Different Disorders

DISSOCIATIVE DISORDER The dissociative disorder is a group of conditions involving disruptions in a person’s normally integrated functions of consciousness, memory, identity, or perception. Included here are some of the more dramatic phenomena in the entire domain of psychopathology: people who cannot recall who they are or where they may have come from, and people who have two or more distinct identity or personality states that alternately take control of the individual’s behavior. I.

NATURE

The term dissociation refers to the human mind’s capacity to engage in complex mental activity in channels split off from, or independent of, conscious awareness. Dissociative Disorders can be acute or chronic. II.

CAUSAL FACTORS

Moderate or severe forms of dissociation are caused by such traumatic experiences as childhood abuse, combat, criminal attacks, brainwashing in hostage situations, or involvement in a natural or transportation disaster. The causes of dissociative identity disorder have not been identified, but are theoretically linked with the interaction of overwhelming stress, traumatic antecedents, insufficient childhood nurturing, and an innate ability to dissociate memories or experiences from consciousness. III.

SYMPTOMS There are four major dissociative disorders: • • • •

Dissociative amnesia Dissociative identity disorder Dissociative fugue Depersonalization disorder

Signs and symptoms common to all types of dissociative disorders include: • • • • •

Memory loss (amnesia) of certain time periods, events and people Mental health problems, including depression and anxiety A sense of being detached from yourself (depersonalization) A perception of the people and things around you as distorted and unreal (derealization) A blurred sense of identity

Dissociative disorder symptoms (depending on the type of disorder) may include: •

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IV.

Dissociative amnesia. Memory loss that's more extensive than normal forgetfulness and can't be explained by a physical or neurological condition is the main symptom of this condition. Sudden-onset amnesia following a traumatic event, such as a car accident, is rare. More commonly, conscious recall of traumatic periods, events or people in your life — especially from childhood — is simply absent from your memory. Dissociative identity disorder. This condition, formerly known as multiple personality disorder, is characterized by "switching" to alternate identities when you're under stress. In dissociative identity disorder, you may feel the presence of one or more other people talking or living inside your head. Each of these identities may have name, personal history and characteristics, including marked differences in manner, voice, gender and even such physical qualities as the need for corrective eyewear. There often is considerable variation in each alternate personality's familiarity with the others. People with dissociative identity disorder typically also have dissociative amnesia. Dissociative fugue. People with this condition dissociate by putting real distance between themselves and their identity. For example, you may abruptly leave home or work and travel away, forgetting who you are and possibly adopting a new identity in a new location. People experiencing dissociative fugue may be very capable of blending in wherever they end up. A fugue episode may last only a few hours or, rarely, as long as many months. Dissociative fugue typically ends as abruptly as it begins. When it lifts, you may feel intensely disoriented, depressed and angry, with no recollection of what happened during the fugue or how you arrived in such unfamiliar circumstances. Depersonalization disorder. This disorder is characterized by a sudden sense of being outside yourself, observing your actions from a distance as though watching a movie. It may be accompanied by a perceived distortion of the size and shape of your body or of other people and objects around you. Time may seem to slow down, and the world may seem unreal. Symptoms may last only a few moments or may come and go over many years. TREATMENT PSYCHOTHERAPY

Adlerian Therapy Adlerian Therapy is a growth model. It stresses a positive view of human nature and that we are in control of our own fate and not a victim to it. We start at an early age in creating our own unique style of life and that style stays relatively constant through the remained of our life. That we are motivated by our setting of goals, how we deal with the tasks we face in life, and our social interest. The therapist will gather as much family history as they can. They will use this data to help set goals for the client and to get an idea of the clients' past performance. This will help make certain the goal is not to low or

