What is Persistent Genital Arousal Disorder (PGAD)?

Persistent Genital Arousal Disorder (PGAD) is a rare disorder that affects mostly women and interferes tremendously in social settings, work, relationships and overall happiness.  This article will talk about what PGAD is, treatment options, resources, and similar disorders.

Persistent Genital Arousal Disorder: What Does It Mean?

PGAD is when a woman, and in some small cases, men, experiences arousal that is spontaneous without any precipitating cause.  In other words, it is not linked to sexual arousal and does not go away after orgasm.  It can last from several hours to several days at a time with little relief in between.  Women with this disorder are not necessarily more sexually active as the arousal is not from being sexually aroused, but rather it is a physical symptom.  In contrast, many women avoid sex due to the frustration of not getting relief from an orgasm.  It should be noted that there are a handful of cases that have involved men.

Stats: How Many Suffer from this Disorder?

It is unknown how many women suffer from this disorder, but to date, there are few women who report it.  There are thought to be more than 7,000 women who suffer from this disorder, often in silence.  It is thought that more women suffer from this but avoid reporting it or seeking help due to lack of knowledge or feelings of embarrassment.

What Causes PGAD?

No one knows what causes PGAD, however, there have been cases where PGAD has resulted from the following:

  • Menopause
  • Tourettes Syndrome
  • Tarlov Cysts
  • Trauma to the central nervous system
  • Epilepsy

In some women, PGAD is exacerbated by stress.  Once the stress is decreased the intensity of PGAD may also decrease.

PGAD has also been linked to sudden withdrawal of SSRI’s or antidepressants.  There have been a number of women who say they have developed PGAD after stopping these medications suddenly.

Signs and Symptoms of PGAD

Symptoms of PGAD are:

  1. Irritation, throbbing, pain or pressure in the genitals
  2. Vaginal contractions
  3. Blood flow that has increased to the vaginal walls
  4. A feeling of tingling in the clitoris
  5. uncontrolled orgasms (spontaneous)
  6. Wetness
  7. Itching

What are the Common Behaviors/Characteristics?

Women that have PGAD typically will feel sensitivity in their nipples and genital area.  They become aroused with or without sexual activity and will often say that they can be cooking, walking down the street, working, or other non-sexual activities when they feel aroused.  This is in the absence of sexual thoughts.  Most women find these feelings unwanted and intrusive in nature and causes a great deal of stress in their lives.  PGAD has been linked to depression, isolation, and suicidal thoughts.  There have been a few cases where women actually committed suicide after having this disorder for many years with no relief.

PGAD and Other Conditions

PGAD was once known as PSAS (Persistent Sexual Arousal Syndrome) but it was later changed to PGAD as the later suggested it resulted in or was an increase in sexual desire.

PGAD vs Nymphomania

Nymphomania is different than PGAD in that nymphomania is a woman who is hypersexual or a greater need for sexual satisfaction.  With PGAD, women are not more sexual than women without it and often experience physical and psychological pain as a result, unlike being hypersexual.

PGAD vs Satyriasis

Satyriasis is the male version of Nymphomania which means a man that is hypersexual.  This is different because someone with Satyriasis likes having sex a lot as opposed to PGAD where a person does not necessarily want sex a lot.

Related Conditions

Priapism is related to PGAD in that it is a male genital arousal disorder.  It is a consistent penile erection that may or may not be caused by sexual arousal and is not relieved by orgasm.

Example Case of PGAD

Mary is a 38-year-old woman who has had a relatively normal sex life until now, when she begins experiencing spontaneous arousal in her genitals.  She notices that it is not relieved by sex, nor is it something that she likes.  At times the pain from the constant arousal is so bad that urinating is a chore.  She notices symptoms that include wetness, pressure, and feelings of being on the verge of an orgasm most of the time.  For Mary, the symptoms are distracting and cause her a great deal of anxiety and stress when in the presence of others.  She talks to her husband about it and they make an appointment with her gynecologist who, after giving her a full exam and find no abnormal findings, refers her to a specialist in the area that knows about this disorder.  Mary is treated, however, her symptoms never completely go away.  Instead, she learns to manage her symptoms through therapy and support from her family.

PGAD

How to Deal/Coping With PGAD

Due to the lack of knowledge in the community about this disorder, many women feel alone and suffer in silence.  It is helpful for women to enlist the help of family and friends as well as educate themselves and family members on the disorder in order to have support.  Seeking counseling has also proven to be helpful for some women.  Exploring and ruling out other medical issues is important to ensure there are no medical problems that have caused this disorder.

Look out for These Complications/Risk Factors

It’s important to seek medical treatment to rule out any other medical conditions.  Therapy will be helpful to learn how to manage the symptoms and therefore should be sought to prevent depression and anxiety.  This is not a disorder that should be dealt with alone as it can cause increased frustration and depression.

It should also be noted that when seeking medical treatment, to make sure you find a doctor that has some familiarity with this disorder or can refer to someone who does.  Due to the lack of knowledge about this disorder, many times doctors who are not familiar with this disorder don’t see PGAD as a real disorder and may not treat it correctly.

PGAD Treatment

Cognitive Behavior Therapy (CBT) can be helpful for women to explore triggers and also learn coping skills to assist with living with this disorder.  Often times learning how to decrease stress can prove to be helpful.  In some cases, ECT (electroconvulsive therapy) has been used but usually only in severe cases.  When it has been determined that the woman has Tarlov Cysts, sometimes surgery has been used to remove the cysts which in turn will relieve the symptoms of PGAD.  Some women have found relief using ice on the affected area or numbing agents, however, it should be noted that both of these should be used at the discretion of a medical doctor.

Possible Medications for PGAD

Anti-seizure medications, as well as antidepressants, have proven to be effective in treating the symptoms of PGAD.  If all medical conditions have been ruled out, it is thought that PGAD may be brought on by psychological stress.  Antidepressants can relieve depression and help to alleviate some symptoms.

Home Remedies to help PGAD

Reducing stress has been known to be of some help and using an ice pack on the affected area might be helpful but you should seek medical attention first to rule out other medical conditions.  Some patients have found some relief using an analgesic on the affected area to help numb the sensations.

Living with PGAD

Living with PGAD can be very stressful and can sometimes bring shame or embarrassment to the person affected when they do not know where to turn.  Finding support from those who are close to you and also seeking medical treatment is helpful and may relieve some stress.  Support groups are also a good way to talk with others who are going through the same thing.  Often times you can find online support groups as well.

Insurance Coverage for PGAD

Most insurances will cover this disorder, as the first thing is usually to rule out any medical conditions related to it.  Therapy and medication treatment are the most common forms of treatment and are also covered by most insurances.  Be sure to talk to your doctor about treatment options and what is covered.

How to Find a Therapist

You can locate a Licensed Therapist by searching online at www.psychologytoday.com or www.goodtherapy.org.  Both of these sites will allow you to search for a therapist by location, specialty, and insurance.  Most therapists list themselves and/or their practices on this site.  Your medical doctor may also be able to refer you to a therapist that they work with.

What Should I be Looking for in an LMHP?

When searching for a Licensed Mental Health Professional, a person should search for someone who specializes in sexual disorders and/or Cognitive Behavior Therapy.  The LMHP should be licensed and have some experience dealing with PGAD as well as be knowledgeable about treatment options.

Questions to Ask a Potential Therapist

Questions to ask a potential therapist when seeking treatment for PGAD are:

  1. Are you knowledgeable about PGAD?
  2. Have you ever treated anyone with PGAD, and if so, how many people?
  3. What are your treatment approaches for someone with PGAD?
  4. Do you accept my insurance?

Finding a therapist that you are comfortable talking to is key to helping to cope with this disorder.  A therapist should be willing to listen to you and involve you in the treatment process as much as possible.

PGAD Resources and Support Helpline

For resources and support for PGAD, please visit their website at www.pgad-support.com.  To reach someone at this organization, it is recommended that you contact them by email at [email protected].  Information and support can also be found by contacting the Genetic and Rare Diseases Information Center at 888-205-2311.  They can assist in finding support, resources and information on PGAD.

 

The lack of research, as well as the lack of knowledge surrounding PGAD, has made it difficult for some women to talk to others.  It is important that the person who is affected reaches out to a physician that has some familiarity with this disorder.  Women are cautioned to not give up on treatment options for this disorder as there are a variety of things that have helped different people.  Educating family and friends and even people in the medical field can prove to be effective in spreading the word about this disorder to hopefully one day bring more research and treatment.

 

What is Schizotypal Personality Disorder

Schizotypal Personality Disorder: What Does It Mean?

Schizotypal personality disorder is a disorder characterized by difficulties in making and maintaining relationships due to extreme discomfort. Someone with the disorder will also usually display odd or eccentric personality traits and may have difficulty in displaying emotions.

Schizotypal Definition

Psychology Today defines the disorder as follows:

“Schizotypal personality disorder is a pattern of social and interpersonal difficulties that includes a sense of discomfort with close relationships, eccentric behavior, and unusual thoughts and perceptions of reality. Speech may include digressions, odd use of words or display “magical thinking,” such as a belief in clairvoyance and bizarre fantasies. Patients usually experience distorted thinking, behave strangely, and avoid intimacy. They typically have few, if any, close friends, and feel nervous around strangers although they may marry and maintain jobs. The disorder, which may appear more frequently in males, surfaces by early adulthood and can exacerbate anxiety and depression.”

Stats: How Many Suffer from this Disorder?

Studies into schizotypal personality disorder have found that around 3.9% of the population will suffer from the disorder during their lifetime. It is slightly more common in men, with 4.2% diagnosed with the disorder compared to 3.7% of women.

Research indicates that the odds of developing the disorder are significantly higher among black women. Asian men are much less likely to have the disorder than any other grouping. People with lower incomes are also more likely to develop the disorder, as well as those who are widowed, divorced or separated.

A recent study has found that people diagnosed with the disorder are less likely to live independently or to have obtained a bachelor’s degree. They are much more likely to work in an isolated job and earn below the national average.  The study also indicates that none of these things seem to be as a result of cognitive impairment or intellectual inability.

What Causes Schizotypal Personality Disorder?

There is not one known cause of schizotypal personality disorder currently. However, it is believed to be developed as a result of a combination of causes.

Genetic vulnerability to the disorder is a significant factor. People who have a direct family member who displays schizotypal symptoms are 50% more likely to display schizotypal symptoms themselves, which may result in being diagnosed with this disorder.

Research is on-going, but some scientists believe that people with this disorder have a significantly different makeup in their brains than those without. Specifically, it is believed that certain areas of the brain have less brain matter and that there are abnormalities of the neurotransmitter dopamine.

There is a possible link to childhood experiences although no research has so far proven this. Other childhood-related factors that increase the likelihood of developing the disorder include a lower birth weight, a small head circumference at 12 months old and a mother smoking whilst pregnant with the child in question.

Signs and Symptoms of Schizotypal Personality Disorder

What are the Common Behaviors/Characteristics?

One of the most common characteristics of people with this disorder is extreme discomfort around other people and in social situations. Developing relationships and maintaining relationships is often extremely difficult. This can often result in the person only having a relationship with direct family members and can cause unhappiness due to lack of friendship. Even interacting in seemingly insignificant social situations, such as a store or workplace, can cause anxiety for someone with this disorder.

People with this disorder often have odd or unusual beliefs or fantasies. They may be very superstitious about particular actions or believe they possess magical powers. A person with this disorder may believe there is significant meaning in a normal occurrence or that they are being sent a sign through an innocuous gesture. They may also be very suspicious of other people and/or have paranoid tendencies.

Another common behavior is having different or odd speech. Someone with schizotypal personality disorder will often use strange phrasing or use words out of context. Their appearance is often unusual also, they may wear dirty or ill-fitting clothing.

Testing: What are the Diagnostic Criteria Per the DSM 5?

The DSM 5 criteria for schizotypal personality disorder is:

“A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

(1) ideas of reference (excluding delusions of reference)

(2) odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations)

(3) unusual perceptual experiences, including bodily illusions

(4) odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)

(5) suspiciousness or paranoid ideation

(6) inappropriate or constricted affect

(7) behavior or appearance that is odd, eccentric, or peculiar

(8) lack of close friends or confidants other than first-degree relatives

(9) excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

  1. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder.”

Schizotypal Personality Disorder and Other Conditions

Schizotypal Personality Disorder vs Schizophrenia

Schizophrenia and schizotypal personality disorder are frequently mixed up but there are many significant differences. The differences mainly center around the ways people with these disorders experience delusions and psychotic episodes.

Although people with schizotypal personality disorder do suffer from psychotic episodes, they are far less frequent and long-lasting than the psychotic episodes someone with schizophrenia will experience. Equally, those with schizophrenia will experience much more severe delusions and usually can’t differentiate between a delusion and reality, whereas someone with schizotypal personality disorder usually can.

The two disorders are often treated the same way and can sometimes be referred to as on the same spectrum.

Schizotypal Personality Disorder vs Schizoaffective Disorder

Schizotypal personality disorder and schizoaffective disorder are both similar in name and in symptoms. They are both classified as personality disorder and can both cause the sufferer to display similar behaviors. However, the main difference is the thought process behind the behavior.

Someone with schizotypal disorder will avoid interaction with others and forming relationships because it causes them great stress and anxiety. A person will schizoaffective disorder will also avoid developing long-lasting relationships with others but because -put simply- they see no benefit to such interactions or to social relationships.

As the two conditions share such similar behaviors to an onlooker, it is essential that a doctor or mental health professional take time to get to know the patient and the reasoning behind their behaviors, in order to make a correct diagnosis.

Related Conditions

People diagnosed with this disorder are also very likely to be diagnosed with additional disorders. It is estimated that between 30 and 50% of people with schizotypal personality disorder will also be diagnosed with a major depressive disorder. A second personality disorder is also likely, such as paranoid personality disorder. The risk of developing schizophrenia is also much higher for people with this disorder.

Schizotypal Personality Disorder In Adults/Children

The signs and symptoms of schizotypal personality disorder normally begin in childhood or adolescence, with the most obvious signs being avoidance of social situations and a tendency to seek alone-time. For people who are not diagnosed until they are adults, it is likely that these behaviors were being displayed in their childhood and the diagnosing party will usually ask the patient about their childhood and adolescence.

