An interview with an ADHD Client

                                                An interview with an ADHD Client

                                                               Gurur Erdiren

               

            Attention Deficit Hyperactivity Disorder (ADHD) is a condition where inattentiveness, hyperactivity and impulsivity have been observed. Although different symptoms from patient to patient exist, the disease has been seen both children and adults. As a result of ADHD, people have trouble in managing time, deficiency in organization, inability to focus and impairment to set goals (Barkley, 1997)

                 The process for this interview has been explained to the client in detail. In order to clarify mind of the client, it has been asked permission from the client and to protect privacy of both clinical psychologist and the client, some data excluded from this paper.

            The client was 18 years old, male, single high school student who prepares for the university exam. He had been diagnosed with ADHD 3 months ago. According to the history of the client, he has a problem to focus on lectures and has inability to motivate during setting up his goals.  He cannot sit at the table, and he demonstrates hyperactivity. According to my observations, he also speaks very fast and he jumps from one subject to another subject. In order to analyze do the behaviors occur continuously or as a response to temporary situation, I have asked to the client how regularly he has been demonstrating this inattention and hyperactivity symptoms. I have also requested from him to give me examples of his ADHD related concerns. He has told me that, when he was started to study for university exam, he never sits at the table, he is easily being distracted, he frequently miss the details. For example, during the courses he took, he easily got bored, even this situation takes three minutes after the lecture began. Additionally, he cannot complete the tasks given such as finishing homework, or he struggles to follow instructions. These symptoms definitely match with the characteristics of ADHD related to inattention. Moreover, he has nonstop talks, and when talking he was touching and playing with the objects. Therefore, I have thought that ADHD was the true diagnosis because of he shows exact symptoms of ADHD. In order to assess the interval of the disease, I have asked that how long he had been thinking that he had ADHD? He told me that, he has been this symptoms almost from the beginning of high school, however, since he would like to enter a good university, he felt that the current situation creates a problem in his future life, therefore he had visited psychologist and psychiatrist. His ADHD related symptoms didn’t get worse, however since he had the symptoms all the time, it has negative influence to his life, before started to use medical treatment with psychiatrist.

         In order to struggle his problems, he has been involved to “Ritalin” treatment.  Ritalin as a stimulant drug effects brain and prevents focusing problems.  He says that, Ritalin helped him to concentrate on his goals. However, he also needs clinical psychologist for the therapies, where he would like to discuss and plan his current life situation which will shape his future.

           ADHD runs in families. Except from its genetic background, brain injuries have also potential contribution to the ADHD (Harrison & Sofronoff, 2002). However, client has no brain injury during his childhood. Since the other family members did not diagnose with ADHD, it does not mean that they do not have ADHD. However, patient strongly deals with ADHD where it has been understood from client’s behaviors and story. For example, jumping from one subject to another, or fast nonstop talk one of the mark of ADHD. Additionally, he has inability to focus on his studies where as a result, he fails to set his goals. He also has been subjected to ADHD scale in psychologist office.

         During the interview, I had observed ADHD patient. Each part of observation keeps its importance to me, due to I observed the psychopathology of ADHD. Therefore, treatment of ADHD is important to prevent the outcomes of the disease. If we manage to prevent the symptoms of the disease both by the help of clinical psychologist and psychiatrists, we can control ADHD patient. It means that, patient will focus on more, and will be successful during his goals.

                                                            References
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions:                constructing a unifying theory of ADHD. Psychological bulletin,121(1), 65.Harrison, C., & Sofronoff, K. (2002). ADHD and parental psychological distress: role of                demographics, child behavioral characteristics, and parental cognitions.Journal of the American Academy of Child & Adolescent Psychiatry, 41(6), 703-711.

Running Head:Perfectionism and Orthorexia Nervosa in Turkish Female Athletes 1

Identification of the Relationship Between Perfectionistic Behaviours and Orthorexia Nervosa in Female Turkish Athletes

Gurur Erdiren

Author Note*
Gurur Erdiren, Yeditepe University, Department of Psychology

Running Head:Perfectionism and Orthorexia Nervosa in Turkish Female Athletes 2

Abstract

   The proposed research is designed to find the relationship between perfectionism and orthorexia nervosa in female Turkish athletes. In literature, there are major deficits in terms of the connection between orthorexia nervosa (ON) and perfectionism in athletes. Since orthorexics demonstrate perfectionistic traits, the eating behaviours of athletes may be associated with perfectionism. The purpose of the present study is to investigate (a) the frequency of ON in Turkish female athletes, (b) how ON has association with perfectionism in female athletes, (c) what are the possible outcomes of ON in terms of eating disorder psychopathology and its association with perfectionism. 250 female athletes between 16-45 ages and sample size matched healthy control groups will be recruited from website and newspapers by advertising. The interview will be done shortly under the supervision of clinician and psychologist to understand their compatibility for the research. Data will be collected according to the given answers of several questionnaire. Later, data will be analysed using up to date IBM SPSS statistical analysis program by using descriptive statistics, regression and correlation analysis. In this research, it was expected to find that (i) Turkish female athletes demonstrate high level of ON, (ii) perfectionism and its forms have association with ON and (iii) female athletes have more tendency to have eating disorders via ON comparison to healthy controls. The proposed research will compensate the unknown knowledge in literature.
Introduction

