Abnormal Psychology PDF

Premenstrual dysphoric disorder Suicidal ideation refers to thinking about, considering, Premenstrual dysphoric disorder (PMDD) is a or planning suicide. severe form of premenstrual syndrome (PMS). While PMS symptoms can be both physical and psychological, PMD...

Premenstrual dysphoric disorder Suicidal ideation refers to thinking about, considering, Premenstrual dysphoric disorder (PMDD) is a or planning suicide. severe form of premenstrual syndrome (PMS). While PMS symptoms can be both physical and psychological, PMDD symptoms tend to be mostly DSM-5 Suicidal Behavior Disorder psychological. According to the DSM-5, there are five proposed criterion Suicidal Behavior Disorder, with two Situational depression specifiers; Situational depression, or adjustment disorder with 1. The Individual has made a sulcide attempt within depressed mood, looks like major depression in the past two years. many ways. However, situational depression is 2. The criterion for non-suicidal self-injurlous brought on by specific events or situations, such behavior Is not met during the aforementloned as: the death of a loved one, a serious illness or sulcide attempts. other life threatening event, going through divorce 3. The diagnosis is not applied to preparation for a or child custody Issues, being in emotionally or suicide attempt, or suicidal ideation. physically abusive relationships, being unemployed 4. the act was not attempted during an altered or facing serious financial difficulties, facing mental state, such as delirium or " confusion". extensive legal troubles. 5. The act was not ideologically motivated e.g. - religious or political. Atypical depression Atypical depression refers to depression that Other specifiers are: temporarily goes away in response to positive Current- Not more than 12-24 months since events. Despite its name, atypical depression is not last attempt. unusual or rare. It also does not mean that it's In Remission- more than 24 months since last more or less serious than other types of attempt. (American Psychiatric Association, 2013). depression. Risk Factors for Depression Onset Biochemistry: Differences In certain chemicals in The DSM-5 notes that Suicidal Behavior Disorder the brain may contribute to symptoms of could occur at any point in the lifespan, very rarely depression. under age 5. (American Psychiatric Association, Genetics: Depression can run in families. For 2013). example, if one identical twin has depression, the other has a 70 percent chance of having the illness Prevalence sometime in life. The DSM -5 does not indicate the prevalence of Personality: People with low self-esteem, who are Suicidal Behavior Disorder (American Psychiatric easily overwhelmed by stress, or who are generally Association, 2013). About 5-8% of teens attempt pessimistic appear to be more likely to experience suicide each year according to some studies depression. (Blaszczak-Boxe, 2014 ).The actual numbers are Environmental factors: Continuous exposure to unknown of course, as attempts may be hidden or violence, neglect, abuse or poverty may make denied, and this is not including suicidal ideation some people more vulnerable to depression. which is not acted out behaviorally. Understanding Suicide Risk Factors Suicide is an extremely personal, private, and The DSM-5 indicates that risk factors for Suicidal complicated act. Escape from psychological suffering Behavior Disorder are mental illnesses such as is often a significant motive in suicide. Suicide is bipolar disorder, major depressive disorder, often defined as death caused by self-directed schizophrenia, schizoaffective disorder, anxiety injuries behavior with intent to die as a result of the disorders panic disorder and PTSD, substance use behavior. disorders (especially alcohol use disorder), borderline personality disorder, antisocial A suicide attempt is a non-fatal, self-directed, personality disorder, eating disorders, and potentially injurious behavior with intent to die as a adjustment disorders (American Psychiatric result of the behavior. A suicide attempt might not Association, 2013). result in injury. Chronic pain and terminal or chronic illnesses, Non Suicidal Self-Injury which cause impairment and loss of physical ability, may be co-morbid with Suicidal Behavior Disorder. Some people deliberately harm themselves without In recent years, there has been increasing trying to end their own lives. The most frequent attention to children and teens contemplating or forms of nonsuicidal self injurious behaviors involve carrying out suicide in response to bullying. It has cutting, burning, or scratching the skin, usually in a been found that there is an especially robust place where the wounds and resulting scars can correlation between cyber bullying and suicidality. easily be concealed from others. Why Do People Commit Suicide? People who engage in nonsuicidal self-injury do it because the pain serves a useful purpose for them - Mental Illness regardless of its impact on their appearance. - Traumatic Stress - Substance Use and Impulsivity Symptoms of Non Suicidal Self-Injury - Loss or Fear of Loss According to DSM-5, NSSI diagnostic criteria are - Hopelessness as follows (American Psychiatric Association, - Chronic Pain and Illness 2013): - Feeling Like a Burden to Others Over the past year, the person has for at least 5 - Cry for Help days engaged in self-injury, with the anticipation Classification of Suicide that the injury will result in some bodily harm. No suicidal intent. Anomic suicide (diminished regulation) occurs -The act is not socially acceptable. following a sudden breakdown in social order or a disruption of the norms that govern people -The act or its consequence can cause significant behavior. Anomic suicide explains increased distress to the individual's daily life. suicide rates that occur following an economic or -The act is not taking place during psychotic political crisis or among people who are adjusting eplsodes, delirium, substance intoxication, or to the unexpected loss of a social or occupational substance withdrawal. It also cannot be explained role. The typical feelings associated with anomic (a by another medical condition. term coined by Durkheim, which literally means -The Individual engages In self-Injury expecting to “without a name”) are anger, disappointment, and get relief from a negative emotion; to deal with a exasperation. personal Issue, to create a positive feeling. Fatalistic suicide (excessive regulation) occurs The self-injury is associated with one of when the circumstances under which a person the following: lives become unbearable. A slave, for example, -The individual experienced negative feelings right might choose to commit suicide in order to escape before committing the act. from the horrible nature of his or her existence. -Right before self-injury, the individual was This type of suicide was mentioned only briefly by preoccupied with the planned act Durkheim, who thought that it was extremely -The individual thinks a lot about self injury even if common. act does not take place. Egoistic suicide (diminished integration) occurs Epidemiology when