Example Case of Schizotypal Personality Disorder

Bex Gibbons wrote about her experience suffering from schizotypal personality disorder for the online publication The Mighty. After being diagnosed with the disorder in 2017, they said:

“When it comes to talking to people I’m unfamiliar with or even ordering a coffee in a cafe — I struggle to find the words and string a sentence together due to my social anxiety and shyness, but then i’ll quite comfortably sit on my own, muttering and whispering to myself, having a conversation and quietly smiling and laughing at myself. When I do venture out it’s a real challenge because the constant fear I’m being watched, observed and followed is a reoccurring thought in my mind. There have been a few occasions I’ve ran down the street running away from those following me, when realistically no one is following. I guess my mind plays treacherous tricks on me, but what do I believe when I feel suspicious of those people unknown to me — feeling “paranoid” — although I dislike the use of that word and I don’t use it lightly.

I don’t have many friends, in fa,ct I probably have two or three people I would call “friends.” I have more feline friends than human and I don’t mind at all — I love cats, who doesn’t. There have been moments of unusual thinking, believing the male pharmacists at my pharmacy have tampered with my medication, only trusting females and only collecting my medications from the female staff; fortunately, I have a pharmacy team who are very understanding, sympathetic, friendly and always asking how I am. Feeling uncomfortable around males I’m unfamiliar with and avoiding eye contact is a real struggle, which I am working on.”

You can read Bex’s full story here: https://themighty.com/2018/03/schizotypal-personality-disorder-diagnosis/

Schizotypal Personality Disorder

How to Deal/Coping With Schizotypal Personality Disorder

Look out for These Complications/Risk Factors

People with this disorder are at risk of developing other mental health disorders, such as depression and schizophrenia. The increased risk of depression is a particular risk due to both the higher likelihood of developing it as well as the increased risk of suicidal tendencies.

Some research indicates that people with this disorder may be more likely to develop issues with alcohol and drug abuse.

The issues with socializing and developing relationships can cause substantial complications. For example, a person with this disorder is at high risk of becoming isolated from society and avoiding necessary health care treatment.

Schizotypal Personality Disorder Treatment

Treatment for this disorder is usually a combination of medication and therapy. Of course, due to the one of the main symptoms of the disorder being extreme social interaction anxiety, it can be very difficult for a person with the disorder to engage in therapy. Those with severe symptoms may require hospitalization in order to undergo treatment.

Psychotherapy, such as cognitive behavior therapy (CBT), is the most common type of therapy offered for someone with this disorder. The therapy will often focus on teaching the patient about social interaction, helping with speech and teach methods to copy with anxiety.

Possible Medications for Schizotypal Personality Disorder

Due to it’s similarity to schizophrenia, people with schizotypal personality disorder are often prescribed the same or similar medications. Antipsychotic medications have proven to be a successful treatment, such as amoxapine, as they will help with symptoms such as illusions and severe anxiety. SSRIs such as fluoxetine are also sometimes prescribed and will work on symptoms such as depression and anxiety.

Home Remedies to help Schizotypal Personality Disorder

There isn’t one particular home remedy recommended for someone with this disorder. In fact, in order to avoid causing more harm or reinforcing negative aspects of the disorder, it is vital that someone with the disorder work closely with their doctor or mental health professional before they attempt any home remedy.

A therapist or doctor can work with a patient on tasks or activities to carry out outside the appointment, if they feel it’s in the patient’s best interests.

Living with Schizotypal Personality Disorder

Due to the risks of social isolation or ostracization, this disorder can be very difficult to live with. That’s why it’s essential to seek treatment as soon as possible. Although someone may never be cured of this disorder, they can learn ways to manage it that will alleviate some of the associated anxieties and stress.

It is also worth noting that living with someone with this disorder can be extremely difficult, too. It’s important to seek support when you need it and there are resources below that can help.

Insurance Coverage for Schizotypal Personality Disorder

Every insurance company will have a different insurance policy so it’s important to contact the relevant provider and ask about their insurance coverage for the specific disorder or for personality disorders. Ask for all the policy details, including outpatient and inpatient treatment, along with the cost for medications etc.

How to Find a Therapist

What Should I be Looking for in an LMHP?

For someone with schizotypal personality disorder, finding a mental health professional can be extremely difficult due to the anxiety over social interactions. Therefore, it may be easier to seek recommendations from a trusted doctor or to research online.

Look for a therapist that has experience in this particular condition, with similar personality disorders and with schizophrenia. It’s important that a therapist will understand the worries and anxieties that someone with this disorder will have, especially those behaviors that will make attending appointments very challenging.

Questions to Ask a Potential Therapist

Ask a potential therapist about their experiences with this disorder and similar and what kind of treatment they usually provide for this condition. You may wish to ask about their insurance policies, particularly about cancelation costs.

You may consider asking a therapist whether they do home visits or can provide therapy a third location that both parties would be comfortable attending.

Schizotypal Personality Disorder Resources and Support Helpline

  • National Suicide Prevention Lifeline      1-800-273-TALK (1-800-273-8255)
  • Mental Health Helpline                        (855) 653-8178
  • National Hopeline Network                  800-784-2433
  • NAMI (National Alliance for the Mentally Ill) 1-800-950-NAMI (800-950-6264)

References

What is Brief Psychotic Disorder?

A Brief Psychotic Disorder is a relatively rare psychotic condition which lasts from twenty-four hours to one month.  Sufferers experience delusions and hallucinations which cause them to act in bizarre ways,

Brief Psychotic Disorder: What Does It Mean?

A person suffering from this condition experiences transitory periods of severe hallucinations, delusions, confusion, and other symptoms which can often include violent or self-harming behavior. These periods of psychotic behavior can last from as little as 24-hours, and up to a maximum of one month. Some people only experience a single episode and then return to their normal comportment, while others have repeated relapses, although between them they function with normality,

What is a Psychotic Break?

A psychotic break is the name given to the rapid, unannounced onset of psychotic symptoms which last less than one month.

Stats: How Many Suffer from this Disorder?

A true Brief Psychotic Disorder occurs in between one and four people per 100,000 or 0.001-0.004 percent of the population. It is more common in women than in men and usually develops between the age of thirty and fifty years.  The average psychotic episode lasts for seventeen days.

What Causes Brief Psychotic Disorder?

A Brief Psychotic Disorder is frequently triggered by a traumatic event in a susceptible person’s life. The death of a close family member or friend, an accident, a natural disaster, or an assault, can all provoke an attack. However, this is probably not the cause of the condition, but a precipitating factor. There is evidence that suggests that Brief Psychotic Disorder may be genetically inherited, as it is quite common to find several members of the same family who have suffered at some time from the condition. There are also theories that environmental, biological, and neurological factors may cause the condition. A Brief Psychotic Disorder may also be the first symptom of a chronic psychiatric condition such as schizophrenia, bipolar disorder or psychotic depression.  The abuse of illegal drugs can provoke a Brief Psychotic Disorder although they are not considered as the cause.

Signs and Symptoms of Brief Psychotic Disorder

For a diagnosis of Brief Psychotic Disorder to be reached, the person must present one of the following symptoms

  • These are fixed erroneous beliefs. Often the person believes that they are being persecuted or plotted against. Less commonly, the person believes themselves to be rich, famous, powerful, or with supernatural powers.
  • These can be visual, auditory or tactile. They are false perceptions of a sound, sight, or sensation that does not exist. Hallucinations are frequently terrifying in nature and can evoke violent responses from the sufferer.
  • The sufferer does not know where they are, what date or time it is, and may not recognize people who are known to them.
  • Disorganized speech. Characterized by rambling disjointed sentences and a lack of fluid thought and rational thinking. Speech is often the response to the hallucinations and delusions and is incoherent and illogical.
  • At least one of these symptoms must be observed for more than one day, but less than one month. Psychotic symptoms which persist for longer periods do not meet the criteria of a Brief Psychotic Disorder. Other symptoms that are commonly observed in a person suffering from a Brief Psychotic Disorder include anxiety and agitation, immobility (catatonic behavior), intellectual impairment, hypochondria, insomnia, and constipation.

To reach a diagnosis of Brief Psychotic Disorder the psychiatrist must rule out other mental or physical health conditions which could be the cause of the symptoms or which could exist concurrently.

Some psychologists classify this type of event as a risk factor for future psychotic events and not as a disorder in itself. Statistics show that after one such event the person has a fifty percent chance that another will occur in the future.

What are the Common Behaviors/Characteristics?

Although the actual onset of the psychotic period may be rapid and without warning, it is quite common for mild symptoms to be developing over a period of years. These can include a general deterioration in intellectual abilities often revealed by lowering grades in studies or a decrease in efficiency at work. A reduction in self-esteem, often manifested in scruffy dress and an unkempt appearance, is also common.

During the psychotic period, the sufferer acts in a bizarre way usually in the response to their delusions and hallucinations, and extreme mood swings are common. Their actions depend on the nature of the irrational belief which they hold. Some may believe they are making a movie and that everyone around them is part of the filming. They may believe that they are a prophet and preach to their followers. They may believe that they have supernatural powers or that they are a dog. Whatever form the delusional thinking takes, the person perceives these thoughts as completely real and cannot be convinced that they are not. They misinterpret external information to fit into their delusional thought patterns.

Sufferers of Brief Psychotic Disorder exhibit bizarre and often violent behavior. They follow the instructions of their auditory hallucinations and are prone to self-harm, suicide, and unprovoked attacks on others. Sufferers may take off their clothes, run about on all fours, or remain immobile in one position for hours (catatonia). They are completely unaware that their behavior is inappropriate or strange. They are often disoriented and confused. They cannot recall the date or time, they don’t know where they are, and they don’t recognize people who should be familiar to them. Their speech is jumbled and illogical and they are completely detached from reality. Attempts to reason with them are impossible, and they can become aggressive if their delusional thoughts are questioned.

Testing: What are the Diagnostic Criteria Per the DSM 5?

According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM–5), the standard used in the US for diagnosis and treatment of mental illnesses, Brief Psychotic Disorder is described as-

“A thought disorder in which a person will experience short-term, gross deficits in reality testing, manifested with at least one of the following symptoms:

  • Delusions- strange beliefs and ideas which are resistant to rational/logical dispute or contradiction from others.
  • Hallucinations- auditory, or visual.
  • Disorganized Speech- incoherence, or irrational content.
  • Disorganized or Catatonic behavior- repetitive, senseless movements, or adopting a pose which may be maintained for hours. The individual may be resistant to efforts to move them into a different posture or will assume a new posture they are placed in.

To fulfill the diagnostic criteria for Brief Psychotic Disorder, the symptoms must persist for at least one day but resolve in less than one month. The psychotic episode cannot be attributed to substance use (ethanol withdrawal, cocaine abuse) or a medical condition (fever and delirium) and the person does not fit the diagnostic criteria for Major Depressive disorder with psychotic features, Bipolar disorder with psychotic features, or Schizophrenia.

There are five specifiers that can be used to further describe the disorder:

  • With marked stressors- the psychotic episode appears following an acute stressor, or series of stressors, which would overtax the coping skills of most individuals.
  • Without marked stressors- there is no apparent stressor preceding the psychotic episode.
  • Post-partum- this disorder can appear during pregnancy or within one month following childbirth.
  • With catatonia.
  • Severity – The clinician can rate the severity of the psychotic episode during the last seven days using a five-point scale- Zero (Absent) to Four (Present and severe).

This disorder will manifest over a period of about two weeks or less, resolve in less than one month, and the person will return to their pre-morbid level of functioning prior to the psychotic state”.

Brief Psychotic Disorder and Other Conditions

Brief Psychotic Disorder vs Schizophrenia

Brief Psychotic Disorder displays basically the same symptoms as Schizophrenia, but, as the name indicates, Brief Psychotic Disorder, only lasts for a short period of time. For a diagnosis of Brief Psychotic Disorder, the person must exhibit psychotic symptoms for between one day and one month. After this time, they return to their normal behavior.  An episode of Brief Psychotic Disorder can repeat itself at intervals, but between attacks, the person maintains a normal life. A diagnosis of schizophrenia requires the presence of two psychotic symptoms, whereas a Brief Psychotic Disorder only requires the presence of one.

Brief Psychotic Disorder vs Schizoaffective

A person suffering from a Schizoaffective disorder manifests many of the same psychotic symptoms associated with schizophrenia and Brief Psychotic Disorder, but usually, the psychotic periods are interspersed with periods of depression or bipolar disorder. People with Brief Psychotic Disorder experience periods when they are free of symptoms, and they only display psychotic behavior for a maximum of one month.

Brief Psychotic Disorder in Adults/Children

Brief Psychotic Disorder usually occurs for the first time in early adulthood but can appear up the age of fifty. It is uncommon in children and teenagers. In most cases with repeated episodes of psychotic symptoms, these do not continue past the age of fifty.

Example Case of Brief Psychotic Disorder

Andrew was a grade A student throughout school and college. His teachers described him as disciplined and intelligent and his fellow pupils said he was just a regular nice guy. Andrew went on to graduate from a major law school and began practicing his profession in NYC.

Five years ago, at the age of 33, Andrew was arrested in a public park, half dressed and screaming obscenities. He was confused, disoriented and delusional. Interviews with a psychiatrist suggested that he was suffering from a psychotic episode. The doctors managed to contact his mother who revealed that she had been concerned about her son. He normally contacted her regularly, but in recent weeks had not been calling. One day when she had managed to reach him he had rambled on in a very disjointed and disconcerting manner. He had mentioned during the conversation that his beloved Doberman had been run over and killed in the street, in front of his eyes.

It would appear that this was the event that sparked Andrew’s Brief Psychotic Disorder. He was taken to a state mental hospital due to his delusional state and his inability to care for himself. While there, he received a course of antipsychotic medication. This helped to reduce his delusions and hallucinations, and ten days after his admission he was sent home.

Andrew has not had another psychotic episode. He is no longer on any medication, but he has been receiving therapy to help him to deal with his anxiety and to make him aware of any signs of a possible recurrence of his psychotic symptoms.

He has returned to his job and keeps in regular contact with his mother. He has expressed fear that another episode could occur but is hopeful that this was a once-off experience.

Brief Psychotic Disorder

How to Deal/Coping with Brief Psychotic Disorder

The person suffering from a Brief Psychotic Disorder is usually oblivious to their condition and their behavior during the acute phase of the attack. Afterward, they may retain some memory of the events, but this is usually fragmented. Those witnessing a person suffering from a Brief Psychotic Disorder may feel frightened and impotent. The vehemence with which the patient experiences their delusions and their reaction to the hallucinations can be a tough event to witness.

It is unwise to try and restrain a person in this delusional state and appropriate medical help should be sought immediately. It is also unwise to contradict them in their delusions as this can provoke intense anger. However, the delusion should not be reinforced either. Patients experiencing extreme delusions and hallucinations will require medication and sometimes restraint to prevent them from hurting themselves or others. It can be very distressing for family members to see a loved one in this condition, but their unconditional support is very important for the patient to achieve a complete recovery.

