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Masterful Lover

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inside your head the screams won't silence

Masterful Lover

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• Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad or empty) or observation made by others (e.g.,
appears tearful). Note: In children and adolescents, can be irritable mood.
• Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by either subjective account or observation
made by others).
• Significant weight loss when not dieting or weight gain (e.g., a change of more
than 5 percent of body weight in a month), or decrease or increase in appetite
nearly every day. Note: In children, consider failure to make expected weight
gains.
• Insomnia or hypersomnia nearly every day.
• Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down).
• Fatigue or loss of energy nearly every day.
• Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being sick).
• Diminished ability to think or concentrate, or indecisiveness, nearly every day
(either by subjective account or as observed by others).
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing
suicide.

Masterful Lover

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The DSM-5 criteria for GAD are as follows:

The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least 6 months, and is clearly excessive.
Excessive worry means worrying even when there is nothing wrong, or in a manner that is disproportionate to actual risk. This typically involves spending a high percentage of waking hours worrying about something. The worry may be accompanied by reassurance-seeking from others.

In adults, the worry can be about job responsibilities or performance, one’s own health or the health of family members, financial matters, and other every day, typical life circumstances. Of note, in children, the worry is more likely to be about their abilities or the quality of their performance (for example, in school).

The worry is experienced as very challenging to control.
Worry in both adults and children may shift from one topic to another.

The anxiety and worry is associated with at least 3 of the following physical or cognitive symptoms (In children, only 1 symptom is necessary for a diagnosis of GAD.):
Edginess or restlessness.
Tiring easily; more fatigued than usual.
Impaired concentration or feeling as though the mind goes blank.
Irritability (which may or may not be observable to others).
Increased muscle aches or soreness.
Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep).
Many individuals with GAD also experience symptoms such as sweating, nausea or diarrhea.

The anxiety, worry, or associated symptoms make it hard to carry out day-to-day activities and responsibilities. They may cause problems in relationships, at work, or in other important areas.
These symptoms are unrelated to any other medical conditions and cannot be explained by the effect of substances including a prescription medication, alcohol or recreational drugs.
These symptoms are not better explained by a different mental disorder.

Masterful Lover

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The DSM-5 includes the following criteria for the combined disorder Depersonalization/Derealization Disorder:
A. An individual consistently has a feeling of both or either depersonalization or derealization.
Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions (e.g.,perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing.)" [2]
Derealization: "Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted."
B. "During the depersonalization or derealization experiences, reality testing remains intact."
C. "The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication or other medical condition (e.g., seizures)." [2]:157
D. "The disturbance is not better explained by another mental disorder." [2]:156-1577

Masterful Lover

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A The presentation of two or more distinct personality states/alters must present, and each must have their own way of being.
"Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual." [2]:155
B Amnesia is a requirement, but the DSM-5 has altered the wording to be:
"Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting." [2]:155
Amnesia in dissociative identity disorder is understood to mean amnesia between two or more of the distinct identities; the host alter will experience "losing time" in the present another alter takes the place of the one the host alter. Rarely is the host alter aware of their time loss. Note that even though the DSM does not make it clear that they mean current [amnesia], 20% of the population who appear to not be traumatized do not remember their childhood.
C An individual must be distressed by the disorder or have an impaired ability to function in a major area of life as a result. This is described as follows:
"The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning." [2]:155
D Normal cultural or religious practice is excluded, and fantasy play in children are excluded.
The disturbance is not a normal part of a broadly accepted cultural or religious practice. [2]:155
E Dissociative identity disorder cannot be diagnosed if symptoms are attributable to substance use or other medical conditions.
"The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures)." [2]:155

Masterful Lover

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Frantic efforts to avoid real or imagined abandonment
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
Identity disturbance: markedly and persistently unstable self-image or sense of self
Impulsivity in at least two areas that are potentially self-damaging (e.g., substance abuse, binge eating, and reckless driving)
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
Transient, stress-related paranoid ideation or severe dissociative symptoms

Masterful Lover

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The person has been exposed to a traumatic event in which both of the following were present:
(1.) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
(2.) The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.
The traumatic event is persistently reexperienced in one (or more) of the following ways:
(3.) Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(4.) Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
(5.) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience; illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
(6.) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(7.) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(8.) Efforts to avoid thoughts, feelings, or conversations associated with the trauma
(9.) Efforts to avoid activities, places, or people that arouse recollections of the trauma
(10.) Inability to recall an important aspect of the trauma
(11.) Markedly diminished interest or participation in significant activities
(12.) Feeling of detachment or estrangement from others
(13.) Restricted range of affect (e.g., unable to have loving feelings)
(14.) Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal lifespan)
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1.) Difficulty falling or staying asleep
(2.) Irritability or outbursts of anger
(3.) Difficulty concentrating
(4.) Hypervigilance
(5.) Exaggerated startle response
Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
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