Category Archives: Senior News

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.

Article Source:

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

Signs of Nursing Home Neglect and Elder Abuse

By: Aaron Crane

Moving a loved one into a nursing home is a difficult decision. Families doing this expect their loved one to be treated properly and with dignity. The unfortunate truth is that nursing home neglect happens more often than one expects, affecting millions of people in America every single year.

Vulnerability of Nursing Home Residents

Nursing home residents are most often not able to care for themselves any longer and are admitted into such a living situation because of their personal vulnerability to injury or death if not cared for in supervised accommodations. Most residents are over the age of 65, although some may be younger people with disabilities.

Many of these residents do not have another place to live due to limited personal resources or few family members in close proximity. Families unable to care for their elderly loved ones may place them in a home to ensure they receive the best possible attention and treatment that cannot be provided at home. Lack of space, financial issues, long work hours, other obligations and situations may apply that prevent families from caring for their own family members in a family environment.

Neglect of Nursing Home Residents

One in three residents of nursing homes suffer from neglect, according to recent studies of American eldercare homes. Neglect is a failure to provide the attention and services required for personal security and comfort of residents. Neglect is not always an intentional act by nursing home staff or management. It is the existence of the situation that causes danger, harm and anxiety to people living in these homes, however.

Federal and state laws regulate how nursing homes must be operated. Neglect can be attributed to overlooking issues of importance, ignoring resident needs and even direct actions of staff leading to grief or misery of residents, whether or not physical harm occurs.

Warning Signs of Nursing Home Neglect

Nursing home residents who do not have regular contact with family members are more often the victims of neglect than those who are frequently visited by family members. Family visitations should include careful observance of the elderly person to look for any signs of neglect or abuse.

Bed sores, stiff joints and other physical signs may be present to indicate there is a problem of neglect when the individual is left in one position for too long on a bed or in a chair. Medical neglect can occur when ailments or injuries are not treated or are improperly handled. There may also be signs of behavioral changes in the elderly person, staff behavior changes toward the patient or limited access to your loved one. Malnutrition and dehydration may also be present. You may have noticed increased frequency of trips to the E.R., hospital or other medical facilities.

Prevention of Nursing Home Neglect

There are many ways that nursing home neglect may occur. But many incidents can be prevented. By being aware and observant of the circumstances of your loved one’s living arrangements, behaviors and care, you can be quick to notice nursing home neglect, should it occur.

Ongoing and regular family contact is the best way to keep nursing home neglect from happening. A thorough background check should be conducted into the performance of a particular nursing home before family members are admitted to the facility. Medical boards provide information about infractions or problems at a nursing home, in regard to abuse and neglect. Caretakers should be screened through background checks by a nursing home prior to employment. This can be confirmed before admitting someone you love into such a facility.

When Nursing Home Neglect or Abuse Occurs

When nursing home neglect or abuse is suspected, it should be promptly reported to law enforcement. Such abuse or neglect can lead to criminal activity at the facility, if left unchecked. When injuries are discovered, medical attention should be provided through licensed medical professionals outside of the nursing home to ensure the victim is treated and issues causing the problem are resolved.

A Lawyer Helps in Cases of Nursing Home Neglect or Abuse

Whenever nursing home neglect or abuse occurs, it is important to contact a legal representative. This lawyer should be experienced in nursing home care issues and protection of victims living in these facilities. The lawyer can investigate the problems of the facility and gather evidence of abuse or neglect for the case. Lawyers may recommend hiring an expert witness who can help substantiate claims of neglect and abuse and in regard to injuries suffered by the victim. A qualified lawyer can help locate other victims within the establishment who may have suffered the same abuse or neglect.

If you know someone that is victim of elder abuse due to nursing home neglect, contact Cantor Crane today.

Article Source:

Independent Aging and Home Safety

By Michael H Price and Hulet Smith

Independent aging and home safety go hand-in-hand. For many seniors, it is extremely important to family and friends to prove that safety measures are in place. They will constantly be on edge that mom, dad, grandpa, or grandma might fall and lay in pain for hours or days before help arrives.

Of course, their worries are justified. One in two people over the age of 65 will fall and break a hip. With age, it becomes harder to assume that pain and injury happens to the other person.

