Lesson 17: Mental Health Disorders

Anxiety

- A normal response to stress, uncertainty, or dread - Occurs as a result of threats to identity or self-esteem; may result when values are threatened or may precede new experiences - May be acute (precipitated by an imminent loss or change that threatens the individual's sense of security) or chronic (anxiety the individual has had for an extended period) -Ranges from mild to panic

Somatic Symptom Disorders: Conversion Disorder

- A physical symptom or a deficit suggests loss or altered body function when no organic cause exists. - The most common conversion symptoms are blindness, deafness, paralysis, and the inability to talk. - The client is unconcerned by his or her symptoms (la belle indifference).

Eating Disorders: Interventions

- Acknowledge the client's emotional and physical difficulties. - Assess the client's suicidal potential. - Assess the client's nutritional status and weight. - Set goals with the client concerning the diet plan for the day. - Set a time limit for each meal (usually a half-hour). - Supervise the hospitalized client during mealtimes and for a specified period after meals. - As the client approaches his or her target weight, encourage the client to make his or her own choices from the menu. - Monitor the client for signs of physical complications related to the eating disorder. - Record intake and output. - Monitor and restore fluid, vitamin, mineral, and electrolyte balance. - Monitor the client's elimination pattern. - Assist the client in identifying precipitants of the eating disorder. - Encourage the client to express feelings about the eating behavior. - Encourage behavior-modification techniques. - Provide praise and positive reinforcement for accomplishments. - Provide an exercise program. - Encourage the client to participate in diversional activities. - Encourage psychotherapy as prescribed. - Refer the client to support groups.

Cognitive Impairment Disorders: Interventions for Impaired Communication

- Adapt to the communication level of the client. - Call the client by name and identify self, then wait for a response before continuing. - Use a calm and reassuring voice; pantomime if the client is unable to understand spoken words. - Use short words and simple sentences; ask only one question at a time and give one direction at a time. - Repeat questions if necessary, but do not rephrase.

Cognitive Impairment Disorders: Interventions for Altered Sleep Pattern

- Allow the client to wander in a safe place until he or she becomes tired. - Provide physical activity during the day. - Try to prevent shadows in the room. - Avoid the use of hypnotics, which may cause confusion.

Phobia

- An irrational fear of an object or situation that persists even though the person may recognize it as unreasonable. - Panic-level anxiety may ensue if the object, situation, or activity cannot be avoided.

Personality Disorders: Interventions

- Assess client for suicide risk. - Maintain safety of client, staff, and visitors. Inform the client that harm to self, others, or property is unacceptable. - Allow the client to make choices and be as independent as possible. - Encourage the client to discuss feelings rather than act them out. - Provide consistency in response to the client's acting-out behaviors. - Discuss expectations and responsibilities with the client. - Set and maintain limits to decrease manipulative behavior. - Discuss the consequences that will follow certain behaviors. - Identify splitting behavior (a defense mechanism used by the individual to protect self) - Help the client deal directly with aggressive or angry feelings. - Encourage the client to keep a journal recording daily feelings. - Encourage the client to participate in group activities, unless the client has a tendency to harm others. - Remove the client from group situations in which attention-seeking behaviors occur. - Provide realistic praise for positive behaviors.

Psychosocial Alterations: Sexuality - Interventions

- Assess sexual history, history of trauma or abuse, and precipitating event for the sexual disorder. - Determine whether the client is a threat to the safety of self or others. - Encourage the client to explore personal feelings and beliefs. - Project a nonjudgmental attitude. - Provide supportive psychotherapy.

Somatic Symptom Disorders: Interventions

- Assess the client for a physical problem. - Do not reinforce the "sick" role, and discourage verbalization about physical symptoms by not responding with positive reinforcement. - Explore with the client the needs being met by the physical symptoms. - Help the client identify alternative ways of meeting needs. - Allot a specific period in which to discuss physical complaints; the client will feel less threatened if this behavior is limited rather than stopped completely. - Convey understanding that the physical symptoms are real to the client. - Assure the client that physical illness has been ruled out. - Use relaxation techniques to ease the client's anxiety. - Encourage diversionary activities to reduce the client's focus on self and redirect the client's thoughts and feelings - Administer antianxiety medications as prescribed.

