Sexual Disorders PDF

SEXUAL DISORDERS Heteronormativity= idea/belief that everyone is heterosexual and that being straight is "ideal" and "normal", while everyone else is not. Sexuality and women: criticized because DSM reflects the Masters &Johnson model of sexual response== it reflects male's experience better than...

SEXUAL DISORDERS Heteronormativity= idea/belief that everyone is heterosexual and that being straight is "ideal" and "normal", while everyone else is not. Sexuality and women: criticized because DSM reflects the Masters &Johnson model of sexual response== it reflects male's experience better than females (not even) Spontaneous Desire (men)---can be aroused even w/o cues. Responsive Desire (women)\-\-- aroused when there are cues. Sexual Disorders: I. SEXUAL DYSFUNCTION Problem with sexual response== difficult to enjoy intercourse distressing sexual frustration, guilt, loss, of self esteem 30% men; 43% women Sexual response cycles: (affected by sexual dysfnx) - Desire= interest/urge to have sex, attract others + fantasies - Excitement= change in physical response: erection + lubrication/swelling of vagina/clitoris - Orgasm= pleasure is at peak---ejaculation and vaginal wall contraction - Resolution= relaxation and reduction in arousal a. Disorders of Desire +-----------------------------------+-----------------------------------+ | **Male Hypoactive Sexual Desire | **Female Sexual Interest/Arousal | | Disorder** | Disorder** | +===================================+===================================+ | Few or no sexual thoughts, | desire & arousal overlap for | | fantasies, or desires | women (cannot djjistinguish both) | | | | | == distress | persistent reduction/lack of | | | interest in sex | | 10-15% WW | | | | == low excitement during | | | intercourse + unaroused + low | | | genital & nongenital sensations | | | | | | 26-43% WW but only 1/3 feel | | | distressed abt it | +-----------------------------------+-----------------------------------+ | WHY IS THERE LOW SEX DRIVE: | | | | | | biologically | | | | | | = High prolactin+ low | | | testosterone+ high/low estrogen | | | (either from birth control, | | | menopause, post labor) | | | | | | = pain meds, psychotic drugs, and | | | illegal drugs | | | | | | = long term physical illness | | | | | | Psychologically | | | | | | = anxiety, depression, anger | | | | | | = attitudes, fears, memories from | | | trauma, beliefs (sex is immoral) | | | | | | = preexisting psychological | | | disorders | | | | | | Sociocultural | | | | | | = situational pressures (divorce, | | | death, job stress, | | | infertility...) | | | | | | = "Double standard" on | | | men---cannot feel sexual desire | | | for women they love and respect | | | | | | = increase in age---lower sexual | | | interest. | | +-----------------------------------+-----------------------------------+ | MOST DIFFICULT TO TREAT due to | | | many issues | | | | | | 1\. Affectual | | | awareness---visualizing sex | | | scenes to figure out where the | | | anxiety/negative | | | thoughts/feelings come from | | | | | | 2\. cognitive self- instruction | | | training---try to change | | | negative reactions w coping | | | statements | | | | | | 3\. medication---hormone | | | treatments | | +-----------------------------------+-----------------------------------+ b. Disorders of excitement == increase \ | | | | - TX: | | | | using dilator regularly= increases size of vaginal muscles | | | | practice tightening and relaxing vaginal muscles= more control | | | | - Dyspareunia -- pelvic or vaginal pain during sex, usually | | physical cause like injury and episiotomy. | | | | | | | | - TX: | | | | via team of professionals either by medical interventions, pain | | mngmnt techniques, or working around sex positions. | +-----------------------------------------------------------------------+ GENERAL TREATMENT: 1\. Sensate Focus: partners caress e/o everywhere except genitals to eliminate performance anxiety== learn to focus on pleasure not orgasm II\. PARAPHILIC DISORDER Paraphilia- kink/bdsm---recurrent sexual