Painful and inappropriate erection of the penis continuing for an extended period of time. In this case you should stop taking this medicine and check with your doctor immediately.

You need to check with your doctor as soon as possible if any the following Trazodone side effects occur:

Less Common

Fainting; muscle tremors; confusion


Unusual excitement; skin rash: fast or slow heartbeat

Symptoms of overdosage of Trazodone

Loss of muscle coordination; nausea and vomiting; drowsiness

While many other Trazodone side effects may occur that usually do not require medical attention, these side effects may go away as treatment progresses and your body adjusts to the medicine. However, you should check with your doctor if the following Trazodone side effects continue or become more bothersome:
More common
Unpleasant taste; nausea and vomiting; dryness of mouth; dizziness or lightheadedness; drowsiness
Less common
Unusual tiredness or weakness; muscle aches or pains; constipation; blurred vision; diarrhea
While other Trazodone side effects not listed above may also occur in some patients, if you notice any other side effects while taking Trazodone or any other medicine you need to check with your doctor immediately.

Trazodone dosage: How much is too much?

Trazodone dosage: Important information

Your Trazodone dosage should be taken with or shortly after a meal or snack to reduce any dizziness or lightheadedness or to lessen stomach upset. Your Trazodone dosage should always be taken precisely as recommended by your doctor without deviation to gain the maximum benefit of this depression medicine. Some patients have reported that it may take as long as four weeks before you begin to feel better although some report improvement within two weeks.

Trazodone dosage: Specific amounts

Although your dose of Trazodone may be different from other individuals, you need to follow your doctor’s orders or the directions on the label of your medication. The following information includes only the average Trazodone dosages. If your dose is different always follow exactly what your doctor tells you to do.

Adult Trazodone dosage

The usual starting dosage is 50 mg per dose taken three times a day or 75 mg per dose taken two times a day. Your physician may increase the dosage as he or she believes will benefit your condition.

Children’s dosage

For children up to the age of six years old, dosage should be determined by your doctor. For children between the ages of six and 18 years old, your doctor will determine the oral dosage to be taken based upon your body weight.

Trazodone dosage for the elderly

The usual starting dosage is 25 mg per dose taken three times a day. Your doctor may than increase your dosage as needed.

Storage of Trazodone:

Always keep this depression medication out of the reach of children, away from heat and direct sunlight. You should never store this medicine in the bathroom or other damp area or near any type of heat or moisture, which may cause this medication to break down. Also, you should never keep this or any other medication any longer than needed. Be sure that any discarded medicine is out of the reach of children.

Missed Trazodone dosage:

If you ever miss your Trazodone dosage you need to take it as soon as possible. However, if it is within four hours of your next dosage you will need to get back on your regular routine schedule. Never take double doses of Trazodone or any other medication for that matter.

Trazodone medication: What are some of the special precautions?

Trazodone medication: Special precautions

The use of Trazodone medication will require regular visits to your doctor to monitor your progress. Your physician will continue to check the effects of your Trazodone medication and adjust the dosage as necessary. You should never quit taking this medication without checking with your doctor first. Frequently the doctor will reduce the amount of this medication gradually before you stop it completely.

Trazodone medication- Other special precautions:

While taking Trazodone medication, always let your doctor or dentist know before having any emergency, dental or medical surgery. Taking this medicine while having surgical or dental treatments may interact negatively with medicines that are used during dental or emergency services and increase the depressant effects on the central nervous system.

Trazodone medication has also been known to cause people to become irritable and agitated, as well as to have suicidal thoughts and tendencies, and to actually become more depressed. If you or your family members notice these effects you should notify your doctor immediately.

This depression medicine will add to the effects of alcohol or other central nervous system depressants, possibly causing drowsiness. Common examples of central nervous system depressants are antihistamines or medicines for allergies, colds, tranquilizers, and sleeping medicines. Other very common central nervous system depressants also include pain medicines or narcotics, medicine for seizures, muscle relaxants, anesthetics and barbiturates.
Trazodone may cause some people to become drowsy or less alert than normal. You should always make sure you know how you will react to this medication before you drive or operate heavy machinery or do anything that may be dangerous if you’re not completely alert. Dizziness, fainting or lightheadedness may occur when you attempt to get up from a lying or sitting position. Many doctors recommend getting up slowly to help with this sensation. If this lightheadedness or dizziness problem continues or gets worse you should talk to your doctor immediately.
Trazodone medication has also been known to cause dryness of the mouth. Sugar, gum, hard candy or small pieces of ice may provide some relief for you. However, if your mouth remains dry for more than two weeks, you should talk to your physician or dentist immediately. A continuing dryness of the mouth may result in dental disease, tooth decay, gum disease or other fungus infections as a result of taking Trazodone medication.

