Transcript Other Disorders

By Salina Chan, R3
2013
Body Dysmorphic
Hoarding d/o
Trichotillomania
Excoriation (skin
picking) Disorder
 Preoccupation
with >1 perceived defects or
flaws in physical appearance that are not
observable or appear slight to others


If a slight physical anomaly is present, the
person's concern is markedly excessive
Skin picking can cause lesions
 Repetitive
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beh./mental acts at some point
Checking
Comparing
Picking
Grooming
reassurance

Persistent difficulty discarding or parting with
possessions, regardless of value

Due to:
perceived need to save items
 distress associated with discarding them


Active living areas are
congested and cluttered with accumulation of
possessions
 substantially compromises their intended use


If living areas uncluttered, it is only because of
third parties (e.g., family members, cleaners,
authorities)
 Trichotillomania

Recurrent pulling out of one’s hair, resulting in
hair loss
 Excoriation

(hair-pulling d/o)
(skin picking) d/o
Recurrent skin picking resulting in skin lesions
 Repeated
attempts to decrease or stop beh
 May
be preceded or accompanied by various
emotional states

E.g. triggered by anxiety or boredom, preceding
tension, post-gratification/pleasure/relief
 Focused
(aware) vs automatic behaviour
Dissociative Identity
d/o
Dissociative Amnesia
Depersonalization/dere
alization d/o

Disruption of identity characterized by >2
distinct personality states
may be described in some cultures as an experience
of possession
 involves marked discontinuity in sense of self and
sense of agency
 Changes in affect, behavior, consciousness, memory,
perception, cognition, and/or sensory-motor
functioning
 As observed by others or reported by the individual


Recurrent gaps in recall of everyday events,
important personal info, and/or traumatic
events

more than just ordinary forgetting
 Can’t
recall important autobiographical info,
usually of a traumatic or stressful nature



not just ordinary forgetting
most often consists of localized or selective
amnesia for a specific event or events; or
generalized amnesia for identity and life history
 Dissociative

fugue
Apparently purposeful travel or bewildered
wandering associated with amnesia for identity
or for other important autobiographical info

Presence of persistent or recurrent experiences
of depersonalization, derealization, or both:

Depersonalization: Experiences of unreality,
detachment, or being an outside observer for one’s
thoughts, feelings, sensations, body, or actions


Derealization: Experiences of unreality or detachment
with respect to surroundings


e.g. perceptual alterations, distorted sense of time,
unreal or absent self, emotional and/or physical numbing
e.g., individuals or objects are experienced as unreal,
dreamlike, foggy, lifeless, or visually distorted
During the depersonalization or derealization
experiences, reality testing remains intact
Somatic symptom d/o
(somatization d/o)
Illness anxiety d/o
(hypochondriac)
Conversion d/o
Factitious d/o

>1 somatic symptoms = distressing or cause sig
disruption of daily life

Excessive thoughts, feelings, or behaviors
related to the somatic symptoms or associated
health concerns with >1 of following:
Disproportionate and persistent thoughts about the
seriousness of one’s symptoms
 Persistently high level of anxiety about health or
symptoms
 Excessive time and energy devoted to symptoms or
health concerns


Persistent state of being symptomatic, though
specific symptoms can change

Preoccupation with having or acquiring serious
illness that is excessive or disproportionate

Somatic symptoms are not present or, if present,
are only mild in intensity

High level of anxiety about health, and person is
easily alarmed about personal health status

Performs excessive health-related behaviors or
exhibits maladaptive avoidance


e.g., repeatedly checks body for signs of illness,
avoids doctor appointments and hospitals
> 6 months, but the specific illness that is feared
may change over that period of time


>1 symptoms of altered
voluntary motor or sensory
Clinical findings show
symptom(s) ≠ recognized
neurological/medical
conditions

weakness or paralysis

abnormal movement

swallowing symptoms

speech symptom

attacks or seizures

anesthesia or sensory
loss

special sensory symptom

mixed symptoms

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
Falsification of physical
or psychological signs or
symptoms, or induction
of injury or disease
associated with
identified deception
individual presents to
others as ill, impaired,
or injured
deceptive behavior is
evident even without
obvious external
rewards
FD imposed on self
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Falsification of physical or
psychological signs or
symptoms, or induction of
injury or disease, in
another
associated with identified
deception
individual presents
another (victim) to others
as ill, impaired, or injured
deceptive behavior is
evident even without
obvious external rewards
Note: The perpetrator =
diagnosis
FD imposed on another
 Brief
frequent visits
 Limit
number of physicians involved
 Focus
on psychosocial
 Hypnosis/Amytal
 Minimize
Interview
investigations
 Psychotherapy
 Minimize
psychiatric medications (may use
anti-depressant)
Anorexia nervosa
Bulimia nervosa
Binge-eating d/o

Intake Restriction leading to sig low body weight WRT
age, sex, developmental trajectory, & PEx health

Intense fear of gaining wt or becoming fat, or,
persistent beh that interferes with wt gain, even
though at a sig low wt.

