Ab_Psych_REVIEWER PDF - Dissociative Disorders

DISSOCIATIVE DISORDERS DEPERSONALIZATION/ (Panic Attack, are DEREALIZATION DISORDER Acute Stress...

DISSOCIATIVE DISORDERS DEPERSONALIZATION/ (Panic Attack, are DEREALIZATION DISORDER Acute Stress commonly DISSOCIATIVE DISORDERS Disorder, PTSD) found in 1. EXPERIENCES OF but these Individuals feel detached from DEPERSONALIZATION AND if it is the main individuals. themselves or their DEREALIZATION: (EITHER symptom, it can surroundings, akin to dreaming OR BOTH) be DDD. or living in slow motion. Depersonalization involves Reactions to dissociative feeling detached from thoughts experiences vary; some or actions, DISSOCIATIVE AMNESIA individuals are not bothered, Derealization involves feeling while others are. detached from surroundings, DISSOCIATIVE AMNESIA Not due to drugs such as experiencing them as unreal or (different from other amnesia) hallucinogens. distorted. (foggy-like) Not due to psychosis Inability to recall significant 2. INTACT REALITY TESTING autobiographical information Depersonalization: Reality testing remains intact during that should be stored and freely depersonalization or derealization recollected or should be Perception alters, leading to a experiences. successfully stored in memory temporary loss of one's own reality. under normalCircumstances. (Astral projection-like) Sensation is 3. CLINICALLY SIGNIFICANT Differs from amnesias caused akin to observing oneself in a DISTRESS OR IMPAIRMENT by neurobiological damage or dream-like state. Symptoms cause clinically significant toxicity, which affect memory distress or impairment in social, storage or retrieval differently. Derealization: occupational, or other important areas of functioning. TYPES OF DISSOCIATIVE AMNESIA Perception of the external world's LOCALIZED AMNESIA reality is lost. Depersonalizatio This Anxiety, Involves the inability to recall specific Surroundings may appear distorted, n tends Mood with changes in shape or size, and and derealization to be and events or periods of time, often individuals may seem lifeless or can happen in CHRONI Personality centered around a traumatic incident. mechanical. other disorders C Disorders SELECTIVE AMNESIA DISSOCIATIVE TRANCE 2. EXCLUSION CRITERIA Disturbance not Characterized by the ability to recall Dissociative trance is a temporary attributable to substance some, but not all, aspects of a altered state of consciousness use, neurological or traumatic event or period. triggered by stress, trauma, or intense medical conditions. emotions, involving disconnection from Not better explained by GENERALIZED AMNESIA surroundings or self, and memory other mental disorders gaps. (some are religion-related) such as Involves a broader memory loss dissociativeidentity encompassing significant portions of DISSOCIATIVE FUGUE (SUBTYPE) disorder, posttraumatic an individual's life history, including stress disorder, acute identity and personal information. Sudden, unexpected travel with stress disorder,somatic memory loss for identity and past life symptom disorder, or SYSTEMATIZED AMNESIA events. major or mild neurocognitive disorder. Refers to memory loss affecting 1. INABILITY TO RECALL specific categories of information or IMPORTANT INFORMATION 3. SPECIFIERS: related to a particular theme. (one Inability to recall family member) significant F44.0 Without Dissociative autobiographical Fugue: CONTINUOUS AMNESIA information, typically of Dissociative amnesia without a traumatic or stressful apparent purposeful travel or Ongoing inability to form new nature, inconsistent with bewildered wandering memories or recall recent events, ordinary forgetting. associated with amnesia. extending into the present moment. May manifest as localized or selective F44.1 With Dissociative Fugue: DISSOCIATIVE FUGUE (SUBTYPE) amnesia for specific events orgeneralized Associated with apparently purposeful Sudden, unexpected travel with amnesia for identity and travel or bewildered wandering memory loss for identity and past life life history. accompanied by amnesia for identity or events. other important autobiographical information.  Switch - the transition from one WHAT IS COMMON AMONG ALL person to another. Occurs Trauma - high rate of childhood THESE? instantaneously. trauma Most common with females 95% of the cases are due to The person has no idea of what (9:1) according to accumulated physical and sexual abuse happened during the dissociative data Abused Children - used episode Can last a lifetime in the imagination too much to the absence of treatment. point they create new identity - DISSOCIATIVE IDENTITY DISORDER “FANTASY WORLD” 1. DISRUPTION OF IDENTITY People can have multiple (2- Presence of distinct TREATMENT OF DISSOCIATIVE 100) alters (average of 15) personality states with IDENTITY DISORDER Identities are complete - marked discontinuity in (PSYCHOTHERAPY) gestures, personality, self and agency. handedness, sense of fashion, Accompanied by Trauma-focused therapy different gender. alterations in various Therapists use approaches such as Some alters starts from voice in aspects such as affect, Trauma-Focused Cognitive Behavioral the head until it develops as behavior, memory, and Therapy (TF-CBT) or Eye Movement alters. perception. Desensitization and Reprocessing Can be a response of stressful Symptoms may be (EMDR) to address and process situation that the true self observed by others or traumatic experiences that may have cannot deal with. reported by the led to the development of dissociative Host Identity - the main patient individual. symptoms. who seeks for treatment The first personality to seek 2. RECURRENT GAPS IN Stabilization techniques treatment is seldom the original Recurrent gaps in the recall of personality of the person. (alter everyday events, important personal Focus on building coping skills, was made to seek help) information, or traumatic events emotion regulation strategies, and Cross-gendered alters are inconsistent with ordinary forgetting. grounding techniques to manage common distressing symptoms and improve CAUSES OF DISSOCIATIVE daily functioning. IDENTITY DISORDER SCHIZOPHRENIA SPECTRUM AND harmed, harassed, plotted or Tasting (gustatory OTHER PSYCHOTIC DISORDERS discriminated against by either hallucinations) an