Information adapted from Consumer Reports Consumer Drug Reference

Additional information by Paul Susic Ph.D. Licensed Psychologist

Weight Control for Seniors: Why now at my age?

Weight control for seniors: An overview

Weight control for seniors focuses on the various complications related to obesity or excessive weight that frequently impact upon your health. The frequent focus of weight control for seniors is on the your general health as well as various medical conditions such as coronary heart disease, osteoarthritis, high blood pressure and gall

bladder disease. These disease conditions are second only to smoking as a cause of preventable death among the elderly. Various studies have concluded that even a reduction of between 5% and 15% of body weight may significantly decrease the risk of these medical problems if you’re either overweight or obese. Some experts actually believe that weight loss may not only reduce the incidence and severity of these diseases but may actually result in reversing the disease progression, which should be an added incentive for weight control for seniors.

Weight control for seniors: Are we there yet?

Although there is significant publicity about the multitude of health risks associated with being overweight and the spending of billions of dollars on products to make people thinner, many Americans are significantly overweight or obese. Some individuals have been more attentive to all the warnings and have significantly cut back on their level of dietary fat. Even studies as far back as 1997 had found that many Americans had reduced their consumption of total fat by approximately 6%, between 1987 and 1992. While this had resulted in achieving an average intake of approximately 36% of the total calories in fat, the amount recommended by most experts is about 30% or less of total calories consumed.

Although there has been some progress, way too many Americans continue to be either overweight or obese. Unfortunately, these statistics have continued to rise significantly since the 1980’s. A much more recent and ongoing study by the National Health and Nutrition Examination (Centers for Disease Control and Prevention) has found that an estimated 61% of US adults are either overweight or obese. Their obesity or overweight status was defined as having a body mass index (BMI) of 25 or more. The large proportion of Americans who are actually defined as obese is even more concerning in that between 1980 and 1999, the percentage of obese individuals has almost doubled from about 15% of the population to approximately 27%. Obesity is defined as having a BMI greater than or equal to 30.

Another huge concern is that obesity seems to be rising among all segments of the American population in addition to the elderly, including individuals from all ethnic backgrounds and especially among children and adolescents. Also, another very unsettling fact is that the obesity epidemic is not limited only to Americans but is increasing worldwide with the increased urbanization of the world’s population. Weight control for seniors and individuals from all age groups as well as ethnicities has now become a global problem.

Some information adapted from The Johns Hopkins Medical Guide to Health After 50 Webpage by Paul Susic Ph.D. Licensed Psychologist

Chronic Pain: Won’t it just go away?

Chronic Pain: Won’t it just go away?

Chronic pain is believed to affect 50 million Americans. Over time, chronic pain may cause a destructive physiologic response characterized by fatigue, mood disorders, brain hormone abnormalities, muscle pain, and other physical as well as mental impairments. Chronic pain may set off a vicious cycle of stress and disability that eventually raises a person’s sensitivity to pain. Uncontrolled, chronic pain can disrupt an individual’s family life, work life and income, it may lead to depression, isolation and anxiety. The key to breaking this damaging cycle is to treat chronic pain early and effectively.

Types of pain: Acute and chronic pain

In order to effectively treat chronic pain you must first distinguish it from acute pain. Acute pain is caused by tissue damage, and its source is usually obvious such as a burn or even possibly a bee sting. Although acute pain may be intense it usually is very short lived. Acute pain is usually repaired through the natural healing powers of the body and the pain eventually fades away. Sometimes individuals will take some type of pain killer for interpreting time until the body has a chance to repair the tissue damage.

