Psychology

Mothers and Eating Disorders
Introduction
It is generally accepted that Western cultural beliefs about what it means to be fat or thin have a greater impact on women  than men in the West ( Wooley   Wooley, 1980). This suggests that increased vulnerability to eating disorders in women may, at least in part, be linked to recent cultural forces acting selectively on women. Relevant forces include female sexual liberation ( Bennett  Gurin, 1982), changes in the role of women, and changes in cultural demands and expectations. These pressures can be linked to specific beliefs, at the cultural or subcultural level, about what it means to be fat or thin. Among other things, it has been suggested that thinness represents a rejection of the feminine stereotype ( Szyrynski, 1973), andor an expression of female sexual liberation ( Bennett  Gurin, 1982), with the attributes or meanings associated with thinness (e.g., athleticism, nonreproductive sexuality) representing a kind of androgynous independence. Others, such as Bruch ( 1978), have emphasized the process rather than the meaning and have suggested that, faced with too many conflicting demands and choices, some women  choose weight and shape as means to control their fives or as realms to be successful in. This is described by Vitousek and Hollon ( 1990) as a New Years resolution style of cognitive process. As well as affecting vulnerability, it also is possible that cultural pressure acting on women  and not men may affect the expression of eating disorders. Western women are, traditionally and unlike men, rewarded for affiliation and dependence. Thus self-esteem, as well as being tied to internal or dispositional factors, also tends to be more strongly tied to interpersonal approval ( Bardwick, 1971). These two processes may be reflected in womens vulnerability to develop weight and shape assumptions tied to both self-acceptance and to acceptance by others.

Eating disorders are more likely to develop in adolescent girls and young women. It has been suggested that adolescence is more difficult for girls than for boys in Western culture ( Hsu, 1990). In particular, it has been suggested that the onset of puberty may make denial or avoidance of the expectations associated with adolescence more difficult for girls and that, in the West, recent cultural changes may magnify the stress.

Negative Self-Beliefs
The concept of schemas ( Neisser, 1967) may be relevant to understanding negative self-beliefs, particularly the concept of self-schemas. A schema may be defined as a cognitive structure that represents knowledge about a concept or type of stimulus, including its attributes and the relations among those attributes ( Fiske  Taylor, 1991). A self-schema is a schema about oneself that is, ones self-concept. Negative self-beliefs represent the content of schema. Such structures possess schematic properties that influence the way we perceive, understand, make sense of, and recall the information presented to us ( Eysenck, 1993). Cultural forces might influence the existence of negatively toned schemas, their structure, and the processes associated with them.

Typically, a self-schema includes objective information or descriptions of physical characteristics (e.g., Im female, Im tall, Im fat) as well as personality descriptors (e.g., Im honest, Im successful, Im caring). To date, it is usually the  more objective or physical descriptors that have been studied ( Markus, Hamill,  Sentis, 1987). While social cognition theory tends to treat these two types of schema as equivalent, this tendency is not apparent in cognitive theories of eating disorders. In particular, personality descriptors appear to exist at a deeper level of meaning than physical descriptors, particularly the belief that one is fat or thin. They can be derived from physicalobjective descriptors by asking, What does being (believing that you are) fat mean or say about you This level of meaning lies at the core of the self-concept in cognitive theory and therapy for eating disorders. Despite this difference in view of the self, the concept of self schema remains useful as a framework for furthering our understanding of cultural influences on eating disorders.

With respect to the existence of negatively toned schemas, preliminary evidence suggests that the self-concept or self-schema may be similar in women with eating disorders and women with depression, at least in Western cultures ( Cooper  Hunt, 1998) that is, in the presence of negative self-beliefs. With respect to cultural differences, Koenig ( 1997) notes that depression may manifest itself in different ways in West and non-Western cultures. In particular, cognitivemotivational symptoms (e.g., guilt, self-deprecation, despair, suicidal ideation) seem to be more common in Western cultures. Koenig links this difference in symptoms to differences in the cultural self way ( Markus, Mullally,  Kitamaya, 1997).

Selfways are characteristic ways of engaging in the social world. Defined as a pattern that establishes or strengthens certain kinds of self-concepts ( Neisser, 1997, p. 5), selfways, like the individual self-concept, have schematic properties. They guide what people notice and think about, what they feel moved to do, what they feel, how they feel, and how they organize, understand and give meaning to their experiences ( Markus, Mullally,  Kitamaya, 1997, p. 15).

In Western cultures, the cultural selfway is reflected in the drive to be distinct and unique, as compared to many non-Western cultures where the drive is to fit in and be a useful member of the group. This difference means that, in the West, negative affect is linked to low self-esteem, which is then reflected in negative self-beliefs. In non-Western cultures, however, negative affect is linked to not fitting in, and does not have the effect of encouraging the development of negative self-beliefs. This may, at a broad level, increase vulnerability to the development of an eating disorder.

Within a specific cultural selfway, and consistent with the suggestion made earlier, Markus et al. ( 1997) also note that females experience may be rather different from that of men, particularly in the West where cultures are more likely to emphasize dependent selves to women that is, maintaining relationships and connection to others. However, in the West, connecting to others is a distinguishing attribute of the self, not fitting in or being part of a relationship. This means that women in the West appear to have both positive, strong, articulated selves and an emphasis on connectivity and relatedness to others. These two themes in the self-concept may help to explain, more clearly and in more detail  than previous researchers have done, why women with eating disorders are concerned not only about weight and shape as a means to enhance their own selfesteem, but also about weight and shape as a means to be accepted by others.

Differences in the type of selfway developed and the emphasis on a dependent self for women in Western cultures may affect vulnerability to eating disorders. Different cultures may also stress different kinds of self-concept. The type found in Western cultures may not be universal and may also relate, at a general level, to vulnerability to eating disorders. For example, the Penobscot Indians have a concept of the self in which each individual is made up of two parts, the body and a vital self dependent on the body but able to have out of body experiences ( Speck, 1920). This structure differs from the coherent, whole, and integrated structure characteristic of the Western self-concept.
Attributional theory may also be extended to negative self-beliefs, specifically to the attribution of responsibility for the belief that one is, for example, a failure or worthless. As with underlying assumptions, responsibility for being worthless or a failure can be located in the self or in external factors. As with its application to underlying assumptions, both the inferential processes and the heuristics used to construct explanations may be open to cultural influence. Again, differences between cultures in these may affect the likelihood of developing eating disorders.

Schema-Driven Processing
Attributional theory is also applicable to schema-driven processing. In relation to eating disorders, the self-serving bias (i.e., the tendency to enhance or protect self-esteem) is relevant to schema compensation in which dieting is seen as a way to overcome or make up for perceived negative qualities. The existence of this bias is open to cultural influence. In the developmental cognitive theory outlined above, schema compensation processes reflect dieting as a means to overcome negative self-beliefs. This process, self-esteem enhancement, seems analogous to the concept of self-serving biases that, within the context of attributional theory, serve to protect or enhance self-esteem or self-image.
While research in Western cultures finds self-serving and self-protective biases in which individuals take credit for their success and attribute it to their own abilities, the opposite pattern is found in other cultures. In Japan, for example, individuals explain success in terms of situational factors ( Kitayama, Takagi,  Matsumoto, 1995). Cultural differences in the existence of the self-serving bias may contribute to individual vulnerability to developing eating disorders.

