Running head: ANXIETY DISORDERS1ANXIETY DISORDERS21

Anxiety DisordersMaLinda DiTonnoLiberty University

AbstractWith the debilitating effect of anxiety accompanied by the high risk of depression and suicidal ideation among those who struggle with anxiety disorders, it is imperative that clinicians be familiar with the symptoms and effective treatments for the disorders under this category. The diagnostic criteria provided within the Diagnostic and Statistical Manual of Mental Disorders V (DSM-5) for each disorder listed under the category of Anxiety Disorders has been discussed. Differential diagnosis for each disorder is mentioned within discussion of each diagnosis. This paper further discusses the potential causes of anxiety disorders including nature, nurture, genetic, and biological. The author goes on to discuss evaluation of anxiety disorders including assessment and treatment approaches. Further ideas discussed are surgery, deep-brain stimulation and electroconvulsive therapy as possible approaches to treatment resistant anxiety disorders. Finally, possible spiritual elements of an anxiety disorder are discussed along with ideas that warrant further research. Keywords: anxiety, diagnosis, youth, adolescent, treatment, symptoms, DSM-5

Anxiety DisordersIntroduction of Anxiety DisordersIn order to understand the predominant symptoms of anxiety disorders one must first understand the difference between anxiety and fear. According to Kring, Johnson, Davison, and Neale (2014), anxiety is a dread or trepidation over a future problem and fear is a response to a current threat. With the hurried pace of society today, most persons will experience anxiety. It is when it causes a considerable hardship in multiple areas of life that a clinician begins to consider an anxiety disorder. With anxiety disorders presenting at young ages and throughout the life span, they have grown to become one of the most common disorders prevalent today. Unfortunately, anxiety exhibits its presence with many physical symptoms that can cause misdiagnosis. Zanni (2010) states that asthma, angina, cardiac arrhythmias, hyperthyroidism, hyperparathyroidism, vestibular dysfunction, transient ischemic attacks, and seizure disorders (pg. 66) can present with symptoms that impersonate anxiety disorders and may be co-occurring with other mental health disorders. An Overview of Specific Anxiety DisordersBecause of the impersonating symptoms of anxiety disorders, all of the disorders listed under the category of Anxiety Disorders have a criterion that cautions clinicians to verify that the disruption being evaluated cannot be better explained by another mental disorder, a medical condition, or the use of a substance. As a result, this criterion will not be listed in the diagnostic criteria for all of the following disorders. Another diagnostic criterion common to the disorders is the requirement that the anxiety or fear causes a sizeable disruption in the individuals life that affects major areas of daily living. This criterion may not be listed in each of the disorders to follow, but should be considered as a requirement. Separation Anxiety DisorderThe DSM-5 lists anxiety disorders by age of onset. This means the anxiety disorder that is most frequently present at the youngest age is listed first. That being said, the first disorder listed is Separation Anxiety Disorder. According to the APA (2013), Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), separation anxiety becomes a disorder only when the individual experiences fear and/or anxiety that are extreme, excess, and inappropriate developmentally for the age of the individual. With this disorder, the individual/child expresses an extreme concern about being apart from whomever the individual has become attached to. The fear, worry, and concern is presented in such a way that it has become chronically present, 4 weeks for a child/adolescent and 6 months or longer for an adult (APA). Additionally, the fear or anxiety must be expressed through at least three of the following symptoms when the individual expects or is currently undergoing separation from their home or figures they have become attached to: concerns about the physical loss of key persons through illness, death, injury, or disasters; persistent anxiety or fears that involve getting lost or kidnapped, or becoming ill in such a way that a physical separation occurs; refusal to go to school, a child care facility, work, or etc.; tireless fear or anxiety about being alone or separated from the attachment figure at home or in other environments; adamant refusal to sleep away from the attachment figure or away from home; recurrent nightmares that involve separation from the attachment figure; and complaints of physical ailments such as headache, stomachache, queasiness, etc. when anticipating a separation.

