In recent years there has been tremendous controversy about sexually compulsive behaviour. Researchers and clinicians alike have argued about the best terminology to use, diagnostic criteria, and treatment approaches. In this presentation, Dr. Carnes discusses the concerns about labelling out control sexual behaviour and examines the new research and the controversy surrounding the diagnosis. Different perspectives on conceptualisation of the disorder and treatment will be discussed.
Psychiatry Cheat Sheet (MDD, GAD, Bipolar)Justin Berk
This student "cheat sheet" is designed to provide medical students with basic information regarding the diagnosis and treatment of basic psychiatric disorders including Depression, Anxiety, and Bipolar Disorder. It includes Questions to Ask, what to look for on a Physical Exam, Labs to Order, and basic Treatment Plans.
These guides are particularly designed for first and second-year medical students as an introduction to ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1.
Any and all feedback is very welcomed.
Psychiatry Cheat Sheet (MDD, GAD, Bipolar)Justin Berk
This student "cheat sheet" is designed to provide medical students with basic information regarding the diagnosis and treatment of basic psychiatric disorders including Depression, Anxiety, and Bipolar Disorder. It includes Questions to Ask, what to look for on a Physical Exam, Labs to Order, and basic Treatment Plans.
These guides are particularly designed for first and second-year medical students as an introduction to ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1.
Any and all feedback is very welcomed.
Neurodevelopmental Treatment and Cerebral Palseyda5884
Description of my Critically Appraised Topic on the effectiveness of Neurodevelopmental treatment with children who have cerebral palsy when compared to alternative therapies.
A study by researchers at the Canadian Network for Mood and Anxiety Treatments (CANMAT) comparing the relative effectiveness of two psychosocial interventions in bipolar disorder has recently been published in the Journal of Clinical Psychiatry.
Bipolar disorder is insufficiently controlled by medication, so several supplementary psychosocial interventions have been tested, all of which are lengthy, expensive, and difficult to disseminate. CREST.BD members Dr. Sagar Parikh and Vytas V. Velyvis co-authored a recent paper along with their collegues at CANMAT, which relates the findings of the recent study that compared psychoeducation (PE) and cognitive behavioural therapy (CBT) in bipolar disorder in bipolar disorder. CBT is a longer, more costly, individualized treatment while PE is less expensive to provide and requires less clinician training to deliver successfully. To date, only a few studies have compared these psychosocial treatments. In this presentation, Dr. Parikh and colleagues compared the relative effectiveness of a brief psychoeducation group intervention to a more comprehensive, and longer individual cognitive-behavioural therapy intervention (CBT) with a sample of 204 individuals who live with bipolar disorder. They measured long-term outcomes in mood burden of the participants in both treatments. Findings indicate that, despite its longer treatment duration and cost, CBT did not show significantly greater clinical benefit compared to group psychoeducation. The implications of these findings for psychosocial interventions in the condition are provided.
Comprehensive Client Family Assessment Demographic.docxAASTHA76
Comprehensive Client Family Assessment
Demographic information: Latino American family. Low socioeconomic status, working class.
Presenting problem: “Social worker believes our discipline style is too harsh and we need
parenting classes”
History of Present Illness: Both clients present to the office with concerns regarding their
children being “taken away” by social services as she believes they parent too harshly. They
adamantly proclaim that they are very good, loving parents but believe that when a child is not
following the rules, strict and physical discipline is necessary. They both explain that they were
brought up this way and that physical or emotional abuse is not present. They explain that this is
part of their culture and all they know is right. The social worker referred to the family as “those
Mexicans” and seemed to be bias towards the family. Also, she seemed to not consider any
alternative for the family after they requested it based on their working schedule and after
explaining their cultural belief system.
Past Psychiatric History: “Needs to be added to”
Medical History: “Needs to be added to”
Substance Abuse History: No indication for substance abuse. “Needs to be added to”
Developmental history: Parents report that their two sons all have met their milestones
throughout their development and are ages 6 and 8 years old. “Needs to be added to”
Family psychiatric history: “Needs to be added to”.
Psychosocial history: Male client works full-time and overtime to provide for the family. “Needs
to be added to”.
History of abuse/trauma: Based on the genogram created, both clients father and mother have a
history of disciplining their children similarly. They both would require the clients to hold
encyclopedias out in front of them until their arms “felt like they were going to fall off”. Both
clients report this type of discipline as being miserable and that they inherited this from their
parents. No physical or mental abuse of concern.
Review of Systems:
HEENT: No loss of vision or hearing. No sign of congestion, sore throat, or runny nose.
SKIN: Cool and dry skin with no signs of wounds or lesions.
CARDIOVASCULAR: No complaints of chest pain, tightness, discomfort or palpitations. S1,
S2 heard upon auscultation. 2+ pedal and radial pulses. No weight gain and no edema.
RESPIRATORY: Clear lung sounds with no adventitious sounds. No rhonchi or wheezes
auscultated, and chest is symmetrical. No cough present.
GASTROINTESTINAL: No nausea, emesis, or diarrhea. Abdomen soft, no distention, no
discomfort on palpation. Bowel sounds present in all four quadrants.
GENITOURINARY: No burning or discomfort when urinating.
NEUROLOGICAL: No double vision, headaches, seizures. No loss of memory. Alert and
oriented x person, place and time. Agitation present in male client.
MUSCULOSKELETAL: No joint or muscles pain. No g.
Neurodevelopmental Treatment and Cerebral Palseyda5884
Description of my Critically Appraised Topic on the effectiveness of Neurodevelopmental treatment with children who have cerebral palsy when compared to alternative therapies.
A study by researchers at the Canadian Network for Mood and Anxiety Treatments (CANMAT) comparing the relative effectiveness of two psychosocial interventions in bipolar disorder has recently been published in the Journal of Clinical Psychiatry.
Bipolar disorder is insufficiently controlled by medication, so several supplementary psychosocial interventions have been tested, all of which are lengthy, expensive, and difficult to disseminate. CREST.BD members Dr. Sagar Parikh and Vytas V. Velyvis co-authored a recent paper along with their collegues at CANMAT, which relates the findings of the recent study that compared psychoeducation (PE) and cognitive behavioural therapy (CBT) in bipolar disorder in bipolar disorder. CBT is a longer, more costly, individualized treatment while PE is less expensive to provide and requires less clinician training to deliver successfully. To date, only a few studies have compared these psychosocial treatments. In this presentation, Dr. Parikh and colleagues compared the relative effectiveness of a brief psychoeducation group intervention to a more comprehensive, and longer individual cognitive-behavioural therapy intervention (CBT) with a sample of 204 individuals who live with bipolar disorder. They measured long-term outcomes in mood burden of the participants in both treatments. Findings indicate that, despite its longer treatment duration and cost, CBT did not show significantly greater clinical benefit compared to group psychoeducation. The implications of these findings for psychosocial interventions in the condition are provided.
Similar to iCAAD London 2019 - Stefanie Carnes - SEXUALLY COMPULSIVE AND ADDICTIVE BEHAVIOUR: THE CONTROVERSY, DIAGNOSIS, AND IMPLICATIONS FOR TREATMENT
Comprehensive Client Family Assessment Demographic.docxAASTHA76
Comprehensive Client Family Assessment
Demographic information: Latino American family. Low socioeconomic status, working class.
Presenting problem: “Social worker believes our discipline style is too harsh and we need
parenting classes”
History of Present Illness: Both clients present to the office with concerns regarding their
children being “taken away” by social services as she believes they parent too harshly. They
adamantly proclaim that they are very good, loving parents but believe that when a child is not
following the rules, strict and physical discipline is necessary. They both explain that they were
brought up this way and that physical or emotional abuse is not present. They explain that this is
part of their culture and all they know is right. The social worker referred to the family as “those
Mexicans” and seemed to be bias towards the family. Also, she seemed to not consider any
alternative for the family after they requested it based on their working schedule and after
explaining their cultural belief system.
Past Psychiatric History: “Needs to be added to”
Medical History: “Needs to be added to”
Substance Abuse History: No indication for substance abuse. “Needs to be added to”
Developmental history: Parents report that their two sons all have met their milestones
throughout their development and are ages 6 and 8 years old. “Needs to be added to”
Family psychiatric history: “Needs to be added to”.
