Term
Bulimia Nervosa
Description- 6
Statistics- 5
Causes- 5
Treatments- 3 |
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Definition
- binging followed by purging
- food is high in calorie and binges and uncontrollable (eat a lot)
-purging type- most common (vomiting, laxs, or diuretics)
-nonpurging type- 1/3- (excessive exercise)
- purging causes medical problems such as dental enamel erosion, electrolyte imbalance, & kidney failure.
- Over-concerned with body shape, fear of weight gain, and comorbid with anxiety/mood disorders
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Term
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Definition
-no eating w/purging
-sever weight loss
- 15% low expected weight
- intense fear of obesity and losing control over eating
-Restricting Subtype- limit calorie intake via dieting & fasting
-Bing-eating-purging Subtypes- about 50% of anorexics
- Cormorbid w/ other psychological disorders
STATS
- White females from middle & upper class families
- Onset= 13 (early adolescence)
- Chronic
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Term
| Binge Eating Disorder- Treatments 3 |
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Definition
1) CBT
2) IPT
3) Self-help techniques (things done outside doctor's office help) |
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Term
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Definition
- Not a DSM disorder
- 33% of adults in US were obese
- high BMI= high mortality rates
CAUSES
1) Related to technological advancement
2) Genetics acct for 30% of obese cases
TREATMENT
1) Greater success in adolescents
2) Treatment Progression- from least to most intrusive options
1. Self-directed weight loss program
2. Commercial self-help programs
3. Behavior modification programs
4. Bariatric Surgery |
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Term
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Definition
Consuming 1/3 or more of daily food intake after the evening meal AND getting out of bed at least once during the night to have a high-calorie snack
- don't usually eat breakfast
- don't binge during night eating, & don't purge.
- Occurs in 7- 15% of treatment seekers
- Occurs in 27% of ppl seeking bariactric surgery |
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Term
| Dyssomnias vs. Parasomnias |
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Definition
- Dysomnias= difficulties in amout, quality, or timing of sleep
- Parasomnias= abnormal behavioral & physiological events during sleep. |
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Term
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Definition
- Polysomnographic Sleep Evaluation (PSG)- detailed history, assessment of sleep hygiene & sleep efficiency
-EEG= Brain waves
-EOG= Eye movements
-EMG= Muscle movements
-Actigraph- small electronic device worn on wrist to record body movements. |
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Term
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Definition
- difficulty initiating, maintaining, & gaining sleep.
- primary insomnia means not related to other medical/psychiatric problems althouth in regular insomnia it may be comorbid.
- 1/3 of population reports this in a given year
- Women report 2x men
-Treatment= Benzos & OTC sleep meds (prolonged use can cause dependence & rebound insomnia- occurs when person stops taking meds and sleep problems come back, sometimes worse) |
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Term
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Definition
- sleeping too much/excessive sleep
- excessive sleepiness= problem.
- complaints of sleepiness through the day but able to sleep through night.
-39% of ppl have family history
-often associated with medical/psychological conditions
-Treatment= Stimulants (Ritalin) |
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Term
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Definition
- daytime sleepines and cataplexic attacks (REM sleep brought on by stong emotion)
- Cataplexy, sleep paralysis, and hypogognic hallucinations
-Rare condition
- 50/50 M/F
-Onset= adolescence
- Improves overtime
-Treatment= Stimulants (Ritalin) & Antidepressants help Cataplexy |
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Term
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Definition
- Restricted air flow and/or brief cessations of breathing
1) Obstructive Sleep Apnea (OSA)- airflow stops but respiratory system works
2) Central Sleep Apnea (CSA)- respiratory system stops for breif periods
3) Mixed Sleep Apnes - Combo of OSA & CSA
-Treatments= medications, weight loss, and mechanical devices. |
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Term
| Circandian Rhythm Disorders |
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Definition
Disturbed sleep (insomnia or excessive sleepiness) due to brain's inability to synchronize day & night
-Circandian Rhythms don't follow a 24 hour clock, follow Suprachiasmatic nucleus (brain's biological clock) which stimulates melatonin.
-Jet Lag, Shift work, advanced sleep, delayed sleep.