In addition, it is nice to know that if any emergency arises, help will be on the way in a matter of minutes. For instance, a lot of seniors are able to stay home because they wear some sort of alert device. Then, family members can quit nagging, lovingly of course, because the phone does not have to be within reach to get help.

Home Safety Ideas

Implementing additional home safety ideas will go a long way in convincing others that seniors are still capable of living alone at home. As long as they can prove they have home safety aids in place, to help prevent a fall or some other injury, it will be a lot easier to remain independent at home.
To make sure their home is as safe as they can possibly make it, begin by going through each room in the house to determine which changes are necessary to make life easier and safer. For example, if getting up and down from a sitting position has become a precarious adventure, a lift chair or lift cushion may be the answer to that problem.

You will want to make the bathroom a priority in home safety. To avoid slipping or falling in the shower or tub, hand grips on the wall will help steady their balance. They may also want to consider a raised toilet seat, so getting up and down from the commode is simpler. A shower chair is also an excellent idea for those who may have difficulty standing for any length of time.

The bedroom can also be unsafe, especially if they have to get up in the middle of the night. If they are tired and half asleep, their balance is likely to be even more unsteady. A bed rail might come in handy for standing up or even switching positions in the night.

Alleviate your Own Fears

Independent aging and living at home for as long as possible is usually preferable to residing in a nursing home, where they are away from what is familiar and less like living in a hospital-like environment. But, they may have some natural fears to being home alone, in case something happens.
With home safety devices implemented and the necessary equipment to make life a little easier and more comfortable, they may be able to continue to enjoy their home and independence. Knowing you have done everything possible to make their house safer, and knowing that help is just an alert away, will give you the confidence to reassure friends, family, and the individual.

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Positive Dreams and a Peaceful Mind

Positive Dreams and a Peaceful Mind: Research Study

A new study conducted at the University of Turku (southwestern Finland) has found that our waking mind truly has an effect on our dreams. Sigmund Freud believed that dreams reveal the unconscious mind. It has long been believed that dreams can also reveal certain aspects of our conscious mind and daily thinking, feeling and over all well-being. Dream researchers in the past have focused more on the dreams of people experiencing various mental disorders rather than the positive aspects of dreaming and well-being. Do you have happier dreams if you are a happier person? Most researchers of well-being have focused on happiness and have neglected the important aspect of “peace of mind”.

Pillerin Sikka, Doctoral Candidate in Psychology at the University of Turku and Lecturer in Cognitive Neuroscience at the University of Skovde, and lead author in a recent article published in the Nature group Journal of Scientific Reports stated: “We wanted to address these important gaps in both dream and well-being research and to study how dream emotions are related to not only different aspects of waking ill-being, but also to different aspects of waking well-being, including peace of mind. In fact, this is the first study to look at how peace of mind relates to dream content.”

She went on to state, “Peace of mind is a state of inner peace and harmony, a more complex and durable state of well-being traditionally associated with happiness in the Eastern cultures”.

The study’s co-author Antti Revonsou, a Professor of Psychology at the University of Turku and Professor of Cognitive Neuroscience at the University of Skovde added that, “Even though it has rarely been directly measured in studies of well-being, in several philosophical traditions and spiritual approaches, peace of mind has always been regarded as central to human flourishing”.

Researchers in the study asked healthy individuals to fill out a questionnaire that measured their “ill-being” or “well-being” while awake and were then asked over the next three weeks to keep a daily dream diary which they would fill out each morning upon awakening detailing their dreams and rating the emotions experienced in those dreams. It was found that individuals experiencing higher levels of peace of mind experienced more positive dream emotions while those experiencing higher levels of anxiety also experienced higher levels of negative dream emotions.

These results concluded that if we are to understand how dreams are related to our waking state, we need to focus not only on symptoms of mental “ill-being” but also need to measure various aspects of “well-being”. Sikka explained that although some aspects of what we typically consider to be “well-being” did not seem to be related to dream content. There seemed to be something unique about “peace of mind”.

It has been proposed by researchers that one explanation for these conclusions is that possibly people who have higher levels of “peace of mind” may be better able to regulate their emotions not only when they are awake but also when they are dreaming. Obviously, the opposite would then be true for individuals with higher levels of anxiety.

Sikka concluded that the next step in research may be to find whether the ability to regulate emotions and maintain a higher-level of self-control is something that is fundamental to people with higher levels of “peace of mind” and whether improving these skills could actually lead to higher levels of peace of mind.