Psychosocial history: Male client works full-time and overtime to provide for the family. “Needs
to be added to”.
History of abuse/trauma: Based on the genogram created, both clients father and mother have a
history of disciplining their children similarly. They both would require the clients to hold
encyclopedias out in front of them until their arms “felt like they were going to fall off”. Both
clients report this type of discipline as being miserable and that they inherited this from their
parents. No physical or mental abuse of concern.
Review of Systems:
HEENT: No loss of vision or hearing. No sign of congestion, sore throat, or runny nose.
SKIN: Cool and dry skin with no signs of wounds or lesions.
CARDIOVASCULAR: No complaints of chest pain, tightness, discomfort or palpitations. S1,
S2 heard upon auscultation. 2+ pedal and radial pulses. No weight gain and no edema.
RESPIRATORY: Clear lung sounds with no adventitious sounds. No rhonchi or wheezes
auscultated, and chest is symmetrical. No cough present.
GASTROINTESTINAL: No nausea, emesis, or diarrhea. Abdomen soft, no distention, no
discomfort on palpation. Bowel sounds present in all four quadrants.
GENITOURINARY: No burning or discomfort when urinating.
NEUROLOGICAL: No double vision, headaches, seizures. No loss of memory. Alert and
oriented x person, place and time. Agitation present in male client.
MUSCULOSKELETAL: No joint or muscles pain. No g.
The DSM-IV and ICD-10 have defined hundreds of mental disorders which vary in onset, duration, pathogenesis, functional disability, and treatability. The designation of gender identity disorders (GID) as mental disorders is not a license for stigmatization, or for the deprivation of patients' civil rights. The use of a formal diagnosis is often important in offering relief, providing health insurance coverage, and guiding research to provide more effective care.
DSM-5 Development Group indicate that GID can still be given to children who reject the assigned gender but who do not experience any anatomical dysphoria. To qualify as a mental disorder, a behavioral pattern must result in a significant adaptive disadvantage to the person or cause personal mental suffering. However, the removal of distress/impairment criterion can lead to over-diagnosis of children who do not meet criteria. Instead, it is argued that criterion should be kept based on distress resulting from living in the present gender as apposed to anguish stemming from societal prejudice and discrimination. It would be more appropriate and respectful if the diagnosis is written in language reflecting contemporary views of gender rather than views that are based on gender-specific games or clothing.
Goals: Psychotherapy often provides education about a range of options not previously seriously considered by the patient. It emphasizes the need to set realistic life goals for work and relationships, and it seeks to define and alleviate the patient's conflicts that may have undermined a stable lifestyle.
The Therapeutic Relationship: The establishment of a reliable trusting relationship with the patient is the first step toward successful work as a mental health professional. This is usually accomplished by competent nonjudgmental exploration of the gender issues with the patient during the initial diagnostic evaluation. Other issues may be better dealt with later, after the person feels that the clinician is interested in and understands their gender identity concerns. Ideally, the clinician's work is with the whole of the person's complexity. The goals of therapy are to help the person to live more comfortably within a gender identity and to deal effectively with non-gender issues. The clinician often attempts to facilitate the capacity to work and to establish or maintain supportive relationships.
Language is very important to indicate that a community is making an effort to be trans-friendly. It often makes the difference in whether a transgender person will approach a community and/or clinician and whether they will choose to stay.
1 Sex, Sexuality, and Substance Abuse In th.docxAASTHA76
1
Sex, Sexuality, and Substance Abuse
In the DSM-IV, the chapter titled “Sexual and Gender Identity Disorders” included a diagnosis
of gender identity disorder. This diagnosis has been eliminated and recategorized into its own
diagnostic class. The new grouping—gender dysphoria— reflects substantial changes in
conceptualization.
Substance-related disorders have also been substantially changed in the DSM-5. The most
significant changes are related to diagnostic labels, criteria, and defining terminology.
A brief summary of key changes in these two diagnostic classification groups are provided
below.
Gender Dysphoria
This new DSM-5 classification represents an evolution in the understanding of the
interrelationship between sex and gender. The diagnostic group is categorized by an
incongruence between assigned gender and the experience of gender. There are only three
diagnoses in this group: gender dysphoria, other specified gender dysphoria, and unspecified
gender dysphoria.
Both other specified gender dysphoria and unspecified gender dysphoria include significant
clinical distress or impairment in their diagnostic criteria but do not meet full criteria for a
specific diagnosis in this class. Clinicians should use other specified gender dysphoria and add
the specific reason for the more general diagnosis (e.g., insufficient duration to meet gender
dysphoria diagnosis). The latter diagnosis—unspecified gender dysphoria— is used when
clinicians cannot (or choose not to) identify reasons for the inability to make a more specific
diagnosis, yet clearly observe multiple criteria from the gender dysphoria criteria.
Gender Dysphoria
Distinct criteria sets for the presence of this disorder in children, adolescents, or adults are
outlined in the DSM-5. Language has been altered to include and clarify cultural and
environmental influences as well. The resulting gender dysphoria diagnosis is more narrow and
specific than the former gender identity disorder. In addition, specifiers have changed
dramatically. Those pertaining to sexual orientation previously part of the gender identity
disorder diagnosis have been removed, as it was determined they were not relevant to the
diagnosis of gender dysphoria. A developmental specifier addressing the potential influence of a
biological component was added. In addition, a specifier reflecting the stage or status of
transition was added.
Substance-Related and Addictive Disorders
There are significant differences in this classification, most prominently in the conceptualization
and association of criteria. This category of disorders is marked by activation of the brain reward
system—an intensive experience that may interfere with desire to partake in normal activities
and/or make pro-social or healthy decisions. This diagnostic classification is divided into
2
substance-related disorders and non-substance-related disorders. The former is fu.
Week 4 6446 Therapeutic Approaches for Disruptive Behaviors ladonnacamplin
Week 4 6446 Therapeutic Approaches for Disruptive Behaviors
You must use the Readings here
· Boyatzis, C. J., & Junn, E. N. (2016).
Annual editions: Child growth and development
(22nd ed.). McGraw-Hill Education.
o Louis, C.S. “Certain Television Fare Can Help Ease Aggression in Young Children, Study Finds” (p. 83)
· Klein, B., Damiani-Taraba, G., Koster, A., Campbell, J., & Scholz, C. (2015). Diagnosing attention-deficit hyperactivity disorder (ADHD) in children involved with child protection services: are current diagnostic guidelines acceptable for vulnerable populations?.
Child: care, health and development
,
41
(2), 178-185.
· Powers, C. J., & Bierman, K. L. (2013). The multifaceted impact of peer relations on aggressive-disruptive behavior in early elementary school.
Developmental Psychology
,
49
(6), 1174– 1186.
·
Document:
DSM-5 Bridge Document: Disruptive Behaviors (PDF)
· Boyatzis, C. J., & Junn, E. N. (2016).
Annual editions: Child growth and development
(22nd ed.). McGraw-Hill Education.
o Lahey, J. “Why Parents Need to Let Their Children Fail” (p. 112)
o Smith, B. L., “The Case Against Spanking: Physical Discipline Is Slowly Declining as Some Studies Reveal Lasting Harms for Children” (p. 105)
· Cochran, J. L., Cochran, N. H., Nordling, W. J., McAdam, A., & Miller, D. T. (2010). Two case studies of child-centered play therapy for children referred with highly disruptive behavior.
International Journal of Play Therapy
,
19
(3), 130–143.
· Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence- based psychosocial treatments for children and adolescents with disruptive behavior.
Journal of Clinical Child and Adolescent Psychology
,
37
(1), 215–237.
· Pardini, D. A., Frick, P. J., & Moffitt, T. E. (2010). Building an evidence base for DSM-5 conceptualizations of oppositional defiant disorder and conduct disorder: Introduction to the special section.
Journal of Abnormal Psychology
,
119
(4), 683–688.
Media
· Laureate Education (Producer). (2014c).
Disruptive behaviors
[Video file]. Baltimore, MD: Author.
· Laureate Education (Producer). (2014d).
Disruptive behaviors: Part one
[Interactive media]. Baltimore, MD: Author.
· Laureate Education (Producer). (2014e).
Disruptive behaviors: Part two
[Interactive media]. Baltimore, MD: Author.