Selective MutismThis specific social anxiety disorder has five diagnostic criteria that indicate its presence. The most observable characteristic is the failure to speak. The DSM-5 indicates that the individual struggling with selective mutism has the ability to speak and does so in other situations, however, within specific social situations where speaking is normal and probable, the individual fails to do so. Second, the failure to speak is a significant disturbance interfering with academic or occupational success. Additionally, the selective mutism must be present for at least one month excluding the first month of school. The lack of speech cannot be a result of a lack of knowledge, or comfort with, the spoken language (APA). Finally, the disturbance must not be better explained by a communication disorder and it cannot occur within the guidelines of other disorders such as autism spectrum disorder, schizophrenia, or any other psychotic disorder (APA).Specific PhobiasPhobia is characterized by an extreme fear or anxiety in relation to a specific object or situation such as spiders or heights. There are seven diagnostic criteria for a specific phobia disorder. The first of course is the presence of the fear of anxiety previously mentioned. Second, the situation or object of the fear consistently incites immediate fear or anxiety. The individual will vigorously participate in avoidant behavior to prevent exposure to the specific object or situation. Fourth, as with other anxiety disorders, the fear and/or anxiety is disproportionate to the actual danger. The fear or anxiety or the avoidant behaviors are unshakable for a duration of six months or longer and should cause substantial disruption that affects key areas of daily performance. Finally, as with other anxiety disorders, this disruption should not be better explained through the criteria of another mental disorder, anxiety disorder, or other panic-like symptoms in other disorders.Social Anxiety DisorderThis disorder deals with social settings where the individual fears scrutiny, observance, or performance in front of others. This is commonly seen when individuals have a fear of public speaking. When present in children or adolescent youth, the fear or anxiety should be present when among peers of the same age, not only when in the presence of adults. The second criterion according the APA is the fear of presenting oneself as being fearful or anxious that would cause others to view them in an undesirable light. The social situation, as with the specific phobias, will chronically trigger the fear or anxiety and avoidance of social settings is apparent. If the social event cannot be avoided, the individual may endure the situation but experience extreme fear or anxiety. Again, the fear and anxiety experienced is disproportionate to the actual threat or danger and the avoidance has become constant usually lasting six months or more (APA). The avoidant behavior or the presence of the fear and anxiety within the social setting has become so intense that it causes a deficiency in the ability to maintain in important areas of functioning. Criterion eight states that the avoidant behavior or the fear and anxiety should not be a result of the use of a substance or any other medical condition. If a medical condition is present, the fear or anxiety should be unrelated and should not be better explained by criteria for another mental disorder.Panic DisorderPanic attacks take place suddenly, are unexpected, and are characterized by the feeling extreme fear that peaks within minutes of onset. Panic disorder is characterized by four separate criterions, however, criterion A has a list of 13 separate symptoms and criterion B has a list of two. The first diagnostic criterion indicates the presence of recurrent panic attacks that includes a minimum of four of the following 13 symptoms: rapid heart rate or palpitations; sweating; shakiness or tremors; the feeling that one cannot get enough air or shortness of breath; perceptions of choking, discomfort or pain in the chest; queasiness or upset stomach; dizziness; hot or cold sensations; numbness or tingling in extremities; derealization or depersonalization; a fear of going crazy; a fear of dying (APA). Caution should take place regarding any symptoms that are culture-specific as these cannot be counted toward the minimum count of four symptoms.The second criteria indicates that a minimum of one panic attack, characterized with four or more symptoms listed above, should be followed by a minimum of one month of either an exaggerated fear or worry of experiencing another panic attack or a significant maladaptive change in behavior (APA, pg. 208), as a direct result of the panic attack or both. Panic attacks cannot occur as a result of the physiological side effects from the use of a substance or any other medical condition such as a cardiopulmonary disorder. Panic Attack SpecifierAccording to the DSM-5, panic attacks alone cannot be coded as a mental health disorder. However, they can occur within the framework of any anxiety disorder. As a result, APA has provided a list of 13 symptoms indicative of a panic attack, which are listed under the Criterion A under Panic Disorder previously discussed. The same 13 symptoms are listed under the heading of Panic Attack Specifier for the purpose of ascertaining whether or not a client is experiencing panic attack(s). The use of the Panic Attack specifier is to indicate the presence of a panic attack or multiple panic attacks alongside and simultaneously as another disorder. For example an individual can be diagnosed with Generalized Anxiety Disorder with the added specifier of Panic Attack.AgoraphobiaAgoraphobia is a social type disorder that is characterized by extreme fear or anxiety in two or more of the following five situations: public transportation, open spaces, enclosed spaces (not claustrophobia, this is small spaces), being in a line or a crowd, or simply just being outside alone. The second diagnostic criterion indicates the individual will have avoidant behaviors in order to prevent finding him/herself in these situations. The fear is directly related to an inability to get help if a panic attack occurs or a fear that he or she will not be able to leave the setting. To be diagnosed with agoraphobia, the individual must consistently experience fear or anxiety when presented with the situations listed above, the settings are vigorously avoided or the presence of another is required to navigate the setting, and the individual may still endure the experience while suffering with feelings of intense fear or anxiety. As with other anxiety disorders, the fear or anxiety is disproportionate to the actual danger, if any that is posed within the setting. Avoidance of the agoraphobic situation must last a minimum of six months and cause substantial hardship socially, with employment, and other significant areas of daily living.Generalized Anxiety DisorderThe DSM-5 lists six individual diagnostic criteria to consider when evaluating for Generalized Anxiety Disorder. Excessive worry, fear, or anxiety must be present for more days than not for a minimum of six months and the individual should find it challenging to keep the worry under control. The third criterion indicates that the worry should be associated with a minimum of three of the following six symptoms which should also be present more often than not for the past six months: A feeling of anxiousness; tiring easily; inability to focus or concentrate; tense muscles; cantankerousness; and disrupted sleep. The physical symptoms listed above and/or the anxiety and worry cause