-Treatment= 1) Phase delays (later bedtime= best approach), 2) Phase advances (earlier bedtime= difficult), 3)Use a very bright light to trick brain's biological clock. |
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Term
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Definition
-Occur during REM sleep
- dreams often awake person
-more common in children than adults
- Treatment= antidepressants and/pr relaxation training. |
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Term
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Definition
-Recurrent episodes of panic-like symptoms during non-REM sleep
-often noted by scream
-more common in children (boys)
-tend to correct self
-Treatment= 1) "Wait-and-See" (if they disappear on their own), 2)scheduled awakenings prior to the sleep terror, & 3) antidepressants or benzos in extreme cases |
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Term
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Definition
- AKA Somnambulism
- Occures during non-REM sleep usually during the first few hours of deep sleep.
-More common in children & usually resolves on its own
-Adult sleepwalking can be a sign of pathology
-Seems to run in families |
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Term
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Definition
- Alcohol, Benzos (Xanax, Valium), & Barbituates (sedatives)
- decrease CNS
- targets GABA & affects glutamate & serotonin systems
-over 50% of US drinks
-highest users are Whites
-Males use & abuse more than females
-Violence associated with alcohol
-Calming (barbituates), Sleep inducing, and anxiety reducing (benzos) |
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Term
| Alcohol related disorders |
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Definition
- Withdrawal delirium
- FAS
-Dementia- general loss of intellecutal abilites
- Wernicke- Korsakoff syndrome- results in confusion, loss of muscle coordination, and unintelligible speech. |
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Term
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Definition
-Amphetamines, cocaine, nicotine, & caffeine.
- most widely consumed drug in US
- increase alertness and energy |
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Term
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Definition
-stimulate CNS by enhancing release of NE & Dopamine and reuptake is blocked.
- followed by extreme fatigue & depression (crash)
- Ecstacy & Crystal Meth- prduce efffects similar to speed but without crash but with high risk of dependance. |
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Term
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Definition
-short lived sensations of elation, vigor, & energy.
-effects block reuptake of dopamine
- highly addictive, but develops slowly
- Most cycle through patterns of tolerance & withdrawal. |
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Term
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Definition
- stimulates nicotinic acetylcholine receptors in CNS
-results in sensations of relaxation, wellness, & pleasure.
-highly addictive
-relapse rates equal to alcohol & heroin. |
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Term
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Definition
- The "Gentle" Stimulant
- Used by over 90% of Americans
- blocks reuptake of adenosine |
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Term
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Definition
-Opiate= natural chemical in the opium poppy with narcotic effects
-Opiod= natural & synthetic substances with narcotic effects.
- AKA Analgesics |
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Term
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Definition
Description
1)Severe anxiety over belief of serious illness without true medical cause.
2)Medical reassurance is only short-term relief
3)Anxiety= main problem expressed through preoccupation of bodily functions, misinterpreting them as symptoms/diseases. (EX: headache= brain tumor)
Statistics
1)7% of primary care patients
2)50/50 M/F
3)Onset any age
4)Chronic
5)Evident cross-culturally
Causes
1)Cognitive Perceptual Distortions- perceptual sensitivity to illness cues & interprets ambiguous stimuli as threatening. (EX: headache= brain tumor).
2)Genetic & Learned from family
3)Faulty interpretation of physical sensations --> Additional physical symptoms --> increased anxiety --> intensified focus on symptoms (cycle).
Treatment
1)Challenge illness-related misinterpretations
2)Provide more substantial & sensitive reassurance (mental health professional NOT family dr)
3)CBT
4)Stress management & coping strategies |
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Term
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Definition
Description
1)Extended history of multiple, wide-ranged physical symptoms before age 30 (without medical explanation)
2)Patients’ primary concern is with symptoms, not what they mean. Symptoms eventually become identity.
3)Substantial impairment of social or occupational functioning.
Statistics
1)Rare- most prevalent among unmarried women in low socioeconomic groups.
2)Adolescence Onset
3)Chronic course
Causes
1)Runs in family (heritable) (similar to hypochondriasis) (minor factor)
2)Related to Antisocial Personality Disorder (both heritable, begin early in life, chronic course, predominant in low SES ppl, difficult to treat, and associated with marital discord, drug/alcohol abuse, and suicide attempts.) --> Both link to weak behavioral inhibition system.
3)Weak Behavioral Inhibition System= impulsivity seen in the characteristic of short-term gain (attention) at the expense of long-term problems (social isolation).
Treatment
1)Difficult to treat
2)CBT to provide reassurance, reduce stress, and minimize help-seeking behaviors (gate-keeper physician).