individual or an institution; it PSYCHOSIS - A loss of contact with is the most common delusions DISORGANIZED THINKING reality (Arango & Carpenter, 2010) Disorganized thinking (speech) is the Delusions of reference - belief external manifestation of a disorder in 1. Delusions that specific gestures, thought form. 2. Hallucinations comments, or even larger 3. Disorganized Thinking environmental cues are Circumstantial or tangential - (Speech) directed to them patients may give unnecessary 4. Disorganized Behavior Delusions of thought details in response to a 5. Negative Symptoms withdrawal - belief that one’s question before they finally thoughts have been removed produce that desired response. DELUSIONS by another source. While the question is eventually Delusions are “fixed beliefs that are not answered in circumstantial amenable to change in light of HALLUCINATIONS speech patterns, in tangential conflicting evidence”. A hallucination is a sensory experience speech patterns the patient that seems real to the person having it, never reaches the point. Delusions of grandeur - belief but occurs in the absence of any Retardation - he individual may they have exceptional abilities, external perceptual stimulus. take a long time before wealth, or fame; belief they are answering the question God or other religious saviors Hallucinations can occur in any of the Derailment - illogical Delusions of control - belief five senses: connection in a chain of that others control their thoughts; tendency to provide thoughts/feelings/actions Hearing (auditory bizarre explanations for things Delusions of thought hallucinations) (illogicality) broadcasting - belief that one’s Seeing (visual hallucinations) thoughts are transparent and Smelling (olfactory DISORGANIZED BEHAVIOR everyone knows what they are hallucinations) Psychomotor symptoms can also be thinking Touching (tactile observed in individuals with Delusions of persecution - hallucinations) schizophrenia. These behaviors may belief that are going to be manifest as awkward movements or expression; reduced display of CLINICAL PRESENTATION even ritualistic/repetitive behaviors. emotional expression Alogia - Poverty of speech or Schizophreniform disorder is similar to Catatonic Behavior - even more speech content schizophrenia, except for the length of striking behavioral disturbance. The Anhedonia - Inability to presentation of symptoms. decreased or complete lack of experience please Schizophreniform and brief psychotic reactivity to the environment Apathy - General lack of disorder as the symptoms are present interest for at least one month but not longer Negativism - resistance to Asociality - Lack of interest in than six months instruction social relationships Mutism or stupor - complete Avolition - Lack of motivation Another key distinguishing feature of lack of verbal and motor for goal-directed behavior schizophreniform disorder is the lack of responses criteria related to impaired functioning. Rigidity - maintaining a rigid or SCHIZOPHRENIA upright posture while resisting SCHIZOAFFECTIVE DISORDER efforts to be moved CLINICAL PRESENTATION Posturing - holding odd, CLINICAL PRESENTATION awkward postures for long At least two of the following at periods least one month: delusions, Schizoaffective disorder is Catatonic excitement - hallucinations, disorganized characterized by the psychotic hyperactivity of motor behavior, speech, disorganized/abnormal symptoms included in schizophrenia in a seemingly excited or behavior, or negative symptoms and a concurrent uninterrupted period delirious way. Significant impairment in an of a major mood episode - either a individual’s ability to engage in depressive or manic episode. NEGATIVE SYMPTOMS normal daily functioning The inability or decreased ability to Presence of symptoms must For individuals with schizoaffective initiate actions, speech, express persist for a minimum of 6 disorder, psychotic symptoms should emotion, or feel pleasure months including the prodromal continue for at least two weeks in the and residual phase absence of a major mood disorder Affective flattening - (APA, 2013). This is the key Reduction in emotional SCHIZOPHRENIFORM DISORDER distinguishing feature between schizoaffective disorder and major  depressive disorder with psychotic Context: functional level, months and no features. present for at least 6 decline in functioning Generalized months require not limited to specific stimuli or DELUSIONAL DISORDER partners. Schizoaffective Brief Psychotic CLINICAL PRESENTATION Disorder Situational Major Mood Disorder occurs only with specific stimuli concurrent with Psychotic Requires the presence of at least one psychotic symptoms Symptoms>1 day or partners. delusion that lasts for at least one and and < 1 month with month duration. delusion/hallucinatio return to premorbid Assessment Factors: n for 2 or more functioning Erotomanic delusion - weeks a. Partner factors delusion of another person b. Relationship factors being in love with them. SEXUAL DYSFUNCTION c. Individual factors Grandiose delusion - d. Cultural/religious conviction of having great talent These disorders are marked by e. Medical factors relevant to or insight significant disturbances in sexual prognosis or treatment. Jealous delusion - conviction response or pleasure. that one’s spouse or partner Cultural Consideration is/has been unfaithful Multiple dysfunctions can occur Complex interactions of Persecutory delusion - simultaneously, requiring biopsychosocial factors believing that they are being comprehensive diagnosis. Coexisting conditions such as conspired against aging Somatic delusion - delusions Onset: regarding bodily functions or Lifelong DELAYED EJACULATION sensation present from the first sexual experiences Marked delay in ejaculation Marked infrequency or absence Schizophrenia Schizophreniform Disorder Acquired of ejaculation Significant feature Developed after normal Symptoms must occur in for most of time, Similar symptoms functioning approximately 75%–100% of failure to achieve but less than 6 partnered sexual activities,  without the individual desiring Severe: Severe or extreme delay. distress over symptoms. Generalized: Not limited to Symptoms must have persisted specific types of stimulation, for