significant difficulty in areas of daily living such as work or school. Substance/Medication-Induced Anxiety DisorderWith this disorder the key element is either panic attacks or anxiety. However, based on a physical examination, patient history, or a laboratory testing, the initial onset of the anxiety and/or panic attacks must have been during or shortly following substance use, withdrawal, or introduction to a medication. It is important however to ascertain whether or not the substance or medication has the ability to induce anxiety or panic attacks. The diagnostic criteria also indication that the symptoms have not occurred entirely during the course of a delirium. The disruption, as with other disorders should cause significant distress in the individuals work, academic, and/or social life. In order to determine if the disorder is better explained by an anxiety disorder unrelated to substance use or medication, it should be determined whether or not the symptoms preceded the use of the substance or medication; if the symptoms continue for a considerable length of time following the discontinuance of the substance or medication, approximately one month or longer; or if there has been a history of the symptoms without substance use or medication.Anxiety Disorder due to another Medical ConditionThis diagnosis is used when the individual is suffering from panic attacks or anxiety that has been determined to be a direct result of a medical condition through the individuals history, examination, or laboratory results. As with the previous disorder, the principal element is panic attacks or anxiety, the disruption should cause significant distress, and it is not better explained by any other mental disorder (APA).Other Specified Anxiety DisorderThis diagnosis is used when the symptoms are indicative of an anxiety disorder previously discussed, however, not all criteria are met in order to diagnose with any other anxiety disorder within the DSM-5 category. However, rationale must be stated as to why the exhibited symptoms do not meet the required criteria for any of the other specific anxiety disorders. As a result, there are four designations to use when diagnosing with this disorder: limited-symptom attacks; generalized anxiety not occurring more days than not; khyal cap (wind attacks); and ataque de nervios (attack of nerves (APA, pg. 233).Unspecified Anxiety DisorderShould the clinician choose not to use one of the four previously mentioned designations and the individual still falls under the criteria to be diagnosed as other, than the clinician can choose to diagnose the individual with the unspecified anxiety disorder. Essentially, it is the same diagnosis as previously mentioned but without the specification of one of the four designations.Potential CausesPsychological and Biological Explanatory ModelsThe basic cycle of anxiety disorders involves three elements: anxiety trigger, increasing levels of anxiety, and escape behavior (Rockhill, et al., 2010). The reward of the reduction in anxiety as a result of the escape behavior quickly reinforces the behavior causing the behavior to become learned and habitual. The genetic model proposes that the disposition to developing an anxiety disorder is genetic as these disorders are commonly grouped within family units. The hereditary component to anxiety disorders has been estimated to be between 36 and 65 percent (Rockhill et al., 2010). This indicates that like many medical conditions, children with parents who suffer with anxiety disorders may have a predisposition to develop the order themselves. Specific characteristics that can be passed on to children are temperamental quality of behavioral inhibition and physiological hyperarousal (Rockhill, et al., 2010, pg. 68). This can be seen when children typically withdraw in new environments or situations or are frequently fearful. When these characteristics are present, the child may be at risk for developing an anxiety disorder in the future.The cognitive-behavioral model proposes that due to the reward of escape behavior, youth learn dysfunctional thoughts, feelings, and behaviors (Rockhill, et al., 2010, pg. 68). These are learned through life experiences from birth through adolescence. As a result, it is imperative that at this age, youth are provided the opportunity to learn new ways of thinking and feeling to develop appropriate behaviors. The ecological model addresses the environmental factors that may contribute to the development of anxiety disorders. These may be poverty, abuse, neglect, parenting styles, or even parental modeling of fearful behavior (Rockhill, et al., 2010).BiologicalInterplay between Biological and Psychological FactorsUnderstanding the schematics of anxiety disorders is a foundational skill needed to efficaciously treat the disorder. Bystritsky, Khalsa, Cameron, and Schiffman (2013) have developed a mathematical model to describe the cognitive processes used when dealing with anxiety. They have dubbed it the ABC Model of Anxiety (pg. 31). A stands for alarms; B stands for beliefs; and C stands for coping strategies (Bystritsky, et al., pg. 31). This particular model focuses on information processing, emotional responses, and cognitive processing that takes place during a significant event. The dysfunction that occurs within the cognitive functioning of a client dealing with anxiety is such that a fear inducing trigger is processed in excessive detail that overwhelms their ability to appraise it properly (Bystritsky et al., pg. 32). This why it is very common for individuals that struggle with an anxiety disorder to automatically view situations in the worst-case scenario, often called catastrophizing.When considering the biological factor in anxiety, it is imperative to consider medical illnesses as stated previously in the diagnostic criteria for the individual anxiety disorders. Furthermore, research previously mentioned by Zanni also discusses several medical conditions that can present as anxiety. Stress is another factor to consider when evaluating biological and psychological factors. High levels of stress on a consistent basis may be a key factor in the treatment of anxiety within the client.Evaluating for these DisordersAssessment ProcessIn most settings it is not difficult to spot anxiety. In the medical setting the challenge comes when determining if the anxiety is the chief concern or if it is a result of another condition. In the mental health field it is important that a thorough assessment and history is made before making a diagnosis. Additionally, if there is any concern about an underlying medical condition it is recommended that the clinician make a referral for an appointment with a medical doctor. The clinician should take her time with the client asking enough questions to get a thorough history of medical, social, relational, work, and substance use. Additionally, the clinician should get a release to talk with family, friends, and physicians in order to make a thorough assessment of the client. Diagnostic assessment tools may be employed such as the Patient Health Questionaire (PHQ-9) to assess for depression which is often co-occurring with anxiety disorders. Additionally, tools such as the GAD-7 can be used for assessing anxiety disorders. The GAD-7 is a 7-question questionnaire used to determine the presence of Generalized Anxiety Disorder. This particular screening tool will assist the clinician in determining if a complete evaluation for anxiety is warranted. After a complete and thorough assessment, the clinician should carefully and studiously consider the diagnostic criteria for the anxiety