Disruptive Behaviors In the DSM-IV,
attention deficit and disruptive behaviors were grouped as a category within the classifications of disorders usually first diagnosed in infancy, childhood, and adolescence. Though it is true that these disorders are generally first diagnosed during these stages, the classifications of these disorders has been reconceptualized to reflect their similarities in manifestation, as well as considerations for the impact on social functioning. ADHD, for example, is grouped in the DSM-5 with neurodevelopmental disorders; research has supported a strong biol ...
Navigating the chaos: ADHD and Addiction, Constant Mouton, Tuesday 2 May 2017.Triora
The skill outcomes for this presentation include being able to recognise ADHD in adults with addiction and a systematic approach to assessment and treatment of ADHD in addiction.
The co-occurrence of ADHD and addiction is a well-known phenomenon. It is also riddled with myths and stigma. So what do we really know about this co-morbidity. Is it true that the medicines used to treat ADHD can cause addiction? What is the true potential for abuse of these medicines? How does ADHD affect addiction and vice versa? What are the psychological implications of this comorbidity on the patients, society and the family? Dr Mouton and his team gives answers to these questions and showcase a treatment model aimed at treating all aspects of ADHD and addiction. The presentation provides up-to-date evidence-based facts about the topic of ADHD and Addiction. The content provides knowledge-based skills and insight into the epidemiology, ethiology, pathology, clinical presentation and treatment options for ADHD and co-occurring addiction.
Dr Constant Mouton obtained his medical qualifcation (MBChB) from the University of Pretoria. After gaining experience in the medical field, he continued to specialise in psychiatry at the University of the Witwatersrand in Johannesburg, South Africa. Holding a fellowship at the Colleges of Psychiatry of South Africa (FCPsychSA) and a Dutch registration as a psychiatrist at the KNMG, he currently works as a Consultant Psychiatrist and Clinical Head of Department at Triora Recovery Clinics based in the Netherlands. Dr Mouton is an expert in e-Health products, rehabilitation and dual diagnosis treatment. He also consults at Triora International, situated in Spain and the UK.
In response to concerns around the high prevalence of depression and anxiety experienced by people with HIV, Positive Life NSW facilitated a community consultation with the aims of uncovering the mental health needs of people with HIV, their resilience or otherwise in meeting challenges & the barriers to achieving good mental health. Kathy Triffitt (Manager, Health Promotion, Positive Life NSW) outlines the consultation process and outcomes from the service provider forum which considered the implications for community & clinical interventions, care & support, advocacy & health promotion.
This presentation was given at the AFAO Positive Services Forum 2012.
Sydney Sexual Health Centre Journal Club presentation by Kristen McCormack on AIDS and Behaviour Volume 20 Issue 7, published in July 2016.
AIDS and Behavior provides an international venue for the scientific exchange of research and scholarly work on the contributing factors, prevention, consequences, social impact, and response to HIV/AIDS. The journal publishes original peer-reviewed papers addressing all areas of AIDS behavioral research including: individual, contextual, social, economic and geographic factors that facilitate HIV transmission; interventions aimed to reduce HIV transmission risks at all levels and in all contexts; mental health aspects of HIV/AIDS; medical and behavioral consequences of HIV infection - including health-related quality of life, coping, treatment and treatment adherence; and the impact of HIV infection on adults children, families, communities and societies. The journal publishes original research articles, brief research reports, and critical literature reviews.
The Sydney Sexual Health Centre Journal Club allows our team to stay up-to-date with what is being published in the field of sexual health. Staff members take turns to read, review and share the contents of an allocated journal. Journal Club encourages knowledge sharing and discussion about topics raised.
The utility of psychotropic drugs on patients with fetal alcohol spectrum dis...BARRY STANLEY 2 fasd
ABSTRACT
BACKGROUND: Treatment of the complications arising from Prenatal Alcohol Exposure (PAE) has largely been focused on psychosocial and environmental approaches. Research on the
use of medications, especially psychotropic medications, has lagged behind.
OBJECTIVES: This systematic review sought to investigate psychotropic medication related findings and outcomes in those diagnosed with Fetal Alcohol Spectrum Disorder (FASD).
METHODS: Comprehensive searches were conducted in seven major databases (Medline/
PubMed, Scopus, Web of Knowledge, Embase, PsycINFO, Cochrane Library, and
PsycARTICLES) up to February 2017. Key search terms with synonyms were mapped on these databases. There were no timeline restrictions and no grey literature searches. Two reviewers
independently assessed 25 studies that met the inclusion criteria. Most studies were reviews of treatment and retrospective case series.
RESULTS: Two crossover randomized trials were reported, and the findings were not amenable to meta-analysis. Several conditions (depression, agitation, seizures, and outburst) combined with the most frequent presentation, ADHD, to represent the rationale for prescribing psychotropic medications. Second-generation antipsychotics were found to improve social skills, but the paucity of data limited the extent of clinical guidance necessary for the field.
CONCLUSIONS: The systematic review showed that there are some clinical evidence displaying
the validity of psychopharmacological interventions in people with FASD, which varies across the spectrum of disease severity, age, and gender. There is a need for more clinical evidencebased studies in addition to clinical expert opinions to substantiate an optimal ground for individualized management of FASD.
The study protocol for this review was registered in PROSPERO with registration number
CRD42016045703
Name Professor Course Date Sexual Harassment .docxroushhsiu
Name
Professor
Course
Date
Sexual Harassment Essay Outline
I. Introduction
A. Background
1. Despite ongoing public campaigns designed to prevent sexual harassment,
this destructive behavior continues to be a widespread issue in the United
States. Sexual harassment is particularly rampant on college campuses,
where 62% of female students and 61% of male students report having
been victims of this form of mistreatment, according to the AAUW
Educational Foundation. Most of the harassment is noncontact, but about
one-third of students are victims of physical harassment.
B. Thesis Statement
1. Although mass media and news outlets alike tend to shy away from the
sexual harassment problem occuring across our campuses nationwide,
universities are failing to protect their students from sexual harassment
resulting in mental health damage of both males and females in all parts of
the nation
II. Body
A. Sexual Harassment Amongst Both Genders
1. Female Sexual Harassment In Comparison
a) Statistics Regarding Harassment Committed Against
b) General Concerns Over Safety Amongst Females
2. Male Sexual Harassment In Comparison
a) Statistics Regarding Harassment Committed Against
b) Lack of Awareness That Men Can Also Experience Harassment
On College Campuses
B. Sexual Harassment Being Neglected Nationwide
1. Lack of Media Coverage & Lack of Awareness
a) Disregard Of A Widespread Issue Going On In Our Nation
b) People Not Taking Sexual Harassment Seriously/Not Being Aware
of It
2. Lack of Knowledge Regarding Universities Legal Duty to Protect
Students
a) Title XI Law of 1972
b) Title VII of the Civil Rights Act of 1964
C. Sexual Harassment’s Effect on Students Experiencing It
1. Short Term Mental Effects
a) People Disregarding and Neglecting People Who Claim Sexual
Harassment Can Cause Them Insecurity and Hopelessness
b) People Tend To Blame Themselves For Being Harrassed
2. Long Term Mental Effects
a) Depression and Inability To Trust Others
b) Can Lead To Drastic Effects Like Turning To Drugs Or
Committing Suicide, It is Afterall A Form Of Bullying
III. Conclusion
A. The failure of our nations awarness and our universities inability to abide to the
law by protecting our students has resulted in many students being permanently
damaged from sexual harassment
B. We the people of the United States have gone through all the proper legal
measures in order to guarantee the youths safety when attending college
universities; yet these laws along with their $60,000 tuitions do not seem to be
enough motivation for these universities to abide to the law. Does a student need
to be found dead in the middle of the campus in order to get the message across?
Psychiatric Diagnostic Screening Questionnaire
Review of The Psychiatric Diagnostic Screening Questionnaire by MICHAEL G. KAVAN, Associate Dean for Student Affairs and Associate Professor of Family Medicine, Creighton University Sch ...
FINANCIAL ANALYSIS REPORT 2
Decision Tree: Personality Disorders
Frank Jones
Sam’s University
Nurs 3333: PMHNP Role IV
Dr. Joe Mark
October 20 , 2010
Running head: DECISION TREE 1
DECISION TREE 6
Decision Tree: Personality Disorders
As described by the American Psychiatric Association (APA) (2013), ‘‘personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment’’. There are different types of personality disorders classified into three clusters. Cluster A individuals are described as the odd or eccentric, cluster B as the dramatic, emotional, or erratic and cluster C as the anxious or fearful. The purpose of this paper is to discuss the case study of a young woman with personality disorder. This paper will explore threes decisions relating to differential diagnosis, psychotherapy and psychopharmacology based on the presented clinical manifestations.