urges, fantasies, or behaviors inv. Nonhuman objects, children, or nonconsenting adults (atleast 6 months)== only with stimulus **Paraphilic Disorders**---when paraphilias cause distress, impairment, or harm to self and/or others. starts in adolescence---must indicate desire, not just behavior TX to PD: = **Aversion therapy**---pair sexually desired object w shock = **Covert sensitizatio**n---type of aversion therapy\-\-- imagine pleasure object + imagine aversive stimulus = **masturbatory satiation**---induce boredom by imagining arousal stimulus right after orgasm = Orgasmic Reorientation---switch between imagining paraphilic object and app obj while masturbating = SSRIs to reduce compulsive behaviors = Anti Androgens---low prod of Testosteron low sex drive PARAPHILIC DISORDERS--- in a form of fantasy, urge, or behavior\-\--must cause distress/impairment to dx +-----------------------------------+-----------------------------------+ | a**.) Fetishistic=** nonhuman | b.) **Transvestic**= sexual | | objects, nongenital body parts | arousal from dressing in clothes | | like feet, shoes, underwear | of other gender (used to be men | | distress/ impairment. | then dress up as women). == | | | starts childhood/adolescence | | WHY: | | | | == NOT the same as transgender | | Psychodynamic\-- avoid anxiety | (sense of self) | | from normal sexual contact | | | | WHY: | | CBT---classical conditioning | | | | CBT: classical condt | | TX: | | | | | | = **Aversion therapy** | | | | | | = **Covert sensitization** | | | | | | = **masturbatory satiation** | | +===================================+===================================+ | c.) **Exhibitionistic**= expose | d.) **Voyeuristic**= observe | | genitals to unsuspecting | unsuspecting individuals naked/ | | individual---aroused by shocked/ | disrobing/ engaging in sexual | | surprised resp. | activity | | | | | \-- often have doubts/fears abt | = enjoys the thought of person | | masculinity + strong bond w | getting humiliated if found out | | possessive mother | they were being observed | | | | | TX: aversion therapy, | WHY: | | masturbatory satiation, social | | | skill training, etc | Psychodynamic: gain power bc they | | | normally feel inferior | | | | | | CBT: learned behavior | +-----------------------------------+-----------------------------------+ | e.) **Frotteuristic**= touching/ | f.) **pedophilic**== feels | | rubbing against nonconsenting | greater sexual arousal towards | | indv | prepubescent/ early pubescent | | | children than from older ppl. | | = starts at teen but eventually | | | cease as they get older. | = not all child molesters are | | | pedos---the act is the problem | | | not the desire | | | | | | WHY: | | | | | | bio: abn activity in amygdala | | | | | | TX: | | | | | | same w fetishistic and | | | exhibiotinist | | | | | | Relapse-Prevention training: | | | learning to cope/ avoid | | | situations that trigger fantasies | | | and behavior | +-----------------------------------+-----------------------------------+ | g**.) Sexual Masochism=** aroused | | | by being humiliated, beaten, | | | bound, made to suffer | | | | | | = can be done to self or by | | | partner | | | | | | = hypoxyphilia: | | | strangling/smother | | | | | | WHY: | | | | | | classical condt | | +-----------------------------------+-----------------------------------+ | | h.) **Sexual** **Sadism**= | | | aroused by physical/ | | | psychological suffering of | | | another | | | | | | = can be both consenting and | | | nonconsenting | | | | | | WHY: | | | | | | classical condt: accidental | | | pairing of arousal w object/ | | | situation | +-----------------------------------+-----------------------------------+ - GENDER DYSPHORIA== feels distressed from gender assigned from birth (from stigma, discrim, anatomy doesn't match identity) a myriad of gender experience, NOT a disorder---only kept in DSM for insurance coverage for tx to align anatomy w identity HIGH suicide ideation and behavior SCHIZOPHRENIA Onset: 23 (m), 28 (f)---equal gender ratio---dies 10-20 earlier---African Americans most likely