disorder she is considering before coming to a final decision.Efficacious Treatment ApproachesMultiple treatment approaches have been found to be helpful when dealing with anxiety disorders. According to Kring, et al. the common denominator in any efficacious treatment is a focus on exposure. The systematic desensitization of a specific trigger for fear or anxiety is done through the teaching of relaxation skills to help the individual learn how to cope when a trigger presents itself. Then participating in exercises that consistently triggers fear or anxiety in a client gives her the ability to practice applying her newly found coping skills. In theory after multiple practices in a therapeutic setting, the client will be able to effectively apply her new skills in an actual situation.Cognitive Behavioral Therapy (CBT) is another treatment approach that has been scrutinized through studies to determine efficacy on anxiety disorders. Interestingly, according to Mohr and Schnieder (2013), CBT is the only treatment approach that fulfills the criteria of an evidence-based treatment approach in youth (pg. S17). Additionally, Mohr and Schnieder have come to the conclusion that parental involvement in CBT when working with youth is not a variable required for efficacy. A fairly recent consideration when employing the use of CBT for anxiety disorders is the inclusion of technology, specifically treatment through the use of the internet. Carlbring, et al. (2010), completed a study on internet-delivered cognitive behavioral therapy. The study indicated that along with improvement in anxiety symptoms, there is an indication that internet CBT may be efficacious in treating co-occurring disorders commonly seen with patients dealing with anxiety disorders.Pharmaceutical therapy is another common treatment approach to anxiety disorders. This approach deals with the neurotransmitters of the brain. Serotonin, Gamma-aminobutyric Acid, Dopamine, Norepinephrine, and a Glutamate is all neurotransmitters affected by anxiety (Bystritsky, et al.). As a result commonly prescribed medications to assist with anxiety are selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, citalopram, escitalopram, etc. as a first line of defense against depression. If these are unproductive in relieving some of the symptoms, a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) may be used (Bystritsky, et al.).Often a combined approach of CBT and medications is employed; however, an emerging approach in CBT is called Mindfulness-based cognitive therapy (MBCT). MBCT is used to treat recurring depression. The goal of MBCT is to prevent depression through cognitive approaches that change how the individual processes their thoughts, feelings, and physical responses. Mindfulness-Based Stress Reduction (MBSR) is a similar technique used to reduce stress. Goldsmith, et al. (2014) indicate that empirical evidence indicates that this approach may reduce stress, anxiety, negative affect, and depression (pg. 227).Additional IdeasTreatment Approaches for Treatment-Resistance AnxietyTreatment resistant anxiety is any anxiety that has not responded positively to traditional treatment approaches. When this happens after all avenues have been explored and the client has not experienced a significant amount relief, other treatment approaches may be explored. Bystritsky (2006) discusses the use of non-pharmacological strategies. According to Rasmussen and Richardson (2011), Electroconvulsive therapy has been proven to be highly effective when treating depression, which often is present in clients diagnosed with an anxiety disorder. However, an improvement in depression may have a positive impact on anxiety levels. Deep brain stimulation, which may have significant side effects, does appear to have encouraging initial results, but further studies should be conducted to confirm the efficacy. Finally vagus nerve stimulation (VNS). This approach deals with the vagal nerve fibers which send information from the body to the brain (Bystritsky, 2006). The idea is that by stimulating the vagus nerve, the stimulation could affect sensory input to the limbic, brain stem and cortical areas known to be involved in mood and anxiety disorders (Bystritsky, 2006, pg. 811). Recently this particular treatment approach was approved by the FDA for treatment-resistant depression. Considering once again the co-occurrence of depression and anxiety, it stands to reason that this approach may also be efficacious for anxiety that has not been sufficiently addressed through other means. Anxiety Disorders and the Christian WorldviewWhat is an efficacious Christian approach to dealing with anxiety? Philippians 4:8 tells us to meditate on those things that are of virtue and praiseworthy. With this scripture, we can easily come to the conclusion that meditation is an appropriate form of treatment. With this in mind, from a Christian perspective, a cognitive approach to mindfulness may be the most efficacious approach to allow God to work in the client. Some cognitive therapy approaches employ the use of recognizing automatic thoughts. This approach as well may be considered scriptural as II Corinthians 10:5 clearly instructs us to take captive every thought to make it obedient to Christ (New International Version). Furthermore, Job went through a very stressful time where it can safely be assumed that there was much anxiety, yet he kept his mind focused on God. As Jesus was being beaten and whipped and then taken to Calvary must have surely experienced stress and anxiety, yet He kept his focus on His father.While it is difficult to escape the stress and anxiety that comes with living in todays society, there must be ways to effectively deal with them so that we can continue to function successfully. When working with our clients it is essential that we can provide them with a stress free, anxiety free, peaceful, and safe place to heal. To that we must be willing to take care of ourselves so that we can provide them with the best possible care.ConclusionAccording to Rockhill et al. (2010), onset of symptoms for anxiety disorders are present by the age of 14 and adults struggling with anxiety disorders often experienced symptoms by the time they reached adolescence. As a result further research is indicated to understand anxiety disorders in children and adolescence. Particular research in early normative childhood anxieties and the prevention of these anxieties developing into disorders later in life is warranted. The relationship between spiritual elements of belief systems and anxiety disorders should also be considered for further research. According to Agorastos, Demiralay, and Huber (2014), recent research indicates that with respect to mental health, the greatest importance seems not to lie on religiosity/spirituality beliefs in general, but rather on specific religious coping strategies. Anxiety disorders wax and wane throughout the life span with initial onset seeming to be in childhood and multiple theories have been discussed to explain how these disorders develop. Regardless of the how and why, particular care needs to take place when evaluating for anxiety disorders. The DSM-5 provides diagnostic differential guidelines for each disorder listed within the category and clinicians should take care to thoroughly evaluate symptoms before coming to a conclusion. Referral to medical doctors should not be avoided as many medical conditions can mimic an anxiety disorder and certain medications/substances can cause similar symptoms. Finally, the spiritual element cannot be underestimated when considering evaluation and treatment approaches.