Culture and the Expression of Eating Disorders
It seems clear that there are cultural differences in the expression of eating disorders, both currently across cultures and historically within cultures. Cases of eating disorders in some less developed countries do not always appear to have  all the typical features of those in Western cultures. For instance, fear of fatness may not be common in non-Western anorexia nervosa ( Khandelwal, Sharan,  Saxena, 1995). Instead, decrease in food intake may be related to fasting for religious purposes or to eccentric nutritional ideas. It has been suggested that degree of Westernization may affect findings such as this ( Fedoroff  McFarlane, 1998), with atypical presentations being more common in less Westernized cultures. Historically, symptoms are not always related to a sense of fatness or to pressure against fatness ( Littlewood, 1995).

Cultural differences can, within a cognitive framework focused on the cultural meaning system ( DAndrade, 1984), explain these differing manifestations. In Western cultures, DSM-IV ( American Psychiatric Association, 1994) provides a set of rules that create eating disorders. These include a focus on dieting or not eating to avoid becoming fat. An examination of subjective experience can highlight many different culturally determined meanings for refusal to eat. In the Middle Ages one got closer to God through fasting. It was this that made fastingdieting good and acceptable. Exploring differences in cultural meaning also may help to explain the rather different meanings attached to weight loss and dieting. For example, the emphasis on control ( Fairburn, Shafran,  Cooper, 1999), as opposed to other outcomes (e.g., self-acceptance), may simply be another instance of a culturally determined meaning attached to dieting andor fasting.

One group in Western countries which is frequently exposed to involuntary under-nourishment and malnutrition is the homeless. The numbers of people who become homeless is rising and mothers with dependent children make up 65 per cent of homeless people and are the most rapidly expanding group in the homeless population most frequently they become homeless following domestic violence (Vostanis et al., 1996). Food deprivation is reported particularly by mothers with children (DiBlasio and Belcher, 1995). For those living in hostels for the homeless, providing food for the family may be less of a concern, since food is often provided. However, the need for hostels to provide food on a limited budget results in a diet that is high in fat (Killion, 1995). Pregnancy rates for homeless women are twice the normal rate and pregnant homeless women have a number of experiences that are associated with complications of pregnancy, including malnutrition (Killion, 1995). Contributing factors to malnutrition among the homeless are poor access to transportation, which means the homeless obtain food from local stores that are often more expensive and stock little fresh food. The lack of usual cooking, storage and refrigeration facilities encourages them to eat more filling convenience foods that do not meet their nutritional requirements. Furthermore, food obtained is sometimes stolen from them. The most extreme under-nourishment and malnutrition is associated with high substance use (Killion, 1995).

Though there is a continuum from good to poor eating practices, poor practices are common. At the extreme they become labeled eating disorders. There are a range of proposed eating disorders, but agreement about their definition is sometimes poor. Cases where there is wide agreement include anorexia nervosa and bulimia. However, probably the most common disorder is compulsive eating. There is variability in the estimates of the prevalence of eating disorders, but it is thought that in Western society about 1 per cent of women will experience anorexia at some time in their lives and 5 per cent will experience bulimia. The prevalence appears to have increased over the last thirty years.
Anorexia nervosa is characterized by a severe loss of weight and a dream of becoming fat and frequently an associated sense of guilt when consuming food. It is predominantly experienced by girls and young women. Anorexia can have a permanent impact on health. An inadequate diet leads to an inadequate supply of vitamins and minerals including low levels of electrolytes such as sodium and potassium. This can result in extreme low blood pressure, heart damage, or cardiac arrhythmia. There has been speculation that anorexic women have a distorted body image, believing themselves to be fat when they are not. Despite the diagnostic criteria of the American Psychiatric Association (Table 1.1), evidence suggests that anorexic women feel fat but are as accurate as other women in making judgments about actual body size and shape nevertheless, there is some distortion in the body image of both eating disordered and normal eaters.

1 Refusal to maintain minimal normal weight Body weight is less than 85 of that expected for age and height 2 Fearful of becoming fat or gaining weight 3 Disturbance in body weight and shape perception. Body image linked to self-esteem 4 Absence of at least three normal non-drug-induced consecutive menstrual cycles Source American Psychiatric Association (1994) TABLE 1.1 Diagnostic criteria for anorexia nervosa

A recent study examined a number of dimensions relating to body image, including fear of fatness, preference for thinness, body size distortion, body dissatisfaction and actual body size, and looked at their relationship to restrictive eating. Fear of fatness, preference for thinness and body size distortion had an effect on body dissatisfaction over and above the effects of actual body size. Fear of fatness was the best predictor of restrictive eating (Gleaves et al., 1995). Bulimia nervosa is associated with binge eating and a feeling that eating is out of the individuals control (see Table 1.2). Binge eating is accompanied by depression and self-deprecation. Self-induced vomiting occurs in the majority of cases. Bulimia can cause a wide range of medical problems including inflammation of the digestive tract and, as with anorexia, it is associated with cardiac problems resulting from low levels of electrolytes.

1 Recurrent episodes of binge eating accompanied by a sense of loss of control 2 Recurrent compensatory behavior, e.g. self-induced vomiting, use of laxatives or enema 3 Binges and compensating behaviors occurring about twice a week for three months 4 Body shape and weight are critical in self-evaluation 5 This experience does not only occur during a period of anorexia nervosa Source American Psychiatric Association (1994) TABLE 1.2 Diagnostic criteria for bulimia nervosa
Weight loss programs that involve the parents are more effective than those that do not. This is partly because obesity runs in families and so weight loss is easiest to achieve when the whole family changes its eating behavior as has been noted above, parents influence their childrens eating and activity levels. One important feature of programs that involve parents is that fewer children drop out of the program. Programs that involve parents are most effective if they provide skills training, such as training parents in behavior modification techniques and problem-solving strategies (Brezinka, 1992). Involving parents in behavior modification programs results in greater weight loss in children than when the family is not involved. Furthermore, involved parents also lose weight (Brownell and Cohen, 1995). The inclusion of physical exercise in weight loss programs assists weight loss among adults, but has less impact on childrens and adolescents weight. Children achieve similar levels of weight loss and maintain weight loss equally on programs that do and do not include exercise. The inclusion of exercise improves fitness but is not a necessary component of weight loss programs for children and adolescents (Brezinka, 1992).

It is widely accepted that parent child relationships play a central role in childrens psychological development and so we will focus largely on these. The quality and form of these relationships are thought to predict later interpersonal relationships and have a profound inuence on personality development and related psychological functioning, such as in the areas of self-esteem and social condense. Surprisingly, there has been until relatively recently, only a small body of good empirical evidence to support the importance of these relationships in development. It is largely within the area of attachment that a lucid and comprehensive theory of early relationships has evolved. The grounds for attachment theory  were laid by Bowlby from the late 1950s (Bowlby, 1958, 1969, 1973, 1980). However, it only formally emerged as a scientic discipline in the 1980s with the development of appropriate research instruments. A means of assessing individual differences in attachment behavior was later developed through the work of Mary Ainsworth (Ainsworth et al., 1978). This has been enormously helpful in enabling intensive, ongoing attempts to assess the psychological effects of early relationships on development. Parental anxiety may be a constitutional trait or arise from a specic child-related antecedent such as a problematic past obstetric history. The index child may be born after a period of infertility or the loss of an earlier child.

Parental ill-health can have an effect on the quality of attachment through a number of routes. The parent may be unavailable either physically or emotionally and the relationship may suffer frequent disruptions. Where disruptions occur without warning, for example as a result of emergency hospitalization, they are likely to be particularly bewildering, while childrens ability to understand the implications of ill-health will be governed by their developmental maturity. Serious ill-health in one parent may be compensated for by a good quality relationship with the other, or a substitute caregiver, but healthy parents are likely in turn to be adversely affected in terms of their physical availability and their own psychological adjustment to their spouses illness.

