Abnormal: Sexual, Conduct, and SUDs

Sexual Dysfunctions

The disorders in this category involve “a clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure.” These disorders cannot be better explained by a nonsexual mental disorder, relationship distress or other stressor, the effects of a substance, medication, or medical condition.

Erectile Disorder

This diagnosis requires the presence of at least one of three symptoms: Marked difficulty in obtaining an erection during sexual activity, marked difficulty in maintaining an erection until completion of sexual activity, or marked decrease in erectile rigidity

Organic

Complete absence of erections during REM sleep suggests [organic/psychological] etiology

True

True or False: The first step in diagnosing Erectile Disorder is typically medical evaluation

Erectile Disorder

CBT (Masters and Johnson, 1970) for this disorder focuses on dysfunctional behaviors, related anxiety (e.g., performance anxiety), faulty attitudes and beliefs, and limited knowledge and skills

6 Months

Symptoms of Erectile Disorder must be present for all or almost all occasions of sexual activity for at least __

Extent

Specifiers for Erectile Disorder include onset (lifelong or acquired), __ (generalized or situational), and severity (mild, moderate, severe)

False

True or False: Sildenafil citrate (Viagra) increases both the ability to maintain erections and a person’s level of sexual desire

Genito-Pelvic Pain/ Penetration Disorder

This disorder involves persistent or recurrent difficulties involving one or more of the following: marked genito-pelvic pain during intercourse or penetration attempts; marked anxiety about genito-pelvic pain before, during, or as a result of penetration; marked tensing of pelvic floor muscles during attempted penetration

Genito-Pelvic Pain/ Penetration Disorder

This sexual dysfunction must be present for at least 6 months, is often treated with sex therapy, and has been linked with sexual and/or physical abuse

Premature Ejaculation

This disorder involves persistent or recurrent pattern of ejaculation during partnered sexual activity within about one minute of vaginal penetration or before the person desires it

Premature Ejaculation

Treatment for this sexual dysfunction includes sensate focus (couples perform structured, at-home touching exercises designed to shift the focus away from "goal-oriented" sex and toward mindful, sensory awareness), start-stop and squeeze techniques, and SSRIs (treat low serotonin levels that have been linked to the condition)

Gender Dysphoria

This diagnosis is characterized by a marked incongruence between one’s assigned gender at birth and one’s experienced or expressed gender

Gender Dysphoria

Children with this disorder must have six symptoms, while adults must have at least two; specifiers include those with DSDs and those who are post-transition

2 and 4

Clinic-referred children with gender dysphoria usually fall between ages _ and _

Lower

Persistence of gender dysphoria varies by AGAB. Those who are AMAB generally have [lower/higher] rates of persistence than those who are AFAB.

Paraphilic Disorder

This type of disorder is characterized by an “intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners… that is currently causing distress or impairment or… has entailed personal harm, or risk of harm, to others.”

Paraphilic Disorders

Examples of this type of disorder include Voyeuristic Disorder, Exhibitionistic Disorder, Sexual Sadism Disorder, Pedophilic Disorder, Fetishistic Disorder, Frotteuristic Disorder, and Transvestic Disorder

Frotteuristic Disorder

This disorder is characterized by intense sexual arousal from touching or rubbing against a non-consenting adult as manifested by fantasies, urges, and/or behaviors—and acting on these or experiencing distress or impairment

False

True or False: Frotteuristic Disorder usually begins in adolescence and increases with age

Transvestic Disorder

This disorder involves cross-dressing for the purpose of sexual arousal as manifested by fantasies, urges, and/or behaviors that cause distress or impairment; it is reported almost exclusively in males (most of whom are heterosexuals, although some who interact with other men when cross-dressing)

Paraphilic Disorders

These disorders used to be treated with in vivo aversion therapy, which had only short-term effects. They are now treated with a combination of cognitive strategies (e.g., reducing distortions, developing empathy for victims, tolerating strong emotions, etc.), behavioral strategies (e.g., covert sensitization - aversive conditioning in imagination, orgasmic reconditioning - replacing fantasies while masturbating), and medication (Depo-Provera)

False

True or False: Benefits of medroxyprogesterone (Depo-Provera) for psraphilic disorders persists even once the medication is stopped

Oppositional Defiant Disorder

This disorder is characterized by a recurrent pattern of angry/ irritable mood, argumentative/ defiant behavior, or vindictiveness

Oppositional Defiant Disorder

This disorder must include at least four symptoms in interactions with others (not siblings): Loses temper, often argues with authority figures, refuses to comply with requests from authority or with rules, blames others for their mistakes. Symptoms must persist for at least 6 months and cause distress for person or others.

Intermittent Explosive Disorder

This disorder is characterized by recurrent behavioral outbursts that are related to an inability to control aggressive impulses as manifested by a) verbal or physical aggression that occurs at least twice weekly for at least three months or b) three outbursts that cause damage to property, people, or animals during a 12-month period

Intermittent Explosive Disorder

For this condition, the severity of outbursts is not proportionate to provocation, and outbursts are not premeditated or committed to achieve tangible outcomes

True

True or False: Intermittent Explosive Disorder cannot be diagnosed before age 6

Conduct Disorder

This disorder is characterized by a persistent pattern of behavior that violates the basic rights of others and/or age-appropriate social norms or rules

Conduct Disorder

This diagnosis is generally not made after age 18 and requires at least 3 symptoms that fall into four categories: Aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules

12

Symptoms for Conduct Disorder must be present for at least __ months, with at least one symptom being present in the last 6 months

Conduct Disorder

This disorder is more common in males than females; girls show more relational than physical aggression, while boys show both

Conduct Disorder

The three subtypes of this disorder, according to DSM-5-TR, are childhood-onset (prior to age 10), adolescent-onset (no symptoms before 10), unspecified onset (onset unknown)

Conduct Disorder

Specifiers for this disorder include limited prosocial emotions and severity based on the number of conduct problems a person has

True

True or False: Childhood onset of Conduct Disorder has higher aggressiveness, continued aggressiveness in adulthood, and eventual Antisocial PD diagnosis

Life-Course-Persistent

According to Moffit, this type of Conduct Disorder begins early (sometimes apparent by age 3), involves increasingly serious transgressions; and is due to neurological impairments (e.g., verbal skills, executive functioning, memory), difficult temperament, and adverse environmental circumstances

Adolescence-Limited

According to Moffit, this type of Conduct Disorder is a temporary state that reflects a “maturity gap” between biology and lack of opportunities for adult privileges; antisocial acts are usually committed with peers and are inconsistent across situations

Conduct Disorder

This diagnosis must be differentiated from ADHD, ODD, and child or adolescent antisocial behavior (sub-clinical)

True

True or False: Treatment for Conduct Disorder is most effective when targeting preadolescents (rather than adolescents)

True

True or False: Treatment for Conduct Disorder is most effective when including family interventions like parent management training (PMT) or multisystemic therapy (MST)

Parent Management Training (PMT)

This intervention, often used for Conduct Disorder, teaches parents to reward positive behaviors and replace physical punishment with time-out, response cost, and similar techniques