3)Therapy to broaden basis for relating to others (reduce supportive consequences of talk about physical symptoms by broadening their topics for discussion). |
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Term
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Definition
Description
1)Severe physical malfunctioning (paralysis or blindness) without medical explanation.
2)People are genuinely unaware they can function normally.
3)Comorbid with somatization disorder
4)“La belle indifference”- lack of concern of symptoms
Statistics
1)Rare
2)Primarily in females, low socioeconomic groups, & men under extreme stress (soldiers)
3)Common in some cultures/religions (EX: sometimes evidence of contact with God)
4)Onset= usually adolescence
5)Chronic, intermittent course
Causes
1)Life stresses or psychological conflict --> social influences (symptoms learned from observing real illness or injury) --> reduced by incapacitating symptoms.
2)Freud’s Psychodynamic View= Popular --> 4 Processes
a.Traumatic Experience (unacceptable, unconscious conflict)
b.Conflict & Anxiety = unacceptable so represses conflict to unconscious
c.Anxiety increases, conflict emerges to consciousness & is “converted” to physical symptoms (decreases anxiety) to avoid dealing with conflict
i.Primary Gain- the reduction of anxiety as a result of “conversion” reinforces problem --> accounts for “la belle indifference”
d.Receives attention & sympathy so continues.
i.Secondary Gain-attention/avoidance of problem which reinforces problem.
Treatment
1)SAME AS SOMATIZATION DISORDER
2)Emphasis on resolving life stress or conflict and reducing help-seeking behaviors
Closely Related Disorders
1)Malingering
2)Factitious Disorders
3)Factitious Disorders by proxy (Abnormal Child Abuse/Munchausen Disorder)
4)Pain Disorder- True pain but psychological factors play an important role in onset, severity, and maintenance. |
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Term
| Body Dysmorphic Disorder (BDD) |
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Definition
Description
1)Socially disabling preoccupation with a normal physical feature that is believed to be hideous (“imagined ugliness”)
2)Have “ideas of reference”- often think everything that goes on in their world is related/about themself (negatively).
3)Associated with OCD
4)Suicidal ideation, attempts, and itself= common
Statistics
1)50/50 M/F
2)Most stay single and/or get plastic surgery
3)Onset= early adolescence thru 20’s (peak age at 16/17)
4)Chronic course
Causes
1)Little is known
2)Heritable
3)Comorbid with OCD
4)Intrusive, anxiety-provoking idea that individual has a physical defect apparent to everyone -->
Pathological attempts to “fix” the problem that prevents a more reality-based appraisal of the “defect” --> Increased Anxiety --> Intensified focus on imagined defects accompanied by extreme self-consciousness.
Treatment- (parallel to OCD)
1)CBT seems most effective (exposure & response prevention= type of CBT)
2)SSRI (drug treatment) to block serotonin reuptake
3)Plastic Surgery often unhelpful (short-term relief) |
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Term
| Depersonalization Disorder |
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Definition
Description
1)Severe and frightening feelings of unreality & detachment
2)Feelings interfere with normal functioning
3)Primary problem involves depersonalization and derealization
Statistics
1)50/50 M/F
2)High comorbidity with anxiety and mood disorders
3)Onset= around age 16
4)Usually lifelong chronic course
Causes
1)Cognitive deficits in attention, short-term memory, and spatial reasoning
2)Cognitive deficits related to tunnel vision (perceptual distortions) and mind emptiness (difficulties absorbing new information)
3)These people are easily distracted
Treatment
1)Little Known
2)Psychological treatments similar to those for panic disorder may be helpful |
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Term
| Dissociative Identity Disorder (DID) |
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Definition
Description
1)Formerly AKA Multiple Personality Disorder
2)Adoption of several new identities (alters) that coexist simultaneously
3)Each alter has unique behaviors, voices, postures, genders, & ages.
4)Only of only disorders with self-injury.
5)Severe form of PTSD b/c of trauma cause.
6)MUST HAVE FUGUE & AMNESIA
7)People try to hide their symptoms
Statistics
1)FEMALES (9:1 ratio)
2)Avg # of alters= 15
3)High Comorbidity (3-6% in US)
4)Rare outside of Western culture
5)Onset= almost always childhood b/c of child abuse (around age 7 doesn’t develop after age 9)
6)Lifelong/Chronic course
Causes
1)Histories of child abuse
2)Closely related to PTSD
3)Dissociation as a mechanism to escape from the impact of trauma if over-powered by an adult who is supposed to be protecting child & child doesn’t have social network or other coping mechanism to deal with trauma, “zoning out” (separating mentally) is result.