at least 6 months. ERECTILE DISORDER situations, or partners. Specify: Must experience at least one of the Situational: Occurs only with Onset: following on approximately 75%–100% certain types of stimulation, Lifelong: Present since the of sexual occasions: situations, or partners. individual became sexually Marked difficulty in active. obtaining an erection Severity: during sexual activity. Acquired: Marked difficulty in Mild: Mild distress over Began after a period of normal maintaining an erection Symptoms. sexual function. until the completion of sexual activity. Moderate: Moderate distress Context: Marked decrease in over symptoms. Generalized: Not limited to erectile rigidity. specific types of stimulation, Severe: Severe or extreme situations, or partners. Symptoms must persist for at distress over symptoms. least 6 months. Situational: Occurs only with FEMALE ORGASMIC DISORDER certain types of stimulation, Specify situations, or partners. Onset: Must experience either of the following on approximately 75%–100% of sexual Severity Lifelong: Present since the occasions: Mild: Mild distress over individual became sexually Marked delay in, marked symptoms. active. infrequency of, or absence of orgasm. Moderate: Moderate distress Acquired: Began after a period Markedly reduced intensity of over symptoms. of normal sexual function. orgasmic sensations. Context:  Symptoms must persist for at least 6 months. Moderate: Moderate distress Absent/reduced genital or nongenital over symptoms. sensations during sexual activity in Specify almost all or all sexual encounters. Onset: Severe: Severe or extreme distress over symptoms. Symptoms must persist for at Lifelong: Present since thE least 6 months. individual became sexually FEMALE SEXUAL Specify active. INTEREST/AROUSAL DISORDER Onset: Acquired: Began after a period Lack of or significantly reduced sexual Lifelong: Present since the of normal sexual function. interest/arousal is identified by at least individual became sexually three of the following: active. Context: Absent/reduced interest in sexuaL Acquired: Began after a period Generalized: Not limited to activity. of normal sexual function. specific types of stimulation, situations, or partners. Absent/reduced sexual/erotic thoughts Context: or fantasies. Situational: Occurs only with Generalized: Not limited to certain types of stimulation, No/reduced initiation of sexual activity specific types of stimulation, situations, or partners. and typically unreceptive to a partner’s situations, or partners. Additional Specification: attempts to initiate. Never experienced an orgasm: Situational: Occurs only with Indicate if the individual has Absent/reduced sexual certain types of stimulation, never experienced an orgasm excitement/pleasure during sexual situations, or partners. under any situation. activity in almost all or all sexual encounters. Severity: Severity: Absent/reduced sexual interest/arousal Mild: Mild distress over Mild: Mild distress over in response to any internal or external Symptoms. symptoms. sexual/erotic cues.  Moderate: Moderate distress Symptoms must persist for at over symptoms. Lifelong: Present since the least 6 months. individual became sexually Severe: Severe or extreme active. Specify distress over symptoms. Onset: Acquired: Began after a period GENITO-PELVIC of normal sexual function. Lifelong: Present since the PAIN/PENETRATION DISORDER individual became sexually Severity: active. Persistent or recurrent difficulties with one or more of the following: Mild: Mild distress over Acquired: Began after a period Symptoms. of normal sexual function. Vaginal penetration during intercourse. Moderate: Moderate distress Context: Marked vulvovaginal or pelvic pain over symptoms. during vaginal intercourse or Generalized: Not limited to penetration attempts. Severe: Severe or extreme specific types of stimulation, distress over symptoms. situations, or partners. Marked fear or anxiety about vulvovaginal or pelvic pain in MALE HYPOACTIVE SEXUAL Situational: Occurs only with anticipation of, during, or as a result of DESIRE DISORDER certain types of stimulation, vaginal penetration. situations, or partners. Persistently or recurrently deficient (or Marked tensing or tightening of the absent) sexual/erotic thoughts or Severity: pelvic floor muscles during attempted fantasies and desire for sexual activity. vaginal penetration. Mild: Mild distress over Judgment of deficiency is made symptoms. Symptoms must persist for at by the clinician, considering least 6 months. factors such as age, and the Moderate: Moderate distress individual’s general and over symptoms. Specify sociocultural context. Onset:  Severe: Severe or extreme Generalized: Not limited to Poor self-esteem and body distress over symptoms. specific types of stimulation, image issues can reduce situations, or partners. sexual desire and satisfaction. PREMATURE (EARLY) EJACULATION Situational: Occurs only with DEPRESSIVE DISORDERS certain types of stimulation, Persistent or recurrent pattern of situations, or partners. DISRUPTIVE MOOD ejaculation occurring during partnered DYSREGULATION DISORDER sexual activity within approximately 1 WHAT ARE THE POSSIBLE CAUSES minute following vaginal penetration OF THESE SEXUAL 1. SEVERE TEMPER and before the individual wishes it. DYSFUNCTIONS? OUTBURSTS (VERBAL OR BEHAVIORAL) 3+ TIMES / Note: Duration criteria for nonvaginal PSYCHOLOGICAL FACTORS WEEK, GROSSLY sexual activities are not established. DISPROPORTIONATE TO MENTAL HEALTH DISORDERS SITUATION Symptoms must be present for Depression, anxiety, and other at least 6 months and occur on psychiatric conditions can lead 2. OUTBURSTS INCONSISTENT approximately 75%–100% of to decreased sexual desire and WITH DEVELOPMENTAL occasions of sexual activity. performance. LEVEL Specify STRESS 3. PERSISTENT Onset: High levels of stress from work, IRRITABILITY/ANGER MOST financial issues, or other OF DAY, NEARLY EVERY DAY. Lifelong: Present since the sources can negatively affect individual became sexually sexual function. 4. SYMPTOMS PERSIST FOR active. ≥12 MONTHS WITHOUT 3+ TRAUMA MONTH BREAK. Acquired: Began after a period History of sexual abuse or of normal sexual function. trauma can lead to sexual 5. SYMPTOMS PRESENT IN ≥2 dysfunction. OF 3 SETTINGS, SEVERE IN Context: AT LEAST ONE. BODY IMAGE  6. ONSET BEFORE AGE 6, PERSISTENT DEPRESSIVE HISTORY BEFORE AGE 10. D. SLEEP DISTURBANCE DISORDER (DYSTHYMIA) (INSOMNIA/HYPERSOMNIA). 