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Here is a list of psychological disorders found in individuals with their clinical treatments.
Contents:
- Adjustment Disorders and its Treatment
- Disruptive Behaviour Disorder and its Treatment
- Developmental Disorders and its Treatment
- Sleep Disorders and its Treatment
- Factitious Disorder and its Treatment
- Impulse Control Disorder and its Treatment
1. Adjustment Disorders and its Treatment:
Currently adjustment disorders are found in every strata of the society perhaps because of the rapid growth of civilization, identity crisis, personal misfortunes, lack of interpersonal relationship particularly between the parents and children. Hence, psychiatrists recently have taken notice of this pathological response.
DSM III-R defines an adjustment disorder as a maladaptive reaction to a clearly identifiable psycho social stress or stressors that occurs with 3 months after the stressors onset. Adjustment disorders are most frequently found in adolescents but can occur to any age. About 5 per cent of the hospital admissions in a particular survey were diagnosed as adjustment disorders.
Etiology of Adjustment Disorders:
The personality of an individual starts to grow from birth within the environmental conditions. Thus, family society, culture, traditions, values and group norms contribute to the disproportionate response to the various stimuli and stressors. A particular incident, personal loss or frustration may cause a stress.
But tolerance to a stress arousing situation depends on the adaptability capacity of the individual. Thus, the same stress may produce different responses or different degree of response in different persons.
Why the stresses and frustrations of the day-to-day life produce mental illness or adjustment disorders in some and not in others? If two persons failed in the examination, why one person commits suicide while the other prepares for the second examination? This question has baffled many.
Freud gave considerable emphasis on constitutional factors and viewed them as interacting with a person’s life experiences to produce fixation and traumas of life.
The role of mother, her child rearing practices and the rearing environment in a person’s capacity to respond to stress have been emphasized by psychoanalysts for producing maladjustment disorders. The parents, particularly the mother should provide enough support to the growing child to tolerate the frustrations of life.
It has been observed that in the middle and upper middle class families the aspirations of the parents are so high that they are bound to create a gap between the aspirations and ability and thus achievement of their growing children.
This obviously leads to severe frustration and subsequent adjustment problems. Failures in life should not be given supreme importance and not to the extent that the growing child considers it to be a matter of life and death.
The child or the adult must be taught to relax and take things easily because maladaptive reactions in no way would help in bringing the desired goal. Who else can be better counselors and guiding stars in this matter than the parents and near and dear ones?
It is seen that loss of parents or one of the parents during infancy, growing in an institution, loss or lack of parental love, nagging parents, unhappy childhood experiences, coupled with severe frustration may make a person susceptible or vulnerable to adjustment disorders.
Symptoms of Adjustment Disorders:
The symptoms of adjustment disorder grow gradually and also subside gradually. Though there is no age bar for the onset of this disorder, it is mostly common in adults. Deterioration in occupational functioning, relationship with others is common symptoms of adjustment disorder. Also such persons show excessive reaction to the stressors.
Other disorders from which the adjustment disorder must be differentiated include major depressive disorder, chronic depressive disorder, brief reactive psychoses, generalized anxiety disorder, somatization disorder, various substance use disorders, conduct disorder, specific academic and work inhibitions, identity disorder and post traumatic stress disorder.
Sometimes adolescents diagnosed as having adjustment disorder subsequently develop mood disorder on psychoactive substance abuse disorder.
Treatment of Adjustment Disorders:
Psychotherapy is the appropriate treatment. People undergoing similar stresses may be treated in a ground which would bring better results. Individual psychotherapy can also be helpful, particularly to explore the meaning of the’ stressor to the patient so that earlier frustrations, traumas and failures can be “seen” and released appropriately.
Occasionally antianxiety drugs may be served to patients having anxiety and antidepressants to patients having depression. However, psychotherapy can help the person to see and realise things for better adjustment to the life stressors.
2. Disruptive Behaviour Disorder and its Treatment:
Disruptive behaviour disorder is a new classification is DSM III-R. It includes socially disruptive behaviour which is more distressing to others than the persons suffering from this disorder.
These behaviour disorders include:
(1) Conduct disorder,
(2) Attention deficit hyperactivity disorder,
(3) Oppositional defiant disorder.
1. Conduct Disorder:
It is a disorder showing a repetitive and persistent pattern of conduct in which either the basic right of others or major age appropriate social norms are violated.
DSM III-R lists three subtypes of conduct disorder:
(a) Solitary aggressive type,
(b) Group type and
(c) Undifferentiated type.
Conduct disorder is commonly found in children and adolescents. Approximately 9 per cent of the males and 2 per cent of females below the age of 18 years usually have this disorder. This disorder is more common in children of parents with low socio economic background and with antisocial personality and alcohol dependence.
Aetiology:
No single factor can be attributed to explain the cause of conduct disorder and antisocial behaviour of children. A number of biological and psychological factors are perhaps responsible for its development.
Parental factors like attitude of the parents, child rearing practices, early frustrations, lack of love and understanding, insecurity, emotional blunting etc. influence the development of this disorder. Frequent quarrels between the parents is a very significant contribution to conduct disorder.