people become relatively detached from -NSSI has a prevalence rate of about 1 to 4 society and when they feel that their existence is percent in the adult population in the United States. meaningless. Egoistic suicide is presumably more Furthermore the extremely severe form of self- common among groups such as people who are injury is seen in about 1 percent of the population. suffering from mental disorders. The predominant Though some research has indicated a lifetime emotions associated with egoistic suicide are prevalence of NSSI being as high as 5.9 percent depression and apathy. and an increased 2.7 percent that have self injured greater than five times. Altruistic suicide (excessive integration) occurs when the rules of the social group dictate that the NSSI is more common among teenagers, with a person must sacrifice his or her own life for the reported 15 percent admitting to some type of self- sake of others. One example is the former practice injury. Furthermore, there is a greater risk for NSSI in some Native American tribes of elderly persons among college students when compared to the voluntarily going off themselves to die after they felt general population, where rates range from 17 to they had become a burden to others. 35 percent. Males and females have comparable NSSI rates, Many NSSI patients use at least 2 different ways to even though men more often report using burning perform self-injury, as high as 69 percent. One and hitting methods, while women report using should also pay close attention regarding when cutting and burning methods. Cutting is the most NSSI greatly increases the risk for suicide. While common form of NSSI, where as much as 70 much concrete data has not been performed percent of NSSI patients, state that they have used concerning this, it is important to gauge how the the cutting form in the past. patient perceives suicide, and life, since this can indicate when self injury increases the risk for Psychiatric Disorders suicidality (Kerr, Muehlenkamp, & Turner, 2010). There is an increased rate of self-injury among the psychiatric populations, where about 2 to 20 Course and Outcome percent reportedly engaged in NSSI (Kerr, Research shows that the normal age of onset for Muehlenkamp, & Turner, 2010). This is especially NSSI is 14 and 24 years of age, with an increase seen among teen psychiatric patients, with high among those between 12 to 14 and those who are prevalence rates of about 40 to 80 percent. Certain 18 to 19 years of age. Over a long period of time, psychiatric disorders are noted for having greater BPD patients tend to have decreased prevalence rates of self-injury. These include Borderline rates of NSSi, from 80 percent to 28 percent, over personality disorder (BPD), dissociative disorders, a 6 year time span. This was also seen with other eating disorders and major depressive disorders. personality disorders, where incidence rates decreased from 16.7 to 1.6 percent. BPD highlights a very high prevalence rate of individuals who commit self-injury, ranging from Defining the changes in about 70 to 75 percent (Kerr, Muehlenkamp, & Turner, 2010). Self-injury is noted to be one of the categorization criteria for establishing a diagnosis of BPD. Much -There have been six revisions since it was first evidence tom research indicates that it is used by published in 1952, the last major revision was BPD patients to experience great relief from ‘DSM-5', published in May 2013, superseding horrible emotions. NSSI is also seen highly in DSM-IV, which was published in 1994 and revised dissociative disorders where as much as 69 in 2000. percent are indicated to have exhibited some self- -Significantly, in DSM-5 there was a significant and injury. controversial change to where OCD was listed. The previous edition of the DSM (DSM-IV) categorized Individuals with eating disorders tend to engage in Obsessive-Compulsive-Disorder (OCD) under NSSI. Research reports prevalence rates of about 'Anxiety Disorders’. However, some experts 26 to 55 percent for individuals that are diagnoses controversially suggested that the revised edition of with bulimia nervosa, while much higher for those the DSM remove OCD from this category and with anoxeria nervosa binge-purge type, about 27 group it with loosely related conditions under the to 61 percent (Kerr, Muehlenkamp, & Turner, heading of 'Obsessive-Compulsive and Related 2010). Disorders', which is what they did indeed do for There appears to be some association between DSM-5 individuals who commit NSSI and major depressive disorder. While data in this area is lacking, Defining Obsessive research has shown that 42 percent of a particular self-injuring sample met the criteria for major Compulsive Disorder depressive disorder (Kerr, Muehlenkamp, & Turner, Obsessive-compulsive disorder (OCD) is a long- 2010). lasting disorder in which a person experiences Suicidal Behavior uncontrollable and recurring thoughts (obsessions), Evidence indicates a strong association that exists engages in repetitive behaviors (compulsions), or between suicidality and self injury. Research states both. that as high as 40 percent of those NSSI patients have dealt with suicidal thoughts while inflicting the injury. Additionally as high as about 50 to 85 percent of NSSI patients have a previous history of at least one suicidal attempt. The association also indicates that as the type of self-injury increases, the severity of suicide also increases. Obsession When confronted with the possibility (or even sometimes the thought) of contamination, people 1. Recurrent and persistent thoughts, urges, or with contamination obsessions often feel impulses that are experienced, at some time during overwhelmed. the disturbance, as intrusive and unwanted, and To feel "pure" or "clean" again, people with that in most individuals cause marked anxiety or contamination-related obsessions may: distress. -Engage in excessive and sometimes ritualized 2. The individual attempts to ignore or suppress hand-washing such thoughts, urges, or images, or to neutralize -Disinfect or sterilize things them with some other thought or action (i.e., by -Throw things away performing a compulsion). -Change clothes frequently -Create clean areas off-limits to others Common Obsession -Avoid certain places or touching things Perfectionism People with perfectionistic obsessions are Causing Harm overwhelmed by fear of making mistakes, Some people with OCD experience obsessions doing something wrong, or leaving things out related to causing harm to themselves or others. of place. Common examples of obsessive fears related to Perfectionistic OCD may involve obsessions with: causing harm include: -Order, symmetry, and organization -Forgetting to turn off household appliances -Neatness -Getting into a car accident -Following specific rules, directions, and routines -Getting someone sick -Feeling that things are "in their place" or "just right -Accidentally dropping a baby -Completing tasks at work or school perfectly Many people with OCD feel an "over-responsibility Relational for harm," meaning that they feel their everyday Relationship-focused obsessions involve actions can cause bad things