7. NO MANIC/HYPOMANIC 1. DEPRESSED MOOD MOST EPISODES >1 DAY. E. PSYCHOMOTOR OF THE DAY, FOR MORE AGITATION/RETARDATION. DAYS THAN NOT, FOR AT 8. SYMPTOMS NOT DURING LEAST 2 YEARS (1 YEAR IN MAJOR DEPRESSIVE F. FATIGUE OR LOSS OF CHILDREN/ADOLESCENTS), EPISODE OR EXPLAINED BY ENERGY. SUBJECTIVE OR OBSERVED. OTHER MENTAL DISORDER. G. FEELINGS OF 2. PRESENCE OF TWO OR 9. NOT DUE TO SUBSTANCE WORTHLESSNESS OR MORE OF THE FOLLOWING OR MEDICAL CONDITION. EXCESSIVE GUILT. WHILE DEPRESSED: MAJOR DEPRESSIVE DISORDER H. DIMINISHED A. APPETITE DISTURBANCE. CONCENTRATION/INDECISIV 1. 5+ SYMPTOMS PRESENT ENESS. B. SLEEP DISTURBANCE. FOR 2 WEEKS, INCLUDING DEPRESSED MOOD OR LOSS OF I. RECURRENT THOUGHTS OF C. FATIGUE OR LOW ENERGY. INTEREST/PLEASURE. DEATH/SUICIDAL IDEATION/BEHAVIOR. D. LOW SELF-ESTEEM. A. DEPRESSED MOOD (SUBJECTIVE OR E. POOR CONCENTRATION OR OBSERVED). INDECISIVENESS. B. LOSS OF F. FEELINGS OF INTEREST/PLEASURE IN HOPELESSNESS. ACTIVITIES. 3. SYMPTOMS PERSIST FOR 2 C. SIGNIFICANT WEIGHT YEARS, WITH NO CHANGE OR APPETITE SYMPTOM-FREE PERIOD DISTURBANCE.  LASTING MORE THAN F.FEELING OVERWHELMED OR OUT MONTHS. OF CONTROL. A. AFFECTIVE LABILITY (E.G., 4. MAJOR DEPRESSIVE MOOD SWINGS). G.PHYSICAL SYMPTOMS (E.G., DISORDER CRITERIA MAY BREAST TENDERNESS, BE CONTINUOUSLY B. IRRITABILITY, ANGER, OR JOINT/MUSCLE PAIN, BLOATING, PRESENT FOR 2 YEARS. CONFLICTS. DISTURBANCE. WEIGHT GAIN). 5. NO MANIC OR HYPOMANIC C. DEPRESSED MOOD OR 4. SYMPTOMS PRESENT IN EPISODES. SELF- DEPRECATING MOST MENSTRUAL CYCLES THOUGHTS. OVER THE PAST YEAR. 6. SYMPTOMS NOT DUE TO ANOTHER MENTAL D. ANXIETY, TENSION, OR 5. SYMPTOMS CAUSE DISORDER OR FEELING ON EDGE. DISTRESS OR SUBSTANCE/MEDICAL INTERFERENCE WITH DAILY CONDITION. 3. ADDITIONAL SYMPTOMS TO FUNCTIONING. REACH FIVE TOTAL: 7. SYMPTOMS CAUSE 6. NOT MERELY CLINICALLY SIGNIFICANT A.DECREASED INTEREST IN USUAL EXACERBATION OF DISTRESS OR IMPAIRMENT. ACTIVITIES. ANOTHER DISORDER. PREMENSTRUAL DYSPHORIC B.DIFFICULTY CONCENTRATING. 7. CONFIRMATION VIA DISORDER PROSPECTIVE DAILY C.LETHARGY, FATIGUE, OR LACK RATINGS DURING TWO 1. AT LEAST FIVE SYMPTOMS OF ENERGY. SYMPTOMATIC CYCLES. PRESENT IN THE WEEK (PROVISIONAL DIAGNOSIS BEFORE MENSES, D.CHANGE IN APPETITE OR FOOD POSSIBLE PRIOR TO IMPROVING AFTER MENSES. CRAVINGS. CONFIRMATION.) 2. ONE OR MORE OF THE E.HYPERSOMNIA OR INSOMNIA. 8. NOT DUE TO SUBSTANCE FOLLOWING MOOD OR MEDICAL CONDITION. SYMPTOMS: Disruptive Mood Dysregulation MDD but persisting over a longer Recurrent, intense sexually arousing Disorder period. fantasies, sexual urges, or behaviors generally involving a.) non-human Onset: Childhood (after 6 months) Time Frame: Symptoms present for 2+ objects, b.) the suffering or humiliation years with no 2-month symptom-free of oneself or one’s partner, or c.) Definition: Severe temper outbursts children or other non-consenting and persistent irritability, often seen in Premenstrual Dysphoric Disorder persons that occur over a period of children and adolescents. time of at least 6 months. Onset: Reproductive Age Time Frame: Symptoms present for The term paraphilia denotes 12+ months Definition:Symptoms occur cyclically any intense and persistent in relation to the menstrual cycle, with sexual interest other than Major Depressive Disorder mood and physical symptoms sexual interest in genital appearing before menstruation and stimulation or preparatory Onset: Any age resolving after. fondling with phenotypically normal, physically mature, Definition: Involves a major Time Frame: Symptoms present in consenting human Partners. depressive episode with symptoms like most cycles during final week of depressed mood, loss of interest, and menses A paraphilic disorder is a significant impairment in daily paraphilia that is currently functioning. PARAPHILIC DISORDER causing distress or impairment to the individual or a paraphilia Time Frame: Symptoms present for 2 PARAPHILIA (PERVERSION) whose satisfaction has entailed weeks causing distress/impairment Derived from the Greek words: personal harm, or risk of harm, “para” - next to to others. Persistent Depressive Disorder “philia” - love DSM-5 TR CRITERIA FOR Onset: Any age The etymological definition of PARAPHILIC DISORDER paraphilia is “next to or along side of Definition: Reflects a chronic love” CRITERION A depressed mood lasting for at least two Specifies the qualitative nature of the years, with symptoms less severe than paraphilia  usually achieved through YOUNG CHILD WHO IS CRITERION B masturbation and fantasy SEXUALLY ABUSED Specifies the negative consequence ETIOLOGY FEAR OF SEXUAL Beside normal sexual The etiology of paraphilia is unknown PERFORMANCE OR behaviour, paraphilic disorder INTIMACY involves aggression, Psychoanalytical Theory victimization and extreme These conditions represent a EXCESSIVE ALCOHOL one-sidedness. regression to or fixation at an INTAKE/MARIJUANA USE earlier level of psychosexual The behaviors exclude or harm development, resulting in a PHYSIOLOGICAL PROBLEMS others and disrupt the potential repetitive pattern of sexual for bonding between persons. behavior that is not mature in its SOCIOCULTURAL FACTORS application and expression. Usually lasts for 6 months PSYCHOSEXUAL TRAUMA Behavioral Theory Always thinking to carry out The paraphilia begins via VOYEURISTIC DISORDER their unusual behavior process of conditioning. Nonsexual objects can become 1. OBSERVING AN Overly obsessed that if the sexually arousing if they are UNSUSPECTING NAKED individual cannot get to their frequently and repeatedly PERSON desired object, they get associated with a pleasurable Intense and recurring sexual stressed. sexual activity. arousal occurs for at least 6 months when observing It causes intense personal SITUATION OR CAUSES THAT someone who is naked, distress or impairment in social, MIGHT LEAD SOMEONE IN A undressing, or engaged in work and other areas of life PARAPHILIC DIRECTION sexual activity, demonstrated functioning. through fantasies, urges, or PARENTAL HUMILIATION DUE behaviors. Paraphilias commonly involve TO ERECTED PENIS sexual arousal