Disorders Not Covered In Class

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Disorders Not Covered In Class
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Impulse Control DisordersNot Elsewhere Classified
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Overview of Impulse Control Disorders (Not
Elsewhere Classified)

• Disorders include
• Intermittent Explosive Disorder
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse Control Disorder Not Otherwise Specified
  (NOS)

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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)

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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
• PEOPLE WITH IED FIND THE EPISODES DISTRESSING

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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

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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
  disorders

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Kleptomania

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
   hallucination
5. The stealing is not better accounted for by
   Conduct Disorder, a Manic Episode, or Antisocial
   Personality Disorder

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Kleptomania

• 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

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Kleptomania

• 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

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Kleptomania

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

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Pyromania

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,
   consequences)
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

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Pyromania

• 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

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Pyromania

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

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Pathological Gambling

• Persistent and recurrent maladaptive gambling
  behavior as indicated by five (or more) of the
  following
• 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
  gamble)
• 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)

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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

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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

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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

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Pathological Gambling

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

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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

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Trichotillomania

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
   condition)
5. The disturbance causes clinically significant
   distress or impairment in social, occupational,
   or other important areas of functioning

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Trichotillomania

• 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

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Trichotillomania

• 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

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Trichotillomania

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

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Trichotillomania

• 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

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Gender Identity Disorder

• A strong and persistent cross-gender
  identification (not merely a desire for any
  perceived cultural advantages of being the other
  sex)
• 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

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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.

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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
  sex
• 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

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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