ReferenecesAgorstos, A., Demiralay, C., & Huber, C. G. (2014). Influence of religiousaspects and personal beliefs on psychological behavior: Focus on anxiety disorders. Psychology Research and Behavior Management 7. 93-101.American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Publishing. Bystritsky, A. (2006). Treatment-resistant anxiety disorders. Molecular Psychiatry, 11, 805-814.Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current diagnosis and treatment of anxiety disorders. Pharmacy & Therapeutics 38(1). 30-57Carlbring, P., Maurin, L., Toerngren, C., Linna, E., Eriksson, T., Sparthan, E., . . . Andersson, G. (2011). Individually-tailored, internet-based treatment for anxiety disorders: A randomized controlled trial. Behaviour Research and Therapy, 49(1), 18-24. Kring, A. M., Johnson, S., Davison, G. C., & Neale, J. M. (2014). Abnormal psychology: DSM 5 update (12th ed.). Hoboken, NJ: Wiley.Leonardo, E. D. & Hen, R. (2005). Genetics of affective and anxiety disorders. Annual Review of Phsychology, 57, 117-137. doi: 10.1146/annurev.psych.57.102904.190118Mohr, C. & Schnieder, S. (2013). Anxiety disorders. European Child Adolescent Psychiatry 22(I), S17-S22.Rasmussen, K. G., & Richardson, J. W. (2011). Electroconvulsive therapy in palliative care. American Journal of Hospice & Palliative Medicine 28(5), 375-277. doi: 10.1177/1049909110390203Rockhill, C. Kodish, I., DiBattisto, C., Macias, M., Varley, C., & Ryan, S. (2010). Anxiety disorders in children and adolescents. Current Problems in Pediatric and Adolescent Health Care, 40(4), 66-69.Zanni, G. R. (2010). Managing anxiety disorders. Pharmacy Times, 76(1), 66.