Recent studies indicate that the parents with psychopathic and antisocial maladaptive personalities give rise to maladaptive children. It has also been seen that there is a lot of similarity in the behaviour of children of antisocial parents with their parents.
Treatment:
Individual psychotherapy, involvement of the family, conjoint marital therapy and family therapy are basically necessary.
Removal of the child from his own home environment and keeping him in another suitable and stimulating environment may be helpful for effective treatment. Behaviour modification may be of some help. Uses of drugs and medications have only limited and temporary effects.
Improvement can be brought about by means of development of internal controls, restoration of positive self image and new adoptive skills.
2. Attention Deficit Hyper Active Disorder:
Attention deficit hyperactive disorder (ADHD) refers to a group of symptoms characterised by a short attention span leading to poor concentration, hyperactivity and impulsiveness. It appears usually before the age of 7 years. The incidence of this disorder is more found in boys than in girls. The parents of such children show an increased incidence of hyperkinesia, sociopathy, alcoholism and hysteria.
Aetiology:
In the aetiology of ADHD neurobiological factors, genetic factors, brain damage, maturational lag and psychosocial factors have been said to play significant roles. Many children with this disorder develop secondary depression in reaction to their continuing frustration and their failure to learn and low self esteem.
Treatment:
Medication, psycho therapy, tolerance sympathy and understanding of the parents prove effective for the treatment of the disease. For development of specific methods of treatment further research in this area is essential.
3. Oppositional Defiant Disorder (ODD):
This disorder is characterised by a host of negativistic hostile and defiant behaviour, often directed towards parents and teachers. ODD is found in 16 to 22 per cent of school age children. It may begin at three years but typically begins by 8 years of age and usually not later than adolescence. According to DSM III-R it is more found in males before puberty.
It has been observed that though no distinct family pattern can be assigned to such disorder almost all parents of such children are over concerned with issues of power, control and autonomy. Sometimes this happens in case of unwanted children. Some of them are very obstinate, have over dominant, controlling and depressed mothers, passive and aggressive fathers.
Aetiology:
Children with this disorder are commonly very argumentative ones, loose temper frequently and get annoyed easily. They tend to blame others for their own mistakes.
3. Developmental Disorder and its Treatment:
Currently specific developmental disorders found in the common population have drawn the attention of clinical psychologists in view of their adverse effects on human behaviour and activities.
The specific developmental disorders include:
A. Developmental arithmetic disorder
B. Developmental expressive writing disorder
C. Developmental reading disorder
D. Developmental articulation disorder
E. Developmental language disorder
A. Developmental Arithmetic Disorder:
Any day to day activity requiring the skill of arithmetic is adversely affected and impaired in this disorder. This skill includes understanding, naming and using mathematical terms, mathematical operations or concepts, translating written problems into mathematical symbols, perceptual skills, attention skills and mathematical skills.
The person having this disorder suffers from serious inferiority complex and other social and personal difficulties because of lack of arithmetic skill.
Aetiology:
The current view is that the aetiology is multifactorial and hence it has not so far been possible to indicate any specific reason of this disorder. It is held that maturational cognitive, emotional, educational and socio economic factors account in different amount and also in combinations for the development of arithmetic disorder.
Treatment:
The causes being diverse it is difficult to treat this disorder by a specific therapeutic technique. However, remedial educational intervention is presently viewed as the most effective treatment of developmental arithmetic disorder.
The technique of treatment however may vary with the nature and degree of the disorder keeping in view the specific patient in mind. Physical therapy and sensory integration activities may help to some extent.
B. Developmental Expressive Writing Disorder:
Developmental expressive writing disorder is a disorder having a quite recent origin. It is in-fact a new entity in DSM III-R. Clinically considered as a clear specific developmental disorder, it is an academic skill disorder and first occurs during childhood. This disorder is characterised by poor performance in writing and composition keeping in view the schooling and intellectual capacity of the person.
When the writing disorder sufficiently interferes with academic achievement and day to day activity it becomes a matter of concern and needs immediate attention for treatment. This disorder is apparent in childhood, particularly by the age of 7 years.
Aetiology:
There is no clear cut and specific aetiology. Though nothing can be held definitely, there are some indications that affected persons who come more frequently from families with a history of this disorder. Currently psychiatrists are trying to find more and more facts about the disease through research and certain hypothesis have been advanced to explain the aetiology.
According to the first hypothesis this disorder is a combined effect of one or more of the following disorders, such as developmental expressive language disorder, developmental receptive language disorder and developmental reading disorder. According to this hypothesis there is a possibility of existence of neurological and cognitive defects or malfunction somewhere in the central information processing area.
In the opinion of the second hypothesis the findings of which are based on empirical research, most children with developmental expressive writing disorder have relatives with this disorder. Thus hereditary predisposition is emphasized as a cause by the second hypothesis. The third hypothesis holds that temperamental characteristics may have something to do with expressive writing disorder.