to happen even when overwhelming doubts and worries about the it's unlikely or impossible. "rightness" of a romantic relationship or partner. People who have obsessive thoughts or worries Discerning Compulsion about a particular romantic partner often have an What is compulsion? intense fear of abandonment. Repetitive behaviors (e.g., hand washing, ordering, People with ROCD may experience symptoms checking) or mental acts (eg , praying, counting, such as: repeating words silently) that the individual feels -Constantly questioning their feelings or their driven to perform in response to an obsession or partner's feelings according to rules that must be applied rigidly. -Wondering if their partner is their soulmate or "the one" The behaviors or mental acts are aimed at -Frequently comparing their current partner to preventing or reducing anxiety or distress, or previous partners preventing some dreaded event or situation; -Preoccupation with their partner's perceived however, these behaviors or mental acts are not moral, emotional, or physical flaws connected in a realistic way with what they are -Worrying that their partner will cheat or leave the designed to neutralize or prevent, are clearly relationship excessive. Contamination Note: Contamination obsessions may involve fears of A.Young children may not be abe to articulate the physical contamination (such as with dirt, bacteria, aims of these behaviors or mental acts. germs, chemicals, or illness) or moral B.The obsessions or compulsions are time- contamination (such as with a person, place, or consuming (e.g., take ore than one hour per day) idea that is perceived as "bad" or distasteful). or cause clinically significant distress or impairment in social, occupational or other areas of functioning. C. The obsessive compulsions symptoms are not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or other medical condition.  D. The disturbance is not better explained by the Development and Course symptoms of another mental disorder (e.g., In the United States, the mean age at onset of excessive worries, as in generalized anxiety OCD is 19.5 years, and 25% of cases start by age disorder; preoccupation with appearance, as in 14 years. Onset after age 35 years is unusual but body dysmorphic disorder, difficulty discarding or does occur. Males have an earlier age at onset parting with possessions, as in hoarding disorder; than females: neary 25% of males have onset hair pulling, as in trichotillomania [hair-pulling before age 10 years. The onset of symptoms is disorder]; skin picking, as in excoriation [skin- typically gradual; however, acute onset has also picking] disorder; stereotypies, as in stereotypic beon reported. movement [skin-picking] preoccupation with substances or gambling as in substance-related If OCD is untreated, the course is usually chronic, and addictive disorders; preoccupation with having often with waxing and waning symptoms. Some an illness, as in illness anxiety disorder, sexual individuals have an episodic course, and a minority urges or fantasies, as in paraphilic disorders; have a deteriorating course. Without treatment, impulses, as in disruptive, impulse-control, and remission rates in adults are low 20% for those conduct disorders; guilty ruminations, as in major reevaluated 40 years later). Onset in childhood or depressive disorder; thought insertion or delusional adolescence can lead to a lifetime of OCD. preoccupations, as in schizophrenia spectrum and However, 40% of individuals with onset of OCD in other psychotic disorders; or repetitive patterns of childhood or adolescence may experience behavior, as in autism spectrum disorder). remission by early adulthood, Th course of OCD is often complicated by the co-occurrence of other Specify if: disorders. With good or fair insight: The Individual recognizes that obsessive-compulsive disorder Compulsions are more easily diagnosed in children beliefs are definitely or probably not true or that than obsessions are because compulsions are they may or may not be true. observable. However, most children have both obsessions and compulsions (as do most adults). With poor insight: The individual thinks The pattern of symptoms in adults can be stable obsessive-compulsive disorder beliefs are probably over time, but it is more variable in children. Some true. differences in the content of obsessions and compulsions have been reported when children With absent insight/delusional beliefs: The and adolescent samples have been compared with individual is completely convinced that obsessive- adult samples. These differences likely reflect compulsive disorder beliefs are true. content appropriate to different develop mental stages (e.g., higher rates of sexual and religious Specify further If: obsessions in adolescents than in children; higher Tic-related: The individual has a current or past rates of harm obsessions [e.g., fears of history of a tic disorder. catastrophic events, such as death or illness to self or loved ones] in children and adolescents than in Specifiers adults). Individuals with OCD vary in the degree of insight they have about the accuracy of the beliefs that Risk and Prognostic Factors underlie their obsessive-compulsive symptoms. Temperamental. Greater internalizing symptoms, Many individuals have good or fair insight (e.g., the higher negative emotionality, and behavioral individual believes that the house definitely will not, inhibition in childhood are possible temperamental probably will not, or may or may not burn down if risk factors. the stove is not checked 30 times. Environmental. Physical and sexual abuse in Some have poor insight (e.g, the individual childhood and other stressful or traumatic events believes that the house will probably burn down if have been associated with an increased risk for the stove is not checked 30 times), and a few (4% developine OCD. Some children may develop the or absent insight/delusional beliefs (e.g., the sudden onset of obsessive-compulsive symptoms, individual is convinced that the house will burn which has been associated with different down if the stove is not checked 30 times). Insight environmental factors including various infectious can vary within an individual over the course of the agents and a post-infectious autoimmune illness. Poorer insight has been linker to worse syndrome. long-term outcome. Genetic and physiological. The rate of OCD Defining Schizophrenia among first-degree relatives of adults with OCD is Schizophrenia is a severe form of abnormal approximately two times that among first-degree behavior that encompasses what most of us have relatives of those without the disorder; however, come to know as "madness." among first-degree relatives, individuals with onset People with schizophrenia exhibit many different of OCD in childhood or adolescence, the rate kinds of psychotic symptoms, indicating that they increased 10-fold. Familial transmission is due in have lost touch with reality. They may hear voices part to genetic factors (e.g., concordance rate of that aren't there or make comments that are 0.57 for monozygotic vs. 0.22 for dizygotic twins). difficult, if not impossible, to understand. The Dysfunction in the orbitofrontal cortex, anterior behavior may be guided by absurd ideas and cingulate cortex, and striatum have been most beliefs. strongly implicated. A. Two (or more) of the following, each present for Comorbidity a significant portion of time during a 1-month period Individuals with OCD often have other (or less if successfully treated). At least one of psychopathology. Many adults with the disorder these must be (1), (2), or (3): have a lifetime diagnosis of an anxiety disorder 1. delusions (76%; e.g., panic disorder, social anxiety disorder, 2.hallucinations generalized anxiety-disorder, specific phobia) or a 3.disorganized speech (e.g., frequent derailment or depressive or bipolar disorder (63% for any incoherence) depressive or bipolar disorder, with the most 4.grossly disorganized or catatonic behavior common being major depressive disorder [41%). 