Mental ill-health in a parent poses particular challenges for the relationship with the child and his or her psychological development. A parent who is anxious or fearful of the world may transmit such attitudes, while depressive mood will have an impact on emotional responsiveness and availability and may present a gloomy outlook on life. Psychotic disorders may confront a child with both disturbances of behavior and belief. For an older child a negative effect on peer relationships may ensue, with the child being reluctant to bring friends home, he or she may suffer bullying.

Eating disorders provide a good example of the effects of the interplay between parental attitudes and behaviors (in themselves and directed to the child). Mothers who diet or have weight concerns themselves are more likely to bottle feed (Crisp, 1969). The mothers attitude to feeding is likely to be a more important inuence than the direct effect of bottle feeding on infant growth.

Childrens perceptions of their parents health in turn impact on their feelings of security and their view of their own health and resilience. The development of an external locus of control or a feeling of personal ineffectiveness may be particularly potent as risk factors for eating disorders.

Parental Attachment Status
There are good grounds for supposing that parents own experiences of being parented and their attachment relationships in their families of origin will predict the quality of their own childrens attachments. Until recently there were few ways of linking intergenerational attachment representations.
The Adult Attachment Interview (AAI George et al., 1984) is a semi-structured interview based measure for adults which enable evaluation of the quality of past attachments in childhood. It is designed to assess the adults state of mind with respect to attachment, by enquiring about relationships in childhood and evaluating the coherence of their accounts.  It is concerned not so much with what happened as what the subject feels about what happened and whether what the subject says is backed up by evidence. The general quality of child caregiver relationships is probed, together with experiences of early separation, illnesses, losses, rejection, and maltreatment the interviewer probes for specic memories to illustrate general statements. There are three main categories in this classication system Free-autonomous (F), Dismissive (D), and Preoccupied (E). Secure adults categorized (F) are said to value intimate relationships, and acknowledge their effects. In addition, some interviews are characterized by an apparent failure to resolve mourning over loss or abuse, and are separately classied as Unresolved (U). Subjects who simultaneously possess E and D qualities are described as Cannot Classify (CC). All interviews are rated on a number of scales concerning Probable Experience (of attachment gures) and current State of Mind of the interviewee these scales contribute to the overall classication (DEFU).

The AAI has been shown to have predictive validity for the quality of infant attachment in the next generation (van IJzendoorn, 1995), in as much as two-thirds of infant attachments on the ABCD classication match their parent s attachment category on the AAI.

Other Inuences on Attachment
Genetics
There is a growing body of evidence from twin studies to suggest a signicant genetic contribution to attachment patterns. It may be that genetic contributions to the temperamental component of distress proneness is greater than that for securityinsecurity (Goldberg, 2000).

Siblings
Brothers and sisters can facilitate or impair attachment formation in a number of ways. They may display jealousy towards the new child or else their behavior or temperament may inuence parental expectations of subsequent infants.

Living Conditions
Good quality attachment is likely to occur when the family is not pressed by nancial hardship or overcrowding. Good quality family relationships can, however, overcome severe material deprivation.

Effects of Attachment beyond Infancy
Bowlby considered attachment to be a feature of signicant relationships throughout the lifespan, as early experiences are coded as internal working models, which are then carried forward to inuence later personality and behavior. These internal models contain both affective and cognitive information. Emotional expressions become more complex and subtle as children get older and they learn implicit rules about displaying affect, including the masking of negative emotions (Lewis  Michalson, 1983).

Attachment theory has been concerned with two aspects of emotional development the way in which attachment  gures respond to affect and the ways in which attachment relationships vary with individual differences in emotional expression and regulation. Attachment relationships are also thought to inuence information processing through their effects on selective attention and memory. By the age of about 6, children develop a theory of mind, i.e. a notion that they and others have thoughts about the world, which may not be the same and which are independent of external objects. Internal working models of attachment come prominently to include attributions of key relationships, e.g. Mummy likes to bake cakes for me.

Attachment and Health
The notion that internal working models play a key role in linking early attachment experiences to later social and psychological consequences is appealing, but not widely tested. A simple hypothesis might be that insecure attachment increases vulnerability to behavioral problems or psychological disorder. The second part of this chapter will address the evidence for associations between attachment style and the development of eating disorders, followed by a review of non-attachment developmental inuences.

Attachment And Eating Disorders
Historical Perspective
Hilde Bruch, writing in the 1970s, linked emergent attachment ideas to her clinical observations. In her seminal work, Eating Disorders Anorexia Nervosa, Obesity and the Person Within (1974), she offers an unusual insight into Mary Ainsworths thinking, as the precursor of the Strange Situation appears associated with early mother infant feeding interactions

When rated at 12 months, the infants in whom the feeding interaction had been most appropriate to their needs, permitting them active participation, showed the strongest attachment to their mothers, with a clear-cut tendency to seek her proximity, and to express distress at her absence. They made active efforts to gain and maintain contact with her. In contrast babies with inappropriate feeding experiences, showed little or no tendency to seek proximity, interaction, or contact with the mother and little or no tendency to cling when picked up or to resist being released. They tended either to      ignore the mother on her return, or to turn away or go away from her. There was a third group which included the one of pseudo-demand with overfeeding (i.e. mother impatient with the baby and staves them off with food), in which children were distressed by separation, but showed less ability to use the mother as a secure base from which they could enjoy exploring the strange environment. They generally displayed more maladaptive behavior in relation to new and strange situations.

(Ainsworth  Bell, 1969 quoted in Bruch, 1974)
Developing these ideas to describe her own patient population, Bruchs formulation was of a mother child interaction in which mother does not respond appropriately to her infants needs, instead superimposing her own needs such that the infant does not learn to discriminate self. The infant adapts, such that the situation may pass unnoticed throughout a well-behaved childhood, only becoming evident as the adolescent striving for autonomyidentity can no longer be ignored. Although this is clearly an oversimplication of Bruchs rich theory, it serves to highlight the interweaving of attachment ideas with some of the earlier clinical literature, providing a basis from which to explore subsequent developments.

Background Research
Since 1996 there has been increased attention to the topic and the use of instruments has tended to become more rened. In particular, the Adult Attachment Interview (AAI), currently regarded as the gold standard in attachment research, has been applied to eating disordered populations. Thus one might anticipate that greater clarity would emerge from a later review. Questions have also been asked about the association between attachment style and eating disorder diagnosis. Following Bowlby, insecure attachment is usually classied as anxiousresistantavoidantdismissive, or angrypreoccupiedenmeshed. Although no association between attachment status and eating disorder subtype emerged from OKearneys (1996) work, there was a belief that such an association might emerge in a larger review with more rened instruments. Clinically, anorexic women appear avoidant, not only of food but of life in the raw, whereas bulimic women are more often angry and chaotic.

The paper provides a brief description of social anxiety disorder. A brief definition and statistics are provided. Symptoms, screening methods, and possible treatment options are described. The paper briefly discusses the impacts of social anxiety disorder on individuals and their daily performance.

Anxiety
Introduction
Anxiety is a recurrent topic in professional literature. Social anxiety disorder represents one of the most common forms of anxiety in different population groups. Because social anxiety disorder is often confused with shyness, many of its symptoms and complications may go unnoticed. Thesis Today, social anxiety disorder presents a serious social problem to those, who either dismiss its symptoms as too insignificant or fail to cope with it without professional assistance.