   The risk of eating disorders in athletes have long been dealing with sports may be higher than the remaining population, since their body shape and mass have a crucial meaning for them (Sundgot-Borgen & Torsveit, 2004). It has been suggested that there is more relevant relationship between self-critical perfectionism and eating psychopathology in female athletes because of their critical personality disposition and self-evaluation (Shanmugam & Davies, 2015). The main feature of perfectionism is to set high and remarkable unrealistic standards for individual’s performance (Dunn & Gotwals, 2005). Egan, Pick & Dyck (2015) demonstrated that athletes have higher achievement strivings and competence, although they had equal level of positive perfectionism.

   The Relationship Between Perfectionism and Orthorexia Nervosa in Female Turkish Athletes 3

Additionally, higher negative perfectionism has been linked to lower agreeableness and elevated competitive behaviours. These findings have been compatible in the research suggesting the higher relationship among perfectionism and low agreeableness in couples (Egan, Vinciguerra & Mazzuchelli, 2015). However, athletes demonstrating performance less than perfect and do not experiencing higher level of negative reactions showed adaptive form of perfectionism (Stoeber, Stoll & Otto, 2008). Therefore, multidimensional perfectionism and its associated behaviours may be applied athletes.

   Orthorexia Nervosa (ON) is different behavioural pattern which implicates the pathological obsession to proper nutrition. People demonstrating ON restrict their diets, avoid rigidly from foods that they think unhealthy which leads crucial outcomes on their life such as nutritional deficiencies and reduction in life qualities. ON shares similar symptoms with anorexia nervosa (AN) where in both people shows perfectionistic behaviors (Koven & Abry, 2015). Orthorexics are achievement oriented individuals and their perfectionistic behaviours may appear when rigid dietary habits and obsession to high quality foods have been taken into consideration. In athletes, eating disorders (EDs) and its associated psychopathology has been linked to body dissatisfaction or having a thin body. Hence, female athletes shows more tendency to have EDs comparison to male athletes (Haase, 2011). ON individuals have shown to premorbid symptoms in the occurance of real EDs (Kummer, Dias & Teixieira, 2008) However, in literature, there is no research demonstrating possible outcomes of ON and perfectionism in female athletes, and these situation remains obscure.

   In order to investigate how ON behaviours have been linked to perfectionistic behaviours, it was aimed to find that (a) how frequently ON has been observed in female Turkish athletes and (b) what are the relationships between multidimensional perfectionism and ON. We hypothesized that ON has been regularly observed in Turkish female athletes in their physical activity since ON symptoms have been demonstrated in fitness activities (Erikkson, Baigi & Marklun, 2008).

The Relationship Between Perfectionism and Orthorexia Nervosa in Female Turkish Athletes 4

Methodology Recruitment of participants

   Female athletes performing competitive and robust fitness activity but not having been recently diagnosed with psychiatric disorders will be recruited by giving an advertise from the websites and newspapers. Sedentary female control groups who do not involve in sports will be recruited from undergraduate students in Yeditepe University. People having been diagnosed with psychiatric disorders and age under 16 or over 45 is excluded in this study since they do not fit the criteria in literature. Total sample size (N=500) will be consisting of 250 female athletes and 250 control groups between 16 and 45 ages.

   Procedure
After participants had been recruited, a short interview will be done under the psychologist and clinician in order to observe they are eligible for this research. Questionnaires will be subjected to the eligible participants. According to the results, female athletes having ON and/or perfectionism will be compared internally and also with the healthy subjects. Later, data will be analysed using statistical tools.

   Anthropometric Assesment
Body Mass Index (BMI) will be measured by using height and weight so as to determine underweight, normal weight, overweight and obese participants. Height and weight measures will be done by using stadiometer with balance scale.
Evaluation of Orthorexia Nervosa
In order to identify ON participants, a scale used to diagnose ON, ORTO-15, will be used for evaluation. Ortorexic tendency has been reflected in ORTO-15 by the 15 items by scoring 1 to 4 for measurement (1= ortorexic eating behaviour, 4= normal eating behaviour). In order to guarantee high specificity of ON, cut off value for the scale would be set to <35.