Decision One
The clinical manifestation presented in the case study are indicative of more than one personality disorder, specifically borderline personality disorder (BPD) and antisocial personality disorder (ASPD). Patients exhibits a fear of abandonment which aligns with BPD. The patient mentioned an interpersonal relationship involvement which she exhibited idolization for the man of her interest, and now is devaluing the man. This is also evident in BPD as outlined by diagnostic criteria set forth by the APA (2013).
My diagnosis for this patient is ASPD, because the client exhibits clinical manifestations of ASPD than BPD. One of the reasons that led me to the diagnosis of ASPD is the client’s lack of remorse. The client stole from a friend, instead of being sorry, client’s blames friend instead. Client exhibits lack of respect for social norm and failure to comply with the law as evidenced by more than one record of arrest. The client fails to upholding financial obligation and is deceitful. Client shows irresponsibility evidenced by inability to keep a job. These presentations are evident in clients with ASPD as outlined in the DSM-5.
The two personality disorders which are classified as cluster B personality disorders by the APA (2013) have clinical manifestations which overlap, thus needs to be ruled out as differential diagnoses for each other. As described on the DSM-5 diagnostic criteria, BPD and ASD have similar features of impulsivity, aggression and manipulative behaviors, which client exhibits in the case study. The differing manifes ...
ASSIGNMENT Respond to at least two of your colleagues.docxmckellarhastings
ASSIGNMENT:
Respond
to at least
two
of your colleagues by comparing the differential diagnostic features of the disorder you selected to the diagnostic features of the disorder your colleagues were assigned.
Note:
Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format.
Colleagues
Respond # 1
Gender Dysphoria
Transgender is the term used to mean that individual sex assigned during birth based on the external genital does not fit their gender identity. These kinds of people usually experience gender dysphoria, which is one of the psychological distresses associated with the incongruence between one's gender identity and the sex they were assigned during birth. Gender dysphoria usually starts at the beginning of childhood, but in some cases, individuals may not experience it until after puberty and even much later in their stages of life. People with transgender may pursue different domains of gender affirmation, which includes: surgical affirmation, medical affirmation, legal affirmation, and social affirmation (Lindley, 2020). Not all people with transgender issues will desire to have all these domains of gender affirmation as these are highly individual and personal decisions.
Medical treatment for gender dysphoria
Medical treatments for this condition may include hormone therapy, such as masculinizing hormone therapy or feminizing hormone therapy. Surgery includes masculinizing surgery or feminizing surgery, which intends to change chest or breasts, internal genitalia, external genital, body contouring, and facial features.
Some people used hormone therapy to seek maximum masculinization or feminization. Other people find relief from gender dysphoria by using hormones to maximize secondary sex characteristics such as facial hair and breasts. These kinds of treatments are based on individuals' goals and the evaluation of the benefits and risks of the medication use, presence of any other conditions, and consideration of individual's economic and social issues (Zucker, 2018). Most of these gender dysphoria individuals find surgery the most effective and necessary procedure that relieves their condition.
The World Professional Association for Transgender Health gives the following procedure for the surgical or hormonal treatment for people with gender dysphoria.
1. Persistent and a well-documented gender dysphoria
2. The capacity to make consent and an informed decision for the treatment
3. The aged majority of a given country and when the patient is young need to follow the standard of care for the adolescents and children.
Behavioral health treatment
This treatment aims to improve the individual's psychological well-being, self-fulfillment, and quality of life. This kind of treatment does not aim to alter an individual's gender identity, but it aims to explore gender concerns and find ways to reduce gender dysphoria. The main goal.
Neurodevelopmental Disabilities and the Ethics of Diagnostic LabelsOlaf Kraus de Camargo
Keynote presented at the 29. Turkish National Congress for Special Education in Izmir on November 7th 2019 - It describes the discriminatory aspect of organizing service delivery by diagnostic labels and proposes using a functional approach based on the International Classification of Functioning, Disability and Health (ICF) as an ethical alternative.
Example of an Annotated Bibliography (APA Style)Gipson, T., .docxelbanglis
Example of an Annotated Bibliography (APA Style)
Gipson, T., Lance, E., Albury, R., Gentner, M., & Leppert, M. (2015). Disparities in
identification of comorbid diagnoses in children with ADHD. Clinical Pediatrics, 54(4): 376-381.
The authors examine ADHD children with relevant comorbid conditions and medication prescribing habits based on comprehensive neurodevelopmental evaluations versus insurance limited evaluations to behavior management and medication. This was done using a retrospective review of medical records at the Center for Development and Learning Clinic. Data for demographics, comorbidities, medications, and interventions were analyzed for associations between groups. Results demonstrated that kids who received comprehensive evaluations had a greater degree of diagnosis for comorbidities. This stimulates the question of income levels and comprehensive evaluations in ADHD kids and comorbid conditions.
Hinojosa, M., Hinojosa, R., Fernandez-Baca, D., Knapp, C., & Thompson, L. (2012). Parental strain, parental health, and community characteristics among children with attention deficit-hyperactivity disorder. Academic Pediatrics, 12(6): 502-508.
The authors examined the impact on parents who have a child with ADHD and comorbidities. Using the National Survey of Children’s Health dataset, they conducted a bivariate, multivariate, and descriptive analysis to look for associations between kids with ADHD and comorbid conditions and the strain on parents, social support, mother’s mental health, and local amenities. Results showed an increase in parental strain when caring for an ADHD child with a co-occurring condition. It also showed that lack of social support and lack of access to community amenities were predictors of increased parental strain. This study demonstrates the impact on the health of caregivers to ADHD children with comorbidities.
Radigan, M., Lannon, P., Roohan, P., & Gesten, F. (2005). Medication patterns for attention-deficit/hyperactivity disorder and comorbid psychiatric conditions in a low-income population. Journal of Child and Adolescent Psychopharmacology, 15(1): 44-56.
The authors examined the psychotropic medications usage of low-income kids who have been diagnosed with ADHD comparing those with and without comorbid conditions. The New York State Department of Health Medicaid Encounter Data System was used to extract information on 6,922 kids 3-19 years of age. A multivariate logistic regression was conducted to look at associations between ADHD with comorbid conditions and medication usage. Results showed the strongest predictors of medication use to be comorbid conditions and Social Security Income Medicaid eligible status. This study stimulates the question of the possibility for ADHD children with comorbidities to have treatment variations based on income status.
Rockhill, C., Violette, H., Vander Stoep, A., Grover, S., & Myers, K. (2013). Caregivers’ distress: Youth with attentio ...
Chapter 1Mental Disorders as Discrete Clinical Conditions Dimen.docxketurahhazelhurst
Chapter 1
Mental Disorders as Discrete Clinical Conditions: Dimensional Versus Categorical Classification
Thomas A. Widiger and Cristina Crego
In DSM-IV, there [was] “no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder” (American Psychiatric Association [APA], APA, 2000, p. xxxi). This carefully worded disclaimer, however, was somewhat hollow, as it was the case that “DSM-IV [was] a categorical classification that divides mental disorders into types based on criterion sets with defining features” (APA, 2000, p. xxxi). The categorical model of classification is consistent with a medical tradition in which it is believed (and often confirmed in other areas of medicine) that disorders have specific etiologies, pathologies, and treatments (Guze, 1978; Guze & Helzer, 1987; Zachar & Kendler, 2007).
Clinicians, following this lead, diagnosed and conceptualized the conditions presented in DSM-IV-TR as disorders that are qualitatively distinct from normal functioning and from one another. DSM-IV-TR provided diagnostic criterion sets to help guide clinicians toward a purportedly correct diagnosis and an additional supplementary section devoted to differential diagnosis that indicated “how to differentiate [the] disorder from other disorders that have similar presenting characteristics” (APA, 2000, p. 10). The intention of the manual was to help the clinician determine which particular mental disorder provides the best explanation for the symptoms and problems facing the patient. Clinicians devote initial time with a new patient to identify, through differential diagnosis, which specific disorder best explains a patient's presenting complaints. The assumption is that the person is suffering from a single, distinct clinical condition, caused by a specific pathology for which there will be a specific treatment (Frances, First, & Pincus, 1995).