Social anxiety disorder is one of the most common psychiatric disorders (Anonymous, 2010). Social anxiety disorder is also known as social phobia and involves persistent fear of one or more social performance situations in which a person is exposed to unfamiliar people or to possible scrutiny by others (Tolman et al, 2009). Social anxiety does not extend beyond the feeling of fear and embarrassment, but social anxiety disorder is associated with serious impairments and produces significant negative impacts on the quality of individual routine performance (Roy et al, 2009). Social anxiety disorder affects 7 of Americans in any given year and 12 of Americans at some point of their lives (Anonymous, 2010). About two-thirds of Americans with social anxiety disorder are women (Anonymous, 2008). Unfortunately, the symptoms of social anxiety disorder in men and women are often confused with shyness and are dismissed as too trivial (Anonymous, 2010). For this reason, researchers often lack opportunities to study social anxiety disorder in more detail, while individuals fail to understand the seriousness of the issue and its psychological life implications.

Why some individuals are more vulnerable to social anxiety disorder than others is unclear, but that SAD symptoms first appear during adolescence is a scientific fact (Anonymous, 2008 Anonymous, 2010). The first symptoms tend to appear between ages 10 and 19 (Anonymous, 2010). The onset usually occurs in middle or late adolescence sometimes, social anxiety disorder is diagnosed as early as 8 years of age (Roy, 2009). Typical symptoms of social anxiety disorder in adults include a dry mouth, a racing heart, blushing and a shaky voice, trembling, sweating, and even nausea (Anonymous, 2010). In younger children, social anxiety disorder can manifest through crying (Anonymous, 2010). The severity of symptoms increases with age adolescents can successfully cope with their shyness and embarrassment, but younger adults display prolonged symptoms of SAD, and their failure to cope with stressful situations results in continuous social, functional, and developmental impairments (Anonymous, 2010).

The DSM-IV lists the criteria, which individuals must meet to be diagnosed social anxiety disorder. These include persistent fear of situations with unfamiliar people, anxiety and or a panic attack produced by the feared situation, and conscious avoidance of anxiety-inducing situations (Anonymous, 2010). Individuals with social anxiety disorder recognize that their fear is excessive but fail to cope with their symptoms (Anonymous, 2010). Social anxiety disorder interferes with school and workplace activity, and negatively influences the quality of social relationships (Anonymous, 2010). Professionals can use a variety of methods to screen individuals for social anxiety disorder. Rytwinski et al (2009) propose that psychology professionals use self-report scales. Self-report scales are an accurate and cost-effective means to identify patients with social anxiety disorder and can increase the percentage of those who will receive necessary treatment (Rytwinski et al, 2009). Crippa et al (2008) write that telephone interviews are more effective compared with personal diagnostic interviews, when used to screen prevalence of social anxiety disorder in different population groups.

Cognitive behavioral therapy is fairly regarded as one of the basic approaches to social anxiety disorder. The goal of CBT is to supply patients with techniques and practices, needed to change their perceptions about socialization and situations that involve unfamiliar people (Anonymous, 2010). Exposure therapy is a form of CBT, in which individuals are exposed to the dreaded situation and learn the ways of managing fear (Anonymous, 2010). Attention training is another form of psychotherapy which can relieve the symptoms and improve the state of anxiety in patients with diagnosed social anxiety disorder (Schmidt et al, 2009). Because attentional bias to threat plays a significant role in maintaining anxiety disorders in individuals, attention training can serve an effective means of coping with SAD (Schmidt et al, 2009).

The effects of psychological treatment are rather limited and can apply only in mild SAD forms. Psychological treatment alone cannot suffice to reduce and eliminate severe symptoms of social anxiety disorder in patients (Acarturk et al, 2009). In such situations, medications are used to address the symptoms of generalized social anxiety disorders, and include selective serotonin reuptake inhibitors, norepinephrine reuptake inhibitor, venlafaxine, beta blockers, and benzodiazepines (Anonymous, 2010). The choice of particular medication and particular form of psychotherapy depends on the wide range of individual and contextual factors. The effectiveness of CBT and medication is almost equal (Anonymous, 2010). Patients must realize that although medication works faster, is can result in physical dependence and substance abuse problems (Anonymous, 2010). Simultaneously, those who choose psychotherapy should not expect fast results. The current state of knowledge about social anxiety disorder provides enough opportunities for patients and psychologists to successfully cope with SAD symptoms and its negative effects on life performance, but these treatment options will lose their relevance if individuals fail to recognize the seriousness of the issue and the value of professional support.

Conclusion
Social anxiety disorder is one of the most common forms of anxiety in adolescents and adults. Today, social anxiety disorder presents a serious problem to those who either dismiss its symptoms as too insignificant or fail to cope with them without professional assistance. Approximately 12 of Americans suffer its symptoms and consequences in any given year. The symptoms include a racing heart, blushing and a shaky voice, and even nausea. Possible treatments cover CBT and medication. The current state of research provides enough opportunities for patients and psychologists to successfully cope with the symptoms and negative consequences of social anxiety, but these treatment options will lose their relevance, unless individuals can realize the seriousness of the issue and the value of professional support in treating SAD.

Child sexual abuse is prevalent with many children suffering this ill in the hands of people who are close to them. Child sexual abuse is as prevalent among boys as it is in girls. It is estimated that in every five boys, one of them becomes sexually abused before they reach eighteen years old whereas in every four girls, one of them becomes sexually molested before the same age (Chisholm, para 2). When a child is sexually abused, it may be possible for one to notice due to some short-term symptoms that may appear. In other cases, it may not be possible to identify such and even if they are identified, failure to help the child out of the situation leads to long-term severe psychological effects. A sexually abused child usually suffers from any or a range of psychological conditions including post-traumatic stress disorders, low self-esteem, apathy, social withdrawal and drug abuse among other conditions. This paper discusses the psychological effects of child abuse presenting later in life after the abuse has occurred.

What is child sexual abuse
Child sexual abuse constitutes any sexual contact involving a child and an adult or an older person. Such contacts include fondling, genital contact, oral or anal penetration including penetration with objects, masturbation, among others. There are also non-contact forms of child sexual abuse which include subjecting a child to watch pornographic materials, making a child witness a sexual act, or exposing a child to any sexually explicit materials and advances (Draucker  Martsolf, p 2). Most children do not report sexual abuse cases due to shame and fear associated with the act. The fact that the perpetrators of this abusive act are close people such as a mother, a father, a brother or sister, a clergy, or a doctor may hinder the child from reporting the incidence. Some children may fear reporting the incidence due to fear that they may break the relationship with the perpetrator and leave the child vulnerable. Failure to report such incidences means that the child harbors the trauma in all hisher life. Unfortunately, the psychological effects of the abuse usually present later mainly in adulthood in several ways.  They may present in form of post-traumatic stress disorder, social withdrawal, a poor self-image, dissociation, self blame among other negative effects.

Psychological effects of childhood sexual abuse
When a child suffers sexual abuse, they are likely to experience short-term psychological effects which usually express in form of emotional impairment. Feelings of isolation and fear overwhelm the victims of this abuse with most of them experiencing difficulties in trusting people. These short-term emotional consequences often become lifelong consequences as expressed in form of low self esteem in adulthood and depression.