In contrast to acute pain, chronic pain is persistent and the nervous system continues to transmit pain impulses for months or even years. Musculoskeletal injury and inflammation usually lie at the root of some forms of chronic pain. Other forms of chronic pain may include rheumatoid arthritis, cancer, or coronary artery disease. In many cases the original cause, such as a herniated disc or tumor may be successfully treated, yet the pain will remain and sometimes even get worse. This type of chronic pain, which is often out of proportion to the original injury, arises from nerve damage and is term neuropathic pain.

Neuropathic pain can occur whenever nerves have been damaged. Until recently, neuropathic pain has usually referred to specific pain syndromes such as postherpetic neuralgia, the intense pain that frequently follows shingles; tic douloureux (trigeminal neuralgia), a condition marked by searing jolts of facial pain; and diabetic peripheral neuropathy, a form of nerve damage that leads to numbness and pain in the hands, feet and legs. It is becoming increasingly clear that a larger array of conditions may fall under the category of neuropathic pain. Pain syndromes that are associated with amputations, spinal cord injury, migraines, multiple sclerosis, mastectomy, and Parkinson’s disease are now also believed to be examples of neuropathic pain. Also, doctors are now starting to believe that some forms of lower back pain may have a neuropathic component.

Regardless of the source of the chronic pain, it is believed that cortisol is triggered and other hormones that can have a significant effect on an individual’s immune system and mental health. Also, research has continued to identify some of the changes underlying chronic neuropathic pain. It is believed that our nervous systems are very flexible; the nerve circuits that transmit pain impulses can become “rewired” after nerve injury and consequently lead to persistent pain. If the pain remains untreated, these wiring changes can then become permanent, resulting in progressive as well as more severe and widespread chronic pain.

Some Information adapted from The Johns Hopkins Medical Guide to Health After 50

Additional Information and webpage by Paul Susic Ph.D. Licensed Psychologist

Top Ten Considerations for Making Your Home Accessible

Whether you currently live with a disability or are planning for when you or someone close to you may, building accessibility into your home can prove vital for aging in place, caring for a family member or increasing the “visit ability” of your home. Listed below are the top issues one should consider before undertaking any improvements, according to Disaboom (, the largest online community for people living with or touched by disability.

Mobility Issues. Be aware of your own needs as a person with a disability and what works best for you. It’s a good idea to make a list of issues you encounter regularly and then think of modifications that would resolve each of these issues. Different degrees of disability will require customized adaptations to achieve greatest ease of use. Always remember, this is your house. Modifications should be designed off your own specifications regardless of what the accessible home standards recommend.

Budget. Modifying a home does not have to be extremely expensive but can prove to be. Be realistic about your budget and if you decide to go through a contractor, insist that they provide a firm bid identifying the total cost of the project and how long it will take to complete. Financial help is out there. Disability Vocational Rehabilitation, Veterans Affairs, church groups, neighbors and even television shows such as “Extreme Home Makeover” are a few good resources that can help shoulder the financial burden. To better understand the costs associated with making your home accessible, visit RE/MAX’s “Assess Your Access” calculator on, which provides estimation based on your house’s criteria.

Location. While locale is a personal preference, a few variables to keep in mind include: walking distance to amenities such as groceries, dining, pharmacies and public transportation stops; the safety of the neighborhood; and your desired level of community support.

It’s important to keep all of these guidelines in mind as well, as you design specific areas of your home, such as the ones listed below.

Garden. The first step in developing an accessible garden is to make sure you can navigate around and through your garden. This includes having wide enough pathways, being able to reach the planters for planting, watering and weeding. Hanging planters, raised beds, and rail systems are practical solutions. Research and utilize the many specialized lightweight, easy to grip and spring-loaded gardening tools available to make gardening much easier.

Entrance. The first key feature to an entrance is a direct access ramp. The ideal location to install this is in your garage, to protect it from the elements, which reduces maintenance and other associated risk factors. If the garage is not an option, be aware of water drainage so that the ramp does not become a hazard. Motion sensor lighting can be extremely helpful for illuminating the ramp and landing area. Make sure that you install an ample doorway and that all passageways and hallways are at least forty-two inches wide.

Kitchen. When designing an accessible kitchen, make sure that you have enough floor space and are able to maneuver easily. This is especially important in front of appliances. Position the kitchen sink and faucet handles in an accessible location to accommodate users of varying heights. Positioning cabinets and countertops at a lower height will provide an accessible prep area for cooking. When space is limited, pull-down cabinets can also be an accessible solution. If you have grip limitations, look at hardware that incorporates levers or loop handles that can be easily operated with a closed fist. This applies to door hardware, cabinet hardware, sink, and stove controls.