high, and that the client has the means to reach it. The goal of Adlerian Therapy is to challenge and encourage the clients' premises and goals. To encourage goals that are useful socially and to help them feel equal. These goals maybe from any component of life including, parenting skills, marital skills, ending substance-abuse, and most anything else. The therapist will focus on and examine the clients' lifestyle and the therapist will try to form a mutual respect and trust for each other. They will then mutually set goals and the therapist will provided encouragement to the client in reaching their goals. The therapist may also assign homework, setup contracts between them and the client, and make suggestions on how the client can reach their goals. Behavior Therapy Behavior therapy is always undergoing refinement and uses learning to overcome specific behavioral problems. In this type of therapy it is believed that behaviors are learned, that we are a product of our environment. Focus will be on present and overt behavior. In this type of therapy it is believed that reinforcement and imitation teaches normal behavior and that abnormal behavior is a direct result of defective learning. Therapy will be based on learning theory. The therapy will include a treatment plan, the goals of the treatment will be laid out up front, and the outcome expected from the therapy will be set right up front too. To eliminate unwanted behaviors you need to learn new behaviors. This may include assertion, behavioral rehearsal, coaching, cognitive restructuring, desensitization, modeling, reinforcement, relaxation methods, selfmanagement, or new social skills. Both client and therapist need to take an active role in learning the more desired behavior. Behavior therapy is well suited to deal with depression, disorders in children's behavior, phobias, sexual disorders of any type, and stuttering. Existential Therapy Focuses on freedom of choice in shaping one's own life. Teaches one is responsible to shape his / her own life and a need for self-determination and self-awareness. The uniqueness of each individual forms his / her own unique personality, starting from infancy. Existential therapy focuses on the present and on the future. The therapist try's to help the client see they are free and to see the possibilities for their future. They will challenge the client to recognize that he / she themselves were responsible for the events in their life. This type of therapy is well suited in helping the client to make good choices or in dealing with life. Gestalt Therapy Gestalt therapy integrates the body and mind factors, by stressing awareness and integration. Integration of behaving, feelings, and thinking is the main goal in Gestalt therapy. Client's are viewed as having the ability to recognize how earlier life influences may have changed their life's. The client is is made aware of personal responsibility, how to avoid problems, to finish unfinished matters, to experience thing in a positive light, and in the awareness of now. It is up to the therapist to help lead the client to

awareness of moment by moment experiencing of life. Then to challenge the client to accept the responsibility of taking care of themselves rather then excepting others to do it. The therapist may use confrontation, dream analysis, dialogue with polarities, or role playing to reach their goals. This may include treatment of crisis intervention, marital / family therapy, problem in children's behavior, psychosomatic disorders, or the training of mental health professionals. Person-centered Therapy Person-centered therapy gives more responsibility to the client in their own treatment and views humans in a positive manner. Founded by Carl Rogers in the 1940's. Rogers had great faith that we could and would work out our own problems. The therapist will move the client towards self awareness, helping the client to experience previously denied feelings. They will teach the client to trust in themselves and to use this trust to find their direction in life. The person-centered therapist makes the client aware of their problems and then guilds them to a means of resolve them. The therapist and client must have faith that the client can and will find self-direction. The therapist focus on the here and how. They motivate the client in experiencing and expressing feelings. The personcentered therapist believes that good mental health is a balance between the ideal self and real self. This is where the problem lies, the result of difference between what we are and what we wish to be causes maladjusted behavior. Psychoanalytic Psychotherapy focus on the unconscious and believes it influences human behavior. It is believed that a person is driven by aggressive and sexual impulses. It focus mainly on the first six years of human life and how the events of this time period determines later personality. Repressed conflicts from childhood lead to personality problems later in life. Anxiety is a direct result of the repression of conflicts Psychotherapist believe that the unconscious motives along with unresolved conflicts lead to maladapted behavior. They believe that to develop a normal personality, a person successful go through five psychosexual stages: • • • • •

Oral - Birth to 1 year: Sucking. Anal - 1 to 3 years: Holding and releasing urine and feces. Phallic - 3 to 6 years: Pleasure in genital stimulation. Latency - 6 to 11 years: Sexual instincts develop. Genital - Adolescence: Sexual impulses return.

Inadequate resolution of any of these stages lead to flawed personality development. The client with the therapist help will make repressed conflicts conscious, making the unconscious conscious. Making this conflicts conscious to the client will help them in working through them, awareness. Psychotherapy is not useful in clients that are selfcentered, impulsive, or severely psychotic. The therapist should have extensive training and expense. The therapist when working with minorities, should focus on the clients family dynamics. Treatment will be long term.

Rational-emotive and Cognitive-behavioral Therapy Rational-emotive therapy is a highly action-oriented and deals with the client's cognitive and moral state. This therapy stresses the clients ability of thinking on their own and in their ability to change. The rational-emotive therapist believes that we are born with the ability of rational thinking but that my fall victim to irrational thinking. They stress the clients ability to think, in making good judgments, and in taking action. The therapist will use directed therapy. The therapist believes that a neurosis is a result of irrational behavior and irrational thinking. The Rational-emotive and Cognitive-behavioral therapist believe the clients problems are rooted in childhood and in their belief system, that was formed in childhood. Therapy will include method is solving and dealing with emotional or behavior problems. The therapist will help the client to eliminate any self-defeating outlooks they may have and to view life in a rational way. The therapist will never have a personal relationship with the client. The therapist will think of the client as a student and themselves as the teacher. Reality Therapy The reality therapist teaches the client ways to control the world around them and how to meet their personal needs. They believe that the client can and will change their life for the better. The reality therapist focuses on the what and the why of the clients actions. They point out what the client doing and in getting them to evaluate it. A behavioral or emotional problem is a direct result of the clients believe and feelings about themselves. The therapist will help the client evaluate their behaviors and feelings, to challenge them to become more effective at meeting their needs. Transactional Analysis Transactional analysis focus on the clients cognitive and behavior functioning. The therapist helps the client evaluate their past decisions and how those decisions affect their present life. They believe self-defeating behavior and feelings can be overcome by an awareness of them. The therapist believes that the clients personality is made up of the parent, adult, and child. They believe that it is important for the client to examine past decisions to help their make new and better decisions.