Treatment:
Children of families of good socio economic background may completely recover from this disorder if timely treatment is made. Severe developmental expressive writing disorder requires continuing extensive remedial treatment through the later period of the High School and even in the first stage of the college.
However, the best treatment is remedial educational intervention. An intensive and continuous administration of expressive and conceptive writing therapy made for each specific individual care seems so far the most effective and successful treatment method.
In order to obtain maximum benefit from this therapeutic technique, it is essential to have optimum patient therapist relationship and high motivation of the patient to cooperate in the therapeutic programme. In addition to this, associated and secondary emotional and behavioural problems should get immediate attention. Counselling of the parents is also necessary for effective recovery.
C. Developmental Reading Disorder:
In developmental reading disorder there is delay and impairment in reading competence. Despite long standing research work there is no consensus about the nature, aetiology and treatment of this disorder.
In the opinion of DSM III-R diagnosis should be made only when this impairment significantly interferes with academic achievement or with activities of daily living requiring reading skills. 2 to 8 per cent of school-age children in the United States are affected by this disorder. It is 2 to 4 times more common in boys than in girls. No Indian statistics is available. Research in India appears to be imperative.
Aetiology:
Although no specific reason can be assigned, it seems to be more prevalent in family members than in general population. This leads only to view that perhaps it may have a genetic origin. But results of family and twin studies do not supply ample evidence in favour of this view.
Developmental reading disorder is commonly found in children with cerebral Palsy, epilepsy, complications during pregnancy, prenatal and perinatal difficulties, prematurity and low birth weight etc. There is some evidence of temperamental factors associated with this disorder.
Some studies also show the evidence of association between malnutrition and cognitive function, developmental reading disorder and psychiatric problems like pre-existing emotional and behavioural disorder. But no definite aetiology of this disorder has yet been established.
It has been observed that most of the children having such disorder if do not get timely remedial assistance, suffer from a sense of shame, and humiliation due to continuous failure and subsequent frustration. Some others develop anguish and depression leading to aggression directed to family members and society at large.
This type of feeling may lead to conduct disorder. As observation shows, children belonging to good socio economic background recover quickly and completely.
Treatment:
Remedial educational approach is by far the best treatment procedure. For effective treatment conducive therapist patient relationship is important. Besides, behavioural and emotional problems should also be treated by psychiatrists. Like other developmental disorders counselling of the parents helps in quick recovery.
D. Developmental Articulation Disorder:
Developmental articulation disorder refers to frequent and recurrent misarticulating of speech sounds, leading to abnormal speech development. Baby talk, delayed speech, lisping, oral inaccuracy etc. come under this disorder. When the disorder becomes severe the speech may be completely unintelligible and require lengthy and intensive treatment.
Developmental articulation is defined by DSM III-R as a consistent failure to make correct articulation of speech sounds at the developmentally appropriate age. It is not an outcome of any structural psychological, anatomical or neurological abnormalities.
10 per cent of the children below 8 years of age and about 5 per cent of the children of 8 years and above suffer from this disorder. It is about two to three times more common in boys than in girls.
Aetiology:
Its cause is unknown and cannot be attributed to any specific factor. However, a disproportionately high rate of developmental articulation disorder has been noticed among children from lower SES families. This obviously suggests the possible casual effects of inadequate speech stimulation and scope for reinforcement in such families.
Constitution factors appear to be an important determining cause of whether a child has developmental articulation disorder. The chance of genetic components cannot also be ignored in view of the high proportion of children with the disorder having relatives with similar disorder.
Treatment:
Speech therapy is considered as the most effective and successful method of treatment. Moreover, the child’s relationship with friends and peers and school behaviour should be monitored. Counselling of parents is necessary for timely implementation of psychiatric treatment.
E. Developmental Language Disorder:
This includes developmental expressive language disorder and developmental receptive language disorder. There is marked deterioration in the development of expressive language and receptive language. The diagnosis should be made only when it affects adversely the academic achievement or day-to-day activities.
Aetiology:
Though the specific causes are unknown the role of genetic factors cannot be ignored. Damages or malnutrition defects in cerebral developments may be one of the causative factors. But no specific evidence supports these contentions.
Several other studies suggest the possible presence of underlying requirement of auditory discrimination. Low self esteem, poor frustration tolerance, depressed mood, outbursts of temper are some of the important causes.
Treatment:
Individual psychotherapy for children suffering from this disorder and counselling and direct training of the parents in child management skills may be used as method of treatment. Behaviour therapy is also helpful.
Behaviour therapy teaches parents to discourage their child’s behaviour pattern and encourage appropriate behaviour. It further emphasises on selectively reinforcing and praising appropriate behaviour and discouraging and not reinforcing undesirable behaviour.
4. Sleep Disorders and its Treatment:
Sleep is a boon to human beings. It is a physiological and psychological necessity. A good night’s sleep helps in retrieving memory, remembering events and learnt materials increasing the ability to learn language and in defusing tiredness.