Bathroom. Creating a safe, accessible bathroom is very important. Simple adjustments such as grip bars and railings can prevent serious injury from occurring. Allocate enough space for a wheelchair to pull in and back out and even consider installing a walk in/roll in shower. Bathroom sinks should also accommodate users of varying heights.

Office. Setting up a home office may be the simplest way to get back into a regular work routine. Some options to consider when designing your accessible office include: wheelchair accessible desk, foot activated mouse, adjustable furniture and speaking devices that record and respond to voice commands. Incorporating such products will not only serve to further enhance productivity, but can also enhance comfort as well.

Accessing Multiple Floors. Home owners with a new disability in a multi-level home looking to access their second floor have a few options; residential elevators, vertical wheelchair lifts, or a stair lift. Wheelchair lifts and stair lifts are less costly, do not require a machine room, and are more space efficient. Wheelchair users should note that if they decide to install a stair lift, two separate wheelchairs are required unless they wish to carry their wheelchair with them.

Other Elements. Attention to detail can make all the difference. Raising electrical outlets, lowering switches, and ridding your home of doorway thresholds (as they present a trip hazard) are some small details that help immensely. Specialized appliances such as front loading washers and dryers and the self running Roomba Vacuum can also make life that much easier.

Whether you currently have a disability, desire to increase the “visit ability “ of your home, or are planning for the future, having an accessible home is a key component to living forward. To discover more information on how to make your home accessible, estimate the costs associated with increasing your home’s accessibility, or share ideas with others in the community, visit Remember, “A house is made of walls and beams; a home is built with love and dreams.”

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About the Author:

Author: Kim Donahue

Ways to Pay For Nursing Home Care

The easiest way to pay for nursing home care for an elderly or disabled family member is also the hardest. You write the monthly check. It hurts because the average yearly cost is now $70,128.

Before writing a check, it makes sense to talk with a knowledgeable attorney or accountant so that your family does not overlook tax deductions or available benefits. For example, if you pay more than 50% of the support for a relative who meets certain gross income guidelines, then you may claim the relative as a dependent on your own federal tax return. You might also qualify for the dependent care credit which is available for a dependent parent who needs full time attention.

The I.R.S. also permits a tax deduction for qualified long term care services. Many of the costs incurred in a nursing home can qualify for the medical expense deduction under a proper plan as long as it is set up by a licensed healthcare practitioner.

Medical expenses can be claimed as itemized deductions, so long as they exceed 7.5% of adjusted gross income. Qualified health insurance premiums, long term care service and other eligible medical expenses can be added together to meet this cutoff. If you pay nursing home costs for a parent or disabled family member, it is important to consider this deduction.

Many people turn to Medicaid to write the check for nursing home care. The program is jointly funded by the states and the U.S. government. The first hurdle is that your family member must have a medical reason to be in a nursing home. It is not a housing program. The next hurdles are the income and asset guidelines. The single person guidelines for Medicaid limit assets to $2,000 in the bank, possibly a car, some personal property and a prepaid funeral account. The rules are more generous for spouses. A spouse can keep approximately $100,000 in assets and the family home. If any assets were given away within five years prior to applying, those transfers may block your family member from eligibility. The guidelines do vary from state to state.

Considering that some government statistics predict that 50% of U.S. population will spend at least some time in a nursing home, it is a good idea to consider long term care insurance. The average stay is 11 months. Long term care insurance policies have many different features, including daily benefits, elimination period, inflation riders and benefit length limits. Two good starting points are to be sure that any policy you purchase is tax qualified and that the insurance company is sound. Since long term care insurance is a new product and the companies have had limited claims losses, it tends to be reasonably priced.

The United States Veterans Administration is another possible source of nursing home care. The U.S. Veterans Administration maintains about 115 nursing care facilities. That is a very small number to house all of our veterans. They have about 300 beds each and there is some availability for spouses of veterans, surviving spouses and certain eligible parents, such as Gold Star mothers.