5.Negative symptoms (i.e., diminished emotional Onset of OCD is usually later than for most expression or avolition). comorbid anxiety disorders (with the exception of separation anxiety disorder) and PTSD but often Delusions precedes that of depressive disorders. Comorbid People with schizophrenia may also experience obsessive-compulsive personality disorder is also delusions-incorrect beliefs that persist, despite common in individuals with OCD (eg., ranging, evidence to the contrary. Delusions often focus on from 23% to 32%). a particular theme, and several types of themes are common among these patients. Up to 30% of individuals with OCD also have a -paranoid delusions involve the theme of being lifetime tic disorder. A comorbid tic disorder is most persecuted by others. common in males with onset of OCD in childhood. -delusions of control revolve around the belief that These individuals tend to differ from those without the person is being controlled by other people (or a history of tic disorders in the themes of their OCD aliens) symptoms, comorbidity, course, and patter of -delusions of grandeur is believing oneself to be familial transmission. A triad of OCD, tic disorder, significantly more powerful, knowledgeable, or and attention-deficit/hyperactivity disorder can also capable than is actually the case, referred to as seen in children. -delusions of reference: the belief that external events have special meaning for the individual. Disorders that occur more frequently in individuals with OCD than in those without the disolder include several obsessive-compulsive and related Hallucinations disorders such as body dysmorphic disorder, hallucinations are sensations so vivid that the trichotillomania (hair-pulling disorder), and perceived objects or events seem real even though excoriation (skin-picking) disorder. Finally, an they are not. Any of the five senses can be association between OCD and some disorders involved in a hallucination, although auditory characterized by impulsivity, such as oppositional hallucinations-specifically, hearing voices-are the defiant disorder has been reported. most common type experienced by people with schizophrenia. Disorganized Thinking (Speech) B. For a significant portion of the time since the onset of the disturbance, level of functioning in one People with schizophrenia can sometimes speak or more major areas, such as work, interpersonal incoherently, although they may not necessarily be relations, or self-care, is markedly below the level aware that other people cannot understand what achieved prior to the onset (of when the onset is in they are saying. childhood or adolescence, there is failure to Effective communication can be impaired, and achieve expected level of interpersonal, academic, answers to questions may be partially or or occupational functioning). completely unrelated. Rarely, speech may include putting together meaningless words that can't be C. Duration: Continuous signs of the disturbance understood, sometimes known as word salad. persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less Disorganized Behavior if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods -Disorganized, behavior, behavior that is so of prodromal or residual symptoms. unfocused and disconnected from a goal that the During these prodromal or residual periods, the person cannot successfully accomplish a basic signs of the disturbance may be manifested by only task, or the behavior is inappropriate in the negative symptoms or two or more symptoms listed situation. in Criterion A present in an attenuated for (e.g., odd -Disorganized behavior can range from laughing beliefs, unusual perceptual experiences). inappropriately in response to a serious matter or masturbating in front of others, to being unable to D. Schizoaffective disorder and depressive or perform normal daily tasks such as washing bipolar disorder with psychotic features have been oneself, putting together a simple meal, or even ruled out because either (1) no major depressive or selecting appropriate clothes to wear. manic episodes have occurred concurrently with the active-phase symptoms, or (2) if mood Negative Symptoms episodes have occurred during active-phase symptoms, they have been present for a minority of Flat Affect: Muted Expression the total duration of the active and residual periods Some people with schizophrenia exhibit flat affect, of the illness. which accurs when a person does not display a great range of emotion and hence often seems E. The disturbance is not attributable to the emotionally neutral. physiological effects of a substance (e.g., a drug of Such people may not express or convey much abuse, a medication) or another medical condition. information through their facial expressions or body language, and they tend to refrain from making eye contact (although they may smile somewhat and do Personality Disorder not necessarily come off as "Cold". Personality disorders in general are pervasive, enduring patterns of thinking, perceiving, reacting, Alogia: Poverty of Speech and relating that cause significant distress or People with schizophrenia who have alogia, or functional impairment. Personality disorders vary poverty of speech, may respond slowly or significantly in their manifestations, but all are minimally to questions and generally speak less believed to be caused by a combination of genetic than do most other people. and environmental factors. Many gradually become A person with alogia will take a while to muster the less severe with age, but certain traits may persist mental effort necessary to respond to a question. to some degree after the acute symptoms that Even choosing among words can be challenging. prompted the diagnosis of a disorder abate. Diagnosis is based on clinical criteria. Treatment is Avolition: Difficully initiating or with psychosocial therapies and sometimes with following through medications. Avolition, the term for difficulty in initiating or following through with activities, hospitalized patients are often shown sitting in chairs apparently doing nothing all day, not even talking to others. Personality disorders exist when these traits D. The impairments in personality functioning and become so pronounced, rigid, and maladaptive that the individuals