The Relationship Between Perfectionism and Orthorexia Nervosa in Female Turkish Athletes 5 

   Evaluation of Perfectionism
To measure perfectionistic strivings and outcomes in female athletes in competitions, Multidimensional Inventory of Perfectionism in Sports (MIPS; Stöber, Otto, & Stoll, 2004) will be used. Basicly, items are asking to the participants, reflection of their feeling both during trainings and competitions. Cronbach’s alpha will be measured to assess internal reliability. The Positive and Negative Perfectionism Scale (PANPS, Terry-Short et al, 1995) will be used to assess positive and negative perfectionism in female control groups and female athletes.
Evaluation of Eating Disorders
In order to demonstrate relationship between ON and EDs, both groups will be subjected to Eating Disorder Examination Questionnaire (EDEQ-6.0; Fairburn & Beglin, 2008).These scale has been used to investigate eating psychopathology and attitudes in athletes and can also be applied healthy controls.

    Results: Proposed Data Analysis
At the beginning of the research, for the questionnaires, Cronbach’s alpha will be computed to understand internal reliability to the given answers as a preliminary analysis and to observe measures are relevant for further statistical tests. Data will be analysed using SPSS statistical analysis program. Descriptive statistics will be done to understand distribution of data. To assess the level difference between ON and perfectionism in controls and athletes, non-parametric Mann- Whitney U test will be conducted. In order to predict the ON associated symptoms has been linked to personal standards and negative form of perfectionism, regression analysis will be done. Later on, correlation analysis will be conducted among athletes and control groups to investigate how ON contributes EDs and perfectionism. The expected results are (i) female athletes demonstrate higher level of ON, (ii) ON level has positive correlation with the negative form of perfectionism and its associated behaviours such as achievement strivings or competition, (iii) orthorexic female athletes have more tendency developing eating disorder psychopathology

    The Relationship Between Perfectionism and Orthorexia Nervosa in Female Turkish Athletes 6 By means of these work, it will be found out how the nature and forms of perfectionism
may play role in ON and EDs psychopathology.

   References

• Dunn, J. G., Gotwals, J. K., & Dunn, J. C. (2005). An examination of the domain specificity of perfectionism among intercollegiate student-athletes.Personality and Individual Differences, 38(6), 1439-1448.

• Egan, S. J., Piek, J. P., & Dyck, M. J. (2015). Positive and Negative Perfectionism and the Big Five Personality Factors. Behaviour Change, 32(02), 104-113.

• Egan, S.J., Vinciguerra, T., & Mazzuchelli, T. (2015). The role of perfectionism, agreeableness and neuroticism in predicting dyadic adjustment. Australian Journal of Psychology, 67, 1–9.

• Eriksson L, Baigi A, Marklund B, et al. Social physique anxiety and sociocultural attitudes toward appearance impact on orthorexia test in fitness participants. Scand J Med Sci Sports 2008; 18: 389-394.

• Haase, A. M. (2011). Weight perception in female athletes: associations with disordered eating correlates and behavior. Eating behaviors, 12(1), 64-67.

• Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric disease and treatment, 11, 385

• Kummer A, Dias FM, Teixeira AL. On the concept of orthorexia nervosa. Scand J Med Sci Sports. 2008; 18: 395-396.

• Luce, K. H., Crowther, J. H., & Pole, M. (2008). Eating Disorder Examination Questionnaire (EDEQ): Norms for undergraduate women. International Journal of Eating Disorders, 41(3), 273-276. ,

• Shanmugam, V., & Davies, B. (2015). Clinical perfectionism and eating psychopathology in athletes: The role of gender. Personality and Individual Differences, 74, 99-105.

• Stöber, J., Otto, K., & Stoll, O. (2004).Multidimensional Inventory of Perfectionism in Sport (MIPS). Skalendokumentation ‘‘Perfektionismus im Sport’’(Hallesche Berichte zur

• The Relationship Between Perfectionism and Orthorexia Nervosa in Female Turkish Athletes 7

• Pädagogischen Psychologie No. 7, pp. 4-13). Halle/Saale, Germany: University of Halle-Wittenberg.

• Stoeber, J., Stoll, O., Pescheck, E., & Otto, K. (2008). Perfectionism and achievement goals inathletes: Relations with approach and avoidance orientations in mastery and performancegoals. Psychology of Sport and Exercise, 9(2), 102-121.