Although everyone is aware of the benefits of sleep research of scientists at the University of Chicago on sleep indicates that while we sleep the brain activity encourages higher type of learning on the bases of findings of experimental studies.
Danial Margoliash of the University of Chicago and his associates hold “Sleep consolidates memory protecting them against subsequent interference or decay. Sleep also appears to recover or restore memories.
” On the basis of the findings of their study on 3 groups of college students Danial Margoliash holes” If performance is reduced by interference, sleep might strengthen relevant associations and weaken irrelevant associations improving access to relevant memories.”
Findings of earlier studies on sleep and retroactive inhibition also indicate that those who learn and do not go to sleep but do other activities recall less than those who go to regular sleep after learning a material. In view of the above, it is desirable to go into the causes of sleep disorders and find out remedial as well as therapeutic measures.
Sleep Requirements:
Individual differences are found in sleep pattern, sleep duration and also sleep requirement. Some person sleep for longer hours (9 hours) to function efficiently. They are called long sleepers. Short sleepers, on the other hands, sleep for about six hours and can function adequately.
According to Kaplan and Suaok (1987) keeping other factors constant long sleepers may tend towards mild depression, anxiety and social withdrawal while short sleepers are by and large ambitious, efficient, happy go lucky and sociable.
With increase in manual work, exercise, general mental stress, illness, pregnancy and rise in mental activity, the need for sleep may increase and vice versa. Length of sleeping period also decreases with age up to adulthood.
Since sleep serves a restoration and homeostatic function every individual needs required amount of sleep every day. Continuous sleep deprivation may lead to irritability, fatigue, lethargy, hallucination, delusion and various ego disorganizations.
Sleep Disorders:
D.S.M. III-R has categorized sleep disorders into two major categories.
1. The Dyssomnias;
2. The Parasomnias.
1. Dyssomnias:
The dyssomnias include insomnia, difficulty in falling asleep, hypersomnia, excessive amount of sleep and sleep-wake schedule disorders.
(a) Insomnia Disorder:
Disorder in initiating and maintaining sleep refers to insomnia. It may be short or persistent. In persistent insomnia, the disorder occurs at least 3 times a week for at-least one month leading to day time fatigue and impairment of social or occupational function.
Brief Insomnia:
But when the insomnia is for a short period because of some anxiety or tension arising out of anticipation of examination result or result of an interview for a job or death of a near relative who has been seriously ill. Also some familial personal loss or grief reaction may lead to insomnia for a brief period.
This type of cause based insomnia is usually not dangerous for the psyche of the person and no specific treatment is required for the same. But a psychotic attack or severe depression may sometimes start with acute insomnia. The psychiatrist should therefore be cautious and watchful in this regard.
(b) Persistent Insomnia:
Persistent insomnia causes concern for both the patient and the psychiatrist. Here the problem is difficulty in falling asleep rather than remaining asleep. It involves somatised tension leading to anxiety and a conditioned associative response.
Persistent insomnia has no other symptom except difficulty in falling asleep. Though anxiety is not directly experienced, it is released through various physiological channels. The patient complains of apprehensive feelings that appear to him from falling asleep. He does not, however, experience any specific fears as he falls asleep.
Treatment of persistent insomnia is quite difficult though not impossible. In a persistent sleep disorder where the conditioned component is very prominent, the deconditioning technique may be helpful.
According to Kaplan and Sadok in the deconditioning technique the patient is understood to use the bed only for sleeping. If he does not fall asleep within 5 minutes in the bed, he instructed to get up and do something else. Actually, changing to another bed or another room or some other work, sometimes is useful in bringing sleep.
In some other cases, where the muscle tension is quite prominent, trans-dental meditation, relaxation tapes or practicing the relaxation response and bio feed backs appear to be helpful. But psychotherapy has not been very helpful in the treatment of persistent insomnia.
Insomnia is also divided into non-organic and organic:
(a) Non-organic Insomnia:
It is related to another mental disorder showing various psychological and behavioural symptoms. In such cases, difficulty of falling asleep is secondary and anxiety is primary. As we know, anxiety is the sign of various psychiatric illnesses.
In cases where the anxiety has clear-cut roots psychiatric treatment of the causes of anxiety is imperative. Individual psychotherapy, group of psychotherapy and family therapy are some of the therapeutic methods which relieves persistent insomnia.
Insomnia associated with depression has drawn the active attention of psychiatrists. Severe unipolar depression associated with normal onset of sleep put repeated awakening in the second half of the night and premature morning awakening leading to a very uncomfortable mood in the morning are experienced.
Maniac and hypomanic patients are usually found to be short sleepers. Though they experience the initial difficulty of falling asleep do not complain of any sleep problems. After 3 to 4 hours of sleep they generally get up and feel refreshed. They also do not feel any further need for sleep thereafter.
Treatment:
Treatment of mania or depression is essential than the sleep problem. An anti-depressant may be given at bed time to improve sleep.
(b) Organic Insomnia:
This type of insomnia is due to a medication or use of drugs or because of a known physical condition.