Look out for These Complications/Risk Factors

Early signs of the onset of a Brief Psychotic Disorder can be restlessness, agitation, anxiety, and insomnia. When the psychotic symptoms are at their peak the patient should be closely monitored at all times as there is a high risk of self-injury, suicide, and unprovoked attacks on others. After an incident, many people can feel ashamed or embarrassed by their behavior. Therapy can help them to understand their condition and to overcome any stigma which may be attached to it.

Brief Psychotic Disorder Treatment

Brief Psychotic Disorder is treated primarily with anti-psychotic medication. Short-term psychotherapy and Cognitive Behavioral Psychotherapy (CBP) are also employed.

Possible Medications for Brief Psychotic Disorder

Second-generation antipsychotic medications such as Aripiprazole, Asenapine, Closapine, Iloperidone, Olanzapine, Paliperidone, Quetiapine, Risperidone, Urasidone, Ziprasidone, are commonly used to treat this disorder.

First-generation antipsychotic medication such as Chlorpromazine, Fluphenazine, Haloperidol, Thioridazine, Thiothixene, Trifluoperazine and Perphenazine may also be employed.

Serotonergic and other anti-depressant medications are also used where depression is evident.

Home Remedies to Help Brief Psychotic Disorder

Vitamins and minerals such as B-vitamins, D-Alanine, D-Serine, Melatonin, N- Acetylcysteine (NAC) and Sarcosine may help sufferers of a Brief Psychotic Disorder.  Avoiding excessive alcohol consumption and recreational drugs, along with practicing ways in which to reduce and control stress, such as yoga, may help to prevent a Brief Psychotic Disorder.

Living with Brief Psychotic Disorder

Many people who have suffered through an experience of Brief Psychotic Disorder are fearful of a repeat attack. With therapy and support, most can overcome the condition and achieve a complete recovery, to continue with their lives as before.

Insurance Coverage for Brief Psychotic Disorder

Most insurance policies cover mental health conditions. You should consult with your provider to see if your policy covers you or if another would serve your needs better.

How to Find a Therapist

Ask your mental health care team to recommend therapists qualified to help with sufferers of Brief Psychotic Disorder.

What Should I be Looking for in an LMHP?

Ensure that the therapist has current relevant qualifications and that they are accustomed to treating people with Brief Psychotic Disorder.

Short-term psychotherapy can assist the sufferer of a Brief Psychotic Disorder to understand the condition and to guide them towards a complete recovery. Those who do not seek treatment are more likely to experience a repeat occurrence.

Cognitive behavioral psychotherapy can help to control some of the symptoms and assists the sufferer to understand his condition and the impact of his behavior on others. It may assist in preventing the development of an acute attack.

Questions to Ask a Potential Therapist

What type of therapies would you use?

How would these benefit the sufferer?

How long would the course of therapy last?

How often would sessions take place?

In many cases, a Brief Psychotic Disorder is an isolated event in the life of a person and they make a complete recovery. Even those who experience multiple events enjoy periods of normality in between, and the condition is not indicative of a chronic mental illness. With support, therapy, and medications, most people overcome this disorder and resume their lives as before.

Brief Psychotic Disorder Resources and Support Helpline

National Alliance on Mental Illness (NAMI) www.nami.org

Phone: 1-800-950-NAMI 1-800-950-6264 hotline for help with depression 703-524-7600 Fax: 703-524-9094

National Rehabilitation Information Center: https://www.naric.com/?q=en/content/resources-specific-disabilities

National Suicide Prevention Lifeline:  https://suicidepreventionlifeline.org/

1-800-273-8255 available 24 hrs a day

Crisis Text Line: Text “home” to 741741

Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1-800-662-HELP (4357)

Resources

  1. https://www.psychologytoday.com/us/conditions/brief-psychotic-disorder
  2. https://www.merckmanuals.com/professional/psychiatric-disorders/schizophrenia-and-related-disorders/brief-psychotic-disorder
  3. https://www.livescience.com/53388-brief-psychotic-breaks-remain-a-mystery.html
  4. https://medlineplus.gov/ency/article/001529.htm
  5. https://www.nami.org/Blogs/NAMI-Blog/March-2017/Understanding-Psychotic-Breaks
  6. https://nypost.com/2017/09/20/this-is-what-a-psychotic-breakdown-actually-feels-like/
  7. https://www.theravive.com/therapedia/brief-psychotic-disorder-dsm–5-298.8-(f23)
  8. https://www.medicinenet.com/brief_psychotic_disorder/article.htm#where_can_people_get_more_information_on_brief_psychotic_disorder

What is Dissociative Amnesia?

Dissociative amnesia is an uncommon disorder causing sufferers to forget important information and experiences. This is usually brought on by traumatic experiences. Read on to find out more about this do

Dissociative Amnesia: What Does It Mean?

Dissociative amnesia is a condition that causes a person to forget certain memories, information and experiences. The memories forgotten are usually associated with trauma or stressful situations. As well as forgetting the memories around the trauma/stress, they may also or instead forget important information about their identity. The type of memory that is lost is described as autobiographical memory.

This condition is part of a group of conditions called dissociative disorders.

Amnesia Definition

Amnesia is medically defined as an impairment to or loss of memory. It can cause issues with either recalling past memories or creating new memories. It doesn’t normally affect people’s intelligence or their skills, such as the ability to read or write or ride a bike.

Stats: How Many Suffer from this Disorder?

The Cleveland Clinic believes that dissociative amnesia affects around 1% of men and 2.6% of women in the general population. Other research suggests that the condition may affect up to 7% of the US population. Some psychologists believe that dissociative amnesia is actually more prevalent but is under-diagnosed.

Rates of the population with dissociative amnesia tend to go up after a natural disaster, war, or other such traumatic experiences. It’s believed that up to 7% of people will experience at least one episode of dissociative amnesia in their lifetime, although they may not be diagnosed as such.

Of the women diagnosed with dissociative amnesia, 68% of them have experienced a sexual trauma.

What Causes Dissociative Amnesia?

Psychogenic Causes

Dissociative amnesia is caused by experiencing or witnessing a traumatic or stressful event, either recently or in the past. Experiencing rape or sexual abuse is a common cause for women diagnosed with the condition.

It is believed that ‘blocking out’ memories of the traumatic or stressful event is the coping mechanism of the brain. Likewise, the brain may ‘block out’ any other memories associated with the event or time period, resulting in a loss of additional memories.

The most common psychogenic cause of the condition is trauma from witnessing a loved one commit suicide or being murdered. 38% of all people diagnosed with the condition developed it after undergoing these experiences.

Research has indicated that there may be a genetic element of the development of the condition, as many people diagnosed with dissociative amnesia also have relatives with the condition or a similar condition.

Acquired Brain Injuries

The definition of dissociative amnesia means that it can not be attributed to a brain injury or any other such neurological condition. Dissociative amnesia is thought to be based on an over-corrective defense mechanism, instead of physical damage to memory related parts of the brain.

Signs and Symptoms of Dissociative Amnesia

What are the Common Behaviors/Characteristics?

The main symptom of this condition is memory loss. There are three different types of memory loss that a person suffering from this condition may have. They may show signs of just one type, two types or all three. They are:

Localized memory loss: forgetting a specific event or a period of time

Selective memory loss: forgetting certain parts about an event or period of time, or forgetting certain events within a period of time

Generalized memory loss: a complete loss of identity and life history.

The period of memory loss can range from minutes through to decades. It may also involve forgetting people and places.

Another common symptom of the condition is feeling detached from oneself. This could be described as feeling in a dream-like state. It can also affect the ability to feel any emotions or have an emotional response to either a present situation or a past situation.

A person with dissociative amnesia may struggle with their perception of others. People may appear ‘blurry’ or ‘unreal’. There may a general sense of detachment from other people and a sense that others aren’t quite there.

People with the condition can have an altered sense of identity. They can struggle with a sense of self or knowing who they really are.

Stress can be a huge problem for people with dissociative amnesia. They may have extreme issues with dealing with any kind of stressful situation, whether that’s in their own personal life or in work situations. This could involve either overreacting or an inability to react, as well as many other improper or unhealthy behaviors.

Testing: What are the Diagnostic Criteria Per the DSM 5?

“A. An inability to recall important autobiographic information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. Note: Dissociative Amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol or other drug abuse, a medication) or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, sequelae of a closed head injury/traumatic brain injury, other neurological condition).

D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder.”

Dissociative Fugue

Dissociative fugue is a rare version of dissociative amnesia that occurs whenever a person forgets all, or mostly all, of their own identity and life history. This can include their own name, who their friends are, where they live etc.

One of the most common ways someone with dissociative fugue will get noticed is after suddenly ‘appearing’ in a new place. People with this condition can travel to new places, sometimes a long distance away from their hometown. They will often have no idea where they have come from or how they got there.

The period of dissociative fugue may last anywhere from hours up to years. The sufferer may take on a new identity, make new friends and have a career. Often other people will have no idea that their friend, loved one or colleague suffers from the condition. It usually only becomes noticeable when the sufferer tries to recall their past, which can cause great distress and trigger other mental health issues such as depression, aggression and/or suicidal thoughts.

The condition is estimated to affect .2% of the population. Having dissociative amnesia does not that mean that one will develop dissociative fugue.

Dissociative Amnesia and Other Conditions

Dissociative Amnesia vs Dissociative Identity Disorder

Although the names of these two conditions are very similar, they are actually very different conditions. Dissociative Identity Disorder was formally known as multiple personality disorder and is described as having two or more very distinct personalities. These seemingly different personalities are actually fragments of a person’s identity, rather than completely different identities.

Like dissociative amnesia, one of the main causes of dissociative identity disorder is experiencing trauma. The most similar symptom between the two conditions is the loss of memory, however, with dissociative identity disorder the memory is usually fragmented and divided between the two or more personalities.

Related Conditions

People with dissociative amnesia are more likely to also be diagnosed with acute stress disorder and/or post-traumatic stress disorder. This is due to the common cause between the conditions of stress or experiencing a trauma. The conditions are often diagnosed together and will be treated similarly.

Sleep disorders are also related to dissociative amnesia and may include symptoms such as night terrors, sleepwalking, and confusion.

Dissociative Amnesia In Adults/Children

Much like in adults, dissociative amnesia in children is often caused by witnessing or experiencing a traumatic event or extremely stressful experiences. To block out the trauma, the child will dissociate from the memories and either block them out completely or forget elements surrounding the event/events.

A child with the condition may sometimes appear to be in a ‘trance’ or seem ‘spaced out’. They can become very confused or frustrated when asked about the past or pressed on certain subjects. Children are believed to be more susceptible to dissociative disorders because they have not yet developed the coping skills necessary.

Example Case of Dissociative Amnesia

The following case study is written by David Woo, MD and describes a patient who was diagnosed with dissociative amnesia.

“Mrs. CP is a 64-year-old widowed Filipino woman who came to see a psychiatrist at an outpatient mental health clinic. She had been in treatment intermittently since 1998 for depression and anxiety. Her symptoms included anxious mood, insomnia, hypervigilant behavior, tearfulness, poor concentration, and feelings of palpitations.

She reported that over the past year she had been more forgetful and distractible, forgetting where she had placed her keys, pocket cash, and other items. She would forget to get off the bus at a familiar stop and could not remember to purchase needed items at the grocery store.

Of greater concern, she had left the stove on several times and had limited recollection of this. Mrs. CP’s behavior included unusual incidents such as leaving rotting bananas in the closet and going back into the shower fully clothed after she had just bathed and dressed herself. Because of these behaviors, her younger son and a close friend moved in with her to assist and monitor her behavior…

Mrs. CP was born in the Philippines and had had a turbulent childhood and a severe eating disorder early on…As a teenager, Mrs. CP had a “nervous breakdown” due to depression, and her father consulted with a psychiatrist. ..While she was in her 20s, she made three attempts to end her life…She described feeling driven by the stress of being in an “inescapable, abusive marriage.” Her husband was often drunk, physically abusive, tortured the children—sometimes with an ax—and used them for ‘target practice.’”

Dissociative Amnesia

How to Deal/Coping With Dissociative Amnesia

Look out for These Complications/Risk Factors

One of the major risk factors with this condition is suffering from flashbacks. These can often be so traumatic that they lead to dangerous feelings and thoughts, such as self-harming and suicidal thinking. It is extremely important to seek immediate medical attention in these circumstances.

For people suffering from the condition, there is higher chance of also developing other conditions such a personality disorders, sleep disorders and depression. Alcoholism and drug addiction can also be risks so it’s important to avoid all or frequent use of drugs and alcohol. Seek medical treatment if worried and always be open and honest about usage and symptoms when speaking to medical professionals.

Men with dissociative amnesia also have a higher chance of becoming involved in the criminal system and going to jail. It is believed this is due to being at risk of aggressive behavior.

Dissociative Amnesia Treatment

Treatment for dissociative amnesia is usually a combination of medications and therapy. The type of therapy will depend on the person’s symptoms and severity, but the most common therapies used are Cognitive Behavioral Therapy (CBT) and interpersonal therapy.

Some therapists will also recommend family therapy, depending on the cause of the condition. Creative therapies can also be a very helpful tool for this condition, such as music or art therapy.

Possible Medications for Dissociative Amnesia

At present, there are no medications designed specifically for dissociative amnesia. There are also no medications that will treat memory loss or prevent memory loss. Instead, patients with dissociative amnesia are often prescribed medications that will help with the symptoms, such as anti-depressants for depression, medication for anxiety or sleeping pills for insomnia.

Home Remedies to help Dissociative Amnesia

There aren’t any particular home remedies recommended for dissociative amnesia without first having recommendation and approval from a doctor or mental health professional. Once you have been fully assessed, they may recommend trying meditation and other relaxation techniques.

Living with Dissociative Amnesia

For most people with dissociative amnesia, it will not be a lifelong condition. In fact, in most cases, full memory will return and the symptoms of the condition will disappear. For others, the memories may never come back and they will need to learn coping mechanisms and skills for dealing with memory loss.

The sooner a person seeks treatment for the condition, the better the prognosis so it’s important to speak a doctor or therapist as soon as possible.

Insurance Coverage for Dissociative Amnesia

Each insurance company will have their policies on dissociative amnesia and other dissociative disorders. Ask your insurance company for their policies on these conditions and mental health treatment.

How to Find a Therapist

What Should I be Looking for in an LMHP?

Look for a mental health professional who has experience in working with people with this disorder, or other similar dissociative disorders. The International Society for the Study of Trauma and Dissociation have a searchable database of therapists. You can find the link below, under the resources section.

Questions to Ask a Potential Therapist

Before meeting a potential therapist, you may want to write down some questions to ask them. As well as questions that are specific to the condition and symptoms you’re experiencing, you can also ask them more personal questions. For example, you may have certain personality types you’d prefer to work with or certain types of therapy you prefer. You may also want to ask for reviews from previous patients with similar conditions.

