Dissociative Identity Disorder (DID)

  1. Symptoms: 2 or more personalities exist between a single individual; persistent and maladaptive disruptions of memory, consciousness, or identity; may produce amnesia, confused travel of long distances
  2. Diagnosis: 2 or more personalities repeatedly take control of a person’s behavior, with alternations in mood, behavior, and at least some loss of recall between the personalities
  3. Course and Outcome: effectiveness of treatment is not known nor is the outcome due to lack of research
  4. Frequency of Disorder: amount of cases of DID shot from 200 to 40,000 after the release of Sybil; 3% of the general population suffers from DID; while the DSM-5 gives a prevalence rate of 1.5% with the disclaimer that the number is based on a “small study”; DID is rarely diagnosed outside of the USA and Canada
  5. Etiology: response to trauma, though this is skeptical; fragmented sleep-wake cycle, sleep deprivation; iatrogenesis (the manufacture of a disorder by its treatment)
  6. Treatment(s): focus on uncovering and recounting traumatic experiences; goal of integrate the different personalities into a whole; sometimes use antianxiety, antidepressants, and antipsychotic medications
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Erectile Dysfunction

  1. Symptoms: the vascular reflex mechanism in the penis fails; sufficient blood is not pumped to the penis to make it erect; occurs any time prior to orgasm; some have trouble achieving an erection during sexual foreplay; occurs in one of two ways:
    1. Difficulties in obtaining an erection long enough to accomplish intercourse
    2. Difficulties in maintaining an erection long enough to satisfy themselves and their partners during intercourse
  2. Diagnosis: Symptoms must occur for at least six months and lead to marked distress in the person that experiences them; diagnosis made by experienced therapists who would take into account persons age, the context of a person’s life, and whether the person experienced stimulation that would ordinarily be expected to lead to sustained arousal and orgasm
  3. Course and Outcome: Sexual disorders such as erectile dysfunction are well understood and there are several treatments that good results to cope with the disorder
  4. Frequency of Disorder: in men 18 to 24, 6% reported erectile problems; men 55 to 59, 20% reported erectile problems; erectile problems increase with age, they achieve erection slower, but can maintain it for a longer period of time; older men find it more difficult to regain an erection if lost before orgasm
  5. Etiology:
    1. Biological factors:
      1. Hormonal impairments: Men with inadequate levels of sex hormones (testosterone) have a lower sexual appetite
      2. Vascular impairments: effects the amount of blood reaching the penis
      3. Neurological impairment: epilepsy and multiple sclerosis; lacking spinal reflexes; diabetes
      4. Drugs: cigarettes, alcohol, marijuana
    2. Psychological Factors: beliefs and attitudes towards sexuality; anxiety; negative emotions in the presence of erotic stimuli
  6. Treatment(s):
    1. Psychological procedures: focuses on activities of sensate focus and scheduling, education and cognitive restructuring, and communication training
    2. Biological treatment:
      1. Medications: phosphodiesterase-5 (PDE-5) inhibitors that facilitate an erection by increasing blood flow to certain areas of the penis: Sildenafil citrate (Viagra), tadalafil (Cialis), vardenafil (Levitra)
      2. Surgical: inserting a penile implant (or prosthesis):
        1. semi-rigid silicone rod that the man can bend into position for intercourse
        2. hydraulic that can be inflated for the purpose of sexual activity

Specific Phobias

  1. Symptoms: persistent, irrational, and narrowly defined fear of a specific object or situation; complete avoidance of contact with said object or situation
  2. Diagnosis: The object or situation is actively avoided; the fear/anxiety is out of proportion with the actual danger posed by the object or situation; exposure must result in an immediate fear response; avoidance or distress associated with the phobia must interfere significantly with the person’s normal activities or relationships with others
  3. Course and Outcome: long-term outcome for anxiety disorders is mixed and unpredictable though some people do completely recover
  4. Frequency of Disorder: one year prevalence of 9% in adults (most common anxiety disorder); 50% rate of comorbidity rate of an anxiety disorder with another anxiety disorder or a mood disorder; 60% of people with a primary diagnosis of major depression also qualify for an anxiety disorder diagnosis; women have higher rates of relapse than men; women are three times more likely to experience a specific phobia; anxiety disorders are higher in elderly people in their 70s and 80s
  5. Etiology: maladaptive evolutionary anxiety and fears- though some anxiety/fear can be adaptive, it is maladaptive when it becomes excessive, becomes intense at an inappropriate time or place, the response systems become more harmful than helpful; social factors- stressful life events involving danger and interpersonal conflict;  stressful life events- high stress levels; childhood adversity- maternal prenatal stress, multiple maternal partner changes, parental indifference, physical abuse;  attachment relationships and separation anxiety;  learning processes- classical conditioning, such as after a traumatic experience, but can also develop in the absence of an direct experience with the feared object; cognitive factors-perceptions, memories, and attention influence the reaction to the environment;  perception of control- people who feel they are less in control of their environment are more likely to develop an anxiety disorder;  catastrophic misinterpretation- pertaining to bodily activities such as a rapid heart rate; attention to threat and biased information processing; genetic factors;  neurobiology-  response to stimuli by the amygdala
  6. Treatment(s): psychoanalytic psychotherapy;  systematic desensitization- recalling items that cause the least to the most fear for the patient;  interoceptive exposure- going through exercises that result in the same stimuli as when the fear or anxiety appears; relaxation and breathing retraining- tensing and releasing muscles with slow breathing, emphasis of the physiological effects of hyperventilation; cognitive therapy- teaching clients more useful ways of interpreting their environment; medications- benzodiazepines (Valium and Xanax) , azapirones, SSRIs (Prozac, Luvox, Zoloft, Paxil)