Treatment through Medication/Drug:
Due to continuous use of C.N.S. depressants to treat insomnia, tolerance increases and the depressants fail to improve or induce sleep. So the drug is increased to improve and induce sleep. Again with abrupt discontinuation of the drug, excessive sleeplessness occurs.
Drug withdraw all symptoms are also seen. Use of the drug for more than 30 days though is tolerated by some patients, others complain of sleep disturbance with more than once brief awakenings during the night.
It is found in many cases, that C.N.S. stimulants like alcohol are the possible causes of insomnia. Moreover, various medications and use of drugs for weight reduction and asthma etc. also lead to insomnia.
Several cold and hot drinks which contain caffeine also may lead to sleep problems. Similarly, thyroid preparations, chemotherapeutic agents, anticonvulsant drugs, oral contraceptives etc. may lead to sleep disorders of different kinds. Instead, any drug containing sedating and tranquilizing agent may produce insomnia.
DSM III-R has coined the term primary insomnia which does not occur because of taking anti-depressants, drugs and stimulants but because of psychiatric illness or medical illness. Primary illness is a sleep disorder which occurs independent of any known physical or mental conditions. Patients with this type of sleep disorder “are preoccupied with getting enough sleep which may be a lifelong pattern”. —Kaplon and Sadok
Hypersomnia means excessive sleep. It can be both non-organic and organic.
Hypersomnia involves two basic types of syndromes:
(a) Excessive amount of sleep,
(b) Excessive day time sleepiness.
Any one of these symptoms or both the symptoms may be found in a person. Some of these patients show a clear tendency to suddenly fall asleep in a waking state. Though long sleepers sleep for 9-10 hours a day, they do not face any problem like the short sleepers.
Only they show the tendency to return to bed frequently, have difficulty in remaining awake and a tendency to remain in bed for unusually long periods. But hypersomnia is less common compared to insomnia.
Non-organic Hypersomnia:
It is found to be related to a couple of mental disorders like Mood and Depressive disorder. In mild expression, excessive day time sleepiness may be experienced at the initial stage. In the depressed phase of bipolar disorder, this symptom may also be observed.
It may continue for a few weeks associated with grief. It is also associated with various other personality disorders like amnesia fugue, dissociative and somatoform disorders etc.
Organic Hypersomnia:
By medication sub-organic hypersomnia is caused by medication, substance abuse and physical conditions like respiratory disorders. Eighty- five per cent of all the sleep disorders include organic hypersomnia.
Primary Hypersomnia:
A sleep disorder is called primary hypersomnia when no other cause for excessive sleep can be traced. Though the sleep is quite lengthy compared to the normal person’s sleep is however normal for the person concerned.
In primary hypersomnia, there is no complain or disorder in the quality of sleep, day time sleepiness, motivation and performance. This long sleep may be a typical lifetime pattern for the person concerned and he may have a family history of long sleepers. Long sleepers do not have the greater tendency to fall asleep compared to the normal.
2. Parasomnias:
“Parasomnias include a group of clinical conditions that are not basically disorders of sleeping or waking but are unusual and undesirable phenomena that appear suddenly during sleep or that occur at the threshold between waking and sleeping.” —Kaplon and Sadok
Parasomnias includes:
(a) Sleep walking disorder or Somnambulism,
(b) Sleep talking disorder,
(c) Sleep terror disorder,
(d) Dream anxiety disorder.
(a) Somnambulism:
Though popularly believed as sleep walking, it is not sleep walking in fact. Rather it is a sleep like state during which the individual may experience a stressful event. It takes place at a particular time during the night either in the waking state or in the sleep state.
The same route is followed and the same kind of behaviour is shown every-time. Though most commonly found in adolescence, the disease may occur during childhood and adult life.
According to Duke and Nowicki (1979) Somnambulistic people may or may not have conscious awareness of the event in their waking state. Once the somnambulistic state is over, the patient does not remember of its occurrence.
In sleep like state, while the main personality remains asleep, dissociated fragment or a secondary personality takes controls of the ego and engages in various activities. However, after the somnambulistic state is over, he completely forgets this secondary personality. The secondary personality is neither asleep, nor awake.
The victim goes to sleep in a normal manner, but sometimes during night gets up, goes to another room or outside and then again comes back and sleeps normally. In the morning he remembers nothing that has taken place.
According to Coleman, usually such sleep walking episodes last from 15 minutes to half an hour.
Somnambulism is found in 5 per cent of the people. It is more common in young people and frequently occurs in college going young people. Jenness and Jorgensen (1941) have reported that 5 per cent of a group of 1808 college freshmen admitted walking in their sleep. Observations show that males are greater victims of Somnambulism than females.
As popularly believed, sleep walking and Somnambulism are not same. There are differences among the two. Somnambulism may occur during sleep or walking state. Somnambulism is usually associated with dreams and is believed to be purposive while sleep walking is more random and directionless.
Aetiology:
According to Kessen and Mandler (1961) anxiety may be reduced by a flight from trauma Anthony views that sleep walking occurs in individuals prone to the motor discharge of tensions rather than to nightmare of fantasy.