Medicare is another checkbook but its funds are very limited. It doesn’t come out until a patient spends three days in a hospital and is prescribed to a nursing home by a doctor for “skilled nursing care.” After 21 days you have to write checks for a significant co-pay of $128 per day. A medi-gap policy can cover this but your own checkbook comes out again for full pay after 100 days.

It pays to plan and consult ahead and long term care insurance may be a bargain in the long run.

Joseph M. Hoffmann, Esq. is an attorney in Newton, who helps clients with trusts, estate planning, Wills and related transactions.

About the Author:

Joseph M. Hoffmann, Esq. is an attorney in Newton, who helps clients with trusts, estate planning, Wills and related transactions.

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Feeding and Eating Disorders: DSM-5 Diagnostic Codes

Feeding disorders: Overview

Some of the more common feeding disorders in infants and young children include pica, rumination disorder, and avoidant/restrictive food intake disorder. These disorders can be very complex and difficult to treat. Successful feeding requires a nurturing relationship between the child and caregiver. Among individuals with feeding disorders, frequently a serious disruption has occurred, or some type of psychopathology has been found between the child and caregiver. The temperament of the child may also be a factor in the development of feeding difficulties. As in eating disorders, feeding disorders feature avoidant and restrictive food intake although unlike with eating disorders, feeding disorders usually are first identified in early childhood rather than in the adolescent years. Currently, prevalence rates for feeding disorders are not well defined.

Eating Disorders: Overview

Eating disorders in adolescents and adults are very similar to feeding disorders in children and infants in that they are very complex, multifaceted and difficult to treat. Also, like feeding disorders, eating disorders have a significant impact upon an individual’s daily functioning. Eating disorders affect a person’s diet in very significant, negative ways. The disorder can be manifested in various ways including eating either very small amounts or absolutely no food at all (NIMH, 2013). Disorders can affect every aspect of an individual’s life including their physical and emotional health as well as their relationships with others. The eating disorders described in this section include anorexia nervosa, bulimia nervosa and binge eating disorder.

Prevalence Rates and Risk of Eating Disorders:

It is believed that as many as 20 million women and possibly 10 million men have suffered from some type of eating disorder at some time in their lives. It is believed that the rates of eating disorder have increased since the 1950’s. The American Psychiatric Association (2013) concluded that the prevalence rates of eating disorders vary significantly, but as published in the DSM-5, the prevalence rate for anorexia nervosa is approximately 0. 4% among the general population and bulimia nervosa is 1% to 1.5% over a 12-month period of time.

Eating disorders are most often first identified in the adolescent years. Issues related to image, weight and body shape that seem to underlie eating disorders may possibly even begin at a much younger age with approximately 40% to 60% of elementary school girls identifying some concern for their body weight or of becoming fat.
Although eating disorders are more frequently seen in females, males may also be at risk. Most often, men with eating disorders are more focused on making their bodies larger and more muscular as opposed to women who seem to be more interested in making their bodies lighter and smaller.

Cause of Feeding Disorders:

Issues associated with feeding are common among infants and small children although not all of these problems result in feeding disorders. However, it is important to recognize that without intervention, sometimes these difficulties can result in a feeding disorder. The specific interventions require a recognition of developmental and medical causation which may then necessitate specific interventions by either parents, medical or mental health professionals.

Clinicians should consider the characteristics of both the children and caregivers interdependently rather than separately. It is especially important to look at maternal factors when considering the cause of feeding disorders in recognition of the fact that maternal depression, anxiety and other eating disorder symptoms in pregnancy have been found to predict feeding difficulties.

The temperament of the child is also very important. It has been found that many of the children with feeding difficulties seem to have a difficult temperament including displays of angry moods, temper tantrums and aggression.

Cause of Eating Disorders:

As with feeding disorders, eating disorders may be caused by a variety of biological, behavioral, genetic and psychological factors (NIMH, 2013). While some researchers seem to focus on cultural considerations among individuals with eating disorders, it is difficult to identify the relative level of socio-cultural considerations in the development of these disorders. It is imperative to consider eating disorders from a holistic perspective and recognize that the interaction between genetic factors, social and cultural factors such as media images determine their relative contributions.