and orgasm 2. ACTED ON A The voyeur feels frustrated and Sexually aroused by exposing NONCONSENTING PERSON incapable of establishing a genitals to prepubertal children The individual either acts on regular sexual relationship with these sexual urges without the person he observes Sexually aroused by exposing consent from the observed genitals to physically mature person, or experiences EXHIBITIONISTIC DISORDER individuals significant distress or impairment in social, 1. EXPOSURE OF ONE’S Sexually aroused by exposing occupational, or other important GENITALS TO AN genitals to prepubertal children areas of functioning due to UNSUSPECTING PERSON and to physically mature these urges or fantasies. Intense and recurring sexual individuals arousal occurs for at least 6 3. AT LEAST 18 YEARS OF AGE months from exposing one's AKA Flashing or Indecent Exposure The individual experiencing the genitals to an unsuspecting arousal and/or acting on the person, evident through Occurs predominantly in men urges is at least 18 years of fantasies, urges, or behaviors. age. Masturbation to orgasm usually 2. ACTED ON A accompanies or follows the event The word comes from the term NONCONSENTING PERSON VOIR, meaning “To see” The individual either acts on The dynamic of men with exhibitionism these sexual urges without is to assert their masculinity by AKA. Scopophilia consent from the observed showing their penises and by watching person, or experiences the victim’s reactions - fright, surprise Onset is usually before the age significant distress or and disgust of 15. impairment in social, occupational, or other important FROTTEURISTIC DISORDER This disorder is more common areas of functioning due to in men these urges or fantasies. TOUCHING OR RUBBING AGAINST A NONCONSENTING PERSON, Masturbation to orgasm usually SPECIFIER Intense and recurring sexual arousal accompanies or follows the occurs for at least 6 months from event touching or rubbing against a nonconsenting person, as evidenced areas of functioning due to these urges ACTED ON A NONCONSENTING by fantasies, urges, or behaviors. or fantasies. PERSON The individual either acts on these ACTED ON A NONCONSENTING SPECIFIER sexual urges without consent from the PERSON With asphyxiophilia: observed person, or experiences The individual either acts on these significant distress or impairment in sexual urges without consent from the If the individual engages in the social, occupational, or other important observed person, or experiences practice of achieving sexual areas of functioning due to these urges significant distress or impairment in arousal related to restriction of or fantasies. social, occupational, or other important breathing. areas of functioning due to these urges Obtaining sexual enjoyment or fantasies. A masochist is someone who from inflicting cruelty seeks pleasure from being SEXUAL MASOCHISM DISORDER subjected to pain Requires a partner to enact sadistic fantasies SEXUAL AROUSAL FROM The three main characteristics HUMILIATION OR of masochism are: Most person with sexual sadism SUFFERING Pain are male Intense and recurring sexual arousal loss of control occurs for at least 6 months from being Humiliation PEDOPHILIC DISORDER humiliated, beaten, bound, or otherwise made to suffer, as evidenced SEXUAL SADISM DISORDER SEXUAL ACTIVITY WITH A by fantasies, urges, or behaviors. PREPUBESCENT CHILD SEXUAL AROUSAL FROM OR CHILDREN ACTED ON A NONCONSENTING ANOTHER'S SUFFERING Intense and recurring sexual arousal PERSON Intense and recurring sexual arousal occurs for at least 6 months from the The individual either acts on these occurs for at least 6 months from the sexual activity with a prepubescent sexual urges without consent from the physical or psychological suffering of child or children (generally age 13 observed person, or experiences another person, as demonstrated by years or younger)., as demonstrated by significant distress or impairment in fantasies, urges, or behaviors. fantasies, urges, or behaviors. social, occupational, or other important ACTED ON A NONCONSENTING Other PERSON SEXUAL AROUSAL FROM The individual either acts on these NONLIVING OBJECTS OR TRANSVESTIC DISORDER sexual urges without consent from the NONGENITAL BODY PARTS observed person, or experiences Intense and recurring sexual arousal SEXUAL AROUSAL FROM significant distress or impairment in for at least 6 months arises from either CROSS-DRESSING social, occupational, or other important the use of nonliving objects or a highly Intense and recurrent sexual arousal areas of functioning due to these urges specific focus on nongenital body for at least 6 months arises from cross- or fantasies. parts. This arousal is evidenced by dressing, evident through fantasies, fantasies, urges, or behaviors. urges, or behaviors. AGE DISCREPANCY The individual is at least age 16 years ACTED ON A NONCONSENTING ACTED ON A NONCONSENTING and at least 5 years older than the child PERSON PERSON or children in Criterion A. The fantasies, sexual urges, or The fantasies, sexual urges, or Note: Do not include an individual in behaviors lead to clinically significant behaviors lead to clinically significant late adolescence involved in an distress or impairment in social, distress or impairment in social, ongoing sexual relationship with a 12- occupational, or other important areas occupational, or other important areas or 13-year-old. - LEGAL CASE of functioning. of functioning. SPECIFIER EXCLUSION OF SPECIFIC FETISH SPECIFY IF: Exclusive Type OBJECTS Nonexclusive Type The fetish objects are not limited to With fetishism: If sexually aroused by articles of clothing used in fabrics, materials, or garments. Specify if: cross-dressing (as seen in transvestic Sexually attracted to males disorder) or devices explicitly designed With autogynephilia: If sexually Sexually attracted to females for tactile genital stimulation (e.g., aroused by thoughts or images of self Sexually attracted to both vibrators). as a woman. Specify if: The literal meaning of the word Limited to incest SPECIFY IF: transvestism is to wear the Body Parts clothing of the opposite sex FETISHISTIC DISORDER Non Living objects  Sometimes accompanied by consequences, and treatment options, OVERVIEW OF PERSONALITY masturbation can help