• Sundgot-Borgen, J., & Torstveit, M. K. (2004). Prevalence of eating disorders in elite athletes ishigher than in the general population. Clinical Journal of Sport Medicine, 14(1), 25-32. 

• Terry-Short, L. A., Owens, R. G., Slade, P. D., & Dewey, M. E. (1995). Positive and negativeperfectionism. Personality and individual differences,18(5), 663-668. 

ADOLESCENCE Adolescent sexual behavior,

Adolescent sexual behavior,

Sexual literacy and sex education;
·      Adolescent can get information about sex from many sources; parents, sibling, schools, peers, magazines, television, and the internet.
·      A special concern is the accuracy of sexual information.
·      Many parents feel uncomfortable talking abour sex.
·      Many adolescents feel uncomfortable talking about sex.
·      Contraceptive use by female adolescents also increases when adolescents report that they can communicate about sex with their parents.
·      Adolescent are more likely to have conversation about sex with their mothers than their father.

Developing sexual identity;
·      Learning to menage sexual feelings, such as sexual arousal and attraction.
·      Developing new forms of intimacy, learning the skills to regulate sexual behavior.
·      Sexual identity involves an indication of sexual orientation.
·      Sexual identity is strongly influenced by social norms related to sex.

Sexual scripts;
·      Sexual script; A stereotyped pattern of role perceptions for how individuals should sexually behave.
·      Females and males have been socialized to follow different sexual scripts.
·      Adolescent girls are more likely than males to report being in love as the main reason they are sexually active.
·      Males making sexual advances, and it is up to the female to set the limits.

Risk factors in adolescent sexuality;
·      Many adolescent are not emotionally prepared to handle sexual experiences, especially in early adolescence.
·      Early sexual activity is linked with risky behaviors, such as drug use and school-related problems.
·      Early menarche and poor parent-child communcation were linked to early sexual behaviors in girls.
·      Parent-adolescent communication about sexuality.
·      Family closeness and support.
·      Sexual-risk taking behavior was more likely to ocur in girls living in single-parent homes.
·      Weak self-regulation and risk proneness set the stage for sexual risk taking at 16 to 17 years of age.

Factors associated with sexual minority behavior;
·      Biological basis, hormone; Early critical period hypothesis
·      In the 2nd to 5th month after conception, exposure of the fetüs to hormone levels characteristics of females might cause the individual to become attracted to males.
·      If critical period hypothesis is correct, it supports why modifying sexual orientation is difficult.
·      Developmental pathways, most gays and lesbians struggle with same-sex attractions in childhood.
·      Many youth do follow this developmental pathway, but others do not.
·      Many youth have no recollection of same-sex attraction in childhood and experience a sudden sense of their same-sex attraction in late adolescence.
·      Freud, no factor alone causes sexual orientation. Combination of genetic, hormonal, cognitive, environmetal.

Adolescent pregnancy;
·      More than 200.000 females in the United States have a child before their eighteenth birthday.
·      The United States continued to have one of the highest rates of adolescent pregnancy.
·      Factors in teenage pregnancy, onset age of sexual activity, poverty and family influence, less school success, less contraception use.
·      Consequence of adolescent pregnancy, creates health risk for both baby and the mother. Infants are more likely to have low birth weights, a prominent factor in infant mortality-as well as neurological problems adn childhood illness. Adolescent mothers often drop out of school. It often is not pregnancy alone that leads to negative consequences for an adolescent mother and her offspring.
·      Adolescent as parents, children of adolescent parents face problem seven before they are born. Aolescent mothers are less competent at child rearing. Adolescent mothers have less realistic expectations for their infants’ development than do older mothers.
·      Adolescent as parents, although some adolescent fathers are involved with their children, the majority are not. Adolescent fathers have lower incomes, less education and more children than do men who delay having children until their twenties.

ADOLESCENCE Self and Identity,

Self and Identity
 
The self;
·      The self consist of all the characteristics of a person.
·      Self is the central aspects of the individual’s personality.
·      İntegrative dimension to our understanging of different personality characteristics.
·      Several aspects of the self, self-esteem and self-concept.

Who are self-esteem and self-concept;
·      Self esteem, also referred to as self-worth or self-image, it is the global evaluate dimensions of the self. For example, an adolescent or emerging adult might perceive that she is not merely a person, but a good person.
·      Self-concept, refers to domain-specific evaluations of the self. For example, an adolescent may have a negative academic self-concept because he is not doing well at school, but have a positive athletic self-concept because he is a star swimmer.

Measuring self-esteem and self-concept;
·      Susan Harter developed a measure for adolescents, the self-perception profile for adolescent. It assesses eight domains. Scholastic competence, athletic competence, social acceptance, physical appearance, behavioral conduct, close friendship, romantic appeal and job competence, plus global self-worth.

