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By Salina Chan, R3 2013 Body Dysmorphic Hoarding d/o Trichotillomania Excoriation (skin picking) Disorder Preoccupation with >1 perceived defects or flaws in physical appearance that are not observable or appear slight to others If a slight physical anomaly is present, the person's concern is markedly excessive Skin picking can cause lesions Repetitive beh./mental acts at some point Checking Comparing Picking Grooming reassurance Persistent difficulty discarding or parting with possessions, regardless of value Due to: perceived need to save items distress associated with discarding them Active living areas are congested and cluttered with accumulation of possessions substantially compromises their intended use If living areas uncluttered, it is only because of third parties (e.g., family members, cleaners, authorities) Trichotillomania Recurrent pulling out of one’s hair, resulting in hair loss Excoriation (hair-pulling d/o) (skin picking) d/o Recurrent skin picking resulting in skin lesions Repeated attempts to decrease or stop beh May be preceded or accompanied by various emotional states E.g. triggered by anxiety or boredom, preceding tension, post-gratification/pleasure/relief Focused (aware) vs automatic behaviour Dissociative Identity d/o Dissociative Amnesia Depersonalization/dere alization d/o Disruption of identity characterized by >2 distinct personality states may be described in some cultures as an experience of possession involves marked discontinuity in sense of self and sense of agency Changes in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning As observed by others or reported by the individual Recurrent gaps in recall of everyday events, important personal info, and/or traumatic events more than just ordinary forgetting Can’t recall important autobiographical info, usually of a traumatic or stressful nature not just ordinary forgetting most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history Dissociative fugue Apparently purposeful travel or bewildered wandering associated with amnesia for identity or for other important autobiographical info Presence of persistent or recurrent experiences of depersonalization, derealization, or both: Depersonalization: Experiences of unreality, detachment, or being an outside observer for one’s thoughts, feelings, sensations, body, or actions Derealization: Experiences of unreality or detachment with respect to surroundings e.g. perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted During the depersonalization or derealization experiences, reality testing remains intact Somatic symptom d/o (somatization d/o) Illness anxiety d/o (hypochondriac) Conversion d/o Factitious d/o >1 somatic symptoms = distressing or cause sig disruption of daily life Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns with >1 of following: Disproportionate and persistent thoughts about the seriousness of one’s symptoms Persistently high level of anxiety about health or symptoms Excessive time and energy devoted to symptoms or health concerns Persistent state of being symptomatic, though specific symptoms can change Preoccupation with having or acquiring serious illness that is excessive or disproportionate Somatic symptoms are not present or, if present, are only mild in intensity High level of anxiety about health, and person is easily alarmed about personal health status Performs excessive health-related behaviors or exhibits maladaptive avoidance e.g., repeatedly checks body for signs of illness, avoids doctor appointments and hospitals > 6 months, but the specific illness that is feared may change over that period of time >1 symptoms of altered voluntary motor or sensory Clinical findings show symptom(s) ≠ recognized neurological/medical conditions weakness or paralysis abnormal movement swallowing symptoms speech symptom attacks or seizures anesthesia or sensory loss special sensory symptom mixed symptoms Falsification of physical or psychological signs or symptoms, or induction of injury or disease associated with identified deception individual presents to others as ill, impaired, or injured deceptive behavior is evident even without obvious external rewards FD imposed on self Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another associated with identified deception individual presents another (victim) to others as ill, impaired, or injured deceptive behavior is evident even without obvious external rewards Note: The perpetrator = diagnosis FD imposed on another Brief frequent visits Limit number of physicians involved Focus on psychosocial Hypnosis/Amytal Minimize Interview investigations Psychotherapy Minimize psychiatric medications (may use anti-depressant) Anorexia nervosa Bulimia nervosa Binge-eating d/o Intake Restriction leading to sig low body weight WRT age, sex, developmental trajectory, & PEx health Intense fear of gaining wt or becoming fat, or, persistent beh that interferes with wt gain, even though at a sig low wt. Cognition: Disturbance in experiencing one’s body wt or shape undue influence of body wt or shape on self-evaluation persistent not recognizing the seriousness of current low body wt Severity based on BMI 1. Restricting type - no binge eating or purging behavior 2. Binge-eating/purging type Recurrent episodes of binge eating Episode = both of following: Eating, in a discrete period of time (e.g., within any 2hour period), an amount of food that is definitely larger than what most ppl would eat in a similar period of time under similar circumstances A sense of lack of control over eating during the episode Recurrent inappropriate compensatory behaviors in order to prevent weight gain E.g. self-induced vomiting, laxatives, diuretics, other meds; fasting or +++ exercise binge eating and inappropriate compensatory behaviors both occur, on avg, >1/week x 3 months Self-evaluation is unduly influenced by body shape and weight Recurrent episodes of binge eating. Episode = both: Eating, in a discrete time period (e.g. any 2-hour period), an amount of food that is definitely larger than what most people would eat A sense of lack of control over eating during the episode Episodes associated with >3 of following: Eating much more rapidly than normal Eating until feeling uncomfortably full Eating lg amounts of food when not hungry Eating alone d/t feeling embarrassed by how much one is eating Feeling disgusted with oneself, depressed, or