Paranoid Disorder: Interventions

- Assess the client for suicide risk. - Assure the client that he or she will be safe. - Monitor food and fluid intake (the client may believe that food is poisoned), sleeping pattern (the client may be afraid to go to sleep), and elimination patterns (may be a problem if intake of food and fluid is deficient). - Try to avoid suspicious behavior (e.g., do not whisper in the client's presence). - Do not be secretive with the client. - Respond honestly to the client and follow through on commitments made to the client. - Acknowledge the client's feelings, but tell the client that you do not share his or her interpretation of an event if this is the case. - Refocus the conversation to reality-based topics. - Provide the client opportunities to complete small tasks. - Involve the client in noncompetitive and solitary activities that require some degree of concentration. - Promote increased self-esteem; provide positive reinforcement for successes. - Gradually introduce the client to groups (but limit physical contact). - Monitor the client for agitation and decrease stimuli as needed. - Respond appropriately to hostile, aggressive, or quarrelsome behavior.

Schizophrenia: Interventions

- Assess the client's physical needs and ensure the client's safety at all times. - Assess the client for his or her suicide risk. - Spend time with the client even if the client is unable to respond (sit with the client in silence, if necessary), and tell the client when you are leaving. - Limit stimuli in the environment as appropriate. - Initiate one-on-one interaction and progress to small groups as this is tolerated. - Maintain ego boundaries and avoid touching the client. - Monitor the client for altered thought processes and maintain reality. - Establish daily routines. - Initially, do not offer choices to the client, then gradually begin assisting the client in making his or her own decisions. - Help the client improve grooming and accept responsibility for personal care. - Provide simple, concrete activities. - Help the client express feelings through music or art therapy or writing. - Remove the client from group situations if the client's behavior is bizarre, disturbing, or dangerous to others. - Provide soft music at night to help ease insomnia. - Institute interventions for delusions or hallucinations as needed.

Panic Disorder: Interventions

- Attend to physical symptoms first. - Interventions are similar to those for a client with anxiety.

Cognitive Impairment Disorders: Interventions for Altered Thought Processes

- Call the client by name. - Orient the client frequently. - Place familiar objects in the client's room. - Place a calendar and a clock in a visible place. - Maintain familiar routines. - Allow the client to reminisce. - Make tasks simple and allow time for the client to complete a task. - Provide positive reinforcement for positive behaviors.

Somatic Symptom Disorders

- Characterized by persistent worry or complaints regarding physical illness when there are no supporting physical findings - May be unconscious, related to conflict and the reduction of anxiety, or related to a secondary gain - May cause significant impairment of social and occupational function

Panic Disorder: Assessment - Physical and Psychological Symptoms

- Choking sensation - Labored breathing - Palpitations and chest pain - Dizziness - Nausea and abdominal pain - Blurred vision - Numbness or tingling of the extremities - Sense of unreality and helplessness - Fear of being trapped - Fear of dying

Schizophrenia: Assessment

- Disheveled appearance - Neglect of eating, sleeping, and elimination - Abnormal Thought Processes - View of the world as threatening and unsafe - Performance of compulsive rituals - Affective disturbances: flat or inappropriate affect with altered thought processes - Delusions - Perceptual distortions (e.g., hallucinations) - Language and communication disturbances

Dissociative Disorders

- Dissociative disorders are a variety of conditions reflecting disruption in the integrative function of memory, consciousness, or identity. - These disorders are associated with exposure to a traumatic event.

Paranoid Disorder: Behaviors

- Emotionally distant - Distorts reality - Low self-esteem - Highly sensitive, experiencing difficulty admitting his or her own errors and taking pride in being correct - Hypercritical and intolerant of others - Hostile, aggressive, and quarrelsome - Delusions, which serve a purpose in establishing identity and self-esteem, with the need for delusions decreasing as trust in others increases

Dissociative Disorders: Interventions

- Encourage verbal expression of painful experiences, anxieties, and concerns and identify sources of conflict (do not flood the client with data regarding past events, however). - Focus on the client's strengths and skills and explore methods of coping. - Maintain the client's orientation and ensure his or her safety. - Encourage the client to do things for himself or herself and to make simple decisions (e.g., routine tasks). - Provide nondemanding, simple tasks and allow the client to progress at his or her own pace. - Use stress-reduction and relaxation techniques. - Plan for psychotherapy (individual, group, or family, as needed) to integrate dissociated aspects of personality or memory and to expand self-awareness.