Self-esteem: perception and reality;
·      Self-esteem may reflect perceptions that do not always match reality. Bolstered self-esteem, narcissism/unwarranted sense of superiority over the others, self-centered and self-concerned approach. Insecurity-inferiority, inaccurate perception of one’s own shortcomings.

Self-esteem change during adolescence;
·      Self-esteem fluctuates across the life span.
·      During and just after many life transitions.
·      According to a longitudinal study, self-esteem decreased during adolescence. Increased in the twenties, leveled off in the thirties, rose in the forties through the mind-sixties. At most ages, males reported higher self-esteem than females, especially during adolescence.

Social context and self-esteem;
·      Social context such as the family, peers, and schools contribute to the development of an adolescent’s self esteem. Authoritative parenting.
·      Peer judgement gain increasing importance in adolescence. The link between peer approval and self-worth increase during adolescence.

Consequences low self-esteem;
·      For most adolescents, the emotional discomfort of low self-esteem is temporary.
·      Low self-esteem has been implicated in depression, suicide, anorexia nervosa, deliquency, and other adjustment problems, and even suicide.
·      Increasing adolescent’s self-esteem, self-esteem often increases when adolescents face a problem and try to cope with it rather than avoid it.
·      Facing problems realistically, honesty, and non-defensively produces favorable self-evaluative thoughts, which lead to the self-generated approval that raises self-esteem.

Identity;
·      Identity is who a person is.
·      Most comprehensive theory of identity development is that of Erik Erikson.
·      Erikson’s ideas on identity, who i am?, what am i all about?, what am i going to do with my life?, what is different about me?, how can i make it on my own?.
·      These questions not usually considered in childhood, surface as a common, virtually universal concern during adolescence.
·      Revisiting Erikson’s views on identity, identity versus identity confusion, adolescents are faced with who they are, what they are all about, and where they are going in life.

Erikson’s views on identity;
·      As a part of their identity exploration adolescents experience.
·      Psychosocial moratorium: The gap between childhood security and adult autonomy. Personality and role experimentation. A deliberate effort on the part of adolescent to find their place in the world.
·      During the moratorium and before they reach a stable sense of self, adolescents try out different roles and personalities.
·      They might be argumentative one moment, cooperative the next.
·      They might dress neatly one day and sloppily the next day.
·      There are many roles for adolescents to try out.
·      İdentitity is composed of many pieces: Vocational/career identity, political identity, religious identity, relationship idetity, achievement, intellectual identity, sexual identity, cultural/ethnic identity, interest, personality characteristics.

The four statuses of identity;
·      James marcia claims that Erikson’s  theory of identity development implies four ways of resolving the identity crisis.
·      A period of identity development during which the adolescent is choosing among alternatives, a state of exploration.
·      Identity diffusion: Identity crisis is not yet experienced, undecided about occupational and ideological choices, Show little interest in such matters.
·      Identity foreclosure: Commitment is made to occupational and idealogical positions, but the adolescent has not experienced an identity crisis. This status ocur when parents hand down commitments to their adolescents, usually in an authoritarian way. They take over patterns of identity from their parents. For example, parents want him/her to be a doctor, but the adolescent has not explored any other options.
·      Identity moratorium: Identity crisis, and not commitment is made to a certaing identity. Not being sure about what life path to follow.
·      Identity achievement: Adolescent has been through an identity crisis and made a commitment. Different career options are explored and acted upon them.
·      Marcia’s approach has been criticized by some researchers that is distorts and oversimplifies Erikson’s concept of crisis.
·      Recent theorizing suggests that effective identity development involves evaluating identity commitments on a continuing basis.
·      Gathering information and talking to others about current choices

Developmental changes in identity;
·      Many of the key changes in identity are most likely to take place in emerging adulthood, from 18 to 25 years of age.
·      Many young adolescents are identity diffused by the time they reach their twenties.
·      In the last few years of college identity achievement increases.
·      Although identity is more stable during adulthood does not mean that identity will be stable throughout life.
·      The process of refining and enhancing the identity choices continues into early and middle adulthood.

Family influences on identity;
·      Parents are influential figures in an adolescent’s search for identity. Family environment  that promotes both individuality and connectedness is important in identity development.
·      Individuality, self-assertion- to have and communicate a point of view. Separeteness- expressing how one is different from others.
·      Connectedness, mutuality – sensitivity to and respect for others’ views. Permeability – opennes to others’ views.
·      Attachment to parents might play a role in identity development.
·      Securely attached adolescents are more likely to be identity achieved than their counterparts who are identity diffused or identity foreclosed.