individuals better understand DISORDERS and manage their condition When personality traits impact Rare in females. relationships, cause distress, or disrupt MEDICATION daily life, they are considered " RARE PARAPHILIAS In some cases, medications such as personality disorders." selective serotonin reuptake inhibitors (SSRIs), anti-androgens, or other Personality disorders are chronic; they psychiatric medications may be do not come and go but originate in prescribed to reduce sexual urges and childhood and continue throughout control impulsive behavior. adulthood. SUPPORT GROUPS A personality disorder is a persistent Participation in support groups or pattern of emotions, cognitions, and group therapy sessions with others behavior that results in enduring who have similar experiences can emotional distress for the person provide validation, encouragement, affected and/or for others and may TREATMENT and practical coping strategies. cause difficulties with work and relationships (APA,2013). COGNITIVE-BEHAVIORAL RELAPSE PREVENTION THERAPY (CBT) Developing strategies to prevent The problems of people with Therapy focuses on changing patterns relapse and maintain progress is an personality disorders may just be of thoughts, feelings, and behaviors important aspect of treatment. This extreme versions of the problems related to paraphilic urges using may involve identifying triggers, many of us experience temporarily, techniques like cognitive restructuring, developing coping skills, and creating a such as being shy or suspicious. behavior modification, and relapse relapse prevention plan. prevention. PERSONALITY DISORDERS PERSONALITY DISORDER CLUSTERS PSYCHOEDUCATION Providing information about paraphilic GENERAL DESCRIPTION CLUSTER A disorders, including their causes, Odd, Eccentric CLUSTER B Tend to present with characteristics GENERAL PERSONALITY Dramatic, that are more submissive, emotional DISORDER Emotional, and insecure Erratic Deviation from cultural COMORBIDITY expectations CLUSTER C Anxious A major concern with the Cognition personality disorders is that Abnormal ways of perceiving STATISTICS AND DEVELOPMENT people tend to be diagnosed and interpreting self, others, Gathering data on the prevalence of with more than one. and events. personality disorders is challenging due to low help-seeking behavior, Overlapping of symptoms are Affectivity leading to varying estimates. common Abnormal range, intensity, lability, and appropriateness of Personality disorders were thought to Complicating this issue is the emotional responses. originate in childhood and continue into phenomenon that people will adult years. A person may transition change diagnoses over time Interpersonal Functioning from one personality disorder diagnosis Difficulty in forming and to another over time, exhibiting PERSONALITY DISORDERS UNDER maintaining relationships. characteristics of different disorders. STUDY Impulse Control GENDER DIFFERENCES Sadistic Personality Disorder, Difficulty controlling urges and which includes people who behaviors. MEN receive pleasure by inflicting If diagnosed with PD, they tend to pain on others. Inflexible and Pervasive display traits characterized as more Pattern aggressive, structures, self-assertive Passive-Aggressive Personality The enduring pattern is rigid and detached Disorders, which includes and exists across various people who are defiant and personal and social contexts. WOMEN refuse to cooperate with requests - attempting to Clinically Significant Distress undermine authority figures. or Impairment  The pattern causes distress or 2. SCHIZOTYPAL PERSONALITY 6. Perceiving attacks on their impairment in social, DISORDER character and reacting angrily occupational, or other important or defensively areas of functioning. 3. SCHIZOID PERSONALITY. DISORDER 7. Recurrent suspicions about the Stable and Long Duration fidelity of their partner without The pattern has been present PARANOID PERSONALITY justification. since adolescence or early DISORDER adulthood and remains Excessive mistrust and suspicion consistent over time. PERVASIVE DISTRUST AND without cause: SUSPICIOUSNESS Recognizable during Begins by early adulthood and is More common among relatives adolescence or early adult life present in various situations. of those with schizophrenia For PD to be diagnosed in an REQUIRES 4 OR MORE OF THE FF: Linked to childhood individual younger than 18 1. Unfounded suspicions that mistreatment and traumatic years old, it has to be present others are exploiting, harming, experiences for at least 1 year or deceiving them. Symptoms may appear in When an individual has a childhood with solitariness, persistent mental disorder that 2. Persistent doubts about loyalty social anxiety, and poor peer was preceded by a preexisting or trustworthiness of friends or relationships PD, the PD must also be associates.. recorded, followed by Associated with childhood “premorbid” 3. Reluctance to confide in others mistreatment, externalizing due to fear of betrayal. symptoms, bullying, and CLUSTER A: ODD AND ECCENTRIC interpersonal aggression in 4. Misinterpreting benign remarks adulthood 1. PARANOID PERSONALITY or events as threatening. DISORDER 5. Holding grudges and being Treatment: unforgiving of perceived insults. Cognitive-Behavioral Therapy SCHIZOID PERSONALITY Schizoid – describe people who have Unusual perceptual experiences: DISORDER the tendency to turn inward and away Experiencing bodily illusions or other from the outside world unusual sensory perceptions. DETACHMENT FROM SOCIAL RELATIONSHIPS AND RESTRICTED The condition is noticeable in childhood Odd thinking and speech: EMOTIONAL EXPRESSION and adolescence. Communication that is vague, Begins by early adulthood and is circumstantial, metaphorical, or present in various situations. Treatment: Social skills training. stereotyped. REQUIRES 4 OR MORE OF THE FF: SCHIZOTYPAL PERSONALITY Suspiciousness or paranoid 1. Lack of desire for close DISORDER ideation: Feeling mistrustful or relationships, including family having paranoid thoughts about bonds. SOCIAL AND INTERPERSONAL others. 