Adapted by Paul Susic Ph.D. Licensed Psychologist from article “Sweeter Dreams in a Peaceful Mind” ScienceDaily, August 24, 2018

Story Source:

Materials provided by University of Turku.

Journal Reference:

Pilleriin Sikka, Henri Pesonen, Antti Revonsuo. Peace of mind and anxiety in the waking state are related to the affective content of dreams. Scientific Reports, 2018; 8 (1) DOI: 10.1038/s41598-018-30721-1

Dissociative Disorders: DSM-V Diagnostic Codes

Dissociative Disorders: Overview

In order to diagnose and treat dissociative disorders, you need to understand the basic concept that dissociation refers to a disconnection or lack of connection between two things that are associated with each other. The DSM-V published by the American Psychiatric Association in 2013 states that dissociative disorders “are characterized by disruption of and/or discontinuity of the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.” They also go on to state that dissociation symptoms are “”a” unbidden and unpleasant intrusions into awareness and behavior, with accompanying losses of continuity in subjective experience (i.e. “positive” dissociative symptoms); and/or “b” and inability to access information or to control mental functions that normally are readily amenable to access or control; (i.e. ‘negative’ dissociative symptoms” (APA, 2013, p. 826).

Some research indicates that about three quarters of people will experience disassociation after a traumatic experience. It is believed that the brain tries to protect itself when individuals experience distressing, traumatic circumstances, although most people will not go on to develop a dissociative disorder.

Diagnostic Considerations:

The International Society for the Study of Trauma and Dissociation (2013) have addressed five different types of dissociation considered in the DSM-V: depersonalization, derealization, amnesia, identity confusion, and identity alteration. Depersonalization is usually referred to as a “sense of being detached from, or “not in” one’s body,” whereas derealization is a sense of the world not being real. Amnesia is a loss in the ability to retrieve information that has previously been stored, which an individual should remember. Identity confusion refers to an unusual change in an individual’s sense of self. Identity alteration “is the sense of being markedly different from another part of oneself…subtler forms of identity alteration can be observed when a person uses different voice tones, range of language, or facial expressions” (ISSTD, 2003, para.7).

As with other mental health disorders, dissociative symptoms may overlap with other disorders, and may be caused by medical illness or be related to substance use and abuse. Neurological conditions have been found that seem to mimic dissociative disorders such as traumatic brain injuries, seizures and neurocognitive disorders.
Substances of use and abuse have also been known to trigger dissociative symptoms such as marijuana, hallucinogenics, ecstasy, ketamine, and salvia (APA, 2013). All clients who present to mental health clinicians with dissociative symptoms need to be referred for a medical evaluation to determine whether treatment is ethically within their field of expertise.

Traumatic experiences are always at the very core of the development of dissociative symptoms. Psychologists and mental health clinicians always need to consider the possibility of a diagnosis of posttraumatic stress disorder or acute stress disorder, in order to determine whether these diagnoses would better address the dissociative symptoms. Clients and patients with dissociative disorders sometimes describe out of body experiences, sometimes have been known to believe they are possessed or even hear voices that may cause a clinician to believe the patient has a psychotic disorder or the psychotic symptoms associated with depression.

Dissociative disorders are comorbid with several other mental health diagnosis including anxiety, depression and substance use disorders. Among children, disassociation has frequently been misidentified as behavioral concerns such as inattention ADHD and temper tantrums as well as oppositional defiant disorder.


The prevalence rate of these disorders is relatively high, usually estimated to be in the range of 2% to 10% of the general population. Individuals experiencing these disorders are vulnerable and at high risk. They are known to be at a very high risk of comorbid disorders and suicidal behaviors.


While researchers have concluded that there does not appear to be a genetic component to dissociation, there does appear to be environmental and biological factors involved. In almost all cases, dissociative disorders appear to be linked to traumatic experiences, frequently early in life. Some of precipitating experiences for children and adolescents seem to involve emotional, physical and sexual abuse; experiencing violence; the death or loss of loved ones; chronic neglect; physical injury, accidents, disasters and medical procedures. In the case of dissociative identity disorder, the American Psychiatric Association (2013) have identified a 90% prevalence rate of childhood abuse and neglect. Depersonalization/derealization disorder seems to be linked to the experience of interpersonal conflicts and emotional abuse.