personality trait expression are not they impair work and/or interpersonal functioning. better understood as normative for the individual's These social maladaptations can cause significant developmental stage or sociocultural environment. distress in people with personality disorders and in E. The impairments in personality functioning and those around them. the individuals personality trait expression are not solely due to the direct physiological effects of a Personality disorders usually start to become substance (eg., a drug.of abuse, medication) or a evident during late adolescence or early adulthood, general medical condition (e.g., severe head although sometimes signs are apparent earlier trauma). (during childhood). Traits and symptoms vary Types of Personality Disorders considerably in how long they persist; many resolve with time. Antisocial Personality Disorder The Diagnostic and Statistical Manual of Mental The essential features of a personality disorder are Disorders, 5th ed, Text Revision (DSM-5-TR) lists impairments in personality (self and interpersonal) 10 types of personality disorders, although most functioning and the presence of pathological patients who meet criteria for one type also meet personality traits. To diagnose antisocial personality criteria for one or more others. Some types (eg, disorder, the following criteria must be met: antisocial, borderline) tend to lessen or resolve as Significant impairments in personality functioning people age; others (eg, obsessive-compulsive, manifest by: schizotypal) are less likely to do so. 1. Impairments in self functioning (a or b): a. Identity: Ego-centrism; self-esteem derived from About 9% of the general population (1) and up to personal gain, power, or pleasure. half of psychiatric patients in hospital units and b. Self-direction: Goal-setting based on personal clinics have a personality disorder (2). gratification; absence of prosocial internal Overall, there are no clear distinctions in terms of standards associated with failure to conform to sex, socioeconomic class, and race. However, for lawful or culturally normative ethical behavior. antisocial personality disorder, males outnumber females 3:1 (3). In borderline personality disorder, and females outnumber males 3:1 (but only in clinical settings, not in the general population) (4). 2. Impairments in interpersonal functioning (a or b): a. Empathy: Lack of concern for feelings, needs, or For most personality disorders, levels of heritability suffering of others; lack of remorse after hurting or are about 50%, which is similar to or higher than mistreating another. that of many other major psychiatric disorders. b. Intimacy: Incapacity for mutually intimate This degree of heritability argues against the relationships, as exploitation is a primary means of common assumption that personality disorders are relating to others, including by deceit and coercion; character flaws primarily shaped by an adverse use of dominance or intimidation to control others. environment. General Criteria for B. Pathological personality traits in the following domains: Personality Disorder 1. Antagonism, characterized by: The essential features of a personality disorder are Manipulativeness: Frequent use of subterfuge to impairments in personality (self and interpersonal) influence or control others; use of seduction, functioning and the presence of pathological charm, glibness, or ingratiation to achieve one's personality traits. To diagnose a personality ends. disorder, the following criteria must be met: Deceitfulness: Dishonesty and fraudulence; a. Significant impairments in self (identity or self- misrepresentation of self; embellishment or direction) and interpersonal (empathy or intimacy) fabrication when relating events. functioning. Callousness: Lack of concern for feelings or b. One or more pathological personality trait problems of others; lack of guilt or remorse about domains or trait facets. the negative or harmful effects of one's actions on C. The impairments in personality functioning and others; aggression; sadism. the individual's personality trait expression are Hostility: Persistent or frequent angry feelings; relatively stable across time and consistent across anger or irritability in response to minor slights and situations. - insults; mean, nasty, or vengeful behavior. 2. Disinhibition, characterized by: 2. Impairments in interpersonal functioning (a or b): Irresponsibility: Disregard for - and failure to honor Empathy: Preoccupation with, and sensitivity to, - financial and other obligations or commitments; criticism or rejection, associated with distorted lack of respect for - and lack of follow through on - inference of others' perspectives as negative. agreements and promises. Intimacy: Reluctance to get involved with people Impulsivity: Acting on the spur of the moment in unless being certain of being liked; diminished response to immediate stimuli; acting on a mutuality within intimate relationships because of momentary basis without a plan or consideration of fear of being shamed or ridiculed outcomes; difficulty establishing and following plans. B. Pathological personality traits in the Risk taking: Engagement in dangerous, risky, and following domains: potentially self-damaging activities, unnecessarily 1. Detachment, characterized by: and without regard for consequences; boredom Withdrawal: Reticence in social situations; proneness and thoughtless initiation of activities to avoidance of social contacts and activity; lack of counter boredom; lack of concern for one's initiation of social contact. limitations and denial of the reality of personal Intimacy avoidance: Avoidance of close or romantic danger relationships, interpersonal attachments, and intimate sexual relationships. c. The impairments in personality functioning and Anhedonia: Lack of enjoyment from, engagement the individuals personality trait expression are in, or energy for life's experiences; deficits in the relatively stable across time and consistent across capacity to feel pleasure or take interest in things. situations. 