Dissociative Amnesia Resources and Support Helpline

National Suicide Prevention Lifeline: 1-800-273-TALK (1-800-273-8255)

International Society for the Study of Trauma and Dissociation: http://www.isst-d.org/default.asp?contentID=18

National Alliance on Mental Illness: 800-950-NAMI     [email protected]   TEXT “NAMI” TO 741741

References

http://traumadissociation.com/dissociativeamnesia#dsm-5-diagnostic-criteria-for-dissociative-amnesia

https://healthresearchfunding.org/22-dissociative-amnesia-statistics/

https://psychcentral.com/disorders/dissociative-fugue-symptoms/

https://www.psychologytoday.com/us/conditions/dissociative-identity-disorder-multiple-personality-disorder

https://www.consultant360.com/articles/case-dissociative-amnesia-older-woman

https://my.clevelandclinic.org/health/diseases/9789-dissociative-amnesia/outlook–prognosis

http://www.minddisorders.com/Del-Fi/Dissociative-amnesia.html

https://www.sciencedirect.com/science/article/abs/pii/014521349390006Q

https://www.msdmanuals.com/en-gb/professional/psychiatric-disorders/dissociative-disorders/dissociative-amnesia

https://www.nami.org/Learn-More/Mental-Health-Conditions/Dissociative-Disorders

 

 

 

Complex Post-Traumatic Stress Disorder (CPTSD)

Complex post-traumatic stress disorder (CPTSD) is a trauma-related mental health condition that results from sustained abuse and powerlessness over time. CPTSD is related to but different from post-traumatic stress disorder (PTSD).

CPTSD: What Does It Mean?

Complex post-traumatic stress disorder develops from life-threatening trauma or abuse that occurs repeatedly and cumulatively over a prolonged period of time. In many cases, the victim feels powerless and sees no hope of escape. The abuse is often premeditated, planned, and carried out by other people.

Complex post-traumatic stress disorder is usually seen within specific relationships or settings. Severe and long-term child abuse, domestic abuse, confinement in prisoner-of-war camps, or forced sexual activity in prostitution brothels may expose individuals to chronic trauma that contributes to the development of CPTSD. People with CPTSD may experience personality issues, emotional deadness, or intense emotional outbursts that overwhelm their ability to cope. They may also have severe relationships issues as well as lapses in judgment, concentration, and problem-solving.

Stats: How Many Suffer from this Disorder?

At present, there are no general prevalence rates of complex post-traumatic stress disorder in the literature. However, a study conducted with a sample of adult survivors of childhood institutional abuse showed 21.4% of survivors had CPTSD. Current research indicates there may be significant gender differences in the onset of CPTSD. In the aforementioned study, women were more than twice as likely to develop CPTSD than men (40.4% to 15.8% respectively).

A second study evaluated a sample of 323 trauma-exposed United States military veterans. In this study, 13% of vets were diagnosed with complex post-traumatic stress disorder.  Approximately 25% to 50% of vets with PTSD also met the criteria for CPTSD.

What Causes CPTSD?

Complex traumatic events are long-lasting, usually interpersonal (caused by someone else), and often occur during a developmentally vulnerable stage in the victim’s life. Interpersonal trauma may result in a more intense emotional response than trauma that is impersonal or accidental.

While there is no specific cause of complex post-traumatic stress disorder, there are circumstances and contexts that may trigger the condition. Factors that contribute to the onset of CPTSD include:

  • Ongoing community violence and poverty
  • Chronic homelessness
  • Incarceration with constant assault and threat
  • Ongoing physical or sexual abuse
  • Severe child neglect
  • Prolonged exposure to war
  • Torture
  • Displacement or refugee status
  • Prolonged exposure to death or inhumane conditions in emergency work

Signs and Symptoms of CPTSD

There are many severe emotional, mental, and relational issues associated with complex post-traumatic disorder. These issues may cause significant impairment in day-to-day functioning. Individuals with CPTSD may experience:

  • Hyperarousal
  • Avoidance of people, places, or things that are reminders of the trauma
  • Low mood
  • Dissociation
  • Uncontrolled anger
  • Self-destructive behavior
  • Nightmares of the trauma
  • Flashbacks of the trauma
  • An ongoing search for a rescuer
  • Preoccupation with revenge
  • Relationship issues
  • Trust issues
  • Hopelessness, worthlessness, or despair
  • Intense guilt or shame
  • Social isolation
  • Digestive issues
  • Sexual promiscuity
  • Physical or medical issues
  • Amnesia
  • Suicidal ideation

What are the Common Behaviors/Characteristics?

People with complex post-traumatic stress disorder generally assign complete power to their abuser. They may feel trapped, overwhelmed, and unable to escape. They may also begin to identify with and protect the person who hurt them most. This puts victims at high risk of continued abuse and re-traumatization.

Victims of complex trauma may also experience dissociation. Dissociation is a state in which you feel emotionally detached from yourself. Survivors of complex trauma often report their abuse as if they watched it happen to another person. Children who are abused by the people they trust most are at higher risk of dissociation than adults

Individuals with CPTSD tend to have severe relationship issues later in life. They may find it difficult to trust or become intimate with other people. In some cases, survivors may believe they are at fault for the trauma they experienced. Consequently, they may feel severe guilt, shame, or believe they are no longer human.

Testing: What are the Diagnostic Criteria Per the DSM 5?

Complex post-traumatic stress disorder does not appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Although several symptoms of CPTSD are alluded to, no diagnostic criteria are provided in the manual.

CPTSD and Other Conditions

There is a lack of awareness of complex post-traumatic stress disorder among the general public. With no clear, consistent diagnostic criteria for CPTSD, mental health professionals are also more likely to misdiagnose the condition. In some cases, therapists may identify and treat symptoms of anxiety or low mood among individuals with CPTSD. However, they may fail to recognize that these symptoms are part of a greater underlying issue.

CPTSD vs Simple PTSD

There are several differences between CPTSD and simple PTSD.

  1. CPTSD is linked with severe, ongoing trauma or multiple types of trauma where the victim has no hope of escape. PTSD may be triggered by a brief one-time event such as a car crash, armed attack, or natural disaster.
  2. CPTSD has severe symptoms that impair everyday functioning. Symptoms of PTSD may range from mild to severe.
  3. People with CPTSD may experience all the symptoms typically associated with PTSD plus additional symptoms.

Related Conditions

CPTSD and PTSD are trauma-related issues with very similar symptoms. Many people with PTSD also have CPTSD. Other mental health issues with similar symptoms include dependent personality disorder, masochistic personality disorder, and borderline personality disorder.

CPTSD In Adults/Children

Complex post-traumatic stress disorder affects people of all ages. Although the condition usually arises from cumulative trauma experienced during childhood, traumatic events during adulthood may also lead to CPTSD. Individuals with PTSD who were exposed to trauma before the age of 14 are more likely to be diagnosed with CPTSD later in life

Older children, teenagers, and adults with complex post-traumatic stress disorder generally have similar symptoms. However, young children with CPTSD may have different symptoms than adults with the condition. Younger children may experience:

  • Bedwetting
  • Loss of speech
  • Re-enacting the trauma during play
  • Clinging behavior toward a parent

Example Case of CPTSD

Cassandra, 31, visits a psychiatrist after years of emotional issues, self-harming behaviors, and relationship challenges. She believes she suffers from depression and anxiety. Cassandra was in foster care between the ages of 8 and 15. While speaking with the psychiatrist, she reveals that she endured repeated sexual abuse from her foster parents. Cassandra explains that she felt powerless to tell anyone about her abuse because she depended on her foster parents to care for her material needs. Since becoming an adult, she has difficulty controlling her anger, very low self-esteem, and regular nightmares about her childhood experiences. Cassandra finds it hard to trust or become intimate with other people. She also blames herself for what happened to her. The psychiatrist listens carefully, and after asking a few follow-up questions, diagnoses Cassandra with complex post-traumatic stress disorder and prescribes a combination of psychotherapy and antidepressant medication. After 11 months of regular treatment, Cassandra reports improved emotional regulation, better interpersonal relationships, and a greater sense of self-worth.

CPTSD

How to Deal/Coping With CPTSD

Although it can be difficult to cope with the symptoms of CPTSD, there are several steps you can take to manage the condition. It is recommended that you:

  • Learn as much as you can about CPTSD
  • Seek professional care
  • Stay in touch with your loved ones
  • Monitor your symptoms and learn about your triggers
  • Learn and use relaxation techniques
  • Join a support group
  • Take part in activities you enjoy
  • Write about how you feel
  • Exercise regularly
  • Avoid alcohol and unprescribed drugs
  • Engage in spiritual activities
  • Find healthy ways to distract yourself from negative thoughts

Look out for These Complications/Risk Factors

Individuals with a history of severe, continuous trauma over an extended period of time are at increased risk of complex post-traumatic stress disorder. Onset of CPTSD is more likely if the victim is at a vulnerable stage of development (such as childhood) and dependent on the abuser for survival. Other risk factors include a family history of CPTSD, chemical imbalances in the brain, as well as a personal history of depression or anxiety.

People with CPTSD are more likely to have psychiatric issues, engage in risky sexual behavior, and use illicit substances. They are also more likely to commit suicide than their peers.

CPTSD Treatment

Complex posttraumatic stress disorder is a serious mental health issue. However, symptoms can improve with treatment. CPTSD is usually treated with psychotherapy, medication, or a combination of both approaches. Types of psychotherapy that have proven to be effective include:

  • Cognitive behavioral therapy (CBT)
  • Prolonged exposure therapy (PE)
  • Cognitive restructuring therapy
  • Dialectical behavior therapy (DBT)
  • Eye Movement Desensitization and Reprocessing (EMDR)

Possible Medications for CPTSD

Different medications may be prescribed to help treat severe symptoms of CPTSD. These may include anti-anxiety medication, antidepressants, and sleep medication.

Home Remedies to help CPTSD

There are no FDA-approved home remedies that may help with complex post-traumatic stress disorder.

Living with CPTSD

Living with complex post-traumatic stress disorder can be challenging. For many people, it is a lifelong condition. Intense feelings of despair and hopelessness may cause individuals with CPTSD to suffer in silence. However, seeking help is the first step toward recovery.

If you have been diagnosed with CPTSD, professional care from a licensed therapist can help you to manage your symptoms. You can also join a support group where you can share your experiences, receive advice, and get emotional support from people with similar issues. If joining a support group in person seems overwhelming, an alternative is to join a support group online. You can live a rich, rewarding life if you take advantage of the mental health resources that are available to you.

Insurance Coverage for CPTSD

Complex post-traumatic stress disorder is not listed in the DSM-5. However, healthcare professionals are becoming more aware of the condition. Your insurance plan may provide coverage for CPTSD. Speak with your insurance provider to confirm your coverage before you visit your doctor or therapist.

How to Find a Therapist

Speak with your doctor if you are experiencing symptoms of CPTSD. Your doctor will refer you to a licensed therapist who is able to help. A trusted friend or family member may also be able to connect you with a qualified mental health professional in your community.

What Should I be Looking for in an LMHP?

Your therapist should have specialized training in trauma-related issues. An unqualified therapist may cause you to re-experience traumatic past events needlessly. As serious, embarrassing, or painful memories may be discussed in therapy, your therapist should be someone with whom you feel completely at ease. If you are not comfortable opening up to your therapist, it may be best to ask for a referral.

Questions to Ask a Potential Therapist

Ask these and other questions to make the most of your time with your therapist:

  • Have you been trained to treat CPTSD?
  • What is your experience in treating trauma-related issues?
  • Do I have CPTSD?
  • Are there any co-occurring conditions?
  • What treatment do you recommend?
  • Do I need medication?
  • How long will I need to take medication?
  • What are the side-effects of this medication?
  • How long does treatment last?
  • What can I do to improve my health?

CPTSD Resources and Support Helpline

People with complex post-traumatic stress disorder may have thoughts of committing suicide or getting revenge. If you believe you may commit suicide or harm other people, please call any of the following numbers immediately:

  • 911 or your local emergency services number
  • The National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to speak with a trained therapist
  • Suicide Prevention Services Crisis Hotline at 800-784-2433
  • Suicide Prevention Services Depression Hotline at 630-482-9696

Many mental health resources for PTSD are also beneficial for individuals with CPTSD. Resources you can access online include:

If you are struggling to cope with complex post-traumatic stress disorder, you do not have to face your challenges alone. With appropriate psychotherapy, medication, and a strong support network, you can control your symptoms, find relief, and improve your quality of life.

References:

Cloitre, M., Stolbach, B. C., Herman, J. L., van der Kolk, B., Pynoos, R., Wang, J., & Petkova, E. (2009). A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 0, 1-10. Retrieved from http://www.traumacenter.org/products/pdf_files/jts_oct_09_cloitre_et_al.pdf

Complex post-traumatic stress disorder. (n.d.). Retrieved from https://www.sciencedirect.com/topics/medicine-and-dentistry/complex-post-traumatic-stress-disorder

Complex PTSD symptoms and treatment. (n.d.) Retrieved from https://www.betterhelp.com/advice/ptsd/complex-ptsd-symptoms-and-treatment/

Courtois, C. A. (2014, July 16). Understanding complex trauma, complex reactions, and treatment approaches. Retrieved from http://www.giftfromwithin.org/html/cptsd-understanding-treatment.html

Croft, H. (2015, June 5). Complex post-traumatic stress disorder (C-PTSD) vs. simple PTSD. Retrieved from https://www.healthyplace.com/blogs/understandingcombatptsd/2015/06/complex-posttraumatic-stress-disorder-ptsd-vs-simple-ptsd

Firestone, L. (2012, July 31). Recognizing complex trauma: Educating ourselves on the after-effects of repetitive or cumulative trauma. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/compassion-matters/201207/recognizing-complex-trauma

Gilles, G., & Morrell, K. (2018). Understanding complex post-traumatic stress disorder. Retrieved from https://www.healthline.com/health/cptsd

Knefel, M., & Lueger-Schuster, B. (2013). An evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse. European Journal of Psychotraumatology, 4(10). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3851534/

Lucario, L. H. (n.d.). Differences between PTSD and complex PTSD. Retrieved from https://www.healingfromcomplextraumaandptsd.com/ptsd–v–complex-ptsd

Nicholas, E. (2015, December 17). The living nightmare of complex post-traumatic stress disorder. Retrieved from https://www.vice.com/en_us/article/vdxjn8/worse-than-ptsd-the-nightmare-of-complex-post-traumatic-stress-disorder

Phillips, J. (2015, September 25). PTSD in DSM-5: Understanding the changes. Psychiatric Times, 32(9). Retrieved from http://www.psychiatrictimes.com/ptsd/ptsd-dsm-5-understanding-changes

Tull, M. (2018, May 6). How to develop coping skills for PTSD: Healthy ways to deal with post-traumatic stress disorder. Retrieved from https://www.verywellmind.com/coping-with-ptsd-a2-2797563

U.S. Department of Veterans Affairs. (2016, February 23). PTSD: National Center for PTSD: Complex PTSD. Retrieved from https://www.ptsd.va.gov/professional/ptsd-overview/complex-ptsd.asp

Wolf, E. J., Miller, M. W., Kilpatrick, D., Resnick, H. S., Badour, C. L., Marx, B. P., Keane, T. M., Rosen, R. C., Friedman, M. J. (2015). ICD-11 Complex PTSD in US national and veteran samples: Prevalence and structural associations with PTSD. Clinical Psychological Science, 3(2), 215-229. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25750837

 

 

What is Hypersomnia?

