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Disorders Not Covered In Class


Gender Identity Disorder Diagnosis requires strong and persistent cross-gender identification and persistent discomfort about one s own sex As children, ... – PowerPoint PPT presentation

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Title: Disorders Not Covered In Class

Disorders Not Covered In Class
Impulse Control DisordersNot Elsewhere Classified
Overview of Impulse Control Disorders (Not
Elsewhere Classified)
  • Disorders include
  • Intermittent Explosive Disorder
  • Kleptomania
  • Pyromania
  • Pathological Gambling
  • Trichotillomania
  • Impulse Control Disorder Not Otherwise Specified

Intermittent Explosive Disorder
  1. Several discrete episodes of failure to resist
    aggressive impulses that result in serious
    assaultive acts or destruction of property
  2. The degree of aggressiveness expressed during the
    episodes is grossly out of proportion to any
    precipitating psychological stressors
  3. The aggressive episodes are not better accounted
    for by another mental disorder (e.g., Antisocial
    Personality Disorder, Borderline Personality
    Disorder, a Psychotic Disorder, a Manic Episode,
    Conduct Disorder, or Attention Deficit/Hyperactivi
    ty Disorder) and are not due to the direct
    physiological effects of a substance (e.g., a
    drug of abuse, a medication) or a general medical
    condition (e.g., head trauma, Alzheimers disease)

Intermittent Explosive Disorder (IED)
  • People with IED often describe the episodes as
    spells or attacks
  • The episode I soften preceded by a sense of
    tension or arousal and is immediately followed by
    a sense of relief
  • The individual often feels upset, guilty, or
    embarrassed by their behavior during the episode

Intermittent Explosive Disorder (IED)
  • High comorbidity with
  • Mood disorders
  • Anxiety disorders
  • Eating disorders
  • Substance abuse
  • IED is not diagnosed if the episodes are a direct
    result of the person using a substance however,
    many people abuse substances to avoid feeling the
    symptoms of a psychological disorder
  • Other impulse control disorders

Intermittent Explosive Disorder (IED)
  • IED seems to be a rare disorder, and there is no
    reliable information on how many people have it
  • Symptoms are usually better accounted for by
    another disorder
  • Higher occurrence in first degree relatives of
    people with IED or other impulse control

  1. Recurrent failure to resist impulses to steal
    objects that are not needed for personal use or
    for their monetary value
  2. Increasing sense of tension immediately before
    committing the theft
  3. Pleasure, gratification, or relief at the time of
    committing the theft
  4. The stealing is not committed to express anger or
    vengeance and is not in response to a delusion or
  5. The stealing is not better accounted for by
    Conduct Disorder, a Manic Episode, or Antisocial
    Personality Disorder

  • The objects stolen are usually of little
    value/use to the individual
  • A person with kleptomania often gives away or
    discards the stolen objects
  • Occasionally they are hoarded or returned
  • Usually a person with kleptomania avoids stealing
    when immediate arrest is likely, but does not
    preplan thefts or fully take into account the
    chances of being caught
  • Stealing is done alone

  • People with kleptomania view their behavior as
    ego dystonic
  • (something that is not typical of them they
    realize that the impulse is coming from their own
    mind but do not consider it to be in line with
    their usual personality)
  • The person is aware that stealing s wrong and
    often fear getting caught or feel depressed or
    guilty about the behavior
  • More common in women in clinical samples
  • Overall prevalence is unknown, but only accounts
    for less than 5 of shoplifters

  • Age of onset is variable
  • High comorbidity with
  • Mood disorders
  • Anxiety disorders
  • Eating disorders
  • Personality disorders
  • Other impulse control disorders

  1. Deliberate and purposeful fire setting on more
    than one occasion
  2. Tension or affective arousal before the act
  3. Fascination with, interest in, curiosity about,
    or attraction to fire and its situational
    contexts (e.g., paraphernalia, uses,
  4. Pleasure, gratification, or relief when setting
    fires, or when witnessing or participating in
    their aftermath
  5. The fire setting is not done for monetary gain,
    as an expression of sociopolitical ideology, to
    conceal criminal activity, to express anger or
    vengeance, to improve ones living circumstances,
    in response to a delusion or hallucination, or as
    a result of impaired judgment (e.g., in dementia,
    mental retardation, substance intoxication)
  6. The fire setting is not better accounted for by
    conduct disorder, a manic episode, or antisocial
    personality disorder