SEXUAL DISORDER Sexual dysfunctions are disorders related to a particular phase of the sexual response cycle. For example, sexual dysfunctions include sexual desire disorders, sexual arousal disorders, orgasm disorders, and sexual pain disorders. If a person has difficulty with some phase of the sexual response cycle or a person experiences pain with sexual intercourse, he/she may have a sexual dysfunction. I.

CAUSAL FACTORS ORGANIZATION OF SEXUAL DISORDER 1. Paraphilias 2. Gender Identity Disorders 3. Sexual Dysfunctions

Causal Factors for Paraphilias · Almost always diagnosed in males · Typically patients referred by others, rather than seeking help · Perhaps this is why Pedophilia, Voyeurism, and Exhibitionism are more commonly diagnosed than sadism or masochism. · Paraphilias often co-occur, i.e. are co-morbid · The interplay between biological, psychological, and cultural factors is complex Causal factors in sexual dysfunctions 1. Dysfunctional learning a. Sexual techniques and attitudes are often learned informally b. Social attitudes about sex may promote inhibitions and anxiety c. Female sexual learning may have emphasized a passive role d. Male's masturbatory experiences may be counter-productive to love relationships 2. Feelings of fear, anxiety, and inadequacy a. Research evidence shows the importance of anxiety in dysfunctions b. Fears of inadequacy can lead to pretending to have orgasms c. Masters and Johnson focus on faulty learning and poor communication 3. Interpersonal problems a. Lack of emotional closeness can lead to sexual dysfunctions b. Hostility and antagonistic feelings are related to sexual functioning

4. Changing male-female roles and heterosexual relationships a. The new female role has challenged many males b. The female's active role in sexuality has stressful consequences c. Sexually transmitted disease has produced anxiety II.

SUBTYPES AND SYMPTOMS

1. Hypoactive sexual disorder A persistently reduced sexual drive or libido, not attributable to depression where there is reduced desire, sexual activity and reduced sexual fantasy. 2. Sexual aversion disorder An avoidance of or aversion to genital sexual contact 3. Female sexual arousal disorder A failure of arousal and lubrication/swelling response. 4. Male erectile disorder Inability to gain an erection or inability to maintain an erection once it has occurred. 5. Female orgasmic disorder A lengthy delay or absence of orgasm following a satisfactory excitatory phase. The GP must take into account the patient's age, previous sexual experience and adequacy of sexual stimulation. 6. Male orgasmic disorder A lengthy delay or absence of orgasm following normal excitation, erection and adequate stimulation.

7. Premature ejaculation Ejaculation occurring with only minimal stimulation, either before penetration or soon afterwards, in either case ceratinly before the patient wishes it. Again the GP must take into account the patient's age, previous sexual experience, extent of sexual stimulation and 'novelty' of the sexual partner. 8. Dyspareunia (not due to general medical condition) Recurrent pain associated with intercourse, but in women not due to vaginismus, poor lubrication, and in women and men not due to drugs or other physical causes 9. Vaginismus An involuntary or persistent spasm of the muscles of the outer third of the vagina, again not attributable to physiological effects of physical causes. Vaginismus may be either lifelong or recent; generalised to all sexual encounters or specific to certain partners or situations. 10. Secondary sexual dysfunction Dysfunction secondary to illness eg hypothyrodism, mental disorder eg depression, or drugs eg fluoextine. 11. Paraphilias Exhibitionism (exposure of genitals to strangers). Fetishism (finding nonliving objects erotic eg women's underwear). Paedophilia. Frotteurism (fantasies, urges or behviour centred around rubbing self against non-consenting other).Transvestic festishism (crossdressing for erotic pleasure). Voyeurism (fantasies, urges or behviour centred around watching non-consenting others undressing, or having sex). 12. Gender identity disorder Strong and persistent identification of the self with another gender. Persistent dissatisfaction with own sex. Desire to participate in stereotyped games and pastimes of opposite sex. Preference for cross-dressing. May insist that they are wrong sex. May occur in children, adolescents and adults. Not concurrent with physical intersex condition. Aetiology was thought to involve aberrant psychological conditioning, but gender identity may be more defined by organic causes in the brain than the postnatal environment.