Persistent Depressive Disorder

Persistent depressive disorder, also known as dysthymia, is a milder form of depression, but the patient is rarely without symptoms.  Symptoms of dysthymia include poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.  Two or more of these symptoms must be present for the diagnosis of persistent depressive disorders and these symptoms cannot be absent for more than two months during a two year period.  Dysthymia has a lifetime risk of about three percent for the average person in a sample of more than nine thousand people in interviews by the National Comorbidity Survey Replication.

The typical onset for a depressive mood disorder is age thirty-two, but this may vary.  Lengths in depressive episodes vary, but must last at least two weeks and usually have to have at least two episodes.  Episodes may reoccur and may be divided with periods of partial or full recovery.  Half of all depressive patients recover within six months of an episode, and after a full recovery are less likely to relapse as the remission period gets longer.

Risk factors may include stressful life events, how people react to events in society surrounding them, genetic predisposition, hormone imbalances of the endocrine glands, brain structure, and neurotransmitter misfires.

Treatments may include interpersonal therapy focusing on relationships especially with family and antidepressant medication

Anorexia

  1. Symptoms: 2 main types are restricting (not engaged in binge eating or purging in the last 3 months) or binge eating/purging type (regular binging and purging)
    1. Classic Symptoms: significantly low weight (a BMI below 18.5; emaciation= 25-30% below regular body weight), distorted view of his/her body, intense fear of gaining weight
    2. Commonly associated symptoms: Amenorrhea (cessation of menstruation), obsessive preoccupation with food, occasional purging, “successful” struggle for control over persistent hunger, struggle for control, act impulsively, conforming and controlling; symptoms of depression (sad mood, irritability, insomnia, social withdraw, diminished interest in sex)
    3. Difficulties associated with Anorexia: mood disturbance; sexual problems; lack of impulse control; medical issues such as: constipation, abdominal pain, intolerance, lethargy, low blood pressure and low body temperature, lanugo (fine, downy hair on face and trunk of the body), anemia, infertility, inpaired kidney functioning, cardiovascular problems, dental erosion, bone loss, electrolyte imbalance leading to cardiac arrest or kidney failure
  2. Diagnosis: Must meet the following 3 criteria:
    1. Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health
    2. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
    3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight r shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
  3. Course and Outcome: 5% of people with anorexia die of starvation, suicide, or medical complications; at a 10-20 year follow-up nearly half of patients have returned to normal range, 20%  remain significantly below healthy body weight, the remainder are at an intermediate body weight; 5% of patients starve themselves to death or die of related complications including suicide; half of all women with a history of anorexia continue to be preoccupied with diet, weight, and body weight, notwithstanding weight gain;
  4. Frequency of Disorder: females are ten times more likely than males to have an eating disorder; 1995-1996 there were 54 cases per million people; 12 month prevalence of anorexia is .4 among females, similar to .9 estimate based on a recent US survey; difficult to establish prevalence in men
  5. Etiology: Typically in adolescents or early adulthood; caused by hormonal changes. Autonomy struggles, various sexual problems;
    1. Social factors: high standards of beauty for extreme thinness; working in fields that emphasize weight and appearance (models, ballet dancers, gymnasts); in adolescence culture puts an emphasis on appearance, beauty, and thinness; greater exposure to popular media, endorse more gender-role stereotypes, internalize societal standards; white women; industrialized societies; troubled family relationships; enmeshed families (overly involved in each others’ lives; child abuse
    2. Psychological factors: control issues, depression/dysphoria, body image dissatisfaction, reactions to dietary restraints; overly conforming, eager to please; perfectionism; lack of interoceptive awareness; low self-esteem; dietary restraint; weight suppression
    3. Biological factors: gene influence on personality characteristics such as anxiety; certain body types; genetic influence on pathology after puberty; hypothalamus
  6. Treatment(s): family therapy, Maudsley method (parents take complete control over the anorexic child’s eating, planning meals, preparing food, and monitoring food), age appropriate autonomy is returned to the teenager as eating and weight improve; 2 goals:
    1. Help patient gain minimal weight; if too severe they may be hospitalized and receive feeding that is forced or through intravenous methods or participate in a strict behavior therapy program that make rewards contingent on weight gain
    2. Address the broader eating difficulties