2. Negative Affectivity, characterized by: d. The impairments in personality functioning and a. Anxiousness: Intense feelings of nervousness, the individual's personality trait expression are not tenseness, or panic, often in reaction to social better understood as normative for the individual's situations; worry about the negative effects of past developmental stage or sociocultural environment. unpleasant experiences and future negative E. The impairments in personality functioning and possibilities; feeling fearful, apprehensive, or the individuals personality trait expression are not threatened by uncertainty; fears of embarrassment. solely due to the direct physiological effects of a c. The impairments in personality functioning and substance (e.g., a drug of abuse, medication) or a the individual's personality trait expression are general medical condition (eg., severe head relatively stable across time and consistent across trauma). situations. F. The individual is at least age 18 years. D. The impairments in personality functioning and the individual's personality trait expression are not Avoidant Personality Disorder better understood as normative for the individual's developmental stage or socio-cultural environment. The essential features of a personality disorder are E. The impairments in personality functioning and impairments in personality (self and interpersonal) the individual's personality trait expression are not functioning and the presence of pathological solely due to the direct physiological effects of a personality traits. To diagnose avoidant personality substance (e.g., a drug of abuse, medication) or a disorder, the following criteria must be met: general medical condition (e.g., severe head A. Significant impairments in personality trauma). functioning manifest by: 1. Impairments in self functioning (a or b): Borderline Personality Disorder Identity: Low self-esteem associated with self- appraisal socially inept, personally unappealing, or The essential features of a personality disorder are inferior, excessive feelings of shame or impairments in personality (self and interpersonal) inadequacy. functioning and the presence of pathological Self direction: Unrealistic standards for behavior personality traits. To diagnose borderline associated with reluctance to pursue goals, take personality disorder, the following criteria must be personal risks, or engage in new activities involving met: interpersonal contact. Z And A. Significant impairments in personality 2. Disinhibition, characterized by: functioning manifest by: Impulsivity: Acting on the spur of the moment in 1. Impairments in self functioning (a or b): response to immediate stimuli; acting on a Identity: Markedly impoverished, poorly developed, momentary basis without a plan or consideration of or unstable self-image, often associated with outcomes; difficulty establishing or following plans; excessive self-critcism; chronic feelings of a sense of urgency and self-harming behavior emptiness; dissociative states under stress. under emotional distress. Self-direction: Instability in goals, aspirations, Risk taking: Engagement in dangerous, risky, and values, or career plans. potentially self-damaging activities, unnecessarily and without regard to consequences; lack of and concern for one's limitations and denial of the reality of personal danger. 2. Impairments in interpersonal functioning (a or b): 3. Antagonism, characterized by: Empathy: Compromised ability to recognize the a. Hostility: Persistent or frequent angry feelings; feelings and needs of others associated with anger or irritability in response to minor slights and interpersonal hypersensitivity (i.e., prone to feel insults. slighted or insulted); perceptions of others selectively biased toward negative attributes or Narcissistic Personality Disorder vulnerabilities. Intimacy: Intense, unstable, and conflicted close The essential features of a personality disorder are relationships, marked by mistrust, neediness, and impairments in personality (self and interpersonal) anxious preoccupation with real or imagined functioning and the presence of pathological abandonment; close relationships often viewed in personality traits. extremes of idealization and devaluation and To diagnose narcissistic personality disorder, the alternating between over involvement and following criteria must be met. withdrawal. Significant impairments in personality functioning manifest by: B. Pathological personality traits in the 1. Impairments in self functioning (a or b): following domains: Identity: Excessive reference to others for self- 1. Negative Affectivity, characterized by: definition and self-esteem regulation; exaggerated a. Emotional liability:Unstable emotional self-appraisal may be inflated or deflated, or experiences and frequent mood changes; emotions vacillate between extremes; emotional regulation that are easily aroused, intense, and/or out of mirrors fluctuations in self-esteem. proportion to events and circumstances. Anxiousness: Intense feelings of nervousness, Self direction: Goal-setting is based on gaining tenseness, or panic, often in reaction to approval from others; personal standards are interpersonal stresses; worry about the negative unreasonably high in order to see oneself as effects of past unpleasant experiences and future exceptional, or too low based on a sense of negative possibilities; feeling fearful, apprehensive, entitlement; often unaware of own motivations. or threatened by uncertainty; fears of falling apart or losing control. 2. Impairments in interpersonal functioning (a or b): Separation insecurity: Fears of rejection by - and/or Empathy: Impaired ability to recognize or identify separation from - significant others, associated with with the feelings and needs of others; excessively fears of excessive dependency and complete loss attuned to reactions of others, but only if perceived of autonomy. as relevant to self; over- or underestimate of own Depressivity: Frequent feelings of being down, effect on others. miserable, and/or hopeless; difficulty recovering from such moods: pessimism about the tuture; Intimacy: Relationships largely superficial and exist pervasive shame; reeling of inferior sell-worth; to serve self-esteem regulation; mutuality thoughts of suicide and suicidal behavior. constrained by little genuine interest in others" experiences and predominance of a need for personal gain B. Pathological personality traits in the B. Cognitive and perceptual dysregulation: Odd or following domain: unusual thought vague, circumstantial, 1. Antagonism, characterized by: metaphorical, over-elaborate, or stereotyped Grandiosity: Feelings of entitlement, either overt or thought or speech; odd sensations in various covert; self-centeredness; firmly holding to the sensory modalities. belief that one is better than others; condescending c. Unusual beliefs and experiences: toward others. Thought content and views of reality that are Attention seeking: Excessive attempts to attract viewed by others as bizarre or idiosyncratic; and be the focus of the attention of others; unusual experiences of reality admiration seeking. C. The impairments in personality functioning and 2. Detachment, characterized by: the individual's personality trait expression are Restricted affectivity: Little reaction to emotionally relatively stable across time and consistent across arousing situations; constricted emotional situations. experience and expression; indifference or D. The impairments in personality functioning and coldness. the individual's personality trait expression are not Withdrawal: Preference for being alone to being better understood as normative for the individual's with others; reticence in social situations; developmental stage or sociocultural environment. avoidance of social contacts and activity; lack of E. The impairments in personality functioning and initiation of social contact. the individual's personality trait expression are not Negative Affectivity, characterized by: solely due to the direct physiological effects of a a. Suspiciousness: Expectations of - and substance (e.g., a drug of abuse, medication) or a heightened sensitivity to - signs of interpersonal ill- general medical condition (e.g, severe head intent or harm; doubts about loyalty and fidelity of trauma). others; feelings of persecution. Schizotypal Personality Disorder Personality Disorder Trait Specified The essential features of a personality disorder are The essential features of a personality disorder are impairments in personality self and interpersonal) impairments in personality (self and interpersonal) functioning and the presence of pathological functioning and the presence of pathological personality traits. personality traits. To diagnose a personality disorder, the following To diagnose schizotypal personality disorder, the criteria met: following criteria must be met A. Significant impairments (ie., mild impairment or Significant impairments in personality functioning greater) in self (identity or self-direction) and manifest by: interpersonal (empathy or intimacy) functioning. 