The most likely psychological problems suffered by survivors of childhood abuse include post-traumatic stress disorder, anxiety disorders, chronic depression, substance abuse, suicide tendencies, psychotic symptoms such as delusions and hallucinations, dissociative disorders, and low self-esteem (Draucker  Martsolf,  p 17).  Individuals who were sexually abused during childhood are often reported to have the above mental conditions later in life. Amongst the almost obvious mental illness following childhood sexual abuse is chronic depression. Up to 95 percent of children who are sexually abused during childhood report any one or more than one of the above mental disorders. The most prevalent however is post-traumatic stress disorder which is in about 50 percent of adult survivors of childhood sexual abuse (HeretoHelp, para 3). Although one cannot not purely associate childhood sexual abuse with psychological illnesses, the likelihood of developing mental illnesses is very high if one went through a sexual abuse ordeal during childhood. Post-traumatic stress disorder usually occurs as bouts of depression especially when an individual gets triggered. Such a trigger may be being involved in a sexual relationship which provokes the horrible experience during childhood. The thought of sexual contact may be enough to provoke post-traumatic stress disorder. Cases of personality disorder have also been identified among some survivors of child sexual abuse. Substance abuse is also very prevalent in adults who experienced childhood sexual abuse.

A literature review done by Mullen and Fleming (para 54) shows that there is as strong association between child sexual abuse and mental illnesses during adult life. The review of literature reiterated that the most common psychological disorders are depression, anxiety, substance abuse, eating disorders and post-traumatic stress syndrome. The review also noted that personality disorder is also likely to occur although this is a controversial finding.

Taking self-esteem as a psychological disorder, the literature review by Mullen and Fleming (para 56), showed that most survivors of childhood sexual abuse portray low self esteem during adult life. That survivors of childhood sexual abuse end up abusing substances was also reviewed by Mullen and Fleming. It was identified that in most individuals (regardless of sex) who reported having sexually abused during childhood, majority of them were abusing alcohol at an adult age. Women were however more likely to be involved in alcohol abuse. It should be noted that sexual abuse is not the only factor that results to alcohol abuse as there may be other contributing factors.

Suicidal thoughts and attempts are very common among adults who suffered childhood sexual abuse. The suicidal thoughts are usually out of self-blame as the individual may feel as if they were the ones responsible for the action. The isolation feelings may also prompt the individual to end their lives through suicide. Again the guilt will tend to be more intense in adulthood when these individuals experience triggers as well as due to coming to terms with what happened then.

Personal testimonies on adult experiences resulting from sexual abuse during childhood are the best way to describe the psychological consequences. Sage Williams (para 3), narrates of her personal experience of child sexual indicating psychological impairment at an adult age. Though raped at a tender age, she only came out to share it out at the age of 31 years. At this age, Williams (para 13-16), still suffered post-traumatic stress disorder especially when she came across any setting that resembles the environment in which her father used to rape her.  Williams clearly mentions that after many years of holding back the trauma of childhood sexual abuse, adulthood experiences include dissociative disorders, depression, low self esteem, and posttraumatic stress disorder among other psychological effects. In her ordeal, Williams also report that sleeplessness, poor concentration, being extra cautious and intense anger were among the conditions she had dealt with in her adult life. In addition, feelings of detachment or estrangement seem to prevail in these individuals thereby translating into social withdrawal and panic.

The increased psychological impairments during adulthood in persons who were sexually molested during childhood are as a result of an impaired psychological development. It should be noted that children suffer sexual molestation at a very important stage of psychological development. The fact that they do not express these aftermaths at childhood does not mean that the consequences are absent. Reaching adulthood seems to open the reality of the past and the mature individual at this time may not be able to hold back the experiences and the effects. Most survivors of childhood sexual abuse make almost unending psychiatrist visits seeking to find help over psychiatric conditions. It is unfortunate that some of them may not even disclose to their counselors of the childhood sexual abuse experiences thus worsening their conditions. Although some report recovering from the episodes of psychiatrist illnesses presenting at adulthood, most of them still remain with these scars. In specific, forgetting becomes very difficult since life experiences always present triggers to the childhood experience. Williams (para 19), says that although she has found much relieve after psychiatrist visits, bouts of depression are part of her life even at the slightest trigger.

Conclusion
Childhood sexual abuse undoubtedly translates to severe psychological consequences in adulthood. Most adult survivors of child sex abuse will present with post-traumatic stress disorder especially at the encounter of a trigger. Chronic depression, dissociative disorder, anxiety, panic and alienation will also characterize the lives of such individuals. Some individuals may also experience personality disorder. Due to these psychiatric conditions, adult victims of childhood sexual abuse will tend to abuse substance such as alcohol which may worsen the mental disorders.

It is widely acknowledged that men and women differ in remarkable ways, with differences in personality characteristics, perceptions and emotions.  There have been various debates concerning the disparities in gender related issues. Even though the bulk of research on gender is marred by controversy, researchers are still involved in researching the various issues concerning gender differences. While some researchers have found enough evidence to suggest that there are different kinds of stress and coping styles across gender (Matud 2004), others have insisted that no difference exist (Hamilton  Fagot 1998).

The bulk of these studies distinguish between stressful life events and chronic stressors (Hamilton  Fagot 1998 Matud 2004). Chronic stressors are those that persist over extended periods of time. The bulk of literature is focused on chronic stressors since it is easier to identify and make sense of an individuals general coping style from observing how he or she deals with everyday situations (Hamilton  Fagot 1998 Matud 2004).

Generally, people have been found to express two coping styles. These are problem focused coping and emotion focused coping. Problem focused coping involves the use of cognitive and behavioral changes to adjust or eliminate stressors. Emotion-focused coping on the other hand involves the modification of an individuals emotional responses caused by the stressor. It is widely agreed that problem focused coping is more effective and that emotion-focused coping may result in psychological distress. According to Matud (2004), women seem to employ emotion-focused coping more than men, who generally use problem-focused coping. This might be the reason why women appear to perceive more stress as well as have more problems with anxiety and depression than men (Matud 2004).

In observing the perception of stress and coping across gender, gender role socialization is a very critical variable. It is often suggested that gender disparity is not attributed to gender itself but to the manner in which men and women are socialized. For example, men are likely to be socialized to be independent, problem oriented and less likely to express their emotions. On the other hand, women may be socialized to be more dependent, emotional, and supportive. Researchers have discovered that individuals who exude traditional gender roles may employ problem-focused and emotion focused coping style while those who exude nontraditional roles may use more personality based coping style that does not correspond with traditional gender role coping style. They may also use both styles of coping.

Researches using various measurements have indicated the differences in the level of stress and coping across gender. Such measurements include the Depression Anxiety Stress Scales and Brief COPE. The Depression Anxiety Stress Scale is a self report measure of depression, anxiety, and stress. The DASS items can be grouped into three scales depression, anxiety and stress. The stress scale includes items for measuring symptoms such as irritability, tension and the propensity to overreact to stressful events.
An analysis of gender effects on DASS suggest that on average, women are more significantly stressed than men. The DASS seem to be a psychometrically relevant and useful instrument for measuring depression, anxiety and stress. It comprises of three self-report scales that are designed to offer relatively pure measures of the three closely associated negative affective states of depression, anxiety and stress.

The Brief COPE (Carver 1997) on the other hand is a multidimensional coping inventory that is used in the assessment of the various ways that individuals respond to stress. The concept is derived from psychological studies conducted on stress. Within the conceptual analysis of stress by Lazarus and Folkman (1984), coping functions with two cognitive appraisals conducted by the individual concerning the perception of a threatening situation and the available resources of handling it. The Brief COPE presents twenty eight item self report measures of both adaptive and maladaptive coping skills. It has the advantage of being constructed from acknowledged theoretical models. It can assess both state coping and trait coping.