DISORDERS OF CHILDHOOD AND ADOLESCENT Children and adolescents may present with symptoms of the other diagnostic categories and be diagnosed accordingly, and adults may on occasion be diagnosed with this group of disorders. However, there is a group of disorders generally first diagnosed in infancy, childhood or adolescence and it is this feature which warrants inclusion in this group. Mental Retardation is characterized by significantly below average intellectual functioning and deficits in adaptive functioning. An IQ of 70 or below is used as the diagnostic indicator. Mental Retardation is classified as • • • •

Mild : IQ level of 50-55 to approximately 70 Moderate : IQ level of 35-40 to 50-55 Severe : IQ level of 20-25 to 35-40 Profound : IQ level below 20-25

Learning Disorders are characterized by academic functioning that is significantly below that expected given the child's age, IQ and educational background. The learning disorders include: • • •

Reading Disorder Mathematics Disorder Written Expression Disorder

Developmental Coordination Disorder is characterized by a marked impairment in the development of motor coordination that results in motor skills substantially below those expected for a child of a given age and IQ and significantly interferes with academic achievement or activities of daily living. Communication Disorders are characterized by difficulties with speech and language and include: • • • •

Expressive Language Disorder Mixed-Receptive-Expressive Language Disorder Phonological Disorder Stuttering

Pervasive Developmental Disorders are characterized by severe deficits and pervasive impairment in multiple areas of development including social interaction, communication and the presence of stereotyped behavior, interests and activities. The Pervasive Developmental Disorders include: • • •

Autistic Disorder Rett's Disorder Childhood Disintegrative Disorder

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Asperger's Disorder

Attention-Deficit Disorders are characterized by symptoms of inattention and/or hyperactivity- impulsivity. Disorders in this category include: • • •

Attention-Deficit/Hyperactivity Disorder Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type Attention-Deficit/Hyperactivity Disorder Predominantly Hyperactive Type

Disruptive Behavior Disorders are characterized by symptoms of antisocial behavior and/or negative, hostile or defiant behavior. Disorders in this category include: • •

Conduct Disorder Oppositional Defiant Disorder

Feeding and Eating Disorders of Infancy or Early Childhood Tic Disorders Elimination Disorders include inappropriate elimination whether involuntary or intentional. • •

Encopresis is the repeated passage of feces into inappropriate places. Enuresis is the repeated passage of urine into inappropriate places.

Other Disorders of Infancy, Childhood, or Adolescence includes those not specifically covered in other sections such as: • • • •

Separation Anxiety Selective Mutism Reactive Attachment Disorder Stereotypic Movement Disorder

MULTIAXIAL SYSTEM A multiaxial system involves an assessment on several axes, each of which refers to a different domain of information that may help the clinician plan treatment and predict outcome. AXIS I. The particular clinical syndromes or other conditions that may be a focus of clinical attention. This would include schizophrenia, generalized anxiety disorder, major depression, and substance dependence. Axis I conditions are roughly analogous to the various illness and diseases recognized in general medicine.

AXIS II. Personality disorders. A very broad group of disorders that encompasses a variety of problematic ways of relating to the world, such as histrionic personality disorder, paranoid personality disorder, or antisocial personality disorder. The last of these, for example, refers to an early-developing, persistent, and pervasive pattern of disregard for accepted standards of conduct, including legal strictures. Axis II provides a means of coding for long-standing maladaptive personality traits that may or may not be involved in the development and expression of an Axis I disorder. Mental retardation is also diagnosed as an Axis II condition. AXIS III. General medical conditions. Listed here are any general medical conditions potentially relevant to understanding or management of the case. Axis III of DSM-IV-TR may be used in conjunction with an Axis I diagnosis qualified by the phrase “Due to [specifically designated general medical condition]”-for example, where a major depressive disorder is conceived as resulting from unremitting pain associated with some chronic medical disease. AXIS IV. Psychosocial and environmental problems. This group deals with the stressors that may have contributed to the current disorder, particularly those that have been present during the prior year. The diagnostician is invited to use a checklist approach for various categories of problems- family, economic, occupational, legal, etc. for example, the phrase “Problems with Primary Support Group” may be included where a family disruption is judged to have contributed to the disorder.

AXIS V. Global assessment of functioning. This is where clinicians indicate how well the individual is coping at the present time. A 100-point Global Assessment of Functioning (GAF) Scale is provided for the examiner to assign a number summarizing a patient’s overall ability to function.

Submitted by: Roxanne H. Galban BS Psychology