1. Impairments in self functioning: Identity: Confused boundaries between self and B. One or more pathological personality trait others; distorted sell-concept; emotional expression domains OR specific trait facets within domains, often not congruent with context or internal considering ALL of the following domains. experience. Negative Affectivity Self-direction: Unrealistic or incoherent goals; no Detachment clear set of internal standards. Antagonism Disinhibition vs. Compulsivity 2. Impairments in interpersonal functioning: Psychoticism A. Empathy: Pronounced difficulty understanding impact of own behaviors on others; frequent NOTE: Trait domain or one or more trait facets misinterpretations of others motivations and MUST be rated as "mildly descriptive or greater. If behaviors. trait domain is rated as "mildly descriptive" then B.Intimacy: Marked impairments in developing one or more of the associated trait facets MUST be close relationships, associated with mistrust rated as "moderately descriptive" or greater. and anxiety. The impairments in personality functioning and the individual's personality trait expression are B. Pathological personality traits in the relatively stable across time and consistent across following domains: situations. a. Psychoticism, characterized by Eccentricity: Odd, unusual, or bizarre behavior or appearance; saying unusual or inappropriate things. c. The impairments in personality functioning and Name Change from Paraphilia to the individual's personality trait expression are relatively stable across time and consistent across Paraphilic Disorder situations. The term paraphilia was first introduced into DSM- d. The impairments in personality functioning and Ill to replace the DSM-ll term sexual deviation the individuals personality trait expression are not "because it correctly emphasizes that the deviation better understood as normative for the individual's (para-) lies in that to which the person Is attracted developmental stage or socio-cultural environment. (philla)". Although paraphilia has been used to refer e. The impairments in personality functioning and to disorders of atypical sexual arousal up through the individual's personality trait expression are not DSM-IV-TR, no term was available in DSM-IV-TR solely due to the direct physiological effects of a to indicate non pathological, atypical sexual substance (e.., a drug of abuse, medication or a interests. general medical condition (eg, severe head trauma) In contrast, DSM-5 redefines the term paraphilia so that it now refers to a persistent, Intense, atypical Clustering of Personality Disorder sexual arousal pattern, independent of whether it causes any distress or impairment,which, by itself, Cluster A is characterized by appearing odd and would not be considered disordered. eccentric. It includes the following personality disorders with their distinguishing features: The term "disorder" was specifically added to DSM-5 to indicate a paraphilia that is causing Paranoid: Mistrust and suspicion distress or impairment to the individual or a Schizoid: Disinterested in others paraphilia whereby satisfaction entailed personal Schizotypal: Eccentric ideas and behavior harm, or risk of harm, to others. This distinction was made in an effort to identify those sexual Cluster B is characterized by appearing dramatic, behaviors and interests that are of clinical emotional, or erratic. it includes the following significance personality disorders with their distinguishing features: With the change in nomenclature, some sexual behaviors may be classied as paraphilic but not Antisocial: Social irresponsibility, disregard for disordered. In other words, some sexual behaviors others deceitfulness, and manipulation of others for may be outside normophilic interests but of no personal gain clinical significance Borderline: Inner emptiness, unstable relationships, and emotional dysregulation Other significant changes to the paraphilias include Histrionic: Attention seeking and excessive the addition of specifiers to indicate the current emotionality status of the paraphilic interests and the grouping Narcissistic: Self-grandiostty, need for admiration, of disorders into classification schemes. and lack of empathy The first group of disorders is classified as anomalous activity preferences. These anomalous Cluster C is characterized by appearing anxious or activity preferences are subdivided into courtship fearful. It includes the following personality disorders, voyeuristic disorder, exhibitionistic disorders with their distinguishing features: disorder, frotteuristic disorder, and algolagnic Avoidant: Avoidance of interpersonal contact due disorders, which involve pain and suffering (sexual to rejection sensitivity masochism disorder and sexual sadism disorder). Dependent: Submissiveness and a need to be taken care of The second group of disorders is classified as Obsessive-compulsive: Perfectionism, rigidity, anomalous target preferences, which include and obstinacy pedophilic disorder, fetishistic disorder, and transvestic disorder. Paraphilia not otherwise specified has been replaced with specified paraphilic disorder and unspecified paraphilic disorder. The specifier "in a controlled environment is used to refer to individuals living in institutional or other settings in which the object of sexual gratification is restricted. The specifier "in full remission" refers to the 1. Anxiety or early emotional trauma interferes with absence of distress or impairment in social, normal psychosexual development. occupational, or other areas of function for at least 2. The standard pattern of arousal is replaced by 5 years. another pattern, sometimes through early exposure to highly charged sexual experiences that reinforce Two new paraphilic disorders, paraphilic coercive the person's unusual experience of sexual disorder and hypersexual disorder, and one pleasure. revision, pedophilic disorder to pedohebephilic 3. The pattern of sexual arousal often acquires disorder, were considered for inclusion in DSM-5. symbolic and conditioning elements (e.g., a fetish Paraphilic coercive disorder refers to a diagnostic symbolizes the object of arousal but may have category based on sexual arousal to coercion or been chosen because the fetish was accidentally