Cognition:


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Disturbance in experiencing one’s body wt or shape
undue influence of body wt or shape on self-evaluation
persistent not recognizing the seriousness of current low
body wt

Severity based on BMI
1.
Restricting type - no binge eating or purging behavior
2.
Binge-eating/purging type

Recurrent episodes of binge eating

Episode = both of following:



Eating, in a discrete period of time (e.g., within any 2hour period), an amount of food that is definitely larger
than what most ppl would eat in a similar period of time
under similar circumstances
A sense of lack of control over eating during the episode
Recurrent inappropriate compensatory behaviors in
order to prevent weight gain

E.g. self-induced vomiting, laxatives, diuretics, other
meds; fasting or +++ exercise

binge eating and inappropriate compensatory
behaviors both occur, on avg, >1/week x 3 months

Self-evaluation is unduly influenced by body shape
and weight

Recurrent episodes of binge eating.

Episode = both:
Eating, in a discrete time period (e.g. any 2-hour period), an
amount of food that is definitely larger than what most people
would eat
 A sense of lack of control over eating during the episode


Episodes associated with >3 of following:


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
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating lg amounts of food when not hungry
Eating alone d/t feeling embarrassed by how much one is
eating
Feeling disgusted with oneself, depressed, or very guilty
afterward
The binge eating occurs, on avg, >1/week for 3 months.
Primary Insomnia
Hypersomnolence
Disorder
Narcolepsy
Obstructive Sleep Apnea
Hypopnea
Central Sleep Apnea
Restless Legs Syndrome
 complaint
of dissatisfaction with sleep
quantity/quality, with >1 of following:


Difficulty initiating sleep
Difficulty maintaining sleep


freq awakenings or problems returning to sleep after
awakenings
Early-morning awakening with inability to return
to sleep
 >3
nights/week x >3 months
 Self-reported
excessive sleepiness despite a
main sleep period >7 hrs, with >1 of
following:



Recurrent periods of sleep or lapses into sleep
within same day
A prolonged main sleep episode >9 hrs/day that
is nonrestorative/unrefreshing
Difficulty being fully awake after abrupt
awakening
 >3/week
x >3 months
 Recurrent
periods of an irrepressible need to
sleep, lapsing into sleep, or napping
occurring within the same day.
 >3/week
x 3 months
 The
presence of at least one of the
following:



Episodes of cataplexy a few times per month
Hypocretin deficiency (CSF)
Nocturnal sleep polysomnography or a multiple
sleep latency test findings consistent with
narcolepsy
 Either
(1) or (2):
1. Polysomnography
showing >5 obstructive
apneas or hypopneas per hour of sleep and
either of the following sleep symptoms:
Nocturnal breathing disturbances
a)

b)
snoring, snorting/gasping, or breathing pauses
during sleep
Daytime sleepiness, fatigue, or unrefreshing
sleep
2. Polysomnography
of >15 obstructive apneas
and/or hypopneas per hour of sleep
regardless of accompanying symptoms

An urge to move the legs, usually with or in
response to uncomfortable and unpleasant
sensations in the legs

Leg sensations characterized by all of the
following:
The urge to move the legs begins or worsens during
periods of rest or inactivity
 The urge to move the legs is partially or totally
relieved by movement
 The urge to move the legs is worse in the evening or
at night than during the day, or occurs only in the
evening or at night


>3/week x >3 months

Central Sleep Apnea


Polysomnography shows >5 central apneas per hr of
sleep
Sleep-Related Hypoventilation

Polysomnograpy demonstrates episodes of  resp
with  CO2 levels
 Circadian

Persistent/recurrent pattern of sleep disruption



Rhythm Sleep-Wake Disorders
due to an alteration of the circadian system; or
endogenous circadian rhythm ≠ the sleep–wake schedule
required by an individual
sleep disruption = excessive sleepiness, insomnia, or
both
Delayed Ejaculation
Erectile Disorder
Female Orgasmic Disorder
Female Sexual
Interest/Arousal Disorder
Genito-Pelvic
Pain/Penetration Disorder
Male Hypoactive Sexual
Desire Disorder
Premature (Early)
Ejaculation
 Delayed