Many clinicians and researchers focus more on the social and cultural aspects in that the beauty ideals of Western culture seem to overemphasize thinness among women, resulting in a higher level of risk in the development of an eating disorder. Although mainstream media seems to focus on the thinness ideal of media images possibly underlying anorexia nervosa, many people are exposed to these same images and do not develop eating disorders.

Feeding and Eating Disorders Treatment:

Because of the multifactorial social and psychological etiology of feeding and eating disorders which makes these disorders so difficult to treat, treatment also needs to be multi-dimensional in most cases. The specific treatment will be according to the specific presentation and individual, social, psychological, and interpersonal factors involved, with special attention to behavioral, physical and emotional health. Also, of consideration will be the necessary level of care, which can range from inpatient to residential to outpatient treatment. The specific treatment venue will frequently depend upon the severity and/or the presentation of the symptoms.

Because of the secretive nature of eating disorders, these disorders often severely isolate individuals and cause them to be very reluctant to see a therapist or talk to a doctor. It is very common among these patients to refuse treatment for their condition. Psychologists and mental health professionals need to focus on the development of an appropriate, supportive therapeutic relationship and help the individual to understand why treatment may be necessary.

Some of the more common therapeutic treatments for eating disorders are cognitive behavioral therapy, interpersonal psychotherapy and dialectical behavior therapy. Cognitive behavioral therapy is often used for people who experience anorexia and bulimia whereas interpersonal psychotherapy seems to be more effective for individuals battling binge eating. While dialectical behavior therapy has been used to treat various eating disorders, it is often used for patients who have tried other therapeutic interventions and have not been successful.

Special Concerns for Individuals with Eating Disorders:

It is of special concern for counselors and mental health clinicians treating individuals with eating disorders to consider the high level of mortality. The mortality rates of eating disorders may be as high as 4% for anorexia nervosa, 3.9% for bulimia nervosa and 5.2% for eating disorder NOS (Crow et al., 2009). Also due to the complex nature of eating disorders in both the development and treatment, counselors will most likely need to collaborate with various other treatment professionals including physicians, psychiatrists, dietitians and other medical professionals to assist with appropriate treatment.

Additional information related to the specific feeding and eating disorders follow below.

Feeding and Eating Disorders: DSM-5 Diagnostic Codes

The following specifiers apply to feeding and eating disorders where indicated:
Specify if: In Remission
Specify if: In partial remission, In full remission
Specify current severity: Mild, Moderate, Severe, Extreme

307.52 (___.__) Pica
(F98.3) In children
(F50.8) In adults

307.53 (F98.21) Rumination Disorder

307.59 (F50.8) Avoidant/Restrictive Food Intake Disorder

307.1 (___.__) Anorexia Nervosa

Specify whether:
(F50.01) Restricting Type
(F50.02) Binge-eating/purging type

307.51 (F50.2) Bulimia Nervosa

307.51 Binge-eating disorder

307.59 (F50.8) Other Specified Feeding or Eating Disorder

307.50 Unspecified Feeding or Eating disorder

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from the following sources

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Crow, S. J., Peterson, C. B., Swanson, S. A., Raymond, N.C. Specker, S., Eckert, E. D., & Mitchell, J. E. (2009). Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry, 166, 1342-1346.

National Institute of Mental Health. (2013). Eating disorders. Retrieved from http: //

Senior Real Estate Specialists; Seniors Enter the Housing Market

Senior Real Estate Specialists, or SRES for short, are realtors who have received specialized training in order to better serve clients who are senior citizens. To receive this designation one must learn about some of the legal and tax aspects that are involved when a senior is buying or selling a home, as well as the emotional ramifications of moving later on in life. Senior Real Estate Specialists can guide seniors through the process of selling their home, finding a new house that will meet their needs, and can empathize with the emotions involved with the entire process. Like any subject from a doctor or a repairman, a specialist is better able to help you and your loved one makes the transition from the beloved family home to one that is more fitting for their current needs.

While selling a home can be stressful for people of any age, it is a particularly difficult experience for older sellers. They may have lived in the neighborhood for many years, and raised their family in the home. There are many years of memories to pack up and leave behind, which can lead to a great deal of sadness and anxiety about the future. As with our current economy, confidence and having a clear sense of direction makes for a better outcome.