Among adults, dissociative disorders seem to be some of the most difficult mental conditions to treat. Although dissociative disorders are almost always associated with trauma, some of the traditional treatments for acute posttraumatic stress disorder such as exposure therapy are ineffective and frequently even counterproductive with these individuals. The effectiveness of medications has also had mixed reviews.

Treatment for dissociative disorders is usually conducted on a individual basis in an outpatient setting over a long period of time. Many of the treatments are psychodynamic in nature, also incorporating other approaches such as cognitive behavioral therapy, dialectical behavior therapy, eye movement desensitization and reprocessing and hypnosis. Most people with dissociative identity disorder receive medications to relieve the distressing symptoms.

Specific information related to each of the dissociative disorders and related treatments are on the following pages below.

Dissociative Disorders: DSM-V Diagnostic Codes

300.14 (F44.81) Dissociative Identity Disorder

300.12 (F44.0) Dissociative Amnesia

Specify if:

300.13 (F44.1) With dissociative fugue

300.6 (F48.1) Depersonalization/Derealization Disorder

300.15 (F44.89) Other Specified Dissociative Disorder

300.15 (F44.9) Unspecified Dissociative Disorder


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

International Society for the Study of Dissociation. (2004). Guidelines for the evaluation and treatment of dissociative symptoms in children and adolescents. Journal of Trauma & Dissociation, 5, 119-150. doi: 10. 1300/J229v05n03_09

Disruptive, Impulse-Control, and Conduct Disorders: DSM-V Diagnostic Codes

Disruptive, Impulse-Control, and Conduct Disorders: Overview

Basic characteristics of disorders that fall within the category of disruptive, impulse-control, and conduct disorders are aggressive and self-destructive behaviors, destruction of property, conflict with authority figures, disregard for personal or social norms, and persistent outbursts of anger disproportionate to the situation (APA, 2013). Behaviors within this category are behaviors that infringe upon or violate the rights of others or vary significantly from the norms of society.

It is important to understand that nearly all children and adolescents experience symptoms of defiance, disobedience, and breaking rules at some point in their childhood development. In disruptive, impulse-control, and conduct disorders the behaviors are much more frequent, pervasive and result in impairment to the individual’s lives. These behaviors also significantly exceed the normative behaviors for their culture, age and gender.

Diagnostic Considerations:

Although the underlying cause of these disorders vary, they all seem to share the common characteristics of problems in regulating behaviors and emotions. All of these disorders result in significant impairment in daily functioning. These disorders are less common in females than males and the age of onset tends to be in childhood or adolescence. It is considered very rare for these types of behaviors to first manifest themselves in adulthood. There appears to be a developmental relationship between conduct disorder and oppositional defiant disorder in that individuals who receive a diagnosis of conduct disorder in their preadolescent years frequently have been diagnosed with oppositional defiant disorder at an earlier point in time. Approximately two thirds of children diagnosed with oppositional defiant disorder still meet the diagnostic criteria three years later. One of the higher risk indicators for conduct disorder is an earlier onset and diagnosis of oppositional defiant disorder. Researchers have concluded that children are three times more likely to receive a diagnosis of conduct disorder if they were previously diagnosed with oppositional defiant disorder. Also, mental health clinicians need to closely monitor clients with conduct disorder as there is a very strong connection between conduct disorder and antisocial personality disorder. Approximately 40% of individuals diagnosed with conduct disorder eventually meet the criteria for a diagnosis of antisocial personality disorder.

Developmental Causation:

There has been much research over the years related to the cause and/or etiology of disruptive, impulse control and conduct disorders. The most common causative factors include environmental, emotional, familial, and genetic factors. Although grouped together, there appear to be various and at times different developmental pathways to each disorder. Research has not currently identified many genetic factors associated with the disruptive behavior disorders although the genetic links to ADHD appear to be significant. Also, the biological contributions to disruptive or conduct disorders appear to be very limited. Most research and clinical experience seem to identify environmental causation to be the most significant. Negative experiences within the family including substance abuse by caregivers, caregiver criminality, low socioeconomic status, severe family dysfunction, negative interactions between parent and children, modeling of aggression, and abuse and neglect have been identified as some of the higher risk factors associated with the development of these disorders.