Authors of the diagnostic manual devote a considerable amount of time writing, revising, and researching diagnostic criteria to improve differential diagnosis. They buttress each disorder's criterion set, trying to shore up discriminant validity and distinctiveness, following the rubric of Robins and Guze (1970) that the validity of a diagnosis rests in large part on its “delimitation from other disorders” (p. 108). “These criteria should…permit exclusion of borderline cases and doubtful cases (an undiagnosed group) so that the index group may be as homogeneous as possible” (Robins & Guze, 1970, p. 108).
Scientists may devote their careers to attempting to identify the specific etiology, pathology, or treatment for a respective diagnostic category. Under the assumption that the diagnoses do in fact refer to qualitatively distinct conditions, it follows that there should be a specific etiology, pathology, and perhaps even a specific treatment for each respective disorder. The theories, hypothese ...
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iCAAD London 2019 - Stefanie Carnes - SEXUALLY COMPULSIVE AND ADDICTIVE BEHAVIOUR: THE CONTROVERSY, DIAGNOSIS, AND IMPLICATIONS FOR TREATMENT
1. Sex Addiction and
Compulsivity: Diagnostic
Challenges and New Research
Stefanie Carnes, Ph.D., CSAT-S
Clinical Sexologist
Certified Sex Therapist
AAMFT Approved Supervisor
2. Full
Disclosure
Dr. Stefanie Carnes is a Senior Fellow at the
Meadows Behavioral Health and the
President of the International Institute for
Trauma and Addiction Professionals.
3. Can Sex be an
Addiction? A
compulsion?
ICD – 11 includes sexual compulsivity under
impulse control disorders
Criteria across these different conceptualizations
are similar
Various authors have argued for different terms
- "Compulsive" (OCD,
Coleman, 2003)
- "Addictive" (Carnes,
1983)
- "Impulsive" (Barth
and Kinder, 1987)
- "Hypersexual"
(Stein et al., 2000,
Reid/ Kafka)
DSM III-R contained a category called "non-
paraphilic sexual addiction"
4.
5. World Psychiatry – WHO
Committee April 2018
Currently, there is an active scientific discussion about
whether compulsive sexual behaviour disorder can
constitute the manifestation of a behavioural addiction.
For ICD-11, a relatively conservative position has been
recommended, recognizing that we do not yet have
definitive information on whether the processes involved
in the development and maintenance of the disorder are
equivalent to those observed in substance use disorders,
gambling and gaming. For this reason, compulsive sexual
behaviour disorder is not included in the ICD-11 grouping
of disorders due to substance use and addictive
behaviours, but rather in that of impulse control
disorders. The understanding of compulsive sexual
behaviour disorder will evolve as research elucidates the
phenomenology and neurobiological underpinnings of
the condition.
6. Sex Addiction
Defined
A pathological relationship to a
mood altering experience (sex)
that the individual continues to
engage in despite adverse
consequences.
46. DSM-5 Hypersexual Disorder
Field Trial Report
Reid, R. , Carpenter, B.N., Hook, J.N., Garos, S., Manning, J.C., Gilliand, R., Cooper, E.B., McKittrick, H.,
Davitan, M., & Fong, T. (2012). Report of findings in a DSM-5 Field Trial for Hypersexual Disorder.
Goal was to examine the inter-rater reliability
of clinicians attempting to diagnose HD.
Reid et al. (2012) conducted a field study to
investigate the “clinical utility, reliability and validity
of diagnostic validity of [hypersexual disorder (HD)]
criteria in clinical settings” for possible inclusion in
the DSM-5.
48. Method
Instruments:
Participants completed the Mini-International Neuropsychiatric
Interview (MINI 6.0) a structured diagnostic interview at intake to
rule out any other psychopathology that could account for HD
symptoms.
They also completed the HD Diagnostic Clinical Interview, the HD
Questionnaire (HDQ), the HD Course Questionnaire (HDCQ),
Hypersexual Behavior Inventory (HBI); Sexual Compulsivity Scale
(SCS), NEO Personality Inventory-Revised (NEO-PI-R), the
Hypersexual Behavior Consequences (HBCS) and the Erotic
Preferences Examination Scheme (EPES).
Included 13 raters from a variety of fields (psychiatry,
psychology, social work, marriage and family therapy,
etc) practicing in outpatient settings
49. Procedures
Raters were trained on how to
complete the structured
diagnostic interviews correctly and
to assess for the proposed HD
criteria
One rater completed and scored
the initial interviews of the MINI
6.0 and HD-DCI and another rater
scored it as well
• A third rater blind to the initial ratings
administered and scored the HD-DCI two
weeks later
50. Results
Inter-rater reliability: kappa
coefficient of .93 among the
clinicians
Indicates the diagnostic criteria
can be reliably used in patients
Test-Retest Reliability: “high” for
the HD criteria after the two
week follow-up p<0.001)
Suggests reliability of the
diagnostic criteria over time
Sensitivity=.88, Specificity=.93,
Positive Predictive Power=.97,
Negative Predictive Power=.74
Results suggested the proposed
HD criteria reflected the
presenting problems well.
High Concurrent Validity
HDQ scores were highly
correlated with HBI (r=.911) and
SCS scores (r=.829)
51. Results Continued
•Participants reporting having sex while experiencing negative
emotions had higher Neuroticism scores on the NEO-PI-R.
•There was a significant positive correlation between the
number of consequences people reported as a result of their
sexual behaviors and higher levels of hypersexual behaviors.
Concurrent Validity
•82% endorsed a gradual progression of HD symptoms lasting
months to years
•48.6% reported a continuous course, while 51.4% reported
episodic symptoms
Clinical Course: 54% of
participants reported
“dysregulated sexual fantasies,
urges and behaviors prior to
adulthood,” 30% indicated
these issues started in their
college years.
52. Conclusions
However, HD was not ultimately included
in the DSM-5.
The researchers suggested the proposed HD
diagnostic criteria could be reliably applied to
people presenting with hypersexual behaviors
and was measuring a valid construct
53. Why Wasn’t
HD Included
in the DSM-5?
REID AND KAFKA (2014) POSITED A NUMBER
OF REASONS WHY HYPERSEXUAL DISORDER
WAS NOT INCLUDED IN THE DSM-5
54. Reid, R.C. & Kafka, M.P. (2014). Controversies about Hypersexual Disorder and the DSM-
Some contended the HD diagnosis “confused
social disapproval and morality with issues of
health and disorder” (Wakefield, 2012)
Some members of the Sexual and Gender Identity
Disorders DSM-5 Task Force Committee were
specifically targeted in the media
Previous DSM editors openly criticized the DSM-5
Task Force and Workgroups before its publication
Politics
55. Potential
Legal
Implications
& Problems
Concerns about
potential misuse
in the forensic
community
• For example, using
an HD diagnosis as
mitigating factor in
cases of child
molestation
• No evidence a
pedophilia
diagnosis has ever
resulted in a
reduced sentence
Authors note a
recent field
study of HD
diagnosis in sex
offenders
resulted in very
few diagnoses
of HD
56. Criticisms of
the
Diagnostic
Criteria
Some argued hypersexual behaviors could
be better accounted for by another
already existing psychological disorder
Reid and Kafka suggested individual criterion
were “dissected” and rejected while
neglecting the fact that a constellation of at
least four of the five symptoms over 6 months
would need to be present for a diagnosis
Belief that the diagnostic criteria did not
differentiate between high sex drives and
pathological levels and activities
57. Empirical
Identification
of
Psychological
Symptom
Subgroups of
Sex Addicts:
An
Application of
Latent Profile
Analysis (Nino
De Guzman
et al. 2015)
There is a sizeable group (38%) of sex addicts that
probably do not have other comorbid disorders
(Class 1 and 2).
This provides further evidence for the existence of
sex addiction as a discrete disorder, as opposed to
merely being symptomatic of other psychological
disorders.
At the same time, about 24% of the sample (Class
4 and Class 5) likely do have other diagnosable
conditions (i.e., mood disorders and anxiety
disorders), and thus highlights the importance of
broad-band psychological assessment to facilitate
treatment planning for sex addicts.