4)Heritability & responsiveness increase vulnerability
5)Hippocampus & Amygdala are smaller in people with DID
6)Social Support= largest protective factor against psychopathology
Treatment
1)Must establish TRUST
2)Focus on reintegration of identities
3)Identify & neutralize cues/triggers that provoke memories of trauma/dissociation |
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Term
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Definition
1)Generalized Amnesia- inability to remember anything, including identity (rare)
2)Localized Amnesia- inability to remember specific events (traumatic, more common, soldiers) |
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Term
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Definition
Description
1)Take off and find themselves in a new place, unable to remember the past (assume new identity or confused about old one), unable to remember how they arrived in a new location.
2)“Fugue”= Flight
3)Fugue states end abruptly
Statistics
1)FEMALES
2)Onset= adulthood
3)Rapid onset & dissipation
Causes
1)Trauma and stress= triggers
2)Intolerable situation
Treatment
1)Self-correcting if current life stress is resolved
2)Therapy focuses on retrieving lost memory/information |
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Term
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Definition
Description
1)Altered state of consciousness, attributed to possession by spirit
2)Presentation varies across cultures
Statistics
1)FEMALES
2)Africa & Asia
3)Rarely seen in Western cultures
Causes
1)Life stressor/trauma
Treatment
1) Little is known |
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Term
Major Depressive Episode
Major Depressive Disorder (2 types) |
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Definition
Description
1)Extremely depressed mood lasting at least 2 weeks
2)Cognitive symptoms= feelings of worthlessness & indecisiveness
3)Disturbed physical functions= altered sleep patterns, significant changes in appetite/weight, or a notable loss of energy) AKA somatic or vegetative symptoms (MOST CENTRAL INDICATORS)
4)Anhedonia- loss of pleasure/interest in usual activities (makes episode so severe/”major”) State of low affect not just high negative affect
5)Duration (if untreated) is 4 to 9 months.
1)Single Episode- one major depressive episode (highly unusual)
2)Recurrent Episode- multiple major depressive episodes, separated by at least 2 months (more common)
3)Begin suddenly, often triggered by crisis, change, or loss |
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Term
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Definition
Description
1)Long-term unchanging symptoms of mild depression (at least 2 years)
2)No more than 2 months symptom free
3)If untreated, can last 20-30 years
4)Daily functioning not severely affected but cumulative overtime causes impairment.
Statistics
1)Early Onset= before age 21
a.Greater chronicity, poorer prognosis, stronger likelihood of genetic link.
2)Late Onset= after 21 (usually restricted to early 20’s) |
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Term
Double Depression
From Grief to Depression.... |
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Definition
Description
1)Alternating periods of major depressive episodes & dysthymic disorder
2)Dysthymic disorder often develops first
3)Associated with severe psychopathology
4)Associated with problematic future course
From Grief to Depression….
•After a loss, symptoms of major depressive episodes are common (anxiety, emotional numbness, and denial) frequency of depression after a loved one dies is so common that it’s not considered a disorder until severe symptoms appear (like suicidal ideation) or the mild syptoms last more than 6 months.
•Naturally grieving time= 6 months to 1 year. (special dates= relapse is common)
•If grief is nonexistent or longer than 1 year, there is concern.
•Psychological and social factors related to mood disorders (like history of depressive episodes) also predict they development of a typical grief response into a pathological/impacted grief response (but can develop with no history)
•Immediate intervention is needed in these cases. |
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Term
Major Depressive Episode
Major Depressive Disorder (2 types) |
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Definition
Description
1)Extremely depressed mood lasting at least 2 weeks
2)Cognitive symptoms= feelings of worthlessness & indecisiveness
3)Disturbed physical functions= altered sleep patterns, significant changes in appetite/weight, or a notable loss of energy) AKA somatic or vegetative symptoms (MOST CENTRAL INDICATORS)
4)Anhedonia- loss of pleasure/interest in usual activities (makes episode so severe/”major”) State of low affect not just high negative affect
5)Duration (if untreated) is 4 to 9 months.