In addition to saying goodbye to the past, seniors must think about the future as they look at potential new homes. Do they plan to move again, or is this where they plan to spend their remaining years? If this is their final move, then the house needs to accommodate any physical limitations that the person may incur later on, such as relying on a walker or a wheelchair to get around. It is helpful to consider the family tree for which maladies maybe in the lineage, in making this choice. The doorways and hallways need to be wide enough to accommodate mobility devices, and the house itself should ideally be one level. As our bones and muscles begin to weaken, some may find stairs to be difficult, and even dangerous. Another concern is yard size. Seniors need to keep in mind that while they can currently tend to a large garden, and mow the lawn, they will not always be able to be so active. They need a property that will be manageable in size as they get older. For some, the resources of a gardener can be a burden as well as worrying about all the lovely plants that once adorned the yard.

Senior Real Estate Specialists also have experience dealing with the financial issues that may come up for seniors, including reverse mortgages, estate taxes, trusts and more. These agents can assist seniors with the paperwork and contractual issues that may not have existed the last time the senior was in the real estate market. All of these items in addition to selling and moving can be overwhelming, especially if the person is moving to a new area. Having an SRES by your side can be immensely helpful. As a Santa Cruz SRES, helping bridge the transition with an adult child and a parent allowing their “kids” to help is a touching and rewarding experience.

Senior specialists also know that not all seniors are the same. Baby boomers have different priorities than older seniors, and even then, everyone has individual requirements. These realtors are trained to respect each seller as an individual, and not to make assumptions about their needs. Call one today and start working on your plans for change.

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About the Author:

Gregg Camp is an experienced Santa Cruz real estate broker who has spent more than 20 years working in the beautiful Santa Cruz home market. Search for homes with a Santa Cruz Seniors Real Estate Specialist (SRES) and view property listings at

Somatic Symptom and Related Disorders: DSM-5 Diagnostic Codes

Somatic Symptom and Related Disorders: Overview

Somatic symptom and related disorders are indicated by the presence of somatic and/or physical concerns, unpleasant thoughts, distress and impairment. People who experience these symptoms usually present to medical professionals for what they believe to be real, distressing physical symptoms. Sharma and Manjula (2013) have concluded that as many as one third to one half of all medical complaints cannot be explained.

Frequently individuals experiencing symptoms that can be defined within the category of somatic symptoms and related disorders are referred by physicians after exhaustive attempts to identify and diagnose the source of physical symptoms. Due to the significant comorbidity between these physical manifestations and depression and anxiety disorders, mental health professionals often find that they are dealing with significant physical distress along with mental health issues.

Changes from DSM-4-TR to DSM-5:

The DSM-4-TR category of Somatoform Disorders was changed to Somatic Symptom and Related Disorders in the DSM-V. Psychologists and other mental health professionals will now find two new diagnostic categories in this section including somatic symptom disorder and illness anxiety disorder. Individuals experiencing somatic concerns with or without current medical conditions can be diagnosed with the new category of somatic symptom disorder if they have both unexplained somatic symptoms and inappropriate or maladaptive reactions to those symptoms (APA, 2013).

The previous diagnosis of hypochondriasis was eliminated by the APA Somatic Symptoms Disorders work group because they believed that it was unnecessarily stigmatizing to patients. Also, they discontinued pain disorder as it was too difficult to determine whether pain was actually due to psychological or physical causes. (APA, 2013).

Diagnosis of Somatic Symptom and Related Disorders:

Because the signs and symptoms of somatic disorders are primarily physical, the initial focus needs to be on completing a comprehensive medical examination to determine the specific apparent cause of the concern. The DSM-5 allows for the consideration of diagnosable health issues along with the distressing reactions to those issues. Therefore, the initial diagnosis may include (a) if there are medical conditions present and (b) whether the individual’s reaction will be in excess to what would be expected in relation to those medical concerns.

The coexistence or comorbidity between somatic symptoms and mental health symptoms such as depression and anxiety is enormous. Frequently there seems to be significant cultural aspects to expressing depression and anxiety related symptoms somatically. Also, somatic and anxiety symptoms are often seen among individuals with substance use issues and patients who have experienced trauma making it imperative to also consider the possibility of PTSD in the differential diagnosis.