Everyone is tired from time to time. Depending on your lifestyle, you may be tired a lot of the time. However, if you find yourself napping frequently throughout the day, sleeping much longer at night than is typical for your age group, and still feeling excessively tired, then you may have a condition called hypersomnia or hypersomnolence disorder. This is a lesser-known condition that can require medical and mental health treatment to eliminate the symptoms and improve functioning:

Hypersomnolence Disorder: What Does It Mean?

Hypersomnolence is a disorder defined by excessive sleepiness. This can appear during the daytime with recurrent episodes and frequent napping. It can also occur with prolonged nighttime sleeps. Individuals who have hypersomnolence do not necessarily feel tired due to poor sleep. In fact, they are likely getting more than enough sleep. These individuals are so tired they feel almost compelled to sleep. They may nap during the day, even during inappropriate times (for example, at work). Despite the naps, the person is still tired and feels no sense of relief from their sleepiness. The condition was previously called hypersomnia, but the name was changed to better capture the symptoms.

Somnolence Definition

Originally, the disorder entitled hypersomnia was named to capture two terms: “hyper” meaning “too much” and “somnia” meaning “sleep.” Put together those terms captured the condition of excessive sleeping, called hypersomnia. Later, the terminology was updated to hypersomnolence (meaning too much sleepiness). This new term was intended to capture both long sleep durations and excessive sleepiness that occurs during the daytime.

Idiopathic Hypersomnia

In some classifications, the terminology ‘idiopathic hypersomnia’ is used to define the sleep disorder. Individuals who have ‘idiopathic hypersomnia’ will usually wake still feeling tired even after they have slept for a long period of time. Individuals with this diagnosis will also exhibit difficulty waking up in response to alarms. Once awake, they may demonstrate ‘sleep inertia’ with difficulty thinking (even confusion) and difficulty moving after being awakened(sleep drunkenness).

Is Hypersomnia a Mental Disorder?

Hypersomnia/hypersomnolence is listed in the Diagnostic and Statistical Manual, along with mental health disorders. It can also impair functioning in ways that are similar to the impairment caused by mental health disorders. However, it is not really a mental health disorder. It is considered a neurological disorder. This is because it is often due to an irregularity of one kind or another in the nervous system that acts almost like a sleeping pill on the brain.

Stats: How Many Suffer from This Disorder?

Hypersomnia/hypersomnolence disorder is not very common. Some studies indicate that approximately 4% to 6% of the population may have the disorder. It is even rarer in children.

Why am I Sleeping so Much? – Causes of Hypersomnolence

Some individuals have hypersomnolence due to a genetic predisposition. Certain medications, substance abuse, medical conditions, and other sleep disorders can contribute to these same symptoms. However, in many people there is no known cause for their hypersomnia.

Signs and Symptoms of Hypersomnia

As noted, hypersomnolence is defined primarily by excessive sleepiness. This leads to frequent napping and prolonged sleeps. The excessive sleepiness and excessive time spent sleeping can cause problems in people’s daily life. The compulsion to sleep may override commitments to other obligations. This could affect a person’s life at home and work. It could also affect their relationships.

What are the Common Behaviors/Characteristics?

The most common symptom of hypersomnolence is excessive sleepiness. The most common behaviors are frequent naps and prolonged sleeping. Additional characteristics include difficulty waking from sleep. Individuals with this disorder may awake feeling rather disoriented.

Other symptoms of the disorder can include: increased anxiety, irritation, restlessness, slowed thinking, impaired memory, slower speech, low appetite, and even hallucinations. The symptoms of this disorder can significantly impair functioning at home, work, and other settings.

Testing: What are the Diagnostic Criteria Per the DSM-5

If you experience the symptoms described above, you will need to seek help before your functioning becomes overly impaired. You will want to start by visiting a medical doctor and they may also recommend visiting a mental health provider for additional intervention to improve the symptoms.

Typically, a physical exam will be needed to assess for medical problems that could cause the excessive sleepiness. A doctor may also request a sleep study to further understand what is happening in the brain during sleep. Substance abuse must also be ruled out as a cause of the symptoms. In some cases, a psychological evaluation will be needed to further assess any existing mental health symptoms. This information will be used to make a formal diagnosis. To assign a diagnosis, professionals must use the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), which presents the following criteria to define hypersomnolence disorder:

  • Excessive sleepiness for at least one month (in acute conditions) or at least three months (in persistent conditions) as evidenced by either prolonged sleep episodes or daytime sleeping that occurs at least three times per week.
  • Excessive sleepiness causes clinically significant distress or at least impairment in social, occupational, and other important areas of functioning.
  • Excessive sleepiness is not accounted for by insomnia or another sleep disorder (such as narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or parasomnia).
  • Excessive sleepiness is not accounted for by a generally inadequate amount of sleep.
  • This disturbance is not caused by the effects of a substance (medication or drug abuse) or another general medical condition.

The condition of hypersomnolence can occur at the same time as other mental and medical disorders and can be concurrently diagnosed if those other conditions do not fully account for the excessive sleepiness. It is important to discern that the excessive sleepiness is a symptom that is either separate from any other conditions and or is at least significant enough to diagnose it as hypersomnolence.

The symptom of hypersomnia can be caused by physical problems including head trauma, tumor, and other injuries to the nervous system. Medical conditions such as multiple sclerosis, encephalitis, epilepsy, and obesity may also contribute to hypersomnia. Depression and other mental health conditions may also be associated with excessive fatigue. In these causes, hypersomnolence may not be able to be diagnosed. It will be important for a trained professional to fully assess the symptoms and decide.

Hypersomnia and Other Conditions

When making a diagnosis, medical and mental health professionals also rule out other conditions:

Hypersomnolence Disorder vs Narcolepsy

Narcolepsy is a more familiar sleep disorder. It is similarly characterized by excessive sleepiness. However, narcolepsy also has other symptoms. Individuals who have narcolepsy are not only excessively tired, they also sometimes suddenly and unexpectedly fall asleep. When this occurs, they may experience cataplexy, which is a loss of muscle control. The sleep episodes are sometimes triggered by strong emotions. These individuals may also sometimes experience dream-like hallucinations during the daytime. At night, they may have vivid nightmares.

Related Conditions

Other sleep disorders such as insomnia and sleep apnea can also be associated with excessive sleepiness. In these cases, the fatigue is due to poor sleep. Some other disorders may also include symptoms of excessive fatigue and frequent sleeping. For example, these symptoms are associated with depression. In those cases, the fatigue is a symptom of the broader condition.

Hypersomnia in Adults/Children

Children may exhibit hypersomnia during certain health conditions. However, the distinct disorder of hypersomnolence is relatively rare in children. If you suspect the disorder, consult a pediatrician.

Example Case of Hypersomnia

Consider this example of hypersomnolence to see if it reminds you of yourself or someone you know:

Martha always feels tired. In the evening she goes to bed as soon as she can. She sleeps through the night and struggles to get up in the morning. She often sleeps through her alarm and hits snooze a few times. She drags herself out of bed when she must, to get to work. However, she never feels fully awake. She feels tired all day and tries to work in a few naps when she can. Usually, she skips her lunch break to take a nap. She has fallen asleep a few times during meetings and at her desk. It is starting to affect her success at work.

Hypersomnia

How to Deal/Coping with Hypersomnia

Individuals with hypersomnia and hypersomnolence will likely feel distressed by their symptoms and the repercussions of those symptoms. The condition can affect functioning at school/work and in relationships. Others may also feel frustrated with the symptoms and their effects on the relationship.

Look Out for These Complications/Risk Factors

Some individuals who have hypersomnolence disorder may experience negative repercussions in their daily life. The condition and any negative effects it has could lead to other mental health problems, including suicidality. To avoid these complications, it is important to see out medical and mental health assistance. The appropriate providers can help you reduce the symptoms.

Hypersomnolence Disorder Treatment

Individuals with hypersomnolence disorder will need to seek medical and mental health treatment. Psychotropic medications are frequently prescribed to manage the symptoms. Mental health treatment is also typically recommended. In a therapy setting, behavioral techniques will likely be taught. These can be used to help regulate the sleep schedule to promote daily functioning.

Possible Medications for Hypersomnia

Individuals with hypersomnolence may need medications to reduce their excessive sleepiness. The specific medication prescribed will depend on the individual and their symptoms. Oftentimes, stimulant medications are used. These typically involve dose-controlled amphetamines, which can help to sustain alertness. Sometimes activating antidepressants will be used. Other medications that may be used include clonidine, levodopa, and bromocriptine.

Home Remedies to Help Hypersomnia

As noted, individuals who have hypersomnolence can learn behavioral techniques that will be helpful in regulating their sleep schedule. For example, it is helpful to make a regular schedule with a regular bedtime. This means avoiding work and social activities late at night that might prevent meeting the planned bedtime. Also, avoid caffeine and alcohol that might disrupt sleep. In addition, people with hypersomnia should practice certain routines at bedtime. This includes turning lights down an hour beforehand and doing activities that will promote relaxation and sleep. Morning routines to get one’s energy going will also be helpful to lift the sleepiness.

Living with Hypersomnia

Individuals who have hypersomnia and hypersomnolence disorder may experience some distress about their symptoms and the effect those symptoms have on their life. Medical treatment and psychosocial support through therapy can be helpful to reduce that distress. Taking medications as prescribed and following other recommendations will be helpful.

Insurance Coverage for Hypersomnia

The medical and mental health fields consider hypersomnolence disorder as a serious condition. After a formal diagnosis of this condition, it is likely that health insurance will cover any necessary treatment including therapy. Call your insurance company to ask about your options. Your provider’s office may also be able to assist you with checking into insurance coverage.

How to Find a Therapist

If you are concerned about your own or someone else’s sleeping patterns and excessive sleepiness, you should first seek help by asking your medical provider about your symptoms. They may prescribe medical tests, physical exams, and therapeutic support from a mental health provider. You can also search online for therapists, using the name of your location.

What Should I be Looking for in an LMHP?

When seeking out a mental health provider to support you with hypersomnolence disorder, you will want to make sure they are trained and licensed in their field. You will also want to find a provider who is specially trained to work with hypersomnolence disorder.

Questions to ask a Potential Therapist

When meeting with a therapist, ask about their training working with hypersomnolence and other sleep disorders. You may also want to ask about their approach to therapy, how they would plan to address/monitor your symptoms, and the likely duration of treatment.

Hypersomnia Resources and Support Helpline

There are resources online regarding hypersomnia and hypersomnolence disorder that may be helpful:

If you have questions about your own mental health or the mental health of a loved one, consider contacting the National Alliance on Mental Illness Helpline or the SAMSHA Helpline. If your hypersomnia symptoms lead to suicidality, consider calling the Suicide Prevention Lifeline for mental health support.

Although the symptoms of hypersomnia/hypersomnolence disorder can be challenging and difficult to manage, it is a diagnosable condition and help is available to alleviate the symptoms. Consider seeking treatment from medical and mental health providers so that you can improve your daily functioning.

Folie a Deux: Shared Psychotic Disorder

Sharing is caring – or is it? A rare psychiatric condition called Folie a Deux shows that snacks and good times aren’t the only things that may be shared amongst people who care deeply for one another. Read on to learn more about the condition in which features of mental illness are shared between people.

Folie a Deux: What Does It Mean

Literally translated from French, Folie a Deux means “madness of two”. This disorder may also be referred to as “shared psychotic disorder” or “induced delusional disorder”. The symptom that most commonly gets shared is a delusion: a thought that you hold onto firmly, even though this idea is clearly irrational.

Usually, this disorder exists between people who already have an established and close bond, including romantic partners, siblings or a parent and child. While the symptoms are usually shared between two people, three (folie a trois) or four (folie a plusieurs) people can also become symptomatic and, in fact, even a whole family or group can be diagnosed.

What Causes Folie a Deux?

These shared delusions are caused by having an extended and close social proximity to someone who has a psychotic disorder (such as schizophrenia or delusional disorder). The person who initially has a mental health concern is referred to as the ‘primary case’ and the person who develops the symptoms of the other person’s condition is known as the ‘secondary case’. Usually, when the two are separated the secondary’s symptoms will begin to resolve. Researchers are still not sure exactly why the symptoms get transmitted, but people who have enmeshed relationships and otherwise live in socially isolated circumstances are thought to be at risk.

Signs and Symptoms of Folie a Deux

Folie a Deux is classified as a psychotic disorder, which is diagnosed in a person who becomes disconnected from reality.

What are the Common Behaviors/Characteristics?

The symptom that most commonly gets shared in Folie a Deux is a delusion, which is a belief that is strange, irrational and unlikely to be changed even when the person is presented with contradictory evidence. Examples include the belief that one of you is the leader of a cult, an alien, or that you’re both being followed by the FBI.

Stats: How Many Suffer from this Disorder?

Folie a Deux is a rare condition and for this reason, reliable statistics on the disorder’s prevalence are hard to come by.

Testing: What are the Diagnostic Criteria Per the DSM 5?

Although the term ‘Folie a Deux’ is frequently used by mental health professionals, this wording isn’t used in the DSM 5, which is the diagnostic ‘bible’ for mental health professionals. Instead, you would qualify for the following diagnosis, which is used to diagnose people who have psychotic symptoms that don’t fit neatly into one of the other disorders: “Other specified schizophrenia spectrum and other psychotic disorder”.

There’s an additional label that would be attached in the case of Folie a Deux: “Delusional symptoms in partner of individual with delusional disorder”. The DSM explains that this label should be used in cases where a primary transmits their symptoms to another person who doesn’t already have another delusional or psychotic disorder.