Various assessments conducted using the Brief Cope inventory in determining the relationship between gender, specific sources of stress and coping strategies have also suggested gender differences in the level of stress and coping (Brougham, Zail, Mendoza  Miller 2009, p.95). The results indicate that women have higher overall level of stress and greater employment of emotion-focused coping strategies than men. The results also indicate that men and women use different coping strategies for different stressors. These results confirm reports on the differences between men and women in coping with stress.

In this regard, there is little doubt that women experience more stress and possess avoidant coping styles as compared to men. This factor has been attributed to the differences in socialization across the genders even though there may be other underlying psychological and biological factors.

There are various therapies which are applied to detect behavior adaptation. This includes Cognitive and Reality therapies. There are therapies which consider the cause of emotional responses and maladaptive behavior as cognitive patterns. This is dealt with in Cognitive therapy. Psychological problems in this case are solved through change of thoughts. Both behavioral and emotional disorders can be treated through behavior therapy. Training is used to help wipe out behavioral disorders with perceived ones. Cognitive restructuring helps change some of the unhealthy behavior in someone. There are also techniques which are applied to do away with the unhealthy behavior (Ledley Deborah, 2005). Some of the behavior disorders which can be treated using cognitive therapy include insomania, mental disorders, panic disorder, eating disorders and depression. This kind of treatment is not applicable to all patients. Some of these cases include cognitive impairments.

A systematic procedure is followed in solving problems using the cognitive theory approach. Some of the problems solved using this approach include cognitions, behavioral and dysfunctional emotions (Basco Monica R., 2005). Manual treatment is applied in treating psychological orders. There are different occasions when behavior therapy can be used. It may involve group setting or individual therapy. Some therapists are behaviorally oriented while others are cognitive oriented. Alleviation of symptoms is the tradition followed in cognitivebehavior therapy. There are various mental health problems which can be treated using this approach. This include depression, Post-traumatic stress disorder and bulimia nervosa (Taylor Steven, 2004). There are various therapeutic methods and approaches which are use in cognitivebehavior therapy. Some of these include multimodal therapy and cognitive therapy. Learning these concepts helps in the development of a therapist. This is because one is in a position to identify the psychological disorders and the choice of treatment to be introduced. It has been noted that, this approach is not applicable to all patients.

William Glasser developed the reality theory. This approach involves counseling and psychotherapy. The theory upon which reality therapy is based is the choice therapy.  The creation of a better future for a patient is the mandate of this approach. The immediate condition of the patient is considered in solving problems and counseling.  One has to identify what heshe wants. The progress is weighed in this case. The goal is taken to be the reference point upon which all other activities are based on. Reality therapy is not only a counseling technique but has much in it as it involves solving problems. There are some scenarios in which people may require help to get out of problems which they might be experiencing. There are also other occasions when certain people may not be wishing to get assistance despite of having problems. Reality therapy is applicable in such scenarios and helps solve problems being encountered. A model may be devised to enable people solve problems. The model is used in training sessions.

The decision to apply reality therapy depends on the individual upon which help is to be introduced.  Good relationship should be established in this case (Trip Simona, 2007). The relationship helps handle clients who may hesitate to get any assistance. A positive relationship is highly required in dealing with individuals who may not be in need of assistance. There may be no influence in the lack of a good relationship. A counseling environment is required in order to extend help to those who may be resistant for help despite of being in problems. There are several basic needs which need to be addressed. This includes fun, belonging, freedom, power and love. These needs can be addressed by building a good relationship.  The person being assisted should be introduced to an environment which prompts a good relationship. An interactive environment is vital in finding a solution.  The actual problem can be handled after creating the need-satisfying environment. A solution can then be found after interrogating the client.

This paper is a careful and detailed discussion and explanation of Bipolar disorder and its purpose is to abstract conceptual relationships from subjective to objective experience, connecting ideas together in a logical and rational fashion (Brondolo, 2008). A psychological manifestation discussed in this paper is an example of identification through psychological studies and research. Furthermore, conclusions that are drawn are always directed outward to some objective product or practical outcome. In the situation presented through the identification of behavior, signs and symptoms exhibited by the disease process, the main concern of such manifestation is to elaborate as fully as possible all the ramifications and implications of an idea (Albrecht, 2007). A healthy individual experiences a variety of mood swings and has a large equal repertoire of affective kind of expressions they feel in hold of their affects and moods. Management of care for this kind of patient is crucial in the course of treatment. Medical interventions and care must involve the whole family and community where the patient is in. Moreover, professional care rendered by the health provider discussed in this paper and other members of the health care team follows standard rules and are directed toward complete recovery and to regain and achieve proper functioning of patient (Brondolo, 2008).

Bipolar Disorder
Bipolar disorder, also termed as manic-depressive illness, is an illness of the brain that results to unusual shifts in the energy, mood and ability to function of a person. This illness varies from the common ups and downs that everybody goes through the sign and symptoms of bipolar disorder are considered as severe (Brondolo, 2008). They can result in bad family or social and interpersonal relationships, poor school attention or job performances, and cause even suicidal ideation. However, there is still good news this disorder can be treated, and individuals with this disorder can live fully and have productive lives. There are about 2 million American adults or about 1 percent of the total population age range from 18 and above in are considered having a bipolar disorder. This disorder typically develops in the stage of late adolescence or manifests at early adulthood (Taylor, 2006).

However, there are people who have their first signs and symptoms during their childhood and some people develop the manifestations later in their life. It is usually not identified as a disorder, and an individual may suffer for a numbers of years before it is properly recognized and treated. Like other diseases such as vascular diseases or diabetes mellitus, bipolar disorder is an illness considered as chronic or long-term that must be managed carefully throughout the life of a person (Albrecht, 2007).
Figure 1. Description of Bipolar disorder

In some individuals, however, manifestations of depression and mania may happen together in what is termed as a state of mixed symptoms of bipolar episodes. Symptoms of an episode of a mixed bipolar state commonly associated with problem with sleeping, significant variation in psychosis, agitation appetite, and suicidal ideation. An individual may have a very lonely, sad and hopeless mood while at the same moment he may be feeling extreme energy (Albrecht, 2007).

Bipolar disorders may show to be a problem other than psychological problems, for example, drug use or alcohol abuse, poor work or job and school performance, or damaged interpersonal relationships. Such conditions in fact may be manifestations of an underlying psychological disorder (Taylor, 2006).

Symptoms of Bipolar Disorder
Bipolar disorder can cause dramatic mood shifts from overly irritable or high to hopeless or extremely sad feeling, and then back to normal mood again, often with moment of normal mood in between intervals. Severe swings in behavior and the level of energy goes along with these mood shifts. The moment of lows and highs are termed as episodes of mania and depression (Burgess, 2006).

Table 1. Signs and Symptoms of Manic Episode
Signs and symptoms(manifestations) of manic episodeIncreased activity level, energy elevation, and restlessness
Extremely euphoric mood and overly high good mood
Extreme irritable
talking very fast and Racing thoughts and, shifting from one thoughts to another
Easy Distractibility, or cant concentrate fully
Sleeplessness
Unrealistic thoughts, ideas or beliefs in ones powers and ability
Poor status on judgment
Spending sprees
A long lasting behavior period that vary from normal
Elevated sexual desire
Abuse of alcohol, drugs, specifically cocaine and medications that induces sleep
aggressive , provocative or intrusive kind of behavior
Denial

A manic episode is recognized if there are 3 or more elevated mood occurs associated with other symptoms in most of the day, manifests nearly every day of the week or longer. If there is irritable mood, another four manifestations must be evident.