Eating Disorders: Compulsive Overeating

- Food consumption is out of the individual's control and takes place in a stereotypical fashion. - The client may be repulsed by his or her binging; the eating relieves tension but does not produce pleasure. - The client is aware that the eating pattern is abnormal and feels depressed after eating. - The client eats secretly during a binge, consuming high-calorie, easily digestible food. - The client repeatedly tries to diet, without success. - The client lacks interest in exercise programs and feels helpless and hopeless about his or her weight. - When experiencing feelings such as guilt, anger, depression, boredom, loneliness, inadequacy, or ambivalence, the client responds by eating.

Cognitive Impairment Disorders: Interventions

- Identify and reinforce retained skills. - Orient the client to his or her environment and furnish it with familiar possessions. - Help the client and family members manage memory deficits and behavioral changes. - Encourage family members to express their feelings about caregiving. - Provide support to the caregiver and identify available resources and support groups. - Monitor the client's activities of daily living and provide step-by-step instructions when directing self-care activities. - Maintain the client's independence as much as possible. - Provide consistent routines and allow plenty of time for client to complete a task. - Provide exercise (e.g., walking with an escort). - Use constant encouragement in a step-by-step approach. - Provide activities that distract and occupy time (e.g., listening to music, coloring, watching TV), but avoid activities that tax the memory. - Provide mental stimulation with simple games or activities.

Obsessive-Compulsive Disorder: Interventions

- Identify the situations that precipitate the behavior. - Do not interrupt the compulsive behavior unless it affects the client's physical well-being or safety. - Give the client time to perform the compulsive ritual. - Devise a schedule for the client that distracts him or her from the compulsive behavior. - Set limits on the rituals that may interfere with the client's physical well-being to protect the client from physical harm. - Encourage the client to verbalize concerns; help the client gradually decrease the frequency of compulsive rituals.

Altered Thought Processes

- Impaired reality testing - Magical thinking - Totally self-centered perception of environment - Inability to organize facts logically - Blocking: sudden cessation of a thought in the middle of a sentence, with client unable to continue the train of thought, and suddenly bringing up new thoughts, unrelated to the topic - Circumstantiality: becoming caught up in countless details and explanations before getting to the point or answering a question - Confabulation: filling of a memory gap with detailed fantasy believed by the teller, the purpose being to maintain self-esteem - Flight of ideas: constant flow of speech in which the individual jumps from one topic to another in rapid succession - Looseness of association: haphazard, illogical, and confused thinking, with connections in thought interrupted - Neologisms: words made up by an individual that have meaning only for that individual

Dissociative Disorders: Dissociative Identity Disorder (Multiple Personality)

- In this disorder, two or more fully developed distinct and unique personalities are present within one person. - The personalities may take full control of the client, one at a time and may or may not be aware of one another. - Transition from one personality to the other is sudden and related to stress.

Abnormal Thought Processes

- Inability to initiate activity - Inability to respond to commands (or response only to commands) - Distorted perception of environment - Catatonia: psychologically induced state in which two extreme motor behaviors, extreme motor agitation and extreme psychomotor retardation (with mutism and stupor), are noted - Dyskinesia: impairment of voluntary movements - Echopraxia: repeating the movements of another person - Parkinsonian symptoms: masklike faces, drooling, shuffling gait, tremors, muscle rigidity - Waxy flexibility: holding a position for hours after having one's arms or legs placed in a specific position

Language and Communication Disturbances

- Inability to organize language, including the formulation of appropriate responses - Difficulty communicating clearly - Use of a single word or phrase to represent the whole meaning of the conversation, with the client possibly feeling that he or she has communicated adequately - Development of a private language by the client - Clang association: repetition of words or phrases that are similar in sound but in no other way - Echolalia: repetition of words or phrases heard from another person - Metonymic speech: mental confusion demonstrated by the use of a word that is not the precise term intended but is of similar meaning - Mutism: absence of verbal speech - Pressured speech: speaking as if the words were being forced out quickly - Stilted language: inappropriate and overly formal communication pattern, usually written, that seems artificial and intellectual - Verbigeration: purposeless repetition of words or phrases - Word salad: form of speech in which words or phrases are connected meaninglessly