Some cognitive deficits have also been identified which include social-cognitive information processing and issues related to being rejected by peers. Neurological research has identified brain structures within the limbic system which is associated with the formation of emotions and memories in the frontal lobe, which is involved in planning and controlling impulses, and have also been identified as having some connection to disruptive and conduct disorders. In addition to the neurological irregularities, there has been some suggestion that imbalances in testosterone may also play some role in the development of disruptive behavioral and impulse control behaviors.


Treatment for the disruptive, impulse-control and conduct disorders can be very complex due to the various risk and etiological factors. Evidence-based treatments for these disorders usually falls within the categories of parent and family interventions, cognitive behavioral therapy and psychopharmacological treatment.

Psychosocial treatments or counseling related interventions usually seem to focus on parent training approaches which include improving positive time between parents and children, modeling behaviors, behavioral reinforcement of rewards and consequences and the development of positive coping skills for dealing with difficult behaviors.
Cognitive behavioral therapy can help to modify cognitive distortions which seem to underly disruptive behaviors. These therapeutic approaches assist children and adolescents to develop better problem-solving skills focused on improving control, recognizing social difficulties and triggers for their disruptive behaviors, and pursuing more effective alternatives. Interventions focusing on the parents and appropriate medications are also very common.
For very young children, parent training should be the primary treatment approach. For more chronic or severe behaviors, psychologists and mental health clinicians should consider a multidimensional treatment approach that involves teachers, parents, and mental health providers.

Individuals diagnosed with pyromania and kleptomania have been found to respond to psychopharmacological interventions. Also, cognitive behavioral therapy and dialectical therapy have been found to be helpful in some circumstances.

Individual diagnostic codes related to disruptive, impulse control and conduct disorders along with specific etiological and treatment information can be found on the following pages.

Disruptive, Impulse-Control, and Conduct Disorders: DSM-V Diagnostic Codes

313.81 (F91.3) Oppositional Defiant Disorder
Specify current severity: Mild, Moderate, Severe

312.34 (F63.81) Intermittent Explosive Disorder

___.__ (___,__) Conduct Disorder

Specifiy whether:
312.81 (F91.1) Childhood-onset type

312.32 (F91.2) Adolescent-onset type

312.89 (F91.9) Unspecified onset

Specify if: With limited prosocial emotions
Specify current severity: Mild, Moderate, Severe

301.7 (F60.2) Antisocial Personality Disorder

312.33 (F63.1) Pyromania

312.32 (F63.3) Kleptomania

312.89 (F91.8) Other Specified Disruptive, Impulse-Control, and Conduct Disorder

312.9 (F91.9) Unspecified Disruptive, Impulse-Control, and Conduct Disorder

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) of the American Psychiatric Association (2013)

Nursing Homes: What critical information should I know?

Nursing home overview:

When a nursing home is needed you will most likely be too ill to make all of the relevant decisions on your own. Knowing what to think about and look for now will help you to know the most critical information necessary to make a wise decision when the time comes for a nursing home. You should talk with your family before-hand and let them know what your intentions and concerns are about being in a nursing home before the time even comes.
Nursing homes are frequently referred to as long-term care facilities or skilled nursing

facilities. Regardless of their name, all of these facilities provide nursing and medical care for patients in a residential environment. It is important to know that living in a nursing home is not the end of the world. People frequently stay for either short or long periods of time for a multitude of reasons. Individuals may stay in long-term care facilities for rehabilitation after hospitalizations or as permanent nursing home residents. If you need this level of care, you will usually be notified by a social worker in the hospital, an assisted-living staff member, family member or doctor.

Nursing home costs:

Medicare will usually pay for nursing home stays for 30 days and a total of 100-day maximum after a three-day hospital stay. Also, Medicare will only pay as long as the patient needs skilled nursing care. If you qualify, Medicaid will pay for your residence after your Medicare coverage ends. Nursing homes are not required to accept Medicare or Medicaid. It is strictly up to their discretion as to the required payment sources necessary for you to remain. Frequently nursing homes will have a limited number of Medicaid beds. However, it is important to understand that if an individual enters a nursing home as a private pay patient and then becomes Medicaid eligible (by spending down to the required Medicaid level); the nursing home cannot make them leave and is required to accept their Medicaid payment.