2. Preference for solitary activities DEFICITS, over social interactions. COGNITIVE/PERCEPTUAL Inappropriate or constricted 3. Little to no interest in sexual DISTORTIONS, AND ECCENTRIC affect: Displaying emotions that experiences with others. BEHAVIOR are out of context or limited in 4. Limited enjoyment in activities. Begins by early adulthood and is range. 5..Absence of close friendships, present in various situations. relying primarily on first-degree Odd behavior or appearance: relatives. REQUIRES 5 OR MORE OF THE FF: Engaging in eccentric or 6. Indifference towards praise or peculiar behaviors or criticism from others. presenting an unconventional 7. Displays emotional coldness, Ideas of reference: Believing that appearance. detachment, or flattened affect. unrelated events or incidents have personal significance. Lack of close relationships: People with schizoid personality Having few, if any, close friends disorder exhibit social detachment, Odd beliefs or magical thinking: outside of immediate family limited emotions, often stemming from Holding beliefs inconsistent with members. childhood shyness, abuse, or neglect. cultural norms, such as superstitions or belief in psychic abilities. Excessive social anxiety: Experiencing intense social  anxiety, often associated with DISREGARD FOR AND VIOLATION without regard for paranoid fears rather than OF OTHERS' consequences. negative self-perceptions. RIGHTS Must have occurred since age 15 and Consistent irresponsibility: Individuals with schizotypal personality requires three or more of the Failing to maintain stable work disorder are socially isolated, exhibit following characteristics: behavior or fulfill financial unusual behaviors, and hold peculiar obligations over time. beliefs. REQUIRES 3 OR MORE OF THE FF: Lack of remorse: Indifference or Higher prevalence in relatives of those Failure to conform to social rationalization when hurting, with schizophrenia. norms: Repeatedly engaging in mistreating, or stealing from behaviors that are grounds for others. Childhood mistreatment linked to arrest or societal disapproval. PTSD symptoms in women. AGE REQUIREMENT Deceitfulness: Engaging in The individual must be at least 18 Disorder has a stable course, with few repeated lying, use of aliases, years old. progressing to schizophrenia. or manipulation for personal gain or pleasure. EVIDENCE OF CONDUCT CLUSTER B: DRAMATIC, DISORDER EMOTIONAL, ERRATIC Impulsivity or lack of planning: There must be evidence of conduct Demonstrating impulsive disorder with onset before age 15 1. ANTISOCIAL PERSONALITY actions or failure to consider years. DISORDER long-term consequences. 2. BORDERLINE PERSONALITY EXCLUSION DISORDER Irritability and aggressiveness: 3. HISTRIONIC PERSONALITY Involvement in physical fights or Antisocial behavior should not DISORDER assaults on a recurring basis. exclusively occur during schizophrenia 4. NARCISSISTIC or bipolar disorder. PERSONALITY DISORDER Reckless disregard for safety: Characteristics include irresponsibility, ANTISOCIAL PERSONALITY Engaging in behaviors that put impulsivity, and deceitfulness DISORDER oneself or others in danger Lack of conscience and empathy, idealization and devaluation in stress-related paranoid acting selfishly without guilt relationships. thoughts or severe dissociative symptoms. Diagnosis after age 18 with prior Identity disturbance: Significant evidence of conduct disorder instability in self-image or sense of self. Individuals with borderline personality disorder often exhibit: Both conduct disorder and substance Impulsivity: Engaging in use disorder are diagnosed if criteria impulsive behaviors in at least Unstable moods, relationships, are met. two areas that may be and self-image self-damaging. Treatment: Parent Training High risk of suicidal behaviors Suicidal or self-mutilating BORDERLINE PERSONALITY behavior: Recurrent suicidal Turbulent relationships and DISORDER behavior, gestures, threats, or intense emotions self-harming acts. INSTABILITY IN INTERPERSONAL Dysfunction in emotional areas RELATIONSHIPS, SELF-IMAGE, Affective instability: Rapid and AND AFFECTS, WITH MARKED intense mood swings, such as Common in families with mood IMPULSIVITY dysphoria, irritability, or anxiety. disorders Must begin by early adulthood and be present in various contexts, requiring Feelings of emptiness: Chronic Common in families with mood five or more of the following feelings of emptiness or Disorders characteristics: boredom. Can manifest in adolescents as REQUIRES 5 OR MORE OF THE FF: Inappropriate anger: Difficulty young as 12 Efforts to avoid abandonment: Frantic controlling anger, experiencing attempts to avoid real or perceived intense and inappropriate Impulsive symptoms improve faster abandonment. anger. than affective symptoms Unstable interpersonal relationships: Paranoid ideation or Recovery is challenging and less Alternating between dissociative symptoms: stable Experiencing transient, Often co-occurs with mood disorders Attention-seeking through Histrionic Personality Disorder and physical appearance: Using Antisocial Personality Disorder Treatment commonly involves physical appearance to attract commonly coexist. Dialectical Behavior Therapy. attention. NARCISSISTIC PERSONALITY HISTRIONIC PERSONALITY Impressionistic speech: DISORDER DISORDER Speaking in a manner that is overly vague and lacking in GRANDIOSITY, NEED FOR EXCESSIVE EMOTIONALITY AND detail. ADMIRATION, AND ATTENTION LACK OF EMPATHY SEEKING Self-dramatization: Must begin by early adulthood and be Must begin by early adulthood and be Exaggerating emotions and present in various contexts, requiring present in various contexts, requiring behaviors for dramatic effect. five or more of the following five or more of the following characteristics: characteristics: Suggestibility: Being easily influenced by others or by REQUIRES 5 OR MORE OF THE FF: REQUIRES 5 OR MORE OF THE FF: circumstances. Grandiose sense of self-importance: Discomfort when not the center of Perceiving relationships as Exaggerating achievements and attention: Feeling uneasy in situations more intimate than they are: expecting recognition as superior where they are not the focus of others' Viewing relationships as closer without corresponding attention. or more meaningful than they accomplishments. actually are. Inappropriate seductive behavior: Fantasies of unlimited success: Engaging in sexually provocative or They tend to display excessive drama Preoccupation with fantasies of flirtatious behavior in interactions with and sometimes come across as if they limitless success, power, brilliance, others. are acting. beauty, or ideal love Shallow expression of emotions: They express emotions in a heightened Belief in uniqueness: Believing oneself Demonstrating rapidly shifting and and exaggerated way. to be special or unique and only superficial displays of emotions. associating with other special or high-status individuals or institutions.  