Simply put, on paper, the secondary is likely to receive the following, incredibly clunky diagnosis: “Other specified schizophrenia spectrum and other psychotic disorder: delusional symptoms in partner of individual with delusional disorder”. You can surely understand now why clinicians choose to use the term ‘Folie a Deux’ instead!

Folie a Deux and Other Conditions

Folie a Deux centers on the presence of shared delusional thoughts. There are many other conditions that include this symptom – including psychosis that is caused by psychological factors, substance use, brain injury or another medical condition. Read on to learn about the relationship between Folie a Deux and related conditions,

Folie a Deux vs Delusional Disorder

Delusional disorder is diagnosed when the main concern is the presence of one or more delusional thoughts. For this reason, Folie a Deux looks fairly similar to delusional disorder. The obvious difference, however, is that Folie a Deux involves two people who share the same delusion.

Secondary vs Primary Delusional Disorder

There are two types of delusions that mental health professionals may refer to: primary’ and ‘secondary’ delusions. In the case of Folie a Deux, both types may be present. The main difference between these two is that primary delusions appear to be bizarre and obviously out of touch with reality. For example, if you believe that a snake lives in your intestines or that your mother-in-law is an extraterrestrial, you may be thought to have a primary delusion.

Secondary delusions, on the other hand, are slightly less bizarre and may be somewhat plausible. For example, a man that suffers with feelings of sadness and guilt made a minor mistake on his latest tax return. Now, he has a delusion that the revenue service and the CIA are spying on him. This is a secondary delusion because although his idea is out of touch with reality, it’s not completely implausible and one can understand why he has developed this sort of thought pattern.

Related Conditions

Folie a Deux is closely related to and shares symptoms with other disorders that involve psychosis. Examples include schizophrenia, schizophreniform disorder, schizoaffective disorder and even bipolar disorder with secondary psychosis.

Usually, however, the primary’s condition is more severe, and the secondary won’t have the other psychotic symptoms – hallucinations, disorganized thought or language patterns and odd muscular movements – that they would need to be diagnosed with another full-blown psychotic disorder.

Example Case of Folie a Deux

Angela (35) was a single mom living with her daughter, Sheila (16). They lived alone on a remote freeholding in Connecticut and they shared an incredibly close relationship, given that they hardly ever saw other people (Sheila received online homeschooling).

Back when Angela was 21, she received a diagnosis of Schizophrenia. However, that was the first and last time that she had experienced any psychotic symptoms. One day, however, Angela started behaving a strangely, talking to herself and spending a lot of time locked in her room.

Sheila asked her what was going on, and Angela revealed to her that God had been communicating with her, saying that she (Angela) was the Messiah. At first, Sheila didn’t know what to make of this. She decided to ignore the situation and hope that her mom would go back to her normal self soon. Gradually, however, with time, Sheila started thinking that her mom might indeed be speaking to God.

One day Angela’s cousin (Adam) decided to pay the two a visit. When he arrived at the house, he recognized immediately that Angela had relapsed back into psychosis, pacing agitatedly and speaking incoherently about being the “chosen one”. Adam quickly found Sheila and explained that they needed to find help because Angela’s symptoms had returned. Sheila disagreed vehemently and said that it was impossible that her mom was sick because Angela held a direct line of communication with God.

Adam drove them both to the nearest emergency room. The couple were seen by a psychiatrist who diagnosed Folie a Deux in Sheila and a Schizophrenia episode in Angela. Angela was placed back on her antipsychotic medication and had to spend 6 weeks in a treatment facility until her symptoms disappeared completely. During that time, Sheila lived with Adam and saw a psychologist twice a week while she continued with online homeschooling.

Three months later, Angela and Sheila were asymptomatic and happy to be re-united. They decided to move to a nearby city where they could be in closer contact with their friends and family; as well as the psychiatrist and psychologists who had helped Sheila overcome Folie a Deux.

Folie à Deux

Folie a Deux Treatment

Folie a Deux is typically treated by separating the pair. It may also be necessary for each of them to see their own therapist, which can help them to develop coping skills and establish a firmer sense of their own identity as separate from their partner. In some cases – usually when there is a risk of suicide, homicide, neglect or abuse – temporary hospitalization might also be necessary.

Possible Medications for Folie a Deux

The secondary experiences delusions, but usually no other psychotic symptoms. These delusions result from being social connected to someone with a psychiatric condition, rather than due to their own pre-existing medical condition. For this reason, the secondary is not usually given medication. The primary, however, is likely to be given antipsychotic to help treat their delusions and other psychotic symptoms.

Home Remedies to help Folie a Deux

Folie a Deux is a serious and high-risk condition: there are no effective home remedies that can be used in the place of a consultation with a qualified health professional. However, your doctor or therapist might recommend certain strategies that you can adopt to make it easier to live with this condition. Read on to learn more.

Living with Folie a Deux

  • Self-care is important for people with Folie a Deux. Psychotic symptoms can be triggered by stress or depression, so do not take on too much. You may need to consider working a part time job so that you can minimize workplace stress and maximize leisure time.
  • Be kind to yourself! Do this by starting a new hobby or resuming an old one that you once enjoyed. If you’re feeling a bit down, meet a friend for coffee or take a walk in nature. You may feel guilt or shame about your condition, but don’t be too hard on yourself – you are not to blame!
  • It can be very comforting to share your experience with people who have gone through something similar. Look for support groups in your area related to Folie a Deux or psychosis more generally.
  • It may be helpful for you to develop a daily routine to give you a sense of stability and predictability.

Insurance Coverage for Folie a Deux

Depending on your health insurance plan, you may have some mental health coverage options. Speak to your doctor or insurance company to find out about what’s available to you.

How to Deal/Coping With Folie a Deux

Cope with your condition by consulting with a licensed professional and working together with them to prevent a relapse. Do this by adhering to any recommendations they might have about therapy sessions, doctors’ visits and medication. Be sure that your family and close friends are able to recognize the warning signs of psychosis, so that you can get the assistance that you need immediately should your symptoms start to resurface.

Look out for These Complications/Risk Factors

Risk factors for developing this illness include having an overfamiliar relationship and being isolated from other social influences; or else having a genetic predisposition to psychotic illnesses. It’s also thought that being passive and suggestible in relationships, or having histrionic personality traits, may put you at risk.

Finally, females are thought to be more at risk than males, with over half of all Folie a Deux cases involving either two sisters or a mother and daughter pair. This doesn’t mean, however, that males can’t be affected!

Complications involve, in extreme cases, suicidal or homicidal behavior; as well as neglect and abuse when the secondary is a child or vulnerable person. If you think that you or someone you know may be in danger, reach out for help immediately by contacting 911 or the National Suicide Prevention Lifeline on 1-800-273-8255

How to Find a Therapist

The doctor who diagnosed you may be able to refer you to an appropriate therapist. Otherwise, speak to your general practitioner for recommendations, or search online for therapists in your area.

What Should I be Looking for in an LMHP?

You’ll want to find someone who has experience working with this disorder, or at the very least with other psychotic disorders. However, it is also important to find someone that you trust and feel comfortable talking to.

Questions to Ask a Potential Therapist

  • Have you treated Folie a Deux or psychosis before?
  • What are your treatment methods?
  • How will treatment help me?
  • How often will sessions take place?
  • Will my family be asked to attend any sessions?
  • What do you charge for a session and will sessions be covered by insurance?

Folie a Deux Resources and Support Helpline

Disinhibited Social Engagement Disorder

While some children are naturally friendly and occasionally enjoy cheerful interactions with strangers, it may be a problem if the child constantly seeks verbal, physical, and social interactions with adult strangers without caution and hesitation. Find out more about disinhibited social engagement disorder.

Disinhibited Social Engagement Disorder: What does it mean?

Disinhibited social engagement disorder (DSED) is an attachment disorder which results from disruptions in the normative relationship between children and their caregivers. Such disruptions are a result of the absence of adequate social and emotional care during childhood. DSED is one of two types of attachment disorder, the other being reactive attachment disorder (RAD).

Attachment describes the behavioral patterns and emotions observed in a child as a result of their relationships with others, usually their caregivers. Generally, attachment disorders result from negative childhood experiences a child may have had with caregivers. This may occur through loss of the primary caregiver or inability of the caregiver to provide adequate emotional and social support for the child.

Stats: How many suffer from this Disorder?

Disinhibited social engagement disorder is typically a disorder of childhood, affecting children younger than 18 years. The condition typically has an onset occurring before the age of 5 years. In severe cases, the disorder may persist with behavioral and relationship problems continuing in preschool and school years. In more complicated cases, the disorder may progress into adolescence and adulthood.

The disorder has its roots in infancy, with attachment problems in this developmental period being the root of this disorder.

What Causes Disinhibited Social Engagement Disorder?

Although the exact causes of disinhibited social engagement disorder are unknown, several factors may contribute to its development. Some of these factors include:

  • Receiving care from multiple caregivers at the same time or sequentially. This makes the child lack a sense of security and permanency associated with long-standing relationships with permanent caregivers.
  • Frequent changes in foster care.

Signs and symptoms of Disinhibited Social Engagement Disorder

The most common symptom of this disorder is the absence of normal restraint and discretion when interacting with strangers. Other symptoms include the following:

  • Being unusually comfortable talking to an unfamiliar stranger, usually against the normal culture or social norms.
  • Willingness to touch or give hugs to adult strangers.
  • A tendency to go off with an adult stranger without any hesitation.
  • Willingness to approach a stranger for help, comfort, or food.
  • Willingness to receive gifts or toys from adult strangers.
  • Children with severe conditions may show an excessive appetite or thirst.

Testing: What are the Diagnostic Criteria per the DSM 5

Criteria for the diagnosis of disinhibited social engagement disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), include

  • A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least 2 of the following:
  1. Reduced or absent reticence in approaching and interacting with unfamiliar adults;
  2. Overly familiar verbal or physical behavior (inconsistent with culturally sanctioned and age-appropriate social boundaries)
  3. Diminished or absent checking-back with adult caregivers after venturing away, even in unfamiliar settings
  4. Willingness to go off with an unfamiliar adult with minimal or no hesitation
  • The behaviors described in the first criterion are not limited to impulsivity (as in ADHD) but also include socially disinhibited behavior
  • The child has experienced a pattern of extremes of insufficient care, as evidenced by at least 1 of the following:
    1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
    2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (for example, frequent changes in foster care)
    3. Rearing in unusual settings that severely limit opportunities to form selective attachments (for example, institutions with high child-to-caregiver ratios)
  • The care described in the third criterion is presumed to be responsible for the disturbed behavior described in the first criterion (for instance, the disturbed behavior began after the inadequate care)
  • The child has a developmental age of at least 9 months.

In a child with disinhibited social engagement disorder, if the disorder has been present for longer than 12 months, it is specified as persistent. If the child exhibits all the symptoms of the disorder, with each symptom manifesting at relatively high levels, the disorder is further specified as severe.

Disinhibited Social Engagement and Other Conditions

There are a number of psychological disorders, as well as personality traits, which have some similarities to DSED but can be distinguished clinically.

Disinhibited Social Engagement vs. Extraversion

Extraversion is one of the five core personality traits. Extraversion is characterized by high sociability, talkativeness, and external excitability. Children with strong extraversion usually love to interact with other people. Extraversion is not a disorder, but a component of normal personality and children high in extraversion are typically cheerful, action-oriented, friendly, and enjoy being the center of attention.

Disinhibited Social Engagement vs. Autism Spectrum Disorders

Autism spectrum disorders are a group of developmental disorders characterized by delayed social, communication, intellectual skills, as well as behavior. A key similarity between autism spectrum disorders and DSED is the delayed emotional development. However, children with DSED usually retain age-appropriate intellectual level and language patterns.

This group of disorders includes Asperger’s Disorder, Autistic Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified, and usually result from abnormalities in the biology of the child’s brain. These conditions are typically associated with developmental regression, abnormal interactions with people, abnormal responses to external stimuli, language delays and abnormalities, and repetitive stereotyped behavior. Autism spectrum disorders are not caused by childhood negative experiences with parents or caregivers.

Related Conditions

Another condition related to DSED is reactive attachment disorder, the other form of attachment disorder, also caused by disruptions in the normative bond between a child and a caregiver during early childhood.

The symptoms are typically opposite of those of DSED and include minimal social and emotional interactions with others, reduced expressions of joy, minimal search for comfort when distressed, and multiple episodes of unexplained sadness and irritability.

Disinhibited Social Engagement in Adults/Children

Disinhibited social engagement disorder is exclusively a disorder of childhood and is typically not diagnosed after the age of 5 years. Usually, as the child grows and attains various developmental milestones, the symptoms reduce.

Similarly, experts note that as the child’s needs to elicit care from strangers and potential caregivers wane, the symptoms will also lessen. However, in a few cases, some children may continue to experience these symptoms in their adolescent and adult years.

Example Case of Disinhibited Social Engagement Disorder

Lola is a 5-year-old girl who is brought to the primary care pediatrician by her new foster parent. Lola was said to have been cared for by five foster parents within a space of two years after her mother abandoned her following her cocaine addiction problems. Her new foster parent describes several incidences where Lola becomes excessively cheerful with adult strangers who come to visit, giving them several hugs, and on two occasions following an adult neighbor to visit his friends. These parents express serious concerns over Lola’s overfamiliarity and think that there may be something wrong with her.

Disinhibited Social Engagement Disorder

How to Deal/Coping with Disinhibited Social Engagement Disorder

Disinhibited social engagement disorder is a serious condition, but full recovery is possible with adequate treatment. Without receiving treatment and building new attachments, children with the disorder have a poor chance of attaining normal emotional development, building strong relationships, and engaging in intimate relationships with members of the opposite sex.

Parents should put the risk factors and complications of the disorder in mind to aid improvement of the child’s symptoms and prevent progression of the symptoms.

Risk factors of disinhibited social engagement disorder include:

  • Children that are institutionalized during infancy or early childhood.
  • Parental neglect
  • Parental maltreatment.
  • Teen parenting
  • Parents with substance abuse or other mental health issues including personality disorders and depression.
  • Childhood emotional trauma such as early sexual abuse.
  • Parental loss – from the death of one parent or divorce.
  • Caregivers who have experienced attachment disorders.

In the absence of treatment, symptoms may progress and lead to a number of complications which include:

  • Exhibition of defiant and uncooperative behavior toward adults
  • Children may become exploitative toward other people.
  • A great fear of closeness and intimacy
  • Transmitting a similar behavioral pattern to their children, when they become parents.
  • As a result of the absence of appropriate caring behavior during childhood, children with disinhibited social engagement disorder may develop conduct disorder.
  • Attention problems which result in poor school performance

Disinhibited Social Engagement Disorder Treatment

Treatment is essential for a child with this disorder to help them attain normal emotional development and build trusting social relationships. The absence of treatment is generally associated with a poor prognosis. Treatment involves the use of medications, as well as behavioral and psychological therapy. Much of the behavioral and psychological therapy is provided by the child’s primary caregivers in their daily interactions.