Cause and Treatment:

Somatoform disorders were initially considered to be psychodynamic reactions to stressors in which the patient was believed to be converting psychological issues into physical symptoms in attempting to cope with the stress. There are currently several models for potentially explaining the cause of somatic symptoms and related disorders. The APA (2013) have identified early traumatic experiences, social learning and social and cultural norms as well as biological and genetic vulnerability. So (2008) has concluded:

Ethnographic fieldwork has long indicated the presence of a specific type of culturally mediated illness where the individual suffering from psychological issues expresses distress in the form of physical symptoms and somatic complaints, with no known organic cause. In Western psychiatry this phenomenon is commonly labeled somatization disorder (p.68)

Most researchers have found a paucity of research into somatic symptom and related disorders due to their rarity. Sharma and Manjula (2013) have stated:

The basic premise of any psychological intervention in disorders with somatic symptoms is that somatization is a universal phenomenon and is a direct consequence of common psychological disorders such as anxiety or depression resulting in autonomic arousal symptoms or somatic complaints; it may be an idiom for help-seeking for severe social adversities such as poverty, domestic violence, stigma, associated with mental illness (p.117).

Referral for treatment usually occurs within the primary care setting and includes psychiatric or psychological consultation and intervention, reattribution therapy, cognitive behavioral therapy and/or a problem-solving approach (Sharma & Manjula (2013). In most cases, cognitive behavioral therapy has been found to be the most effective. Treatments for what was previously referred to as hypochondriasis in the DSM-4-TR and now defined as somatic symptom disorder or illness anxiety disorder frequently involves cognitive behavioral therapy, medication and psychoeducation.

Psychoeducation may be most appropriate when used for milder concerns and seems to concentrate on facilitating increased coping strategies and recognizing the role of stress in physical manifestations, as well as training in relaxation instead of attempts to convince individuals that their symptoms are unreal or “only in their heads”. Among the antidepressants, fluoxetine seems to be most helpful especially for symptoms that were formally referred to as hypochondriasis.

As with all counseling related therapeutic interventions, the therapeutic relationship is absolutely essential when working with people with somatic symptom and related disorders, especially given the fact that individuals may have experienced significant frustration from the medical conditions and healthcare providers who have a lack of understanding of the etiology of their symptoms. Because of the lack of understanding by both patients and clinicians, individuals experiencing these somatic symptoms can become very frustrated, feeling misunderstood, and will be quick to discontinue treatment if they feel that they are not being taken seriously.

Please see the following pages for specific symptoms and treatment information related to each diagnosis within the category of somatic symptom and related disorders.

Somatic Symptom and Related Disorders: DSM-5 Diagnostic Codes

300.82 (F45.1) Somatic Symptom Disorder
Specify if: With predominant pain
Specify if: Persistent
Specify current severity: Mild, Moderate, Severe

300.7 (F45.21) Illness Anxiety Disorder
Specify whether: Care seeking type, Care avoidant type

300.11 (___.__) Conversion Disorder (Functional Neurological Symptom Disorder)

(F44.4) With weakness or paralysis
(F44.4) With abnormal movement
(F44.4) With swallowing symptoms
(F44.4) With speech symptom
(F44.5) With attacks or seizures
(F44.6) With anesthesia or sensory loss
(F44.6) With special sensory symptom
(F44.7) With mixed symptoms
Specify if: Acute episode, persistent
Specify if: With psychological stressor (specify stressor), Without psychological stressor

316 (F54) Psychological Factors Affecting Other Medical Conditions
Specify current severity: Mild, Moderate, Severe, Extreme

300.19 (F68.10) Factitious Disorder (includes Factitious Disorder Imposed on Self, Factitious Disorder Imposed on Another)
Specify Single episode, Recurrent episodes

300.89 (F45.8) Other Specified Somatic Symptom and Related Disorder

300.82 (F45.9) Unspecified Somatic Symptom and Related Disorder

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from the following sources.


American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Sharma, M.P., & Manjula, M. (2013). Behavioral and psychological management of somatic symptom disorders: An overview. International Review of Psychiatry, 25, 116-124. doi:10.3109/09540261.2012.746649

So, J.K. (2008). Somatization as cultural idiom of distress: Rethinking mind and body in a multicultural society. Counseling Psychology Quarterly, 21, 167-174. doi:10.1080/09515070802066854