The personality traits like immaturity, suggestibility and heightened need for approval and security obvious in the conversion hysteric patients are also found in sleep walkers. Coleman views that various problems during adolescence like dependence, independence, struggles, sexual conflicts and allied problems seem to be related to sleep walking.
In adulthood it seems to be precipitated by the stress and anxiety caused by adult responsibilities and making decisions for self.
In the opinion of Sadler (1945) the precipitating cause in the sample he analysed was same type of traumatic experience that had just occurred or was about to occur in the near future. Desires repressed and suppressed due to social restrictions and inhibitions may lead to sleep walking or somnambulism in which the patient tries to satisfy these suppressed or repressed desires.
(b) Sleep Talking Disorder:
Otherwise known as Somniloquy, sleep talking is commonly found in children and occasionally in adults. Extensive studies conducted in various sleep laboratories show that sleep talking occurs at all stages of the sleep of the sleep talker.
Talking while sleeping is called sleep talking. Usually the sleeping person utters a few words which are jumped up and quite difficult to understand. Sleep talking’s are usually very brief and does not normally relate to ones dream or secret of life. Sleep talking sometimes’ may be accompanied with sleep walking and night terrors. However, sleep talking does not require any treatment.
(c) Sleep Terror Disorder:
Sleep terror disorder occurs usually in the first terror of the night during deep sleep. In sleep terror disorder the sleeping person screams, cries or shows various behavioural manifestations of intense anxiety leading to panic like state. The patient gets up from bed, is scared, trembles with frightening expressions, screams loudly or sobs and sometimes shows a sense of intense terror.
Polygraphic recordings of night terrors are like those of sleep walking and actually sleep walking and sleep talking is found to be highly related. Sleep terrors are particularly found in children. It is more common in males than in females. It is believed that sleep terror disorder has a genetic root.
Kaplan and Sadok are of view that it is possible that night terrors represent a minor neurologic abnormality perhaps in the temporal lobe or underlying structures, because in these cases where night terrors begin in adolescence and young adult hood, they turn out to be the first symptom of temporal lobe epilepsy.
In a typical case of night terror however no signs of temporal lobe epilepsy or other seizure disorders are seen either clinically or on E.E.G. recordings.
Besides being closely related to sleep walking, night terrors are also occasionally related enuresis. But night terrors and nightmares are not same.
Treatment:
Though no specific treatment for night terror disorder is required, stressful family environment may be a cause of night terror and hence the family environment of the child is to be changed from stress to relaxation. Individual family therapy can be of some help in reducing night terror.
Parents and relations should not try to scare the child and should not tell him fearful stories particularly in the night. Too much pressure on the child to study and study, to be disciplined, obedient, socialized should not be put.
The rearing of the child should be done in a normal and relaxed manner. Fear, anxiety and stressful life of the parents have also negative impact on the child’s personality. Hence parents should be very careful and cautious in this regard. Medication may be required in very rare cases.
(d) Dream Anxiety Disorder:
A dream anxiety disorder is otherwise called a nightmare. It is a long frightening dream from which the person awakens frightened. Dream anxiety disorders almost always occur during REM sleeper after a long REM period late in the night.
While people usually have dream anxiety disorder, it is frequent when they pass through illness, stressful period of life, or when some nightmares are experienced. Valliant holds persons with frequent nightmares throughout their life appear to have certain vulnerability to schizophrenia. About 5 per cent of the general population reports this dream anxiety disorder at some time of their lives.
Dream anxiety disorder symptoms show repeated awakening from the major sleep period i.e., in the second half of the sleep period with detailed recall of extremely fearful dreams, usually involving threat to their security, self esteem and survival. On awakening, the person becomes completely normal, alert and reality oriented.
Of course on awakening, the dream experience causes distress. That some organic factor like medication is responsible for such disorder has not been established. However, excessive anxiety and stress may explain to some extent dream anxiety disorder. As dream is said to be the royal road to unconscious any amount of repression of anxiety provoking experiences is reflected in one’s dream.
Development of a sound and healthy, stress free, pressure free personality during early and late childhood perhaps can prevent dream anxiety disorder, unless of course any organic or genetic factor is responsible for the same which future research can only establish.
5. Factitious Disorder and its Treatment:
Any physical or psychological disorder intentionally produced or imagined by the patient is called factitious disorder. This disorder is better known as Munchausen’s syndrome. Factitious literally means artificial and not natural or genuine.
Those whose primary aim is to stay in the hospital by hook or crook and get nursing and care treatment, get by being hospitalized, they develop this disorder deliberately and purposefully though actually there is no such disorder. To an extent this is similar to certain hysterical illness where the patient complains of several illnesses to get sympathy and attention of others.
But this disorder differs from hysterical disorders in one respect. While in several hysterical disorders the symptoms are unconsciously produced to relieve stress and anxiety in fictitious disorder, the symptoms are consciously and wilfully produced and are under the voluntary control of the patient.