58. Pathologizing
Normal
behavior?
Some researchers and clinicians
argue hypersexual behaviors are
simply variants of normal sexual
behavior that an HD diagnosis is
pathologizing
There are also concerns regarding
increasing the number of people
diagnosed with a mental illness, the
number of false positives and the
number of people on unnecessary
psychotropic medications
59. Insufficient Empirical Research
on HD
Concerns about adding new disorders without sufficient
scientific research
There is a definite lack of epidemiological studies
More studies with objective data (“e.g., genetic
abnormality, deficits in brain function, etc) are needed as
well
60. ICD DX – Considers the
criticisms
Early critics were concerned that any
formal diagnosis would be used to
pathologise sexual minorities and
alternative sexual practices. However, to
meet the diagnostic criteria for CSBD,
the problematic behavior must cause
persistent marked distress or significant
impairment in personal, family, social,
educational, occupational, or other
important areas of functioning. In other
words, the new diagnosis doesn’t
diagnose patients based on what sexual
behavior they freely engage in. It
diagnoses patients based on persistent
impairment and distress. If sexual
behavior, whatever form it takes, results
in neither, the new diagnosis will not
apply.
61. ICD DX – Considers the
criticisms
Other critics warned that a CSBD diagnosis
might result in mistaken diagnosis by
patients whose behavior was not, in fact,
compulsive, and whose distress was due to
moral judgment by patient or professional.
To prevent such outcomes, the new
diagnosis provides that, “Distress that is
entirely related to moral judgments and
disapproval about sexual impulses, urges,
or behaviours is not sufficient.” In other
words, a patient must actually be unable to
control impulses and be engaging in
repetitive sexual behavior that has become
problematic.
63. Appropriate Diagnostic Categories
DSM-5 also lists
‘other specified
sexual dysfunction’ as
F52.8. This diagnosis
may thus be used for
hypersexual disorder.
(Krueger, 2016)
The recommended
code for the ICD 11
index is 6C72 -
“Compulsive Sexual
Behavior Disorder”
64. /
Differential Diagnosis
DSM-5 - Possibilities:
Other Specified Sexual Dysfunction
Other Specified Disruptive, Impulse Control and Conduct Disorder
Unspecified Paraphilic Disorder
Common Co-morbidities:
Antisocial / Narcissistic personality disorder
Paraphilia
ADHD
Mood and Anxiety Disorders
PTSD
Substance induced disorder
OCD
Delirium, dementia, or other cognitive disorder or organic condition
65. Differential Diagnosis
Continued
Carpenter, B.N., Reid, R.C., Garos, S. & Najavits, L.M. (2013). Personality Disorder comorbidity
Suggests people with HD may have some pathological
personality traits but do not have a diagnosable Personality
Disorder
However, only 17% of the sample met full criteria for a
Personality Disorder when assessed with the SCID-II
Structured Interview
Carpenter et al. (2013) found that 92% of their sample of
men seeking treatment for Hypersexual Disorder (HD)
screened positive for potential Personality Disorders
when using the SCID-II Personality Questionnaire
69. Frequencies
of Multiple
Addictions
(N = 1604)
Alcohol was the most frequently co-
occurring addiction in both males and
females at 46%, however in gay males
drug abuse was most frequent 54%.
Gay males also scored higher on high
risk/ dangerous behaviors
Women scored higher on compulsive
spending, compulsive eating, and
compulsive cleaning
75. Just because someone has had affairs,
used prostitutes, attended a strip club,
uses porn recreationally…does not
mean they are a sex addict… It is just as
important to determine who is NOT a
sex addict as it is to determine who is.
76. /
Paraphilias are not always Sex
Addiction
DSM-5 Paraphilias include
•Exhibitionism
•Fetishism
•Frotteurism
•Pedophilia
•Sexual masochism
•Sexual sadism
•Voyeurism
•Transvestic fetishism.
In DSM -5– new definition
must include “psychological
distress” or “distress, injury or
death of unwilling persons – or
those not of legal age”
77. Sex Addiction Paraphilia
Sex Addiction
With Paraphilic
Thoughts and
Behaviors
Overlap of Sex Addiction and Paraphilic Thoughts and Behaviors
80. Common Questions….
Are these men “Sex
Addicts”? Is that
really a “diagnoses”?
Is this just an excuse
for bad behavior?
How is a sex addict
different from
individuals with a
more sinister profile?
What’s the difference
between sex
addiction and sex
offending?
What is the
prognosis for these
individuals?
What is the best
course of treatment?
83. Sex offending is not sex addiction
Research shows that about
10 % - 30 % of sex
offenders are sex addicts
Sex offending is a legal
term – must be adjudicated
in the legal system
Most common sex crimes –
sexual assault, sexual
battery, statutory rape,
rape, child enticement and
endangerment, child sexual
abuse
Includes a victim/
exploitation/ lack of
consent
Prostitution – is a sex
crime, but in most states
does not require
registration as a sex
offender
Sometimes clients with
offending history may be
recommended to
participate in offender
treatment if indicated
84. Sexual harassment and
abuse of power is an
offending behavior
because it includes a
victim, lack of consent
and exploitation
IT’S NOT “JUST SEX ADDICTION”!
92. Cycle of Narcissistic Sexual
Exploitation
1 – Narcissist
experiences ego
degradation
2 – Core sense of
shame and
unworthiness
3 – Thought
Distortions =
Entitlement
4 – Sexual Acting
out
5 – Shame and
Guilt
93. Sex offenders – 73%
personality disorder
McElroy et al.
Sex addicts
17% personality
disorders
Reid et al.
94. /
Poor prognostic indicators
Dark Triad
Personality
Characteristics
Forced or coerced
into treatment
Lacking remorse,
shame and
empathy
History of other
types of offenses –
or assaultive violent
tendencies
Other types of
unethical behavior
History of other
types of impulsive
behaviors
Lack of openness,
lots of defenses
Evasion of
consequences
98. Dickenson, J. A.,
Gleason, N.,
Coleman, E., &
Miner, M. H.
(2018). Prevalence
of Distress
Associated With
Difficulty
Controlling Sexual
Urges, Feelings,
and Behaviors in
the United
States. JAMA
Network Open,1(7).
doi:10.1001/jamanet
workopen.2018.446
8
Results: “Among men, 10.3% endorsed clinically relevant
levels of distress and/or impairment associated with
difficulty controlling sexual feelings, urges, and behaviors,
in comparison with 7.0% of women.“
Conclusion: "This study was the first we know of to
document the US national prevalence of distress
associated with difficulty controlling one’s sexual
thoughts, feelings, and behaviors—the key feature of
CSBD. The high prevalence of this sexual symptom
has major public health relevance as a sociocultural
problem and indicates a significant clinical problem
that warrants attention from health care professionals.
Moreover, gender, sexual orientation, race/ethnicity,
and income differences suggest potential health
disparities, point to the salience of sociocultural
context of CSBD, and argue for a treatment approach
that accounts for minority health, gender ideology, and
sociocultural norms and values surrounding sexuality
and gender."
101. Trauma and
Abuse History
Most came from families were
abuse and trauma were present.
72% experienced physical abuse
81% experienced sexual abuse
97% experienced emotional abuse
In addition, they came from
families where shame was present.
102. “CSB (Compulsive Sexual Behavior) has
been strongly linked to early childhood
trauma or abuse, highly restricted
environments regarding sexuality,
dysfunctional attitudes about sex and
intimacy, low self-esteem, anxiety, and
depression.”
- Eli Coleman
“Sexual addiction is strongly anchored
in shame and trauma. Research
conducted over the last fifteen years
has consistently shown the prevalence
of emotional, physical, and sexual
abuse in this population.”
Cox et al (2007)
Coleman, E. (1992). Is your patient suffering from compulsive sexual behavior? Psychiatric Annals , 22(6),
320-325. Cox, R. P., & Howard, M. D. (2007). Utilization of EMDR in the treatment of sexual addiction: A
case study. Sexual Addiction & Compulsivity, 14(1), 1-20. doi: 10.1080/10720160601011299
103. Blain, L. M., Muench, F., Morgenstern, J., & Parsons, J. T. (2012). Exploring the role of child sexual abuse and
posttraumatic stress disorder symptoms in gay and bisexual men reporting compulsive sexual behavior. Child
This finding is in line with Briere and Runtz’s (1990) report
that childhood sexual abuse was uniquely associated with
maladaptive sexual behavior, and with previous literature
supporting childhood sexual abuse as a possible etiological
factor in CSB development (Perera et al., 2009) (p.419).”