Possible Medications for DSED

Although there is no specific medication for treating DSED, some drugs may be used in treating symptoms and associated problems such as hyperactivity, social anxiety, emotional outbursts, and sleep disturbances. These drugs include anxiolytics, mood stabilizers, and sedatives.

Home Remedies to Help DSED

Therapy for children with disinhibited social engagement disorder is largely provided by the caregivers in their day-to-day interactions. One psychological therapy used in the treatment of this disorder is play therapy in which children learn to express their fears, worries, and emotional needs during play sessions. In the context of play also, caregivers will learn to be more sensitive to the needs of the child.

During interactions, caregivers should incorporate security, stability, and sensitivity as key ingredients to help the child develop healthy attachments. These reparative processes require consistency and repetition to allow the child to overcome the scars of attachment disruption and develop trust in the caregiver and other people. This is the sense of security a child needs in the caregiver-child relationship.

Stability refers to building a long-standing attachment with the child. It is not uncommon for children to feel that a new caregiver will disappear or neglect them. Incorporating a sense of stability in the relationship helps a child to understand that their needs can be met by a particular caregiver repeatedly and consistently.

Sensitivity, as a key ingredient of therapy, refers to attentiveness to the needs of the child. Because a child’s emotional development may be delayed by repeated attention disruptions, a new caregiver must be emotionally available and attentive to the needs and desires of the child for them to improve. In a case, for instance, where a naturally independent child develops dependency needs and wants to always be around the caregiver, the caregiver should be sensitive to these dependency needs and meet them.

Living with DSED

It may be challenging living with and grooming a child with DSED. However, active participation of the caregivers is pivotal for the clinical improvement of the child. In addition, new caregivers may require emotional support and therapy to cope with the difficult behaviors the child may exhibit.

A behavioral management program that encourages a positive learning model is essential for improvement of the child’s symptoms. For example, excessive corrective measures such as punishment or abandonment may exacerbate symptoms instead of relieving them.

Insurance Coverage for DSED

Check your insurance plan benefits for coverage of mental or behavioral health services. You may inquire directly through your human resources office for employer-sponsored health coverage for treatment of this condition or contact your health insurance company directly. Also, find out about out-of-pocket costs and deductibles you will pay to access the mental health services under your insurance plan.

How to Find a Therapist

After an initial evaluation, your primary care physician will refer your child to a psychiatrist or child psychologist who will confirm the diagnosis and institute appropriate therapeutic measures. You may also ask friends and family for good therapists, or check through online resources and directory to find the right therapist for you.

What should I be looking for in a Licensed Mental Health Professional (LMHP)?

Qualities you should look for in an LMHP include:

  • Good Communication Skills: An effective LMHP should communicate their expert ideas about your child’s symptoms effectively.
  • Empathy: You do not want a counselor who would rush through medical facts without considering your emotional needs or those of your child. You need an LMHP that is considerate, patient, calm, and compassionate with you.
  • Problem-Solving Skills: Your chosen LMHP must be knowledgeable enough to help you through to a satisfactory resolution of your child’s symptoms. While your resolution of your child’s symptoms is not entirely up to your counselor, they must demonstrate an ample ability to help manage those symptoms effectively.
  • Good multicultural Relationship: Your counselor must be able to strike a good patient-therapist relationship with you and your family irrespective of your racial, ethnic, or cultural differences. Therapy must be devoid of such prejudices which may hamper on the effectiveness of treatment.

Questions to ask for Potential Therapist

You should ask a potential therapist the following questions to help you gain more insight into your symptoms and the scope of your treatment options.

  • What do you think is causing my child’s symptoms?
  • How will the diagnosis be determined?
  • Does my child have disinhibited social engagement disorder?
  • Is the condition self-limiting or chronic?
  • What factors contribute to the problem?
  • Does my child require screening for other mental health disorders?
  • What are the likely complications of this condition?
  • What is the treatment approach you recommend?
  • How long will therapy be for, if necessary?
  • What medications will my child be on?
  • What side effects should I expect from those drugs?
  • Should I inform my child’s school teachers about the diagnosis?
  • Are there effective strategies to use at home and school to improve my child’s behavior?
  • Do you recommend therapy for the caregivers as well?
  • Are there any resources or websites you recommend?

Disinhibited Social Engagement Disorder: An Overview

Disinhibited social engagement disorder (DSED) is an attachment disorder of childhood caused by disruptions in a child’s attachment to or negative experiences with the caregiver during early childhood or infancy. Symptoms center on the child’s physical, verbal, and emotional overfamiliarity with adult strangers.

DSED has an onset typically below the age of 5 years and may progress, in some children, to adolescence and adulthood. Treatment of the disorder is largely based on psychological and behavioral modification with the caregiver actively participating, meeting the child’s emotional needs and creating new attachment and relationships.

Resources

https://psychcentral.com/disorders/symptoms-of-disinhibited-social-engagement-disorder/

https://www.theravive.com/therapedia/disinhibited-social-engagement-disorder-dsm–5-313.89-(f94.2)

http://traumadissociation.com/disinhibited

https://emedicine.medscape.com/article/915447-treatment#d9

https://www.healthline.com/health/disinhibited-social-engagement-disorder#symptoms

https://www.medscape.com/viewarticle/761663

https://emedicine.medscape.com/article/912781-overview#a1
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Conduct Disorder

Conduct disorder (CD) is more than just bad behavior from children or teenagers. It is a mental health condition that is marked by persistent, repetitive behavioral patterns that violate societal rules or the rights of other people.

Conduct Disorder: What Does It Mean?

While most children become disruptive from time to time, conduct disorder involves problematic behaviors that are more serious and long-lasting. These disruptive behaviors generally fall into four groups: aggressive conduct that threatens or causes harm to people or animals, nonaggressive conduct that involves property damage or loss, theft or deceitful conduct, and persistent violations of important rules.

Youths with conduct disorder find it challenging to control their emotions. Disruptive behaviors typically occur in a variety of settings and may cause serious problems. In many cases, people with mental health conditions such as anxiety or depression direct their distress inward. However, individuals with CD direct their distress outward where it may affect other people.

Stats: How Many Suffer from this Disorder?

Approximately 1-4% of children age 9-17 years old have conduct disorder. The prevalence of the condition is consistent across various ethnicities, races, and countries. Conduct disorder is more common among teenagers than younger children. Males are more likely to develop CD than females.

What Causes Conduct Disorder?

The specific causes of conduct disorder are unknown. However, mental health experts believe there are genetic and environmental factors that influence its onset. Conduct disorder is more likely to develop in children who have:

  • A history of physical or sexual abuse
  • Parents with substance addiction
  • Family members with conduct disorder
  • Parents with depression, bipolar disorder, or schizophrenia
  • Abnormalities in brain areas that control emotional regulation

Oppositional defiant disorder (ODD) may be a precursor to conduct disorder. When ODD is untreated, children are more likely to develop conduct disorder later in life.

Signs and Symptoms of Conduct Disorder

Children may show many signs and symptoms of conduct disorder. The disruptive behaviors are persistent, repetitive, and socially inappropriate. Symptoms of conduct disorder may change as children get older, stronger, smarter, and more sexually mature. Problematic behaviors may include:

  • Physically abusing animals or people
  • Bullying others
  • Forced sexual activity
  • Damaging property
  • Breaking into buildings, cars, or houses
  • Shoplifting
  • Lying
  • Skipping school before the age of 13
  • Running away from home at least twice

What are the Common Behaviors/Characteristics?

The behaviors that characterize conduct disorder go beyond what people may expect during teenage rebellion. They cause serious concern among peers, parents, and teachers.

Youths with conduct disorder are usually aggressive. They are more likely to misperceive the actions of others as threatening, and may respond with aggressive behavior they believe is justified. Young people with CD display a low tolerance for frustration, poor self-control, high irritability, recklessness, thrill-seeking behavior, and insensitivity to punishment. Substance misuse is associated with CD, especially among adolescent females. Young people with CD are at higher risk of suicidal ideation and physical fights with a weapon.

Testing: What are the Diagnostic Criteria Per the DSM 5?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) gives the following guidelines for diagnosing conduct disorder:

  • A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:

Aggression to People and Animals

  1. Often bullies, threatens, or intimidates others.
  2. Often initiates physical fights.
  3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
  1. Has been physically cruel to people.
  2. Has been physically cruel to animals.
  3. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
  1. Has forced someone into sexual activity.

Destruction of Property

  1. Has deliberately engaged in fire setting with the intention of causing serious damage.
  2. Has deliberately destroyed others’ property (other than by fire setting).

Deceitfulness or Theft

  1. Has broken into someone else’s house, building, or car.
  2. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
  3. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering: forgery).

Serious Violations of Rules

  1. Often stays out at night despite parental prohibitions, beginning before age 13 years.
  2. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.
  3. Is often truant from school, beginning before age 13 years.
  • The disturbance in behavior causes clinically significant impairment in social, academic,

or occupational functioning.

  • If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

Conduct Disorder and Other Conditions

Conduct disorder is more prevalent among youths with oppositional defiant disorder and attention deficit hyperactivity disorder (ADHD). CD may also occur with other mental health issues such as anxiety, mood disorders, learning disorders, and substance-related disorders. Young people with conduct disorder may have lower intelligence than expected for their age. They may have lower achievement in communication, reading, and other verbal skills.

Conduct Disorder vs Intermittent Explosive Disorder

Conduct disorder and intermittent explosive disorder (IED) are behavioral issues that are characterized by high levels of aggression. However, there are differences between both conditions. Aggressive conduct in CD is often premeditated and purposeful (for example, to gain money or power), while aggressive conduct in IED is impulsive and unplanned. While CD has nonaggressive symptoms such as lying or truancy, IED does not have similar nonaggressive symptoms that characterize the condition.

Conduct Disorder vs Oppositional Defiant Disorder

Conduct disorder and oppositional defiant disorder are marked by disruptive behaviors toward parents, teachers, and other authority figures. However, the behaviors that define conduct disorder are more severe than those in oppositional defiant disorder. Youths with conduct disorder may engage in destruction of property, theft, and physical abuse toward animals or people. While children with ODD have emotional issues such as irritability and anger, young people with CD do not have similar emotional issues that define the condition.

Conduct Disorder vs Antisocial Personality Disorder

Individuals with conduct disorder or antisocial personality disorder tend to externalize their distress. Conduct disorder is usually diagnosed in young people up to the age of 18; adults with similar symptoms may be diagnosed with antisocial personality disorder. Youths with conduct disorder are at higher risk for developing antisocial personality disorder as they age.

Related Conditions

Pyromania and kleptomania are behavioral issues that are related to conduct disorder. Individuals with pyromania are fascinated with fires and my start fires to release pent-up emotions. People with kleptomania have an urge to steal things they do not need. While conduct disorder is more prevalent among males, kleptomania is three times more common among females.

Conduct Disorder In Adults/Children

Although conduct disorder usually affects older children and teenagers, onset may occur during a child’s preschool years. The DSM-5 defines two subtypes of conduct disorder:

  • Childhood-onset type – the child shows at least one criterion symptom of conduct disorder before the age of 10. Children with this subtype are at increased risk of criminal behavior, substance abuse, and antisocial personality disorder in adulthood.
  • Adolescent-onset type – the child does not show any criterion symptoms of conduct disorder before the age of 10. Youths with this subtype tend to achieve adequate occupational and social adjustment as they get older.

Conduct disorder is rarely diagnosed in adults as symptoms may remit by adulthood. However, adults may be given a diagnosis of conduct disorder if symptoms persist and the criteria for antisocial personality disorder is not met.

Example Case of Conduct Disorder

Megan, 16, visits a therapist with her parents after a referral from her doctor. Her father explains that her behavior has become very disruptive over the past 18 months. Megan has been caught shoplifting, setting fires in the school library, and skipping classes without permission. In the past year, she ran away twice. After speaking with Megan, the therapist learns that she has unprotected sex at parties. Megan’s father reveals she was suspended from school a week ago for fighting her classmate. The therapist diagnoses Megan with adolescent-onset type conduct disorder and recommends a combination of peer group therapy and social skills training. After 9 months of bi-weekly sessions, Megan reports better emotional control and improved relationships with her classmates, parents, and teachers.

Conduct Disorder

How to Deal/Coping With Conduct Disorder

Many therapeutic strategies have been developed to help youths cope with conduct disorder. When treating preadolescent children, parent training and family-based interventions have proven to be most effective. As children get older, they may try to individuate and separate from their family. Consequently, older children and teenagers may respond better to individual therapy and peer group therapy.

Look out for These Complications/Risk Factors

Children with conduct disorder tend to have lower academic achievement than their peers. They are also at higher risk of dropping out of school. Frequent behavior problems mean youths with CD have fewer friends and poorer relationships. They are more likely to display violent behavior, misuse substances, have legal problems, and contract sexually transmitted infections.

Children with oppositional defiant disorder are at higher risk of developing conduct disorder. Other risk factors that may contribute to the onset of CD include parents with addiction issues, sexual abuse, physical abuse, and family members with the condition.

Conduct Disorder Treatment

Psychotherapy (talk therapy) is the recommended treatment for conduct disorder. Different types of psychotherapy may be used depending on the specific circumstances of the child. Therapy may be presented in individual, group or family settings. Therapeutic approaches that have proven to be effective include:

  • Functional family therapy – teaches the family about CD and how to improve family interactions.
  • Social skills training – teaches the child how to initiate conversations, respond to others, make requests, and refuse requests.
  • Parent management training – teaches parents behavior management strategies to control aggressive conduct and promote safety.
  • Wilderness school and treatment interventions – offers an intensive therapeutic program that eliminates triggers and focuses on building positive behaviors.
  • Residential placement – provides a therapeutic environment and professional care for children with uncontrollable behaviors and helps keep the family safe
  • Medication – treats coexisting issues

Possible Medications for Conduct Disorder

There are no specific FDA-approved medications that treat conduct disorder. However, medications may be prescribed to treat co-occurring issues such as depression or ADHD.

Home Remedies to help Conduct Disorder

There are no home remedies that are clinically proven to help with conduct disorder.

Living with Conduct Disorder

Conduct disorder can disrupt a person’s school, work, family, and social life. Behaviors that may cause harm to people or animals require immediate professional care.