  • May make considerable advance preparation for
    starting a fire
  • May be indifferent to the consequences to life or
    property after fires, or may derive satisfaction
    from the destruction
  • Behaviors may lead to property damage, legal
    consequences, injury, or loss of life
  • Insufficient data about typical age of onset
    unclear if theres a relationship between fire
    setting in childhood and adulthood
  • Fully diagnosable pyromania in children is
    particularly rare

  • Pyromania is extremely rare, but is more commonly
    diagnosed in males
  • There is high comorbidity with alcohol or
    substance dependence and abuse

Pathological Gambling
  • Persistent and recurrent maladaptive gambling
    behavior as indicated by five (or more) of the
  • Is preoccupied with gambling (e.g., preoccupied
    with reliving past gambling experiences,
    handicapping or planning the next venture, or
    thinking of ways to get money with which to
  • Needs to gamble with increasing amounts of money
    in order to achieve the desired excitement
  • Has repeated unsuccessful efforts to control, cut
    back, or stop gambling
  • Is restless or irritable when attempting to cut
    down or stop gambling
  • Gambles as a way of escaping from problems or of
    relieving a dysphoric mood (e.g., feelings of
    helplessness, guilt, anxiety, depression)

Pathological Gambling
  • After losing money gambling, often returns
    another day to get even (chasing ones losses)
  • Lies to family members, therapists, or others to
    conceal the extent of involvement with gambling
  • Has committed illegal acts such as forgery,
    fraud, theft, or embezzlement to finance gambling
  • Has jeopardized or lost a significant
    relationship, job, or educational or career
    opportunity because of gambling
  • Relies on others to provide money to relieve a
    desperate financial situation caused by gambling
  • The gambling behavior is not better accounted for
    by a manic episode

Pathological Gambling
  • Note that the symptoms described closely mirror
    those of physical addiction/dependence!
  • There are often distortions in thinking that
    accompany the gambling (e.g., denial,
    superstitions, overconfidence, or a sense of
    power or control)
  • Many pathological gamblers view money as both the
    cause of and solution to their problems
  • Frequently are highly competitive, energetic,
    restless, and easily bored
  • May be overly concerned with approval of others
    and generous to the point of extravagance
  • When not gambling are often workaholics

Pathological Gambling
  • Prone to general medical conditions that are
    associated with stress
  • Hypertension
  • Peptic ulcer disease
  • Migraines
  • High incidence of suicidal ideation and attempts
  • High comorbidity with
  • Mood disorders
  • Attention deficit/hyperactivity disorder
  • Substance abuse or dependence
  • Other impulse control disorders
  • Antisocial, Narcissistic, and Borderline
    Personality disorders

Pathological Gambling
  • Often abnormal laboratory findings
  • Levels of serotonin, norepinephrine, and dopamine
  • Abnormalities in platelet monoamine oxidase
  • High levels of impulsivity on neuropsychological

Pathological Gambling
  • Females seem to account for 1/3 of pathological
    gamblers, but only 2-4 of those in treatment
  • Life time prevalence estimates range from .4 to
    8 depending on location and age group
  • More common among relatives of pathological
    gambles and substance abusers

  1. Recurrent pulling out of ones hair resulting in
    noticeable hair loss
  2. An increasing sense of tension immediately before
    pulling out the hair or when attempting to resist
    the behavior
  3. Pleasure, gratification, or relief when pulling
    out the hair
  4. The disturbance is not better accounted for by
    another mental disorder and is not due to a
    general medical condition (e.g., dermatological
  5. The disturbance causes clinically significant
    distress or impairment in social, occupational,
    or other important areas of functioning

  • Sites of hair pulling include anywhere on the
    body where hair may grow
  • May occur in brief periods scattered throughout
    the day or in less frequent but longer periods
    that can continue for hours
  • Hair pulling often occurs while the person is in
    a state of relaxation or distraction (e.g., while
    reading a book or watching TV.) but can also
    occur during stressful circumstances
  • For some, tension does not necessarily precede
    the hair pulling but is associated with attempts
    to resist the impulse
  • Some people experience an itch like sensation
    that is eased by pulling the hair