due to higher stress == experiences psychosis loss of contact w reality, hallucinations (false sensory perception), delusions (false beliefs) == can be multiple disorders w common features Schizophrenia spectrum disorder - schizophrenia: delusions, hallucinations, disorganized speech, catatonia -- MORE than 6 months, only 1 % prev - Brief Psychotic disorder: same sx but LESS than 1 month - Schizophreniform disorder: Less than 6 months but.2 % prev - Schizoaffective disorder schizo + MDD/ mania for MORE than 6 - Delusion disorder: more than 1 month \\> Symptoms can be grouped into 3 categories +-----------------------+-----------------------+-----------------------+ | POSITIVE SYMPTOMS= | NEGATIVE SYMPTOM= | PSYCHOMOTOR SYMPTOMS | | TYPE I | TYPE II | | | | | \-- unusual mvmnts or | | \-- excessive | \-- deficits in | gestures | | thoughts, emotions, | thoughts, emotions, | | | behavior | behaviors | | | | | | | \-- sudden onset, can | \-- poorer prognosis | | | get better over time | & tx | | | and become worse | | | | again | \-- slow onset + diff | | | | to detect+ always | | | | happening | | +=======================+=======================+=======================+ | 1\. DELUSIONS | 1\. ALOGIA / POVERTY | \-- slow, awkward | | | OF SPEECH | mvmnts, grimaces, odd | | \- ideas they fully | | gestures | | believe | | | | | | 1\. CATATONIA: | | a\. **D of | | extreme | | Persecution**: | | | | belief that | | 1.a) Stupor: stop | | someones out to get | | responsing, | | them, being | | motionless, silent | | plotted/disrim | | | | against, spied on, | | 1.b) Rigidity: rigid, | | slandered, | | upright posture, | | threatened | | resist efforts to be | | | | moves | | b**. Reference**: | | | | attach special | | 1.c) excitement: move | | meaning to others' | | too much | | actions/events | | | | | | 1.d) waxy | | c**. Grandeur** | | flexibility: if | | | | manipulated at a | | d\. **Control:** | | position, they will | | belief their | | keep it there until | | feelings, thoughts, | | moved again | | and actions are | | | | being controlled by | | | | other ppl. | | | +-----------------------+-----------------------+-----------------------+ | | 2\. RESTRICTED | | | | AFFECT | | | | | | | | \-- inability to | | | | express emotions | | | | | | | | 2.a) Blunted: low | | | | grade emotions | | | | | | | | 2.b) Flat: no emotion | | +-----------------------+-----------------------+-----------------------+ | | 3\. LOSS OF VOLITION | | | | | | | | 3.a) AVOLITON/APATHY: | | | | feeling drained of | | | | energy & interest in | | | | normal goals ++ | | | | unable to | | | | start/follow through | | | | on a course of action | | | | | | | | 3.b) AMBIVALENCE: | | | | conflicting feelings | | +-----------------------+-----------------------+-----------------------+ | 2\. DISORG THINKING | | | | & SPEECH | | | | | | | | a\. formal thought | | | | dis: great | | | | confusion and diff. | | | | in communication | | | | | | | | **a.1) Loose | | | | Association** / | | | | derailment: rapid | | | | shifting of | | | | thoughts/topic,, | | | | thinks incoherent | | | | statements makes | | | | sense | | | | | | | | a**.2) Neologism**: | | | | made up words make | | | | sense to just them | | | | | | | | **a.3) | | | | Perseveration**: | | | | repetition of words | | | | and statements | | | | | | | | **a.4) Clang**: | | | | rhyming to express | | | | themselves | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | \-- 6 months in | | | | total! | | | | | | | | - 1 month of 2+ of | | | | these | | | | | | | | \- delusions, | | | | hallucinations, or | | | | disorganized symptoms | | | | | | | | \- abnormal motor | | | | activity (catatonia) | | | | | | | | \- negative sx | | | | | | | | - 5 months of | | | | impaired fxn | | +-----------------------+-----------------------+-----------------------+ | | | ETIOLOGY | +-----------------------+-----------------------+-----------------------+ | 3\. HALLUCINATIONS | 1\. Prodromal: not | Biological: | | | obv, before active | | | \-- contributes to | sx---social | \- genetics | | memory impairments | withdrawal | | | | | \- high lvls of | | \-- sounds,tactile, | 2\. Active | dopamine (know | | somatic, visual, | | history) | | gustatory, olfactory | 3. | | | | Residual---experienci | \- enlarged | | | ng | ventricles | | | less active sx BUT | | | | negative sx persists | -problem w | | | | hippocampus, | | | 25% may recover | amygdala, thalamus | | | completely | | | | | \- viral theory (flu | | | | during pregnancy) | | | | | | | | Sociocultural: | | | | | | | | \- low SES | | | | | | | | \*\* Sociogenic | | | | Theory\*\* | | | | | | | | = high stress | | | | lvls---higher chance | | | | | | | | \*\* Downward Drift/ | | | | Social Selection\*\* | | | | | | | | = ppl drift to low | | | | SES bc of | | | | schizophrenia (from | | | | low employability) | | | | | | | | \*\*Family Theory\*\* | | | | | | | | = high expressed | | | | emotions | | | | | | | | Hostility, emotional | | | | overinvolvement. | | | | | | | | (10% rehospitalized | | | | if low EE) | | | | | | | | (58% from high EE) | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | TREATMENT : | | | +-----------------------+-----------------------+-----------------------+ | 1\. Conventional/ | | | | Typical (1^ST^ gen) | | | | | | | | \-- block excessive | | | | activity of dopamine | | | | by binding receptors | | | | | | | | \-- side effects: | | | | | | | | a\) Extrapyramidal: | | | | parkinsons | | | | | | | | b\) Tardive | | | | dyskinesia: | | | | involuntary mvmnt | | | | of tongue, mouth, | | | | face, bdy | | | | | | | | 2\. Novel/ Atypical | | | | (2^nd^ gen) | | | | | | | | \-- first line tx | | | | | | | | \-- blocks d | | | | receptors | | | | | | | | \-- fewer | | | | extrapyramidal side | | | | effects (exc. | | | | Drowsiness and wt | | | | gain) | | | | | | | | \-- more effective w | | | | NEGATIVE sx | | | | | | | | 3\. CBT -- reduces | | | | hospitalization by | | | | 505 | | | | | | | | \-- cognitive | | | | remediation: build | | | | skills needed for | | | | planning and problem | | | | solving | | | | | | | | \-- hallucination | | | | reinterpret and | | | | acceptance | | | | | | | | 4\. Family therapy | | | | | | | | \-- reduce expressed | | | | emotion | | | | | | | | \-- provide education | | | | abt illness | | | | | | | | == fewer relapses, if | | | | there is, less severe | | | | | | | | 5\. behavioral | | | | therapy | | | | | | | | a.) Milieu Therapy: | | | | keeping pt active to | | | | foster sense of | | | | agency and self | | | | respect | | | | | | | | b.) Token Economy: | | | | reinforce desirable | | | | behavior and focus on | | | | social skills + daily | | | | living skills== | | | | reduces expressed | | | | emotion from family | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ PERSONALITY DISORDER == CRITERIA== - An enduring, inflexible pattern of inner experience and outward behavior that repeatedly impairs a person's sense of self, emotional experiences, goals, capacity for empathy, and intimacy. - pervasive across situations - extreme behaviors deviates from cultural expectations - causes distress/ impairment - evident since adolescence/ early childhood - ego-syntonic ( ppl are the problem) 15% prevalence---many don't think they have a problem---sometimes self dx know little about its etiology and tx (exc: antisocial and borderline) must be considered in cultural context (ex. Some cultures value dependence and submissiveness) I. CLUSTERS OF ODD Extreme suspiciousness, social withdrawal peculiar ways of thinking, and perceiving things. +-----------------------+-----------------------+-----------------------+ | PARANOID | SCHIZOID | SCHIZOTYPAL | +=======================+=======================+=======================+ | \-- distrust + | \-- avoid, no social | \-- more severe | | suspicious | relations (their | | | | preference), display | \-- seeks isolation | | \-- hold grudges, | little emotion | | | read praise | | \-- interpersonal | | negatively | \-- " loners"---focus | problems from: | | | on self | | | \-- people out to get | | - extreme | | them | \-- unaffected by | discomfort from | | | praise or criticism | close relations | | \-- cannot recognize | | | | own mistakes BUT | \-- "cold, humorless, | - odd thinking and | | sensitive to | dull" | perception | | criticism | | patterns | | | \-- men more than | | | | women | - eccentric | | | | behaviors | +-----------------------+-----------------------+-----------------------+ | | | SYMPTOMS: | | | | | | | | 1\. Ideas of | | | | Reference---belief | | | | unrelated events | | | | involves them | | | | | | | | 2\. Bodily | | | | Illusion---sensing | | | | external force/ | | | | presence | | | | | | | | \-- magical beliefs | | | | | | | | \--low | | | | attention/focus | | | | | | | | \-- convos are | | | | digressive and vague | +-----------------------+-----------------------+-----------------------+ | THEORIES: | THEORIES: | | | | | | | 1\. Psychodynamic: | 1\. Psychodynamic | | | | | | | \- demanding parents | \- unsatisfied need | | | + distant rigid dads | for human contact | | | ++ overcontrolling, | | | | rejecting mothers | \- parents | | | | unaccepting + abusive | | | More distrust + | | | | alertness= anger | cope= avoid | | | | | | | 2\. CBT | 2\. CBT | | | | | | | \- maladaptive | \- deficiencies in | | | assumptions ("ppl are | thinking vague, | | | evil/ will attack) | empty, w/o meaning, | | | | trouble at accurate | | | 3\. Biological | perceptions | | | Theory | | | | | \- cannot comprehend | | | \- genetics | emotional cues | | +-----------------------+-----------------------+-----------------------+ | | | THEORIES: | | | | | | | | 1\. same with | | | | schizoid | | | | | | | | = low attn + memory | | | | | | | | = low backward | | | | masking | | | | | | | | = high dopamine | | | | | | | | 2\. could be paired | | | | with MDD and | | | | Bipolar | +-----------------------+-----------------------+-----------------------+ | TREATMENTS: | TREATMENTS | | | | | | | \-- doesn't see self | \--social withdrawal= | | | as needing help= low | less likely to seek | | | tx willingness | tx | | | | | | | \-- "patient"= | 1\. CBT | | | inferior | | | | | \*\*behavioral\*\*- | | | 1\. Psychodynamic | role playing, | | | | exposure, at home HW, | | | \- see past anger | group therapy for | | | | better social skills | | | 2\. CBT | | | | | \*\*cognitive\*\*- | | | \*\*behavioral\*\*- | list of emotions + | | | anxiety reduction= | write/remember | | | more solving | pleasurable | | | interpersonal | experiences | | | problems | | | | | | | | \*\*cognitive\*\*- | | | | increase realtistic | | | | interpretations of | | | | others' words and | | | | actions | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ II\. CLUSTERS OF DRAMATIC dramatic, emotional, erratic +-----------------------------------+-----------------------------------+ | ANTISOCIAL PD | BORDERLINE PD | +===================================+===================================+ | "psychopaths/ sociopaths" | \--high instability -- shifts in | | | mood, unstable self-image, | | \-- persistently | impulsive | | disregard/violate others' rights | | | | \-- self destructive leads to | | \-- adult criminal | substance abuse, delinquency, | | behavior---lies a lot | unsafe sex... | | | | | \-- low work ethic, financial | \-- self harm\-\-- physical | | resp= Irresponsible | discomfort= relief (distraction) | | | | | \-- impulsive, aggressive, | \-- dramatic identity shifts | | irritable, reckless, | | | self-centered | \-- fear of abandonment | | | | | \-- likely to have substance | \-- short stormy relations\-\-- | | abuse | chronic feeling of emptiness | +-----------------------------------+-----------------------------------+ | THEORIES: | THEORIES: | | | | | 1\. Psychodynamic | 1\. Psychodynamic | | | | | \- low infancy parental love== | \- lack of acceptance= low self | | distrust | esteem= more dependence= cant | | | cope w separation | | \- emotionally distant | | | | \- neglect= trauma | | \- stress from poverty, violence, | | | abuse, divorce | 2\. Biological | | | | | 2\. CBT | \- genes | | | | | \*\*behavioral\*\*- | \- low serotonin= impulsivity | | modeling/imitation== Operant | | | conditioning: keeps reinforcing | \- abnormal activity brain | | aggressive behavior ( tantrum= | structures | | give in) | | | | 3\. Sociocultural---unstable | | \*\*cognitive\*\*\-- cannot | culture | | recognize POVS & feelings | | | | 4. Biosocial---internal/external | | 3\. Biological | forces | | | | | -inherited: risk-taking, | 5\. Dev. Psychopathology -- | | impulsivity (due to low | internal/ external factors | | psychological response to | intersect over life course | | stimuli) | | | | \- early trauma and abuse== | | \- low serotonin = aggressive, | inattentive, uncaring, confusing, | | impulsive | threatening parents | | | | | \- low anxiety---cant learn from | "Disorganized attachment | | consequences | style"---attachments to other ppl | | | reflects problematic attchmnts to | | | parents anxiety, unstable | | | emotions | +-----------------------------------+-----------------------------------+ | TX: INEFFECTIVE | | | | | | 1\. CBT---morality and other | | | POVS | | | | | | 2\. Psychotropic Medications | | +-----------------------------------+-----------------------------------+ | APD VS PSYCHOPATHY | | | | | | \- interchangeable | | | | | | \- apd= behavior,,, psychopathy= | | | attributes | | | | | | Example: | | | | | | -poverty of emotion, no anxiety | | | | | | -superficially charming | | | | | | \- impulsive | | | | | | -habitually unethical behavior | | | | | | = cant say that APD is | | | criminal---depends on culture and | | | SES differences | | +-----------------------------------+-----------------------------------+ | | TX: DIALECTAL BEHAVIOR THERAPY (1 | | | yr group and individually | | | | | | -behavioral: learn emotional reg, | | | mindfulness + skills | | | | | | \-- Individual: apply skills, | | | accept px unconditionally, | | | reinforce boundaries, decrease | | | self harm | +-----------------------------------+-----------------------------------+ IV\. CLUSTERS OF ANXIETY AND FEAR \-- obsessive compulsive: anal retentive , preoccupied w rules, setails, devoted to work, hoarding, stubborn, ridged. \-- avoidant: want connection but afraid of rejection, avoid activities, wont open up in relationships, fear of failure, wont take risks \-- dependent: cant be on their own, cant make own decisions, excessive reassurance, wont disagree, helpless when alone. CRITICISMS TO DIAGNOSING PD: \-- low reliability---high comorbidity---diversity of presentations == proposed revision to dx system: \- dimensional vs Categorical= addresses high comorbidity, diverse presentations \- DSM-5: Personality Disorder- Trait Specified (rejected tho) 1\. NEGATIVE AFFECTIVITY---neuroticism= frequent and intense 2\. DETACHMENT---withdraw from social activities 3\. ANTAGONISM---behavior that is odd= keep having quarrels 4\. DISINHIBITION---act impulsively 5\. PSYCHOTICISM---unusual CHILDHOOD AND ADOLESCENT DISORDERS Overview: - Boys outnumber girls - Children from low SES more likely - Disorders displayed by children have adult counterparts but are presented differently ( anxiety, depression, disruptive disorders) - Other childhood disorders disappear by adulthood. - Some begin at birth and persist into adult life (ex. Autism, intellectual dis) 1\. CHILDHOOD ANXIETY DISORDERS (25%) Note: some anxiety is good, it makes ppl think about consequences. +-----------------------------------+-----------------------------------+ | **Childhood Phobias** are similar | **Separation Anxiety** fear of | | to adult phobias (but more on | being separated/ away too long | | imaginary) | from caregiver. ==scared | | | caregiver would get hurt or die | | | or that they themselves would go | | | through smth horrible. | | | | | | == takes in the form of "School | | | refusal" | +===================================+===================================+ | **Selective mutism** | | | unwillingness to speak in | | | specific situations outside the | | | home/ w other ppl other than | | | family (can speak just fine) | | | | | | == thought to be an early form of | | | social anxiety disorder | | +-----------------------------------+-----------------------------------+ | | Symptoms: response more on | | | behavioral and somatic ( | | | clinging, cant sleep, avoidance, | | | irritability, stomach pain) | | | rather than cognitive. | +-----------------------------------+-----------------------------------+ 2\. CHILDHOOD DEPRESSION - Triggered by negative life events like losses, major changes, rejection, or ongoing abuse - Symptoms: behavioral and somatic= irritability, headache, stomachache, no interest in toys and games - More common in teens---NO gender difference prior to puberty but becomes 2x for girls after puberty Controversy prescribing antidepressants to adolescents/ children= higher suicide rates after starting meds== needs close monitory 3\. CHILDHOOD BIPOLAR DISORDER - 1994-2003: 40x increase in dx due to inaccurate diagnostics---dx immediately for something usually expected on kids (explosive, aggressive, irritable, etc behaviors) - To fix: Disruptive Mood Dysregulation Disorder (new) - Dx for extreme rage and temper tantrums - ½ treated w antipsychotics, 1/3 w mood stabilizer (lack research) - Goal: control behavior 4\. DEFIANT DISORDERS **Oppositional Defiant Disorder (10%)** - argumentative, defiant, angry, vindictive - more on boys before puberty---equal after - 80% who has conduct disorder had oppositional defiant disorder **Conduct Disorder (5-10% children; 75% for boys)** - more severe= violate rights of others - aggressive to ppl and animals - steal, lie, threat, skip school, etc - mild cases likely to improve,, if severe, leads to antisocial PD etc, criminal lifestyle etc. - 1/3 has ADHD - Relational Aggression social misdeeds, rumors, lying, manipulating etc a. Overt Destructive pattern- openly confrontational b. Overt-nondestructive- openly offensive but not confrontational c. Covert destructive- secretive destructive behaviors d. Covert destructive- secretly commit nonaggressive behavior - Children with MAOA gene and maltreatment-filled childhood- high risk TREATMENT effective if 13\< - Parent-management treatments---combo family and CBT to improve family fxning - Parent-Child Interaction Therapy (age: preschool) 4 principles: - Interact more positively with child - Set appropriate limits - Act consistently - Understand appropriate expectations for age - More effective: in home via videoconferencing, coaching via Bluetooth earpiece - Family Therapy\-\-- everyone identifies problematic behaviors and participates in collaborative problem solving - Child focused treatments\-\-- via problem solving skills training,, teach them constructive thinking and positive social behaviors - Stimulants -- reduce aggression - Residential treatment - Treatment foster care---child, bio family, & foster fam gets therapy - Juvenile training centers---not effective,, worsens delinquent behavior. 5\. ELIMINATION DISORDERS +-----------------------------------+-----------------------------------+ | Enuresis | Encopresis | +===================================+===================================+ | \- bed wetting or clothes | \- soiling/ pooping in clothes | | | | | \- must be 5+ yo to dx---2x more | \- less common than enuresis -- | | in boys | common in boys | | | | | \- from stress | -causes intense social problems, | | | shame, embarrassment. | | \- may be resolved w/o tx | | | | -might be from bio factors like | | TX: | constipation, stress, or improper | | | toilet training | | \- Bell & Battery Technique | | | (Classical condt)- bell sounds | TX: | | when first drop of urine hits | | | foil sheets,, awakens child | \- CBT + medical approaches | | | | | \- Dry-Bed Training (Operant | \- high fiber diet | | condt) | | | | | | awakened periodically to go to | | | bathroom | | +-----------------------------------+-----------------------------------+ 6\. NEURODEVELOPMENTAL DISORDERS -- emerge at birth or early childhood \-- affects behavior, memory, concentration, or ability to learn. -- significant impact throughout life. +-----------------------------------+-----------------------------------+ | Attention Deficit/Hyperactive | Autism Spectrum Disorder | | Disorder | "Asperger's " | +===================================+===================================+ | \- was prev called ADD | \- before 3yo---1 in 60 dx---80% | | | in boys | | -7% all,, 70% boys | | | | \- many undx---90% disabled into | | \- to be dx, must either be or | adulthood | | both: 6+ mo | | | | S/SX: | | diff attending to tasks | | | | \- unresponsiveness to other ppl | | overactive/impulsive | | | | \- communication deficits (1/3 | | \- diff in communication, | speechless) + nonverbal | | academics, interacting w other | | | kids, self-esteem | == Echolia---echoing other ppls | | | phrases | | \- many grow out of it by | | | adulthood or attenuated form | \- rigid + repetitive behaviors, | | | lack of interest and activities | | \- dx should incl observing child | | | in multiple settings | \- perseveration of sameness: | | | gets upset when something is not | | CAUSES: | inorder/usual | | | | | - Problem w brain circuit in | CAUSES: | | attention | | | | \- NOT bc of parenting or | | \-- type 1 attention processes: | vaccines | | beyond voluntary ctrl + focuses | | | attn on unexpected things in env | \- Genetics: prenatal problems, | | (sudden sounds) | problem w cerebellum | | | | | \--Type 2 attention process : | \- theories: | | mental activities that we | | | control+ effortful focus of | failure to develop Theory of | | attention | mind: understanding that others | | | have beliefs, desires, | | ==( type 2 cannot override type | intentions, and perspectives | | 1) === | different from own | | | | | - Stress + racial biases + | Deficiencies in joint | | family dysfunctions | attention---cannot share focus w | | | other ppl on items and events in | | TX: | their immediate surroundings | | | | | - Drug therapy---calm + focus | TX: does not reverse it | | | | | - CBT | \-- Applied Behavior Analysis: | | | break the behavior into small | | - Token economy | steps +reinforcements + improve | | | social skills, speech, classroom | | = (daily report card) | skils, DLS | | | | | - Parent mgmnt | \- Communication training: ASL, | | | augmentative communication | | | systems | | | | | | -Parent training | +-----------------------------------+-----------------------------------+ | INTELLECTUAL DISABILITY -- rosa's | | | law replaced term from "mental | | | retardation" | | +-----------------------------------+-----------------------------------+ | \- symptoms | | | | | | - IQ below 70 (2 SD below mean) | | | | | | - Biased towards those of | | | middle and upper classes | | | and English as first | | | language | | | | | | - Poor adaptive functioning | | | (communication, daily living, | | | self-diretcion, | | | work/safety\-\-- observed in | | | everyday environment=== does | | | NOT eliminate problem of BIAS | | | | | | - Learns slowly \-\-- diff w | | | attention, memory, planning, | | | and language | | | | | | \- 3% all; 60% male | | | | | | FEATURES: | | | | | | a. MILD (IQ: 50-70) 80-85% of | | | dx=="educable", can still | | | benefit from schooling and | | | can support themselves as | | | adults. | | | | | | - May not be recognized until | | | tested in school,, need | | | assistance under stress | | | | | | - Cause: sociocultural and | | | psychological (poor | | | unstimulating env, inadequate | | | parent-child interactions, | | | insufficient learning | | | experience) | | | | | | - Biological factors: mothers | | | drinking, drug use, | | | malnutrition during pregnancy | | | | | | b. MODERATE ( IQ:35-49) 10% of | | | dx, clear deficits in | | | preschool | | | | | | - Can still fx as adult ,,, | | | unskilled/semiskilled jobs | | | | | | c. SEVERE (IQ: 20-34) 3-4% ,, | | | apparent in infancy (motor | | | and communication) | | | | | | - Neurological dysfunction + | | | likely to have brain seizures | | | | | | - Need supervision: group | | | homes, nursing homes, family | | | | | | d. PRFOUND (IQ: -20) 1-2%, | | | noticeable at birth/ early | | | infancy | | | | | | - Basic talking, walking, | | | feeding self | | | | | | - Need very structured env w | | | close supervision | | +-----------------------------------+-----------------------------------+