If your child has been diagnosed with conduct disorder, consider these strategies to improve your family life:

  • Model and promote the healthy behaviors you want your child to imitate
  • Set clear limits to help curb disruptive behavior
  • Establish daily routines
  • Praise your child for his/her positive behaviors
  • Do not overreact to challenges
  • Help older children to understand they are responsible for their conduct

Insurance Coverage for Conduct Disorder

Conduct disorder is a diagnosable behavior disorder. Your child’s insurance plan may provide coverage for this health condition. Call your child’s insurance provider to confirm coverage and obtain any authorization you may need before visiting a doctor or mental health provider.

How to Find a Therapist

Speak with your child’s physician or school guidance counselor if your child is showing symptoms of conduct disorder. They may be able to refer you to a licensed therapist who specializes in behavioral disorders.

What Should I be Looking for in an LMHP?

Your therapist should have training and/or clinical experience in treating behavioral disorders. He or she should relate well to adults and youths, without giving the impression of taking sides. As serious or embarrassing issues may be discussed, it is important for therapists to be direct, positive, and encouraging. Having a therapist who makes your entire family feel comfortable goes a long way toward successful treatment.

Questions to Ask a Potential Therapist

Questions you can ask your child’s therapist include:

  • Does my child have conduct disorder?
  • Which subtype of conduct disorder does my child have?
  • Are there any other co-occurring mental health conditions?
  • What factors contributed to my child developing conduct disorder?
  • Are there any long-term complications?
  • What adjustments may improve my child’s behavior?
  • How long will these behavioral issues last?
  • What treatment do you recommend?

Conduct Disorder Resources and Support Helpline

If your child is threatening to commit suicide or harm others, call any of the following numbers immediately:

  • 911 or your local emergency services number
  • The National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to speak with a trained therapist

Conduct disorder can cause serious issues in the lives of young people. However, early intervention and effective psychotherapy can help affected youths control their emotions and learn the social skills they need to succeed.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Bressert, S. (2016, May 17). Conduct disorder symptoms. Retrieved from https://psychcentral.com/disorders/conduct-disorder-symptoms/

Conduct disorder. (2013). Retrieved from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Conduct-Disorder-033.aspx

Connor, M. G. (2014, May 21). Understanding and dealing with conduct and oppositional disorders. Retrieved from http://www.oregoncounseling.org/Handouts/ConductOppositional.htm

Morin, A. (2018, May 26). What are the signs of conduct disorder in children? Retrieved from https://www.verywellmind.com/signs-of-conduct-disorder-in-children-4127239

Parekh, R. (2018). What are disruptive, impulse-control and conduct disorders? Retrieved from https://www.psychiatry.org/patients-families/disruptive-impulse-control-and-conduct-disorders/what-are-disruptive-impulse-control-and-conduct-disorders

Oppositional Defiant Disorder

Oppositional Defiant Disorder: What does it mean?

Oppositional defiant disorder (ODD) is a psychological disorder characterized by frequent and persistent behavioral patterns of anger, irritability, defiance, and vindictiveness, usually of a child to parents or those in authority. Well-behaved children could occasionally prove stubborn and difficult, but this differs from ODD because in the latter situation, the pattern is more regular, frequent, and occurs for a long period of time, usually a minimum of six months.

The behavioral pattern in oppositional defiant disorder has three components: defiant behavior, obstinate behavior, and vindictive behavior.

Defiant behavior is characterized by deliberately refusing to comply with rules or requests of those in authority and blaming other people for his or her mistakes.

An obstinate behavior refers to a pattern of deliberately annoying others and being unnecessarily resentful and a vindictive pattern of behavior is one characterized by been spiteful or vengeful.

These symptoms must be present in a child within the past 6 months to make a diagnosis of ODD.

Studies show that oppositional defiant disorder has a prevalence rate of 1-11% in the general population. The condition is more common in boys than in girls, before puberty. However, after puberty, it occurs in both boys and girls equally. Oppositional defiant disorder has an age of onset of 8 years.

What Causes Oppositional Defiant Disorder?

Although the exact cause of oppositional defiant disorder is not known, there are certain factors which may contribute to its development.

Genetics – A child’s personality type and temperament contributes significantly to the development of ODD. In addition, certain problems in a child’s brain chemistry and function, such as poor emotional control, high emotional reactivity, and poor stress tolerance may affect a child’s risk of oppositional defiant disorder.

Environmental Factors – Environmental factors such as neglectful or harsh parenting, inconsistent parental discipline, abuse, and excessively authoritarian parenting may contribute to a child’s risk of developing the disease.

Signs and Symptoms of Oppositional Defiant Disorder

A child with oppositional defiant disorder is often confused for a strong-willed child. However, the persistence of the symptoms, impairing a child’s relationship with parents and other authority figures and, in turn, daily functioning at home and school creates a need for therapy.

Signs of ODD manifest in preschool years, although it may develop later in some individuals. However, in almost all cases, symptoms begin to manifest by the early teen years. These symptoms include:

  • Having frequent temper tantrums and aggressive outbursts.
  • Being easily irritated and offended
  • Being angry most of the time
  • Arguing frequently with parents and other adults
  • Disobeying requests or instructions given by an adult
  • Always questioning rules and disobeying them
  • Deliberately annoying others, including adults
  • Blaming others for one’s mistakes or misbehaviors.
  • Speaking aggressively and without considering the other’s feelings
  • Seeking revenge for anything done wrong to them

What are the Diagnostic Criteria for Oppositional Defiant Disorder?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines oppositional defiant disorder as a recurrent pattern of irritable/angry mood, argumentative/defiant behavior, or vindictiveness in an individual for a minimum of 6 months. An individual must have at least 4 of the following criteria to fulfill this diagnosis.

Angry/Irritable Mood

  • Often loses temper
  • Often touchy or easily annoyed
  • Often angry and resentful

Argumentative/Defiant Behavior

  • Often argues with authority figures or with adults (if a child or adolescent)
  • Often actively defies or refuses to comply with requests from authority figures
  • Often deliberately annoys others
  • Often blames others for his or her mistakes or poor behavior

Vindictiveness

  • Has been spiteful or vindictive at least twice within the past 6 months

These symptoms are distinguishable from behaviors that are developmentally normal for children of different ages: for children younger than 5 years, these symptoms should occur on most days; for children 5 years or older, the symptoms should occur at least once per week.

Furthermore, these symptoms may occur at home, in the community, at school, with peers, or in all settings. Mild ODD is characterized by the presence of symptoms in only one setting, moderate ODD occurs with symptoms in at least two settings, while severe ODD is characterized by the presence of symptoms in three or more settings.

Oppositional Defiant Disorder and Other Conditions

The symptoms of oppositional defiant disorder closely overlap with several other disorders and it is essential to differentiate them clinically.

Oppositional Defiant Disorder vs. Conduct Disorder

Both oppositional defiant disorder and conduct disorder have several similarities. However, conduct disorder is an extreme psychological disorder characterized by the violation of others’ rights and societal norms. The symptoms of conduct disorder are typically more extreme than those of oppositional defiant disorder and include aggressive behavior toward people and animals, physical fights with others, physical cruelty to animals, deliberately destroying property, and using a weapon that could cause harm on self or others.

Oppositional Defiant Disorder vs. Intermittent Explosive Disorder

Both disorders have a number of similarities, however, while the symptoms of intermittent explosive disorder typically manifest in late adolescent years, the symptoms of oppositional defiant disorder manifests earlier, at the age of 8. Another key difference between both conditions is that symptoms of intermittent explosive disorder are not pre-meditated and usually occur within 30 minutes, after which the patient feels guilt and remorse. Typical symptoms of intermittent explosive disorder include short episodes of symptoms of aggression such as tremors, restlessness, rage, and racing thoughts, as well as aggressive outbursts characterized by temper tantrums, shouting, physical fights, destruction of property, heated arguments, and threats which are out of proportion to the inciting situation.

Related Disorders

Attention-deficit hyperactivity disorder is a common comorbidity in patients with oppositional defiant disorder. Children with ADHD are particularly vulnerable to developing ADHD in the presence of environmental risk factors including harsh parenting and inconsistent punishment. Studies reveal that half of the children with ADHD have oppositional defiant disorder. Other conditions related to oppositional defiant disorder include antisocial personality disorder which is characterized by persistent rebellious behavior, lack of remorse, and gross social irresponsibility.

Oppositional Defiant Disorder in Adults/Children

Oppositional defiant disorder usually manifests at the age of 8 and is among the commonest mental health disorders in childhood. Although the symptoms may remit spontaneously as the child grows, about 50% of children with ODD may continue experiencing symptoms through adulthood. Some of these adults may go on to develop antisocial personality disorder.

Example Case of Oppositional Defiant Disorder

John, a 5-year-old boy is brought to the clinic by his parents on account of his temper tantrums at home and in school. The parents noted that John is always arguing with them when they give him an instruction, and he eventually refuses to carry out the tasks he is asked to do. They also noted that when they try to discipline him by removing his desert privilege, he becomes very aggressive, breaking his toys and tearing his school notes. The parents affirmed that they thought it was just a “childish” behavior, but he exhibits the same behavior in school and has resulted in poor performance and several bad reports from his teachers.

Oppositional Defiant Disorder

How to Deal with Oppositional Defiant Disorder

Oppositional defiant disorder is a complex disorder which is common among children. Symptoms may spontaneously remit over time or may progress into adulthood. Risk factors for oppositional defiant disorder to look out for include:

  • Temperament – A child with a temperament which is characterized by difficulty control his or her emotions or being unable to endure stress or frustrating situations has a high risk of developing oppositional defiant disorder.
  • Poor parenting – A child who experiences parental neglect, harsh parenting, or physical abuse from parents has a high risk of developing oppositional defiant disorder. In addition, a child who lives with a parent with mental health issues or substance abuse disorders is likely to develop oppositional abuse disorder. Positive parenting is, therefore, essential in improving behavior and preventing complications.
  • Environmental factors – Oppositional defiant disorder can be exacerbated by inconsistent discipline from authority figures.

Oppositional and defiant behavior often begins with mild symptoms which may progress to causing serious complications which include:

  • Poor school performance
  • Poor social relationships and antisocial behavior
  • Substance use disorder
  • Suicidal tendency.

Oppositional Defiant Disorder Treatment

Children with ODD show significant improvement with early treatment, and this could restore the child’s self-esteem, positive attitude, and rebuild positive social relationships. Treatment for ODD includes the use of certain medicines, parental training, personal and family therapy, and parent-child interaction therapy.

Possible Medicines for ODD

Medicines are not often used in treating ODD, as the mainstay of treatment is therapy. However, children with co-occurring disorders such as ADHD may be treated with agents such as Ritalin, Dexmethylphenidate, and antidepressants including imipramine.

Home Remedies to Help ODD

In addition to clinical therapy instituted by your doctor, the following home strategies may help improve your child’s symptoms:

  • Recognize and reward your child’s positive behaviors. The rewards should be specific and consistent.
  • Model the desired behavior – Modeling appropriate social behavior which you desire in your child may help them improve their behavior and social relationships.
  • Set clear boundaries – Behavioral patterns should be limited by clear boundaries and the consequences should be consistent so the desired behavior is reinforced.
  • Spend time together – creating a consistent and regular schedule for spending time with your child may help in improving their behavior.
  • Assign tasks – Give clear instructions for your child to carry out tasks which will not be done if the child does not do it.

Living with ODD

It may be challenging dealing with a child with ODD. Parents, tutors, and other adults who take care of such children need to be patient with them and work together to ensure the inappropriate behavioral pattern is eliminated.

  • Parents and other family members may also seek the help of a therapist to learn coping strategies to help them overcome the emotional distress which comes with being a parent of a child with ODD.
  • Build supportive relationships which would help you acquire coping strategies and help provide support for the child.

Insurance Coverage for ODD

Check your insurance plan benefits for coverage of mental or behavioral health services. You may inquire through your human resources unit for employer-sponsored health coverage for treatment of this condition or contact your health insurance company directly. Also, find out about out-of-pocket costs and deductibles you will pay to access the mental health services under your insurance plan.

How to Find a Therapist

After an initial evaluation, your primary care physician will refer your child to a psychiatrist or child psychologist for therapy. You may also ask friends and family for good therapists, or check through online resources and directory to find the right therapist for you.

What should I be looking for in a Licensed Mental Health Professional (LMHP)?

Qualities you should look for in an LMHP include:

  • Good Communication Skills: An effective LMHP should be able to effectively communicate their expert ideas about your child’s symptoms effectively.
  • Empathy: You do not want a counselor who would rush through medical facts without considering your emotional needs or the needs of your child. You need an LMHP that is considerate, patient, calm, and compassionate with you.
  • Problem-Solving Skills: Your chosen LMHP must be knowledgeable enough to help you through to a satisfactory resolution of your child’s symptoms. While your child’s remission is not entirely up to your counselor, they must demonstrate ample ability to help manage your symptoms effectively.
  • Good multicultural Relationship: Your counselor must be able to strike a strong patient-therapist relationship with you and your family irrespective of your racial, ethnic, or cultural differences. Therapy must be devoid of such prejudices which may hamper on the effectiveness of treatment.

Questions to ask for Potential Therapist

You should ask a potential therapist the following questions to help you gain more insight into your symptoms and the scope of your treatment options.

  • What do you think is causing my child’s symptoms?
  • How will the diagnosis be determined?
  • Does my child have oppositional defiant disorder?
  • Is the condition self-limiting or chronic?
  • What factors contribute to the problem?
  • Does my child require screening for other mental health disorders?
  • What are the likely complications of this condition?
  • What is the treatment approach you recommend?
  • How long will therapy be for, if necessary?
  • What medications will my child be on?
  • What side effects should I expect from those drugs?
  • Should I inform my child’s school teachers about the diagnosis?
  • Are there effective strategies to use at home and school to improve my child’s behavior?
  • Do you recommend family therapy?
  • Are there any resources or websites you recommend?

Oppositional Defiant Disorder: Overview

Oppositional defiant disorder is a chronic psychological disorder characterized by at least 6 months duration of a child demonstrating angry and irritable mood, defiant behavior, and vindictiveness. Oppositional defiant behavior may remit spontaneously or require medications for comorbidities and sessions of family therapy, parent-child interaction therapy, and parental training.

Resources

https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831

https://emedicine.medscape.com/article/918095-overview?pa=VHBMDPEH9oTIMFc1J11foa4cNqTJAgJTl2n0aSltiYsubVgPPj%2BYZdBteA84GyM743mU9jD%2B1DtnxY47OmyybA%3D%3D#a1

https://www.hopkinsmedicine.org/healthlibrary/conditions/mental_health_disorders/oppositional_defiant_disorder_90,P02573

https://www.verywellmind.com/signs-of-conduct-disorder-in-children-4127239

https://www.aafp.org/afp/2008/1001/p861.html