  • Hair pulling usually does not occur around other
    people (except family members) but social
    situations may be avoided
  • Individuals frequently try to find ways to hide
    their behavior or camouflage the results
  • Some may have impulses to pull hair from other
    people or objects
  • Associated behaviors include
  • Examining the hair root
  • Pulling the hair strand between teeth
  • Eating hairs
  • Nail biting
  • scratching

  • High comorbidity with
  • Mood disorders
  • Anxiety disorders (especially obsessive
    compulsive disorder)
  • Substance abuse
  • Eating disorders
  • Personality disorders
  • Mental retardation

  • Seems to be equally common among males and
    females in children
  • Among adults, more common in females
  • This may reflect differences in who seeks
    treatment among adults the resulting hair loss
    may be more acceptable to an adult male than
    adult female due to societal norms
  • Overall prevalence is unclear, but it is
    relatively uncommon

  • This slide left blank as a divider

Gender Identity Disorder
  • A strong and persistent cross-gender
    identification (not merely a desire for any
    perceived cultural advantages of being the other
  • In children, the disturbance is manifested by
    four (or more) of the following
  • repeatedly stated desire to be, or insistence
    that he or she is, the other sex
  • In boys, preference for cross-dressing or
    simulating female attire in girls, insistence on
    wearing only stereotypically masculine clothing
  • Strong and persistent preferences for cross-sex
    roles in make-believe play or persistent
    fantasies of being the other sex
  • Intense desire to participate in the
    stereotypical games and pastimes of the other sex
  • Strong preference for playmates of the other sex
  • In adolescents and adults, the disturbance is
    manifested by symptoms such as a stated desire to
    be the other sex, frequent passing as the other
    sex, desire to live or be treated as the other
    sex, or the conviction that he or she has the
    typical feelings and reasons of the other sex

Gender Identity Disorder
  • B. Persistent discomfort with his or her sex or
    sense of inappropriateness in the gender role of
    that sex
  • In children, the disturbance is manifested by
    any of the following in boys, assertion that his
    penis or testes are disgusting or will disappear
    or assertion that it would be better to not have
    a penis, or aversion toward rough-and-tumble play
    and rejection of male stereotypical toys, games,
    and activities in girls, rejection of urinating
    in a sitting position, assertion that she has or
    will grow a penis, or assertion that she does not
    want to grow breasts or menstruate, or marked
    aversion toward normative feminine clothing.
  • In adolescents and adults, the disturbance is
    manifested by symptoms such as preoccupation with
    getting rid of primary and secondary sex
    characteristics (e.g., request for hormones,
    surgery, or other procedures to physically alter
    sexual characteristics to simulate the other sex)
    or belief that he or she was born the wrong sex
  • C. The disturbance is not concurrent with a
    physical intersex condition
  • D. The disturbance causes clinically significant
    distress or impairment in social, occupational,
    or other important areas of functioning.

Gender Identity Disorder
  • Diagnosis requires strong and persistent
    cross-gender identification and persistent
    discomfort about ones own sex
  • As children, people with GID may insist that they
    will grow up to be the opposite sex and prefer to
    play with toys and take on roles typically
    associated with the opposite sex
  • Some children may refuse to attend events where
    they are required to dress as their biological
  • There is a high risk of social isolation because
    of stigma and ostracism
  • People with GID are at a higher risk for low self
    esteem and dropping out of school
  • There are high rates of depression and anxiety
    disorders among people with GID this may be
    largely due to cultural reasons

Gender Identity Disorder
  • Men seem to seek treatment more often
  • As children, females may experience less
    ostracism because tom boy behavior is often
    accepted and parents are more likely to seek
    treatment for a son who is effeminate
  • Men tend to seek sex-reassignment surgery more
    often than women
  • Adults who are diagnosed with GID usually have
    onset of cross-gendered interests/behaviors
    around 2-4 years of age
  • Most children who express the same behaviors grow
    out of them and do not have GID as adults
  • Note GID is NOT the same as or necessarily
    connected with homosexuality
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