Psychopathology Exam 3

Factitious disorder imposed on self

This is when a person intentionally produces symptoms in the self in order to assume the role of patient

Motives for Factitious disorder imposed on self

seeking attention, warmth, nurturance, and reducing loneliness

Factitious Disorder imposed on another

This is when a person (often a parent) intentionally produces symptoms in a vulnerable other (usually a child)

Motives for Factitious Disorder imposed on another

To gain attention as a “savior” or dutiful person/parent. 

Or the parent could have an intense desire not to be separated from the child or have a sincere but delusional belief that the child is ill.

 An overwhelmed parent could also be looking for help in caring for the child;

Prevalence of factitious disorder

Mostly young females with relatively stable social connections

Mostly nurses

Most common comorbid disorder with factitious disorders (high comorbidity)

Depression

Malingering

entails external motivations/gains (mostly monetary gain).

false or grossly exaggerated physical or psychological complaints where the goal is receiving some type of reward (e.g., insurance money, time off work, obtain prescriptions, etc.).

Is malingering in the DSM 5?

It’s NOT considered an official disorder.

Malingering is rather a legal issue of fraud

somatic symptom disorders

bodily (physical) symptoms result from psychological distress

medically unexplained symptoms (MUS)

the physical symptoms do not appear to be related to a medical condition that is known

Conversion Disorder

has no physical cause and seems related to psychological problems

sudden symptoms just after an especially stressful event

not consciously trying to produce the symptoms

Somatic Symptom Disorder

excessive worry about somatic (bodily) symptoms

Often, the patient will become an expert on their symptoms, and will go to many doctors.

physical symptoms prominent

Somatic Symptom Disorder: Somatization pattern

Many and varied physical symptoms

Somatic Symptom Disorder: Predominant Pain pattern

…excessive worry about physical pain symptoms

Illness Anxiety Disorder

interprets insignificant symptoms as signs of serious illness in the absence of any organic evidence of such illness

the person has an actual symptom, but is over-interpreting it. The person is not imagining their symptom; it actually exists. It’s just over-interpreted

physical symptoms less prominent, 

anxiety/preoccupation = main complaint

Sexual Dysfunctions

difficulties (e.g., erectile disorder) at some point in the sexual response cycle. They have to do with difficulty in sexual functioning

Examples of Sexual Dysfunction Disorders

Disorders of Desire

Disorders of Excitement

Disorders of Orgasm

Paraphilic Disorders

sexual arousal and urges about people/things that are unusual (e.g., fetishes for shoes, attraction to children, etc.)

Requires

1. personal distress 

OR…

2. another’s psychological distress/injury/death, or…

3.unwilling persons or…

4. persons unable to give legal consent

Fetishistic Disorder

intense sexual urges, sexually arousing fantasies, or behaviors that involve inanimate objects

Transvestic Disorder

fantasies, urges, or behaviors involving dressing in the clothes of the opposite sex in order to achieve sexual arousal

Exhibitionistic Disorder

arousal from the exposure of genitals in a public setting 

Voyeuristic Disorder

“Peeping Tom”

observes people in secret as they undress or spies on couples having intercourse

Frotteuristic Disorder

non-consensual rubbing against or touching another person to achieve sexual arousal or even orgasm

Pedophilia

attraction to children but without acting on it

Pedophilic Disorder

fantasies, urges, or behaviors involving some form of sexual behavior with a child usually 13 years of age or younger

The person has acted on these desires, is distressed  by them, or has experienced interpersonal difficulties as a result

Sexual Masochism Disorder

fantasies, urges, or behaviors involving the act or thought of being humiliated, beaten, bound, or otherwise made to suffer

Sexual Sadism Disorder

fantasies, urges, or behaviors involving the thought or act of psychological or physical suffering of a victim sexually exciting

What do paraphilic disorders have in common?

pathological expressions of control and power

Gender Dysphoria

a feeling of incongruence between one’s expressed gender (biological sex) and one’s assigned gender

This includes wanting to rid oneself of primary or secondary sex characteristics, acquiring the sex characteristics of the opposite gender,  a strong desire to be the other gender and to be treated as the other gender, AND the person experiences significant personal and interpersonal distress as a result.

desistance

Research suggests that most children (65 – 94%) “outgrow” transgendered behavior/identity

“Triadic” Approach Treatment for Transgender

1. real-life experiences (e.g., change name, dress in clothes of preferred gender, etc.)

2. hormonal

Female to male (FTM): receive testosterone to normal male dose

Male to Female (MTF): must suppress testosterone production to get best results: Anti-androgen(s) + Estrogen given in higher doses

3. surgery: this only occurs as the last step in the process, and is preceded by counseling and the recommendation of the therapist that transition surgery is indicated

Personality Disorders

inflexible ways of seeing the world

Most personality disorders are not usually diagnosed until age 18

often very resistant to treatment

Borderline Personality Disorder (symptoms)

Unstable, causes conflict

instability in relationships, relatively frequent emotional displays in response to real or imagined abandonment, and stubborn, inflexible opinions (“I’m right!”). These  can all include unreasonably angry/rageful responses to perceived offenses, Polarization, i.e., they often view themselves and others in extremes (e.g., good/bad), and are often unable to accept that both qualities can reside within the same person. They also can often “split” people, Unstable identity/fluctuating views of themselves, also often “bait” people into conflict

Treatment of Borderline Personality Disorder

Dialectical Behavior Therapy

Narcissistic Personality Disorder

Extreme pride

inflated sense of self (power, ability, etc.), Lack of empathy for others, Haughtiness, arrogance, Expect special treatment and believe that they are in some special class of people that others just don’t understand well, Exploit others for their own gain, Intolerant of criticism; tend to retaliate when confronted

Treatment of Narcissistic Personality Disorder

cognitive-behavior therapy

challenge the person’s irrational sense of self and help them to develop a healthier sense of self, which includes acknowledging one’s strengths and weaknesses

Histrionic Personality Disorder

Melodramatic, need attention

They have intense, unstable emotions, and often display these openly and inappropriately, They have distorted self-images, and their self-esteem depends on the approval of others, They have an overwhelming desire to be noticed, and often behave dramatically or inappropriately to get attention, They often believe that relationships are more intimate than they actually are, They can act in overly seductive ways as part of their attention-getting behaviors, They are also quite impulsive

Etiology of Personality Disorder

One factor is early childhood trauma

• 1. As noted earlier, those with borderline personality disorder were especially likely to have  been sexually abused as children.

• 2. A history of verbal abuse in childhood was significantly related to borderline and narcissistic personality disorders.

Genetic factors

Natural temperament