Table 2. Signs and symptoms of depressive episode
Signs and symptoms (manifestations) of depressive episodeLong lasting anxiety, anxiety or empty mood
Feelings of pessimistic or being hopeless
Feelings of decreased self worth, guilt, sad or helpless
decreased appetite or interests in certain activities, including sexual relationships and intercourse
 Feeling of being tired, weakness or of being slowed down
Difficulty in remembering things, concentration and decision making
Irritability or Restlessness
Sleeplessness or sleeping too much
unintended gain of weight or loss and Changes in appetite
other consistent physiological symptoms or Chronic pain that are not caused by any  physiological alterations or injuries

Ideas of suicide or death, or tendency of suicide attempts
Diagnosis of depressive episode happens if five or more of this manifestation lasts most of the day, for a period of two consecutive weeks or longer.

Diagnosis of Bipolar Disorder
Like other psychological illnesses, bipolar disorder cannot yet be recognized physiologically, for instance, through a brain scan or blood test. Therefore, a diagnosis of this disorder is carried out on the symptoms basis, illness course, and, when available, history of family. The criteria of diagnosis for bipolar disorder are explained in the fourth edition of (DSM-IV) or Diagnostic and Statistical Manual for Mental Disorder (Brondolo, 2008).

Major Depressive Episode
DSM-IV-TR Criteria
Five or more of the following manifestation have been identified during the same 14 day period and a change from previous functioning represent at least one of the manifestations is either (1) loss of pleasure and interest or (2) depressed mood. Depression most of the day, nearly every day, as represented by either report based on subjected cues (e.g., feels empty or sad) or observations are cited by other people (e.g., appears tearful) (American Psychiatric Association, 2008).

In adolescents or children, depressive episode can be an irritable feeling markedly decreased pleasure or interest in all, activities most of the day, or almost all, nearly everyday (as showed by either observation or subjective account or opinion made by other people).In children, failure considers to make when weighing on expected gains. Hypersomnia or Insomnia or nearly everyday is experienced. Psychomotor retardation or agitation nearly every day is manifested (observable by other people, not merely subjective thoughts of restlessness, irritability or being slowed down). Psychomotor retardation or agitations nearly every day are observed by other people, not merely subjective thoughts of restlessness, irritability or being slowed down. Loss of energy or fatigue experienced nearly every day. Feelings of excessive or inappropriate guilt and worthlessness (which may be considered as delusional nearly every day - not merely guilt or self-reproach about being sick (American Psychiatric Association, 2008).

Decreased ability to concentrate or think, or feeling of indecisiveness are experienced nearly every day (either by observed by other people or subjective account by the patient). There is a recurrent idea of death (not just fear about dying), recurrent thought of suicidal ideation without a specific plan, or attempt of suicide or specific plans for committing suicide (Albrecht, 2007).

The manifestation do not reached criteria for a mixed episode. The symptoms cause significant clinical distress or social impairment, occupational, or other areas of important functioning. The signs and symptoms are not caused by direct physiological affectations of a drug or substance abuse or a general medical condition like goiter and hypothyroidism. The manifestations are not accounted better for by bereavement like loss of a loved one, or symptoms persists for a period of more than 2 months or characterized by significant morbid preoccupation or functional impairment with feeling of worthlessness, psychotic symptoms, suicidal ideation, or psychomotor agitation or retardation  (American Psychiatric Association, 2008).

Manic Episode
DSM-IV-TR Criteria
Manic episode is a  significant period of persistently and abnormally elevated, or irritable and expansive mood, lasting for about 1 week (or any period if the hospitalization is vital) , during the time of mood disturbances, three or more of the following manifestations is persistent (four if the behavior is irritable only) and have been involved to a significant degree

The manifestations do not meet mixed episode criteria. The disturbance in mood is sufficiently severe that results to marked impairment in social and occupational functioning or in usual occupational or social relationships activities with others, or to necessitate a confinement in health facilities or hospitalization to prevent injury to self or other people, or there are some psychotic characterizations. The symptoms are not because of the direct effects of a substance physiologically (e.g. abuse of drugs, medications, or other mode of treatment) or a general physical and medical condition (e.g., goiter or hyperthyroidism) (American Psychiatric Association, 2008).

Etiology
Scientists are studying about the possibility and other causes of bipolar disorder through different types of studies. Most of the scientists agree that there are no causes for bipolar disorder rather, many features work together to develop the illness. Because bipolar disorder have the tendency to run in family, researchers have been looking for specific genes or genetic factors, the microscopic of building blocks DNA present in all human cells that can influence the mind and body work and developed and passed down through the generations that may elevate a persons risk of developing bipolar disorder. But genes are not considered as the whole story (Taylor, 2006).

Researches on identical twins, who shared the same genes, indicate that same genes and other features play an important function in bipolar disorder. If this kind of disorder were affected by genes only, then the identical twin of mother with the disorder would commonly form the illness, and study has shown that this is not the only case (Brondolo, 2008). In addition, results from research of genes suggest that bipolar disorder, like other psychological illnesses, does not happen because of a single gene only. It shows likely that different kind of genes act together, and in mixture with other risk factors of the individual or the surrounding of person, to develop the disorder. Scientists continually advance researches that will lead to the discoveries and to a new and better mode of medical interventions for bipolar disorder. The brain-imaging studies also aid scientists in learning what is abnormal in the brain to develop bipolar disorder and other psychiatric illnesses (Taylor, 2006).

Risk factors
Genetic Factors
Bipolar disorders have the characteristic that runs in the family. There is a high incidence that there is a genetic factor to this disorder. 80 to 90 of people with bipolar disorder have a family member with either bipolar disorder or depression.

Medical and Conditions Medications
Medications or drugs such as corticosteroids and medical conditions such as neurological diseases and thyroid disease such as Parkinsons syndrome may accompany with features of this disorder. The medical diagnosis of bipolar disorder is executed only when none of these medical conditions are present.

Cultural Issues
The issue on how a certain society responds is essential to the detection or diagnosis and treatment course of mental disorders like bipolar. In some countries or cultures, mental illnesses are blamed on supernatural power or witches. It aids the individual who is experiencing the disease to know that their uncommon behavior is not acceptable and they are not responsible for, but the product of a witchs spell (Brondolo, 2008). Current epidemiological research and studies in the United States of America show that Bipolar I Disorder is considerably common equally in women and men (compare to Major Depressive Disorder, which is more prevalent in women). Gender also shows to be directly related to the type and number of Major Depressive and manic Episodes. Individuals who are diagnosed with bipolar disorder manifest signs and symptoms within a conceptual framework that is based in their values, cultural beliefs and norms (Taylor, 2006).

Treatment
Most individual with bipolar disorder even those individuals who have the most severe type can achieve the highest possible stabilization of mood swings experienced and related manifestations with proper dose of treatment. Because the bipolar illness is a recurrent type of disease, a preventive long-term treatment is highly recommended and always been indicated. A medical strategy that integrates psychosocial treatment and medication is optimum intervention for the management of disorder over a period of time (Brondolo, 2008).

In some cases, bipolar disorder is better managed and controlled if the course of treatment is continuously than if it is off and on. Apparently, even when there are no intervals in treatment, changes in mood can experience and should be consulted directly to your doctor. The psychiatrist may be able to avoid a full-blown symptoms and episode by making modifications to the plan of treatment. Closely working with the physician and communicating effectively and openly about the course of treatment options and concerns can make a significant difference in effective treatment (Taylor, 2006).