very guilty afterward The binge eating occurs, on avg, >1/week for 3 months. Primary Insomnia Hypersomnolence Disorder Narcolepsy Obstructive Sleep Apnea Hypopnea Central Sleep Apnea Restless Legs Syndrome complaint of dissatisfaction with sleep quantity/quality, with >1 of following: Difficulty initiating sleep Difficulty maintaining sleep freq awakenings or problems returning to sleep after awakenings Early-morning awakening with inability to return to sleep >3 nights/week x >3 months Self-reported excessive sleepiness despite a main sleep period >7 hrs, with >1 of following: Recurrent periods of sleep or lapses into sleep within same day A prolonged main sleep episode >9 hrs/day that is nonrestorative/unrefreshing Difficulty being fully awake after abrupt awakening >3/week x >3 months Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day. >3/week x 3 months The presence of at least one of the following: Episodes of cataplexy a few times per month Hypocretin deficiency (CSF) Nocturnal sleep polysomnography or a multiple sleep latency test findings consistent with narcolepsy Either (1) or (2): 1. Polysomnography showing >5 obstructive apneas or hypopneas per hour of sleep and either of the following sleep symptoms: Nocturnal breathing disturbances a) b) snoring, snorting/gasping, or breathing pauses during sleep Daytime sleepiness, fatigue, or unrefreshing sleep 2. Polysomnography of >15 obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying symptoms An urge to move the legs, usually with or in response to uncomfortable and unpleasant sensations in the legs Leg sensations characterized by all of the following: The urge to move the legs begins or worsens during periods of rest or inactivity The urge to move the legs is partially or totally relieved by movement The urge to move the legs is worse in the evening or at night than during the day, or occurs only in the evening or at night >3/week x >3 months Central Sleep Apnea Polysomnography shows >5 central apneas per hr of sleep Sleep-Related Hypoventilation Polysomnograpy demonstrates episodes of resp with CO2 levels Circadian Persistent/recurrent pattern of sleep disruption Rhythm Sleep-Wake Disorders due to an alteration of the circadian system; or endogenous circadian rhythm ≠ the sleep–wake schedule required by an individual sleep disruption = excessive sleepiness, insomnia, or both Delayed Ejaculation Erectile Disorder Female Orgasmic Disorder Female Sexual Interest/Arousal Disorder Genito-Pelvic Pain/Penetration Disorder Male Hypoactive Sexual Desire Disorder Premature (Early) Ejaculation Delayed Marked delay in ejaculation or Marked infrequency or absence of ejaculation Erectile Disorder Marked difficulty in obtaining an erection, maintaining an erection or decrease in erectile rigidity Female Ejaculation Orgasmic Disorder Marked delay in, marked infrequency of, or absence of orgasm, or, Markedly reduced intensity of orgasmic sensations 75-100% of the time x >6 months Lack of, or sig reduced, sexual interest/arousal, via >3 of following: Absent/reduced interest in sexual activity Absent/reduced sexual/erotic thoughts or fantasies No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all sexual encounters* Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues Absent/reduced genital or nongenital sensations during sexual activity in almost all or all sexual encounters* *~75%–100%, situational vs all contexts Persistent or recurrent difficulties with >1 of following Vaginal penetration during intercourse Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration. Male Hypoactive Sexual Desire Disorder Persistently or recurrently deficient/absent sexual/erotic thoughts or fantasies and desire for sexual activity Clinical judgment X 6 months Premature (Early) Ejaculation Persistent or recurrent pattern of ejaculation occurring during partnered sexual activity w/in ~1 min following vaginal penetration and before the individual wishes it 75-100% of the time x >6 months Intermittent Explosive Disorder Pyromania Kleptomania Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either of the following: Verbal aggression or physical aggression toward property, animals, or other individuals ~2x/week x 3 months, but no damage/destruction of property and no physical injury to animals or others 3 behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or others occurring within a 12month period Aggression of outbursts grossly out of proportion to the provocation or to any precipitating psychosocial stressors not premeditated and are not committed to achieve some tangible objective Deliberate and purposeful fire setting on >1 occasion Tension or affective arousal before the act Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts Pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath Pyromania Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value Increasing sense of tension immediately before committing the theft Pleasure, gratification, or relief at the time of committing the theft stealing is not to express anger or vengeance and is not in response to psychosis Kleptomania Voyeuristic Disorder Exhibitionistic Disorder Frotteuristic Disorder Sexual Masochism Disorder Sexual Sadism Disorder Pedophilic Disorder Fetishistic Disorder Transvestic Disorder >6 months recurrent and intense sexual arousal manifested by fantasies, urges, or behaviors. individual has acted on these sexual urges with a nonconsenting person, or Sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning Voyeuristic Disorder Exhibitionistic Disorder from the exposure of one’s genitals to an unsuspecting person Frotteuristic Disorder from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity from touching or rubbing against a nonconsenting person Sexual Masochism Disorder from the act of being humiliated, beaten, bound, or otherwise made to suffer Sexual Sadism Disorder from the physical or psychological suffering of another person Fetishistic Disorder from either the use of nonliving objects or a highly specific focus on nongenital body part(s) Transvestic Disorder from cross-dressing recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children, generally <13 years individual has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty individual is at least age 16 years and at least 5 years older than the child or children Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old Anti-androgen Behaviour drugs modification Psychotherapy