On the disguise of some illness they try to stay in the hospital. This disorder appears more frequently in males and hospital or health care workers. The disorder begins in early adulthood. The aim of a factitious patient is to play the role of a sick person by cheating the doctor.
Aetiology of Factitious Disorder:
Early childhood frustration and deprivation, rejected and oppressed home life, serious illness during childhood or adulthood and care, nursing and sympathy provided by doctors and medical staff, etc. are said to be some, known causes of the factitious disorder.
Persons disabled from early life, rejected and oppressed home life, negligent and rejecting mother, absent father, want of good relationship with parents etc. are conducive to factitious disorder keeping other factors constant. Thus to recreate a positive parent child bond between the patient and his family members he pretends to be ill so as to draw their sympathy and attention.
Usually, the patient identifies his rejecting parents with the doctors, nurses and staff of the hospital. “The factitious disorder is a kind of repetition or compulsion i.e., repeating the basic conflict of needing and seeking acceptance and love while expecting that they will not be forthcoming. Hence the patient transforms the physician and staff into rejecting parents.” —Kaplan and Sadok
Some have suggested that quite a few factitious patients assuming the role of a patient and relieving the painful and frightening experience over and over again through a number of hospitalizations try to be relieved of the past and early traumatic experience.
The self esteem, identity formation, self-image of these patients is very poor and low. They have disturbed interpersonal relationship. They have no self confidence, no view of their own and are highly suggested by those around them.
Though the patients imagine a lot regarding their so called disease, the persons around them are also partly responsible in contributing to the factitious disorder. Friends and relatives participate in fabricating the illness. The major defence mechanism used by some factitious patients are repression, identification, regression and symbolization.
Symptoms of Factitious Disorder:
i. Physical Symptoms:
The patients develop:
(i) Munchausen’s Syndrome also known as hospitalizing addiction, and
(ii) Professional patient syndrome.
These patients develop various physical symptoms so perfectly that they easily get admission into hospitals and stay there. They very well imagine physical symptoms of a particular disease. The clinical symptoms usually observed are hematoma, hemoptysis, abdominal pain, fever, hypoglycemia, nausea, vomiting, dizziness and seizures.
Pain due to renal colic are common with patients wanting narcotics. When the various medical tests show negative results they blame, abuse and threaten the doctor. If they are discharged from one hospital, they go to another hospital and get admission there.
According to DSM III-R actual physical disorders during childhood which required long term and extensive medical treatment, grudge against the medical profession, employment as a medical, para medical professional etc. are the predisposing factors.
ii. Psychological Symptoms:
Certain psychiatric syndromes are shown by some patients which are found to be imaginary and act as genuine symptoms are found to be false or imagined only after thorough investigation. Depression, auditory and visual hallucination, bizarreness, various hysterical symptoms, memory loss etc. are commonly complained.
Findings of studies conducted recently indicate that factitious psychotic symptoms are now more common than what was suspected earlier. Patients may present themselves as depressed mentioning the cause of such depression as death of a close relative or major financial loss.
Usually factitious disorders combined with both physical and psychological symptoms are more commonly found than either of the one which is less common.
Factitious disorder usually starts in early adult life although in some cases it may begin during childhood and adolescence. The actual disorder starts after a genuine and real illness for which the patient was hospitalized. Loss of support and affection of parents and parental rejection also are additional causes of onset of factitious disorder.
Sometimes the patient identifies with the hospitalization of a close relative and develops factitious dysfunction. This disorder makes the patient en-capable, produces severe trauma or in-toward reactions related to the treatment.
A few patients with this disorder may show signs of severe thought disorder or delusions common in schizophrenia patients. Many of these patients appear to show hysterical symptoms and have border line personality disorder. In order to ascertain whether the illness of the patient is genuine or false interview of close friends and relatives can be taken besides conducting various physical or psychological tests.
The interview should be conducted cautiously so that the patient will not suspect the intention of the psychiatrist as otherwise it may aggravate the symptoms of the patient. By use of various psychological tests the specific underlying pathology may be traced.
These people have identity crisis, poor frustration tolerance, confusion over sexual identity, poor sexual adjustment, store dependency needs and narcissism. The outcome of the disease varies between brief disorders and lifelong disorders.
Treatment of Factitious Disorder:
In the treatment of factitious disorder no particular psychiatric treatment has proved effective. Therefore prevention and management rather than cure should be followed for the factitious patients only by recognizing the disorder.
Successful management of the disease can be possible. The patient physician relationship should be cordial. Otherwise it would aggravate the condition of the patient. Physicians should not resent, complain or feel otherwise if and when some patients misbehave or humiliate them.
Usually factitious patients show resistance to treatment and change physicians once their cheating is discovered. The treatment is also made by considering the symptomatology with reference to the psychological factors, past and present. Comorbid psychiatric disturbance is evaluated and treated in some cases.
6. Impulse Control Disorder and its Treatment:
An impulse is a disposition or complex to act abruptly or hastily to decrease tension caused by diminished ego defences against instinctual drives. Impulse control disorder lacks deliberation.