These findings are “largely consistent with previously
studied self-identified community samples of individuals
with CSB (Black et al., 1997; Kafka & Prentky, 1992)
Recent Study (2012) found 39% of gay and bisexual men
with compulsive sexual behavior had experienced
childhood sexual abuse
104.
105.
106.
107.
108.
109. Contemporary VS. Classic SA
Reimersma & Sytsma (2013)
Classic Typology:
History of
abuse
Insecure
attachment
Poor impulse
control
Cross
Addictions
Co-morbid
mood
disorders
Used to
soothe toxic
emotions
110. Contemporary
Rapid onset
Due to explosive growth
of internet technology
Chronic exposure to
graphic content online
Content – unique,
intense, graphic,
limitless novelty
Culture – trending
towards virtual and non-
relational sex
Early exposure to
graphic sexual material
Sexual conditioning
Less trauma history/
attachment problems
May not be having sex
(or may never have had
sex)
May not be able to
perform – can include
performance anxiety,
unrealistic performance
standards
112. Voon – Neural Mechanisms Underlying CSB
Similar to Those in Found in CD
2014
113. Neural
Correlates of
Sexual Cue
Reactivity in
Individuals
with and
Without
Compulsive
Sexual
Behaviors
(2014 – Voon
et al.
Cambridge
University)
Compulsive porn users react to porn cues in
the same way that drug addicts react to
drug cues
Compulsive porn users craved porn (greater
wanting), but did not have higher sexual
desire (liking) than controls. This finding
aligns perfectly with the current model of
addiction.
Over 50% of subjects (average age: 25) had
difficulty achieving erections with real
partners, yet could achieve erections with
porn
114. Enhanced
Attentional Bias
towards
Sexually Explicit
Cues in
Individuals with
and without
Compulsive
Sexual
Behaviors –
Voon et al.
2014
“Our findings of enhanced attentional bias in CSB
subjects suggest possible overlaps with
enhanced attentional bias observed in studies of
drug cues in disorders of addictions. These
findings converge with recent findings of neural
reactivity to sexually explicit cues in CSB in a
network similar to that implicated in drug-cue-
reactivity studies and provide support for
incentive motivation theories of addiction
underlying the aberrant response to sexual cues
in CSB.”
117. Brain Structure and Functional Connectivity Associated With
Pornography Consumption: The Brain on Porn (2014)
Simone Kühn continued - "We assume that subjects with a
high porn consumption need increasing stimulation to
receive the same amount of reward.”
Simone Kühn - "That could mean that regular consumption
of pornography more or less wears out your reward system.“
Higher hours per week/more years of porn viewing
correlated with a reduction in grey matter in sections of the
reward circuitry (translates into sluggish reward activity, or a
numbed pleasure response – desensitization)
118. Gola et al. (2017)
Gave fMRIs to 28 men in treatment for problematic pornography use (PPU) and 28 men without
PPU to examine ventral striatal responses to “erotic and monetary stimuli”
Wanted to differentiate “cue-related ‘wanting’ from reward-related ‘liking’”
Participants completed an incentive delay task during the fMRI and were given “erotic or
monetary rewards preceded by predictive cues”
PPU group had higher activation in the ventral striatum for cues that predicted erotic stimuli
but not for cues that predicted monetary reward or to the actual erotic pictures
◦ Authors argued this is “consistent with the incentive salience theory of addiction”
Sensitivity to erotic stimuli cues was related to increased motivation to see the erotic stimuli
(suggests “higher wanting”), higher pornography use, severity level of PPU and more frequent
masturbation
Gola, M., Wordecha, M., Sescousse, G., Lew-Starowicz, M., Kossowski, B., Wypych, M., ... & Marchewka, A. (2017). Can pornography be
addictive? An fMRI study of men seeking treatment for problematic pornography use. bioRxiv, 057083.
“Findings congruent with research on gambling and substance
addictions suggesting PPU may be a behavioral addiction”
119. Ji-Woo Seok
and Jin-Hun
Sohn of the
Brain
Research
Institute at
Chungnam
National
University in
South Korea
Sex addicts focus a higher-than-normal share of their
attention on addiction related cues (i.e., pornography), doing
so in the same basic ways and to the same basic degree as
other addicts.
The brain response of sex addicts exposed to sexual stimuli
(i.e., pornography) mirrors the brain response of drug
addicts when exposed to drug-related stimuli. For example,
the dorsal orbital prefrontal cortex lights up just as it does
with substance addicts. Equally important is the fact that this
region goes below baseline for neutral stimuli, the same as
with substance abusers. In other words, the dorsal orbital
prefrontal cortex overreacts to addiction cues and
underreacts to neutral cues in all forms of addiction,
including sexual addiction.
120. Banca et al. (2016)
Examined whether men with CSB showed more of a preference for “sexual novelty and stimuli conditioned sexual rewards”
compared to a healthy control group
CSB group:
◦ Had a stronger preference for novel sexual images in comparison to control images
◦ Demonstrated a preference for cues that had been conditioned to sexual and monetary rewards over neutral
outcomes
This result was not observed in the control group
◦ Had higher levels of dorsal cingulate habituation during an fMRI when presented with repeated sexual images
compared to monetary images
◦ Level of habituation to sexual images was positively correlated with self-reported preference for sexual novelty
◦ Had an early attentional bias to sexual cues compared to control group that significantly correlated with higher levels
of approach behaviors towards cues conditioned to sexual images
Authors concluded the CSB participants had a “dysfunctional enhanced preference for sexual novelty possibly mediated by
greater cingulate habituation” as well as an overall enhanced reaction to rewards
Banca, P., Morris, L. S., Mitchell, S., Harrison, N. A., Potenza, M. N., & Voon, V. (2016). Novelty, conditioning
and attentional bias to sexual rewards. Journal of psychiatric research, 72, 91-101.
“The novelty seeking and cue conditioning found in CSB participants
is similar to results seen in studies on substance addictions”
121. Ventral Striatum Activity Correlated with
Porn Addiction (Brand et al. 2016)
Reward center activity (ventral striatum) was higher for
preferred pornographic pictures.
Ventral striatum reactivity correlated with the internet sex
addiction score.
Both findings indicate sensitization and align with the
addiction model. The authors state that the "Neural basis
of Internet pornography addiction is comparable to other
addictions."
122. Soek & Sohn
2018
The caudate nucleus is the main subregion of the striatum,
and is important for reward-based behavioral learning,
intricately associated with pleasure and motivation, and
related to the maintenance of addiction.
Compared to healthy subjects, individuals with PHB had
significantly decreased functional connectivity between the
Superior Temporal Gyrus and the caudate nucleus.
This fMRI study compared carefully screened sex addicts
("problematic hypersexual behavior") to healthy control
subjects. Sex addicts had reduced gray matter in the
temporal lobes - regions the authors say are associated
with inhibition of sexual impulses.
124. Executive function
– Reid et al. 2010
Patients seeking help for hypersexual behavior
often exhibit features of impulsivity, cognitive
rigidity, poor judgment, deficits in emotion
regulation, and excessive preoccupation with
sex. Some of these characteristics are also
common among patients presenting with
neurological pathology associated with
executive dysfunction. These observations led
to the current investigation of differences
between a group of hypersexual patients (n =
87) and a non-hypersexual community sample
(n = 92) of men
125. Pornographic Picture Processing Interferes with
Working Memory Performance
Laier, Schulte and Brand (2013) examined the effect of sexual arousal
during internet sex on Working Memory (WM)
Found worse performance of WM for pornographic pictures compared
to neutral, negative and positive stimuli
◦ Results moderated by need to masturbate and sexual arousal suggesting this
arousal interferes with working memory processes
Laier, C., Schulte, F.P. & Brand, M. (2013). Pornographic picture processing interferes with
working memory performance. Journal of Sex Research, 50(7), 642-652. DOI:
Authors concluded that the cognitive problems often
reported by people with sexual addiction following
pornography consumption (forgetfulness, neglecting
responsibilities, missing appointment, etc.) may be
accounted for by the interference with WM related to
pornographic material
126. Messina et al. (2017)
Compared cognitive flexibility and decision making in 30 men
with CSB and 30 control subjects before and after viewing an
erotic video
No significant differences in cognitive flexibility and decision
making between the groups prior to viewing the erotic video
Messina, B., Fuentes, D., Tavares, H., Abdo, C. H., & Scanavino, M. D. T. (2017). Executive Functioning of
Sexually Compulsive and Non-Sexually Compulsive Men Before and After Watching an Erotic Video. The
Journal of Sexual Medicine, 14(3), 347-354.