Conclusion
People with bipolar disorder have different manifestation of symptoms from episode of mania to depression. They receive pharmacological interventions andor psychosocial therapy by voluntarily participating in researches or clinical studies. Researches in psychiatric health can produce information about the effectiveness of a combination of treatments or medications, the benefits of psychotherapy or a behavioral intervention and the validity of a diagnostic procedure, or the prevention method success. Clinical researches also guide physicians and scientists in knowing how the condition lessens, progresses, develops, and affects both body and mentation. Many people diagnosed with bipolar disorder lead healthy, progressive and productive lives because of new modalities of treatment and knowledge discovered by means of adherence to medical interventions, psychotherapy and clinical researches and studies. These researches and studies are not always applicable for everybody. However, it is necessary for each person to carefully consider the possible benefits and risks.

Social bias has been with us for many years now and the vice seems far from over. Even with legislations entrenched in our constitution criminalizing the negative aspects of social bias, the discrimination has persisted. The subtle biases have prevailed in spite of criminalizing negative social biases. The most fascinating aspect of the issue is that subtle biases appear to be unconscious and involuntary. Nevertheless, we have to work extra hard to remove the vice in our society whether in its subtle or blatant form.

Social bias is not a new concept. Human societies have historically been characterized with indifferent treatment of others. The projected hatred towards other people is what is referred to as social bias. In some instances, the hatred can be overwhelming that it may culminate into violence towards the victims of the social bias. Social bias result in a divided society since the society becomes differentiated based on particular criteria that may include race, economic status, religion, ethnic background, and gender among other criteria. Social, bias may stem from prejudice, stereotyping, and discrimination of any kind. This paper will offer a critical analysis of the concept of social bias and how it affects the society in general.

Definition of terms
Social bias involves several concepts that include prejudice, stereotypes, and discrimination and for a comprehensive understanding of the issue there is need for a clear definition of these terms. Though the three concepts appear to go hand in hand, each can be explained independent from one another. Prejudice can be defined as those negative or hostile attitudes that an individual may be having towards a particular group on the basis of generalized derivatives from a partial source of information. Prejudice thus leads to a negative prejudgment regarding a particular group or its members. Thus prejudice not only incorporates opinions and beliefs, but also consists of attitudes including the feelings of detest, disrespect and hatred (Grobman, 1990).

Stereotypes are the generalizations made in regard to the typical characteristics of a particular group or its members. Stereotypes are usually contained in the minds as they are described as mental products of reality which results in generalizations in regard to a particular group andor its members.

The stereotypical generalizations can be positive or negative but in most cases they are found to be negative. The human society is known to develop stereotypes especially when they are either reluctant or not able to access all the information needed for making a fair judgment about given situations or individuals. Due to the lack of comprehensive information, stereotypes usually aids in filling the blanks. The society more often than not is engaged in the creation and perpetuation of stereotypes without knowing the repercussions and these stereotypes later leads us into biased discrimination and persecution especially the negative stereotypes (Grobman, 1990).

Discrimination on the other hand involves the aspect of placing a particular group and its members at a disadvantaged position and exposing the members of the group to unfair treatment due to their identity. Discrimination occurs when we provide judgments based on our prejudices and stereotypes hence subjecting the victims to different treatment. Discrimination can be split in two categories including personal and institutional discrimination. Personal discrimination is the type of discrimination that refers to discriminatory actions that are committed by at individual levels whereas the institutional discrimination involves those discriminatory activities that are carried out by particular different institutions and organizations. Institutional discrimination may take the form of discriminatory policies or practices (Plous, 2010).

Categories of Biases
Biases can generally be categorized into two main classes of subtle and blatant biases. The subtle bias has been described as a new concept in bias and involves self enhancing techniques. It is oftenly referred to as cool and indirect biases. In these kinds of biases, individuals do not openly declare their biasness. Subtle biases usually underlie the contemporary discrimination where by individuals are more tolerant and comfortable with ones own group as opposed to the out-group. To the out-group, individuals of the inner group are usually exclusive and avoid mixing with the other group. These biases are said to originate from the prevailing internal conflicts between the cultural ideals and biasness. Subtle biases are usually considered as automatic, unconscious, and often unintentional. They are usually underground and may lead to exclusions (Fiske, 2002).

On the other hand the blatant biases are usually the most pronounced overt discriminatory activities which are more often than not conscious, direct and unambiguous. They are usually associated with extremists and originate from the perception that there is an inter-group conflict in regard to economics and values in a hierarchical and dangerous world. Blatant biases are usually associated with violence and the extremists may pose a great danger to those they hate. The extremists usually perceive their in-group to be under eminent threat as opposed to the moderates with the differences exemplified in the nature and measure of the perceived threat (Fiske, 2002).

Impact of bias on the lives of individuals
The impacts of social bias are tremendous since the concept denies the individual a fair opportunity to actualize and enjoy the full resources as provided by the society. Incidences of discrimination are known to negatively impact on the self esteem of the individual. This has emotional repercussions and the individual will have low self esteem and would be emotionally dumb. Institutional bias may result in denial of essential services including insurance policy covers, access to quality education, and the general access to the social amenities provided by the society. At the work place, social biases may result in unnecessary harassments of the victims for instance most gay and lesbian employees are usually harassed based on their sexual orientation as depicted by Raymond Zhou in reporting to China Daily. In his report, Zhou presented a case of Gu Du who was a victim of extortion and harassment after revealing that he was a homosexual (Zhou, 2005). The victims of social bias are usually exposed to unfair treatment and this could go as far as eliciting violence towards the victims. This was the case with slaves in the United States and the Nazi concentration camps during the World War where the Jews were persecuted as the Nazis thought of themselves as a super race. Genocide is regarded as the ultimate expression of hatred against a particular group. This is usually the case with the blatant kind of bias where the extremists can turn violent towards their victims (Grobman, 1990).

Overcoming social biases
There are several strategies that can be employed in overcoming social biases which include but not limited to education and legislation. Education seems to be the most effective way of handling social biases. Direct confrontation may not help and therefore there is need for the public to be educated on the effects of social bias and the importance of social integration. Since social biases as a concept has to do with beliefs and perceptions of a particular group towards another, education is destined to succeed albeit at a slow pace considering that a shift in someones values and beliefs usually takes time. Nevertheless, with time the public will have to change the previously held negative attitudes towards the other group and integration will be inevitable (Fiske, 2002).

The other way of dealing with social biases is by implementing legislations that would criminalize discriminatory acts in what is seen as a more direct confrontational approach. In this regard, all the negative prejudices, stereotypes, and discriminatory activities should be criminalized and thus subject to being punished by law. This serves better to address the problem of blatant biases where the extremists may take advantage of lack of legislation to advance their violent and discriminatory actions. Legislation will also ensure that there are fair opportunities for all people irrespective of their racial, religious, ethnic, economic, and political background. With legislation, the need to be fair and not biased in itself to serve the interests of a particular group as the case of the infamous Jim Crow laws in the South during the 1960s (Plous, 2010).

Conclusion
Social bias has traversed our society in such a manner that children grow up with the socialization that the society is structured. The young children then grow up feeling that they are different and unique as opposed to others. These stereotypes and prejudices are then nurtured to old age and may be regarded as involuntary. Social bias has persistently posed a great challenge to the modern day human society. The vice that reached its peak in the 20th century has followed us into the 21st century. As human beings and having witnessed and learnt about how devastating the effects of social bias can be there is need to tackle the problem with all the seriousness that it deserves. Social biasness has led to great loss of human life and inhuman treatment of fellow human beings and has been responsible for the discrimination that has continued to characterize human civilization.