1)Single Episode- one major depressive episode (highly unusual)
2)Recurrent Episode- multiple major depressive episodes, separated by at least 2 months (more common)
3)Begin suddenly, often triggered by crisis, change, or loss |
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Term
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Definition
Description
1)Long-term unchanging symptoms of mild depression (at least 2 years)
2)No more than 2 months symptom free
3)If untreated, can last 20-30 years
4)Daily functioning not severely affected but cumulative overtime causes impairment.
Statistics
1)Early Onset= before age 21
a.Greater chronicity, poorer prognosis, stronger likelihood of genetic link.
2)Late Onset= after 21 (usually restricted to early 20’s) |
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Term
Double Depression
From Grief to Depression.... |
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Definition
Description
1)Alternating periods of major depressive episodes & dysthymic disorder
2)Dysthymic disorder often develops first
3)Associated with severe psychopathology
4)Associated with problematic future course
From Grief to Depression….
•After a loss, symptoms of major depressive episodes are common (anxiety, emotional numbness, and denial) frequency of depression after a loved one dies is so common that it’s not considered a disorder until severe symptoms appear (like suicidal ideation) or the mild syptoms last more than 6 months.
•Naturally grieving time= 6 months to 1 year. (special dates= relapse is common)
•If grief is nonexistent or longer than 1 year, there is concern.
•Psychological and social factors related to mood disorders (like history of depressive episodes) also predict they development of a typical grief response into a pathological/impacted grief response (but can develop with no history)
•Immediate intervention is needed in these cases. |
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Term
Major Depressive Episode
Major Depressive Disorder (2 types) |
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Definition
Description
1)Extremely depressed mood lasting at least 2 weeks
2)Cognitive symptoms= feelings of worthlessness & indecisiveness
3)Disturbed physical functions= altered sleep patterns, significant changes in appetite/weight, or a notable loss of energy) AKA somatic or vegetative symptoms (MOST CENTRAL INDICATORS)
4)Anhedonia- loss of pleasure/interest in usual activities (makes episode so severe/”major”) State of low affect not just high negative affect
5)Duration (if untreated) is 4 to 9 months.
1)Single Episode- one major depressive episode (highly unusual)
2)Recurrent Episode- multiple major depressive episodes, separated by at least 2 months (more common)
3)Begin suddenly, often triggered by crisis, change, or loss |
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Term
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Definition
Description
1)Long-term unchanging symptoms of mild depression (at least 2 years)
2)No more than 2 months symptom free
3)If untreated, can last 20-30 years
4)Daily functioning not severely affected but cumulative overtime causes impairment.
Statistics
1)Early Onset= before age 21
a.Greater chronicity, poorer prognosis, stronger likelihood of genetic link.
2)Late Onset= after 21 (usually restricted to early 20’s) |
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Term
Double Depression
From Grief to Depression.... |
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Definition
Description
1)Alternating periods of major depressive episodes & dysthymic disorder
2)Dysthymic disorder often develops first
3)Associated with severe psychopathology
4)Associated with problematic future course
From Grief to Depression….
•After a loss, symptoms of major depressive episodes are common (anxiety, emotional numbness, and denial) frequency of depression after a loved one dies is so common that it’s not considered a disorder until severe symptoms appear (like suicidal ideation) or the mild syptoms last more than 6 months.
•Naturally grieving time= 6 months to 1 year. (special dates= relapse is common)
•If grief is nonexistent or longer than 1 year, there is concern.
•Psychological and social factors related to mood disorders (like history of depressive episodes) also predict they development of a typical grief response into a pathological/impacted grief response (but can develop with no history)
•Immediate intervention is needed in these cases. |
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Term
Major Depressive Episode
Major Depressive Disorder (2 types) |
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Definition
Description
1)Extremely depressed mood lasting at least 2 weeks
2)Cognitive symptoms= feelings of worthlessness & indecisiveness
3)Disturbed physical functions= altered sleep patterns, significant changes in appetite/weight, or a notable loss of energy) AKA somatic or vegetative symptoms (MOST CENTRAL INDICATORS)
4)Anhedonia- loss of pleasure/interest in usual activities (makes episode so severe/”major”) State of low affect not just high negative affect
5)Duration (if untreated) is 4 to 9 months.