Patients with impulse control disorders have the following characteristics:
1. They fail to resist or control an impulse consciously. They cannot check temptation to do something which appears to be harmful to them or others in the society.
2. Before starting the impulsive act an increase in the sense of arousal and tension is experienced by them.
3. The impulsive act is in consonance with the individual’s immediate conscious drive. Some may feel guilty, show regret after the act while others may not. While committing the act there may be pleasant feeling, feeling of gratification or release.
4. The 5 categories of impulse control disorder are:
1. Intermittent Explosive Disorder:
It is characterized by discrete episodes of loosing control of one’s aggressive behaviour and leading to violent actions like assault, murder, destruction of property or causing injury to other people.
2. Kleptomania:
The unconscious desire and the strong impulse for theft refers to kleptomania.
3. Pyromia:
It means deliberate and purposeful fire setting on more than one occasion.
4. Pathological Gambling:
It means a chronic and increasing failure to check impulses to gamble that damages personal reputation and professional life.
5. Trichotillomania means the continuous failure to resist impulses to pull out one’s own hair. It is distinguished from hair pulling caused by inflammation of skin or a response to a delusion or hallucination.
Aetiology of Impulse Control Disorder:
Causes of impulse control disorder are not specifically known. It is believed by experts that biological, psycho-social or psychodynamic cause interacts with such other to cause impulse control disorder. The outcome of impulse control disorder is dangerous for the person committing it as well as to others. The knowledge of past guilt and pain can aggravate the impulse control disorder.
In Fenicheli’s view the impulsive actions defend the person against depression and danger and produce a distorted sexual and aggressive satisfaction. These actions are more focused in reducing tension and less directed towards achieving a goal.
Many clinical psychologists and psychiatrists have emphasized the patient’s fixation at the oral stage of psycho-sexual development and these patients try to express their anxiety and guilt etc. through their impulsive action. But these actions rarely give any relief even temporarily.
Many psychiatrists doing experiments on brain and brain dysfunctions to hold that there are some organic causes in impulsive behaviour particularly in patients showing violent and aggressive behaviour. They have noticed that specific brain regions like the limbic system is associated with impulsive and violent behaviour.
Also hormones like testosterone are found to be associated with violent actions. Relationship between head trauma and aggressive behaviour, temporal lobe epilepsy and some violent behaviour has been observed.
Certain recent investigations in the area of impulse control disorder and its treatment have indicated that persons classified as suffering from childhood minimal brain dysfunction syndromes carry the disease of impulse disorder to adulthood. Moreover, mental deficiency and sometimes reversible brain functions are found to be aggravating impulse control disorder.
Sometimes drugs, alcohol and other intoxicants also diminish ego defences leading to stealing, gambling, setting fire and actual physical fight for fun sake without any genuine reasons. Child imitates models, peers and parents lacking the capacity to control their impulsive behaviour and starts behaving like them.
Aggressive angry parents engaged in violent quarrelling, showing anti-social tendencies, taking excessive alcohol also may lead to impulse control disorder.
Treatment of Impulse Control Disorder:
The five different types of impulse control disorders have different types of treatments:
1. Intermittent Explosive Disorder:
For treatment of intermittent explosive disorder, a combined pharmacological psychotherapeutic treatment procedure giving work emphasis on the former is applied. For violent patients, psychology in not possible. Group psycho-therapy and family therapy may be of some help to violent but adolescent and young patients.
2. Kleptomania:
Insight oriented psychotherapy and psychoanalysis are found to be successful provided the patient is motivated to be cured and cooperates with the treatment. Those kleptomaniacs who experience guilt and shame for their impulsive action and want to be cured are benefitted by insight oriented psychotherapy.
Systematic desensitization and aversion conditioning and marital therapy used separately and combined as and when necessary may also prove successful in cases where there may not be motivation.
3. Pathological Gambling:
Experience and investigation show that pathological gambling rarely come forward on their own for the treatment of their disorder. However, family and peer, public pressure, social and legal difficulties compel them to come forward for treatment.
Gambler’s Anonymous is perhaps the most effective treatment of pathological gambling. Sometimes by removing the patient from his environment and hospitalizing him may prove successful. Insight oriented psychotherapy may also be beneficial.
4. Pyromania:
Because of lack of motivation treatment of fire setters has been difficult. However, behaviour therapy may be of some help. In case of children intensive intervention should be made whenever possible as preventive measures.
5. Trichotillomania:
The continuous failure to resist one’s impulses to pull out one’s own hair is known as Trichotillomania the treatment for which has no common opinion. However, psychiatrists and dermatologists make joint efforts for this treatment.
Psychopharmacologic method, anti-depressants and neurodeptics have been used as treatment methods. Hypnotherapy to some extent may be helpful. Though nothing can be opened specifically, biofeedback also proves to be effective in some cases. Supportive and insight oriented psychotherapy may also reduce the symptoms.
Since most of these treatments have been made on small samples with little follow up study it cannot be concluded which technique of treatment is most effective. Further research in this area is desirable to reach at same definite view on the treatment of Trichotillomania.