If a nursing home does not accept Medicaid, it will not be required to keep the resident once their private pay funds have been expended. Also, an individual who enters a nursing home under Medicare or Medicaid cannot be required to pay a security or advance payment. Also, nursing homes are required to have a bed hold policy in which Medicaid will pay for a set number of days while a patient is away at a hospital or another facility.

It’s important to understand that nursing homes are very expensive with an average cost per year of about $50,000 according to the AARP (formerly known as the American Association of Retired Persons). If you have long-term care insurance or private insurance, some of the cost may be reimbursed through the insurance coverage. You always need to make sure to read the policy closely and make sure that all of the nursing home costs are covered under your policy. Many have percentages or caps that may apply to payment for your nursing home care.

Some information from Senior’s Rights: Your Legal Guide to Living Life to the Fullest By Brette McWhorter Sember
Additional Information By Paul Susic Ph.D. Licensed Psychologist (Geriatric Psychologist)

The 4 Stages of Addiction

Four Stages of Addiction:

According to the dictionary addiction means:

1. Being abnormally tolerant to and dependent on something that is psychologically or physically habit forming (especially alcohol and narcotic drugs).

2. An abnormally strong craving.

3. (Roman Law) a formal award by a court sentence of a thing or person to another (as of a debtor to his creditor), a surrender to a master; “under Roman law, addiction was the justification for slavery”.

The Chinese have a saying about heroin ‘You begin chasing the dragon but then it jumps on your back and begins chasing you’. Jackie Pullinger, the British woman who set up a ministry in Hong Kong t, wrote a book about her experiences there in ‘Chasing the Dragon’.

This expression relates to smoking heroin, but it could be applied for all mood altering drugs, alcohol, painkillers, tranquilizers, speed, solvents, LSD, cocaine, heroin, crack, ecstasy, barbiturates, and cannabis. It can apply to adrenalin based addictions like gambling, sex, shopping, people (co-dependency) and eating disorders.
Addiction doesn’t just happen. There is a progression towards chemical dependency, or any other addiction. It passes through four main stages.

1. Experimental Stage of Addiction

The Experimental Stage could happen out of curiosity or peer pressure. The user may say “I’ll just try it I don’t have to use it again” The user may experience pleasure or mood swings. The outcome may be intoxication or being stoned, or a ‘rush’ of some sort. Many who experiment with drugs do not progress to the next stage of addiction.

This may start in early teens (sometimes younger) with trying alcohol, cigarettes or cannabis. It is easy to get high because of the body’s low tolerance. Often done with their peers away from a parent or guardian. It may be seen as acting grown up, or a simple act of rebellion.

2. The Recreational Stage of Addiction

During the recreational stage the user may use at the weekends with friends, just to unwind from a stressful week. Looking for relief. Tolerance increases and more substances may be used, amphetamines (speed), larger quantities of alcohol. Symptoms may include stopping out late, suffering hangovers.

The user is by now starting to plan for use. Waiting for the weekend to be with friends, but also risk taking may increase by smoking on the way to school. Starting to lie about how much, and what is being used. Parents may react at this stage by grounding their child.

3. The Early Dependency Stage

During this stage, the regular user becomes an abuser. Now maintaining an addictive lifestyle that starts to affect others. The young user may be missing school and stealing money to feed the habit. Older users may be struggling to keep their job and running up debts. There is a daily preoccupation to source drugs and this often leads to meeting dealers.

4. The Full Dependency Stage

During this stage of addiction, there is a self destructive and compulsive desire to escape to oblivion, or escape from reality. Sobriety is too difficult to face. If left untreated, the addict may now face despair and risks premature death through overdose, suicide, accidents or side effects. Many end up with legal problems, imprisonment and family breakdown.

Addiction causes two main problems, a chemical (or an adrenalin) dependency problem, and a lifestyle problem. These are explored within the framework of other articles. Has addiction faced you or your family?

About the Author: Alan J Butler is a Recovery Coach and has worked with recovering addicts and ex offenders for the last 10 years. He spent 3 years living on site as a staff member of the Ovis Farm Project in Devon, England. He is an Associate of Life for the World Trust, an organisation whose aim is to equip the church to reach marginalised people. He holds a Diploma in Coaching & Mentoring from the Institute of Counselling, Glasgow. He welcomes comments at

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