Research Paper: Final Grading RubricCriteriaPoints PossiblePoints EarnedInstructors Comments

Title Page

Running head is present and proper (i.e., Running head: abbreviated title; flush left).4

Full title is appropriate and in the proper place.2

Additional title page information is in correct, current APA format.4

Total10/10

Abstract

The abstract is no more than 250 words and has relevant content.6

Proper, current APA style formatting (not indented; no references, double-spaced, correct heading, etc.).4

Total10/10

Assignment Content and Organization

The assignment is grammatically correct.10

The assignment is typographically correct.10

1. Proper use of quotations, commas, italics, and other punctuation marks.2. No additional spacing between paragraphs.3. Proper indenting and paragraph length.10

Proper current APA style headings are present for each section of the paper (Abstract, Introduction, Sections 16, Conclusion, Reference Page)10

Text is written in a coherent, succinct, and well-organized manner (proper sentence structure; good transitions from paragraph to paragraph and section to section).10

Points are well presented, logical, and insightful.10

Points are supported by proper use of references (in-text citations are used wherever facts are stated).20

CriteriaPoints PossiblePoints EarnedInstructors Comments

Content is relevant in regards to, and sufficiently fulfills, assignment requirements:1. An overview of the disorders in this DSM-5 category (do not copy and paste from the DSM-5this must be evaluated and reworded into your own words.)2. Potential causes of these disorders (think nature and nurture heregenetics, heredity, environment, spiritual)3. What processes would be used to evaluate for disorders in this category4. Treatment options for these disorders5. A biblical worldview of these disorders and their treatment6. Future research considerations for disorders in this category30

Assignment is professionally written (in the 3rd person) 10

Assignment is the proper length (1214 pages, not including title page, abstract, and reference page; does not exceed required length).10

Total130/130

Citations, Quotations, and References

The assignment contains a reference page free of errors (current APA style).10

The reference page contains at least 10 sources, 50% from empirical article references that are all cited in the context of the paper.20

References are from professional sources (Codes, professional journals, and professional texts; no informal web-sites)10

Quotations are introduced properly, not excessive, and presented in proper and current APA style (i.e. Smith & Jung, 2004, p. 123).10

Citations, Quotations, and References Total50/50

Research Paper Final Total200/200