1)Single Episode- one major depressive episode (highly unusual)
2)Recurrent Episode- multiple major depressive episodes, separated by at least 2 months (more common)
3)Begin suddenly, often triggered by crisis, change, or loss |
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Term
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Definition
Description
1)Long-term unchanging symptoms of mild depression (at least 2 years)
2)No more than 2 months symptom free
3)If untreated, can last 20-30 years
4)Daily functioning not severely affected but cumulative overtime causes impairment.
Statistics
1)Early Onset= before age 21
a.Greater chronicity, poorer prognosis, stronger likelihood of genetic link.
2)Late Onset= after 21 (usually restricted to early 20’s) |
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Term
Double Depression
From Grief to Depression.... |
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Definition
Description
1)Alternating periods of major depressive episodes & dysthymic disorder
2)Dysthymic disorder often develops first
3)Associated with severe psychopathology
4)Associated with problematic future course
From Grief to Depression….
•After a loss, symptoms of major depressive episodes are common (anxiety, emotional numbness, and denial) frequency of depression after a loved one dies is so common that it’s not considered a disorder until severe symptoms appear (like suicidal ideation) or the mild syptoms last more than 6 months.
•Naturally grieving time= 6 months to 1 year. (special dates= relapse is common)
•If grief is nonexistent or longer than 1 year, there is concern.
•Psychological and social factors related to mood disorders (like history of depressive episodes) also predict they development of a typical grief response into a pathological/impacted grief response (but can develop with no history)
•Immediate intervention is needed in these cases. |
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Term
| Depersonalization Disorder |
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Definition
Description
1)Severe and frightening feelings of unreality & detachment
2)Feelings interfere with normal functioning
3)Primary problem involves depersonalization and derealization
Statistics
1)50/50 M/F
2)High comorbidity with anxiety and mood disorders
3)Onset= around age 16
4)Usually lifelong chronic course
Causes
1)Cognitive deficits in attention, short-term memory, and spatial reasoning
2)Cognitive deficits related to tunnel vision (perceptual distortions) and mind emptiness (difficulties absorbing new information)
3)These people are easily distracted
Treatment
1)Little Known
2)Psychological treatments similar to those for panic disorder may be helpful |
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Term
| Dissociative Identity Disorder (DID) |
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Definition
Description
1)Formerly AKA Multiple Personality Disorder
2)Adoption of several new identities (alters) that coexist simultaneously
3)Each alter has unique behaviors, voices, postures, genders, & ages.
4)Only of only disorders with self-injury.
5)Severe form of PTSD b/c of trauma cause.
6)MUST HAVE FUGUE & AMNESIA
7)People try to hide their symptoms
Statistics
1)FEMALES (9:1 ratio)
2)Avg # of alters= 15
3)High Comorbidity (3-6% in US)
4)Rare outside of Western culture
5)Onset= almost always childhood b/c of child abuse (around age 7 doesn’t develop after age 9)
6)Lifelong/Chronic course
Causes
1)Histories of child abuse
2)Closely related to PTSD
3)Dissociation as a mechanism to escape from the impact of trauma if over-powered by an adult who is supposed to be protecting child & child doesn’t have social network or other coping mechanism to deal with trauma, “zoning out” (separating mentally) is result.
4)Heritability & responsiveness increase vulnerability
5)Hippocampus & Amygdala are smaller in people with DID
6)Social Support= largest protective factor against psychopathology
Treatment
1)Must establish TRUST
2)Focus on reintegration of identities
3)Identify & neutralize cues/triggers that provoke memories of trauma/dissociation |
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Term
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Definition
1)Generalized Amnesia- inability to remember anything, including identity (rare)
2)Localized Amnesia- inability to remember specific events (traumatic, more common, soldiers) |
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Term
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Definition
Description
1)Take off and find themselves in a new place, unable to remember the past (assume new identity or confused about old one), unable to remember how they arrived in a new location.
2)“Fugue”= Flight
3)Fugue states end abruptly
Statistics
1)FEMALES
2)Onset= adulthood
3)Rapid onset & dissipation
Causes
1)Trauma and stress= triggers
2)Intolerable situation
Treatment
1)Self-correcting if current life stress is resolved
2)Therapy focuses on retrieving lost memory/information |
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Term
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Definition
Description
1)Altered state of consciousness, attributed to possession by spirit
2)Presentation varies across cultures
Statistics
1)FEMALES
2)Africa & Asia
3)Rarely seen in Western cultures
Causes
1)Life stressor/trauma
Treatment
1) Little is known |
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