Marked delay in ejaculation or Marked
infrequency or absence of ejaculation
 Erectile

Disorder
Marked difficulty in obtaining an erection,
maintaining an erection or decrease in erectile
rigidity
 Female

Ejaculation
Orgasmic Disorder
Marked delay in, marked infrequency of, or
absence of orgasm, or, Markedly reduced
intensity of orgasmic sensations
 75-100%
of the time x >6 months

Lack of, or sig reduced, sexual interest/arousal,
via >3 of following:
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Absent/reduced interest in sexual activity
Absent/reduced sexual/erotic thoughts or fantasies
No/reduced initiation of sexual activity, and typically
unreceptive to a partner’s attempts to initiate
Absent/reduced sexual excitement/pleasure during
sexual activity in almost all or all sexual encounters*
Absent/reduced sexual interest/arousal in response
to any internal or external sexual/erotic cues
Absent/reduced genital or nongenital sensations
during sexual activity in almost all or all sexual
encounters*

*~75%–100%, situational vs all contexts
 Persistent
or recurrent difficulties with >1 of
following



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Vaginal penetration during intercourse
Marked vulvovaginal or pelvic pain during vaginal
intercourse or penetration attempts
Marked fear or anxiety about vulvovaginal or
pelvic pain in anticipation of, during, or as a
result of vaginal penetration
Marked tensing or tightening of the pelvic floor
muscles during attempted vaginal penetration.
 Male



Hypoactive Sexual Desire Disorder
Persistently or recurrently deficient/absent
sexual/erotic thoughts or fantasies and desire for
sexual activity
Clinical judgment
X 6 months
 Premature


(Early) Ejaculation
Persistent or recurrent pattern of ejaculation
occurring during partnered sexual activity w/in
~1 min following vaginal penetration and before
the individual wishes it
75-100% of the time x >6 months
Intermittent Explosive
Disorder
Pyromania
Kleptomania

Recurrent behavioral outbursts representing a failure
to control aggressive impulses as manifested by
either of the following:

Verbal aggression or physical aggression toward property,
animals, or other individuals


~2x/week x 3 months, but no damage/destruction of property
and no physical injury to animals or others
3 behavioral outbursts involving damage or destruction
of property and/or physical assault involving physical
injury against animals or others occurring within a 12month period

Aggression of outbursts grossly out of proportion to
the provocation or to any precipitating psychosocial
stressors

not premeditated and are not committed to achieve
some tangible objective




Deliberate and purposeful
fire setting on >1 occasion
Tension or affective
arousal before the act
Fascination with, interest
in, curiosity about, or
attraction to fire and its
situational contexts
Pleasure, gratification, or
relief when setting fires or
when witnessing or
participating in their
aftermath
Pyromania

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

Recurrent failure to resist
impulses to steal objects
that are not needed for
personal use or for their
monetary value
Increasing sense of tension
immediately before
committing the theft
Pleasure, gratification, or
relief at the time of
committing the theft
stealing is not to express
anger or vengeance and is
not in response to
psychosis
Kleptomania
Voyeuristic Disorder
Exhibitionistic Disorder
Frotteuristic Disorder
Sexual Masochism
Disorder
Sexual Sadism Disorder
Pedophilic Disorder
Fetishistic Disorder
Transvestic Disorder
 >6
months
 recurrent
and intense sexual arousal
 manifested
by fantasies, urges, or behaviors.
 individual
has acted on these sexual urges
with a nonconsenting person, or
 Sexual
urges or fantasies cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning

Voyeuristic Disorder


Exhibitionistic Disorder


from the exposure of one’s genitals to an
unsuspecting person
Frotteuristic Disorder


from observing an unsuspecting person who is naked,
in the process of disrobing, or engaging in sexual
activity
from touching or rubbing against a nonconsenting
person
Sexual Masochism Disorder

from the act of being humiliated, beaten, bound, or
otherwise made to suffer
 Sexual

Sadism Disorder
from the physical or psychological suffering of
another person
 Fetishistic

Disorder
from either the use of nonliving objects or a
highly specific focus on nongenital body part(s)
 Transvestic

Disorder
from cross-dressing

recurrent, intense sexually arousing fantasies,
sexual urges, or behaviors

involving sexual activity with a prepubescent
child or children, generally <13 years

individual has acted on these sexual urges, or
the sexual urges or fantasies cause marked
distress or interpersonal difficulty

individual is at least age 16 years and at least 5
years older than the child or children

Note: Do not include an individual in late
adolescence involved in an ongoing sexual
relationship with a 12- or 13-year-old
 Anti-androgen
 Behaviour
drugs
modification
 Psychotherapy