Need for excessive admiration: They lack sensitivity and compassion Must begin by early adulthood and be Requiring constant admiration towards others due to an unreasonable present in various contexts, requiring and validation from others. sense of self-importance four or more of the following characteristics: Sense of entitlement: Expecting Display exaggerated feelings of special treatment and greatness and may be fixated at a REQUIRES 4 OR MORE OF THE FF: compliance with their self-centered, grandiose stage of expectations without development Avoidance of occupational activities: justification. Avoiding jobs or tasks that involve Common in adolescents but not a significant interpersonal contact due to Interpersonally exploitative: definite indicator of developing fear of criticism, disapproval, or Taking advantage of others to narcissistic Personality Disorder in rejection. achieve their own goals. adulthood Reluctance to engage with others: Lack of empathy: Being CLUSTER C: ANXIOUS Unwillingness to initiate relationships or unwilling to understand or interactions unless assured of being identify with the feelings and 1. AVOIDANT PERSONALITY liked. needs of others. DISORDER 2. DEPENDENT PERSONALITY Restraint in intimate relationships: Envy or belief in others' envy: DISORDER Holding back within close relationships Feeling envious of others or 3. OBSESSIVE-COMPULSIVE due to fear of being shamed or believing that others are PERSONALITY DISORDER ridiculed. envious of them. AVOIDANT PERSONALITY Preoccupation with criticism or Arrogant or haughty behaviors: DISORDER rejection: Constantly worrying Displaying arrogant or about being criticized or disdainful attitudes or behaviors SOCIAL INHIBITION, FEELINGS OF rejected in social situations. towards others. INADEQUACY, AND HYPERSENSITIVITY TO Inhibition in new social They feel they are unique and NEGATIVE situations: Feeling inadequate deserving of special treatment EVALUATION and inhibited in new interpersonal situations.  DEPENDENT PERSONALITY of confidence in judgment or Negative self-view: Viewing DISORDER abilities. oneself as socially inept, unappealing, or inferior to EXCESSIVE NEED FOR CARE AND Excessive seeking of others. SUPPORT, LEADING TO nurturance: Going to great SUBMISSIVE BEHAVIOR AND FEAR lengths to obtain care and Reluctance to take risks: Being OF SEPARATION support from others, even unusually hesitant to take Must begin by early adulthood and be volunteering for unpleasant personal risks or try new present in various contexts, requiring tasks. activities due to fear of five or more of the following embarrassment. characteristics: Discomfort when alone: Feeling uncomfortable or helpless when Avoidant Personality Disorder REQUIRES 5 OR MORE OF THE FF: alone due to exaggerated fears characterized by sensitivity to others' of being unable to care for opinions, leading to social avoidance Difficulty making decisions: Having oneself. trouble making everyday decisions Low self-esteem limits friendships, without excessive advice and Urgent seeking of new dependency on familiar individuals reassurance from others. relationships: Seeking out new relationships immediately after Feel chronically rejected, pessimistic Reliance on others for major life areas: a close one ends, as a source about future Needing others to take responsibility of care and support. for most aspects of life. Onset often in childhood with shyness, Preoccupation with fears of isolation, fear of new situations Difficulty expressing abandonment: Being disagreement: Finding it hard to unrealistically preoccupied with Avoidant PD can occur without Social disagree with others due to fear fears of being left to care for Anxiety Disorder (SAD) of losing their support or oneself. approval. Treatment involves Behavioral Rely on others to make ordinary Intervention Techniques Difficulty initiating tasks: decisions as well as important ones, Struggling to start projects or which results in an unreasonable fear tasks independently due to lack of abandonment  Rigidity and stubbornness: Agree with other people’s opinion just Excessive devotion to work: Displaying inflexibility and for them to be not rejected Dedication to work and stubbornness in attitudes and productivity at the expense of behaviors. Feel uncomfortable or helpless when leisure activities and alone cause of exaggerated fears of friendships, not solely due to Fixation on things being done “the right being unable to take care of economic necessity. way” themselves Over Conscientiousness: Being This preoccupation with details OBSESSIVE-COMPULSIVE overly scrupulous and inflexible prevents them from completing much PERSONALITY DISORDER about morality, ethics, or of anything values, not solely due to PREOCCUPATION WITH cultural or religious beliefs. Need to control all aspects of their lif ORDERLINESS, PERFECTIONISM, AND CONTROL, AT THE EXPENSE Difficulty discarding items: When criteria for both OCD and OCPD OF FLEXIBILITY Unable to throw away worn-out are met, both diagnoses should be Must begin by early adulthood and be or worthless objects, even recorded present in various contexts, requiring when they have no sentimental four or more of the following value. Treatment: CBT characteristics: Reluctance to delegate: SUMMARY REQUIRES 4 OR MORE OF THE FF: Hesitancy to delegate tasks or collaborate with others unless Preoccupation with details: Being they adhere strictly to one's overly focused on details, rules, lists, own methods. order, or schedules to the extent that the main goal of the activity is lost. Miserly spending habits: Adopting a frugal spending Perfectionism: Struggling to complete style, hoarding money for future tasks because personal standards are emergencies. excessively strict.