non-consenting sexual behavior. associated with sexual curiosity, desire, and excitement). Hypersexual disorder refers to an excessive level of sexual behavior or preoccupation that results in 8 Specified Paraphilic Disorder clinically significant impairment in functioning. Pedohebophilic disorder was coined to refer to 1. Fetishism Disorder sexual attraction to peripubescent children. With fetishism, a person has recurrent and intense sexual arousal from inanimate objects ог non- Paraphilic disorders are recurrent, intense, sexually genital body parts. Fetishism can be harmless. arousing fantasies, urges, or behaviors that are It's only classified as a disorder when it causes distressing disabling and that involve inanimate significant distress or causes some form of harm objects, children or nonconsenting adults, or and occurs for at least six months. Some common suffering or humiliation of the person or a partner, fetishes include undergarments, feet, rubber and with the potential to cause harm. leather items. Paraphilias involve sexual arousal to atypical 2. Frotteuristic Disorder objects, situations, and/or targets (eg, children, A person with frotteurism is excited by touching or corpses, animals). However, some paraphilias that rubbing their genitals against another's in a sexual seem unusual to another person, do not rise to the manner without the other person's consent. It's a level of a paraphilic disorder simply because they rare type of paraphilia, and much research still are unusual. People may have paraphilic interests needs to be done to understand it. but not meet the criteria for a paraphilic disorder. According to the DSM-5, for a person to be diagnosed with frotteuristic disorder, they must have The unconventional sexual arousal patterns in experienced an intense and recurrent urge to rub paraphilias are considered pathologic disorders their genitals against a non-consenting party to only when both of the following apply: achieve sexual gratification for at least six months. This must have caused significant distress or They are intense and persistent. impairment, or the individual must have acted upon They cause significant distress or impairment in this urge. social, occupational, or other important areas of functioning, or they harm or have the potential to 3.Sexual Sadism Disorder harm others (e.g., children, nonconsenting adults). Sexual sadism involves inflicting physical or psychological pain on another person to achieve People with a paraphilic disorder may have an sexual gratification. It's important to distinguish impaired or a nonexistent capacity for affectionate, between sexual sadism disorder, a paraphilic reciprocal emotional and sexual intimacy with a disorder, and sadistic sexual behavior, which is not. consenting partner. Other aspects of personal and It's normal for mild sadistic sexual behavior to occur emotional adjustment may be impaired as well. between two adults who consent. With sexual sadism disorder, for at least six months The pattern of disturbed erotic arousal is usually the sadistic sexual urges cause significant distress, fairly well developed before puberty. At least 3 impairment or the individual has acted on these processes may be involved: urges with a non-consenting person. 4. Exhibitionistic Disorder Template for Paraphilias nvolving People with an exhibitionistic disorder experience recurrent and intense arousal from the exposure of Non-consenting Victims (i.e., their genital to an unsuspecting person. They may Voyeurism, Exhibitionism, become distressed and unable to function properly due to their urges or have acted on these urges Frotteurism, Sexual Sadism) except with a non-consenting person. On the other hand, exhibitionism isn’t a paraphilic Pedophilia disorder, which is simply the desire to expose your A. Over a period of at least 6 months, recurrent genitalia to a consenting party for the purpose of intense sexually arousing fantasies, sexual urges, sexual arousal. or behaviors... 5. Pedophilic Disorder involving the act of observing an unsuspecting Pedophilia is sexual attraction to children. person who is naked, in the process of disrobing, According to the DSM-5, a person with pedophilic or engaging in sexual activity [Voyeurism]. disorder must have felt intense and recurrent sexual urges, behaviors, and fantasies toward involving the exposure of one's genitals to an prepubescent children for at least six months. unsuspecting person [Exhibitionism] A vital component of the condition is that it must bring significant distress or impairment to a person involving touching or rubbing against a with it. It's important to note that acting on sexual nonconsenting person (Frotteurism] attraction to children is a crime. involving acts (real, not simulated) in which the 6. Sexual Masochism Disorder psychological or physical suffering (including Sexual masochism may be seen as the flip side of humiliation) of the victim is sexually exciting to the sexual sadism. With sexual masochism, being person [Sexual Sadism] beaten, humiliated, or abused will bring sexual excitement and gratification. B. The person has acted on these sexual urges, or Asphyxiophilia, a desire to have your breathing the sexual urges or fantasies cause marked restricted during sexual activity, is sometimes distress or interpersonal difficulties. considered a subtype of sexual masochism. 7. Voyeuristic Disorder Template for Paraphilic Disorders Voyeuristic disorder causes a person to have not involving Non-consenting intense and recurrent urges to watch a non- consenting person engage in sexual activity. Victims (including Sexual Voyeuristic disorder causes significant distress and Masochism, Fetishistic Disorder, and can limit a person's ability to function. Voyeuristic disorder is more common amongst men Transvestic Disorder) than women. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, 8. Transvestic Disorder or behaviors... A person who is sexually aroused by cross-... involving the act (real, not simulated) of being dressing may have transvestic disorder. For it to be humiliated, beaten, bound, or otherwise made to regarded as a disorder, the urges or behaviors suffer [Sexual Masochism] must have been recurrent, intense, and present for at least six months. involving the use of nonliving objects (e.g., female While people who cross-dress do not necessarily undergarments) [Fetishism] have a disorder, a person with transvestic disorder experiences significant distress or impaired.. involving cross-dressing in a heterosexual male functioning. [Transvestic Fetishism]. B.The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Template for Pedophilia A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger). B. The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty. C. The person is at least age 16 years and at least 5 years older than the child or children in Criterion A. Note: do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12-or 13-year-old. Specify type: Exclusive type (attracted only to children) Nonexclusive type Specify if: Sexually attracted to males Sexually attracted to females Sexually attracted to both Specify if: Limited to incest