“The control group members made fewer impulsive
choices and demonstrated higher levels of cognitive
flexibility than CSB participants”
127. Schiebener, Laier & Brand (2015)
Studied relation between executive functioning and cybersex addiction in
104 heterosexual men
Subjects completed an executive multitasking paradigm with two subsets of
pictures (humans & pornography) they had to classify on certain criteria
◦ Subjects were supposed to work on all tasks in equal amounts which required
switching between the two subsets in a balanced way
Individuals with more symptoms of cybersex addiction had less balanced
performances in the multitasking paradigm
◦ These individuals “often either overused or neglected working on the
pornographic pictures”
◦ Suggested tendency towards approach/avoidance of pornography similar to motivational models of
addiction
Schiebener, J., Laier, C., & Brand, M. (2015). Getting stuck with pornography? Overuse or neglect of cybersex
cues in a multitasking situation is related to symptoms of cybersex addiction. Journal of behavioral
Indicated lower levels of executive control in multitasking performance when
viewing pornography may “contribute to dysfunctional behaviors and negative
consequences resulting from cybersex addiction”
128. Banca, Harrison & Voon (2016)
Studied two facets of compulsivity (reversal learning and attentional set
shifting) in participants with CSB vs healthy control group
No significant differences between the groups in set shifting or reversal
learning.
Banca, P., Harrison, N. A., & Voon, V. (2016). Compulsivity across the pathological misuse
of drug and non-drug rewards. Frontiers in Behavioral Neuroscience, 10.
CSB group learned faster from rewards and slower from
losses than control group
Suggests perseveration and enhanced sensitivity to
rewards in CSB
129. Sexual Picture Processing Interferes
with Decision-Making Under Ambiguity
Sexual arousal might interfere with the decision-making process and
should therefore lead to disadvantageous decision-making in the long
run.
Results demonstrated an increase of sexual arousal following the
sexual picture presentation. Decision-making performance was worse
when sexual pictures were associated with disadvantageous card
decks compared to performance when the sexual pictures were linked
to the advantageous decks. Subjective sexual arousal moderated the
relationship between task condition and decision-making
performance.
Laier, C., Pawlikowski, M., & Brand, M. (2014). Sexual picture processing interferes
with decision-making under ambiguity. Archives of sexual behavior,43(3), 473-482.
This study emphasized that sexual arousal interfered with decision-making,
which may explain why some individuals experience negative
consequences in the context of cybersex use.
130. Schmidt et al. (2017)
Compared brain volumes and resting state functional connectivity
between men with CSB and healthy men
Results suggested CSB is related to higher volumes in parts of the
limbic system that are associated with processing emotions and
motivation
◦ Unknown whether increased amygdala volumes pre-exists CSB and
is a risk factor or is the result of CSB
Schmidt, C., Morris, L. S., Kvamme, T. L., Hall, P., Birchard, T., & Voon, V. (2017). Compulsive sexual behavior:
Prefrontal and limbic volume and interactions. Human brain mapping, 38(3), 1182-1190.
Also found reduced connectivity between the amygdala and the bilateral
dorsolateral prefrontal cortex (DLPFC) in CSB group which is associated with
higher levels of impulsivity and lower levels of emotional regulation.
Authors argued the dysfunction in these brain systems in people engaging
in CSB is similar to incentive motivation theory research on substance
addictions
131. Seok & Sohn
(2018) Altered
Prefrontal and
Inferior
Parietal
Activity During
a Stroop Task
in Individuals
With
Problematic
Hypersexual
Behavior
Accumulating evidence suggests a relationship
between problematic hypersexual behavior (PHB)
and diminished executive control. Clinical studies
have demonstrated that individuals with PHB exhibit
high levels of impulsivity; however, relatively little is
known regarding the neural mechanisms underlying
impaired executive control in PHB. This study
investigated the neural correlates of executive control in
individuals with PHB and healthy controls using event-
related functional magnetic resonance imaging (fMRI).
Twenty-three individuals with PHB and 22 healthy
control participants underwent fMRI while performing a
Stroop task. Response time and error rates were
measured as surrogate indicators of executive control.
Individuals with PHB exhibited impaired task
performance and lower activation in the right
dorsolateral prefrontal cortex (DLPFC) and inferior
parietal cortex relative to healthy controls during the
Stroop task. In addition, blood oxygen level-dependent
responses in these areas were negatively associated with
PHB severity. The right DLPFC and inferior parietal
cortex are associated with higher-order cognitive control
and visual attention, respectively. Our findings suggest
that individuals with PHB have diminished executive
control and impaired functionality in the right DLPFC
and inferior parietal cortex, providing a neural basis for
PHB.
132. Our clients experience
Powerful sexual conditioning and learning
Neuroplastic change
Structural changes in the brain
Deficits in areas of functioning (e.g. memory, decision making)
Over 40 articles on the neuroscience
of sex addiction…
Embedded in a large body of research on behavioral
addictions (130 behavioral addiction articles - e.g. 70
brain articles on internet addiction)
Longitudinal research in other areas
140. Some Evidence Based
Approaches to Treatment
Del Giudice MJ, Kutinsky J. Applying motivational interviewing to the treatment of sexual compulsivity and addiction. Sex
Addict Comp. 2007;14(4):303-319.
Shepherd L. Cognitive behavior therapy for sexually addictive behavior. Clin Case Stud. 2010;9(1):18-27.
Sadiza J, Varma R, Jena SPK, et al. Group cognitive behaviour therapy in the management of compulsive sex behaviour.
International Journal of Criminal Justice Sciences. 2011;6(1-2):309-325.
Motivational Interviewing
Cognitive Behavioral Therapy
141. Evidence Based Approaches to
Treatment
The overall reduction in problematic Internet pornography use was
reported as 92% immediately after the study ended, and 86% after 3
months.
Crosby JM, Twohig MP. Acceptance and commitment therapy for problematic Internet pornography use: a randomized
trial. Behav Ther. 2016;47(3):355-366.
Twohig MP, Crosby JM. Acceptance and commitment therapy as a treatment for problematic internet pornography
viewing. Behav Ther. 2010;41(3):285-295.
Acceptance Commitment Therapy
142. Evidence Based Approaches to
Treatment
Yaniv & Gola (2018) Compulsive Sexual Behavior: A 12 Step Based Therapuetic
Approach. Journal of Behavioral Addictions.
Sevcikova et al. (2018) Excessive Internet use for Sexual Purposes Among Members
of Sexaholics Anonymous and Sex Addicts Anonymous.
12 Step Group Participation
143. TASK 7: CULTURE OF SUPPORT
Maintains a healthy support system
144. Treatment
Programmatic care – Long term
treatment
Celibacy agreement
Sexual health plan
Task methodology
12 step
Mindfulness, CBT
IFS, Trauma treatment, EMDR, SE
Family / Couple treatment
147. IITAP Core Beliefs–
Healthy Sexuality
•IITAP celebrates diversity, and our
ethical guidelines promote non-
discrimination by race, creed, color,
ethnicity, national origin, religion, sex,
sexual orientation, gender expression,
age, height, weight, physical or mental
ability, veteran status, military
obligations, and marital status.
•IITAP does not condone the practice of
Reparative Therapy. Homosexuality is
not pathological and is not a mental
illness.
•Sexual addiction is not defined by the
type of sexual act or the gender of the
sexual partner
148. For Healing…Three Legged
Stool
Addict’s therapist
◦ Individual therapy
◦ Support Groups/ 12 step support
Partner’s therapist
◦ Individual therapy
◦ Support Groups
Couples therapist
149. Family
therapy
Treatment for sex
addiction induced
trauma for whole family
and betrayal trauma for
partners
Treatment from a
relational paradigm
Effective and well
orchestrated disclosure
to partner
Long term couples
therapy