Mania

- Inappropriate, high, and unstable affect - Restlessness - Extroverted personality - Delusional self-confidence - Flight of ideas: constant flow of speech in which the individual jumps from one topic to another in rapid succession - Grandiose and persecutory delusions - Urgent motor activity and unlimited energy - Distraction by environmental stimuli - Manipulative - Quickness to anger, leading to combative or violent behavior - Inability to eat or sleep because of involvement in "more important things" - Inappropriate dress - Sexual promiscuity

Deescalation Techniques

- Maintain the safety of the client, other clients, and yourself. - Maintain a large personal space and use a nonaggressive posture. - Use a calm approach and communicate in a calm, clear tone of voice; be assertive, not aggressive. - Determine what the client considers his or her need. - Avoid verbal struggles. - Provide the client with clear options that deal with the client's behavior. - Assist the client in problem-solving and decision-making regarding options.

Panic Disorder

- May be associated with a phobia or other fear-producing event, but sometimes the cause is unknown - Sudden onset of feelings of intense apprehension and dread - Characterized by severe, recurrent, intermittent anxiety attacks lasting 5 to 30 minutes

Events Associated With PTSD

- Natural disaster - National attack - Combat experiences - Accidents - Crime or violence (victims and witnesses) - Sexual, physical, or emotional abuse

Obsessive-Compulsive Disorder

- Obsessive-compulsive disorder includes disorders such as hoarding disorder and excoriation(skin-picking) disorder. - Obsession is a preoccupation with persistent, intrusive thoughts and ideas. - Compulsion is the repeated performance of rituals or purposeless behaviors designed to prevent some event, divert an unacceptable thought, and ease anxiety. - Obsessions and compulsions often occur together and may disrupt normal activities. - Anxiety occurs if an obsession or compulsion is resisted.

Psychosocial Alterations: Sexuality

- One's sense of being a sexual individual - Includes how one looks, behaves, and relates to others - May take many different forms

Cognitive Impairment Disorders: Dementia

- Organic syndrome with progressive deterioration in intellectual function - Long-and short-term memory loss with impairment of judgment, abstract thinking, problem-solving ability, and behavior - Most common type: Alzheimer's disease

Post-Traumatic Stress Disorder (PTSD): Assessment

- Persistent negative alterations in cognition and moods (persistent negative emotional states) - Alterations in arousal and reactivity such as irritable or aggressive behavior or self-destructive behavior - Sleep disturbances and nightmares - Guilt about surviving the event - Poor concentration and avoidance of activities that trigger the memory of the event

Anxiety: Interventions

- Protect the client and attend to any physical needs. - Reduce anxiety quickly, particularly if the client's anxiety is in the range of severe to panic. - Stay with the client. - Minimize environmental stimuli. - Help the client identify the thoughts and feelings that occurred before the onset of anxiety and talk about them. Monitor for signs of impending destructive behavior. - Allow the client to use appropriate and safe coping mechanisms. - Encourage relaxation techniques and problem-solving. - Encourage gross motor exercise. - Administer antianxiety medications as prescribed.

Cognitive Impairment Disorders: Interventions for Wandering

- Provide a safe environment to prevent unsafe wandering. - Provide close supervision. - Close and secure doors with safety locks. - Use identification bracelets and electronic surveillance.

Anorexia Nervosa: Assessment

- Refusal to eat, appetite loss, and denial of appetite - Feelings of lack of control - Self-induced vomiting and self-administered enemas - Compulsive exercise - Classically affects overachievers and perfectionists - Development of physical manifestations affecting every body function as deficiencies (e.g., fluid, vitamin, mineral, electrolyte) develop

Post-Traumatic Stress Disorder (PTSD): Interventions

- Relaxation techniques - Individual therapy addressing loss-of-control issues, anger, or guilt - Desensitization, if appropriate - Hypnotherapy - Support groups

Cognitive Impairment Disorders: Interventions for Impaired Judgment

- Remove hazardous items (e.g., throw rugs, toxic substances, dangerous electrical appliances) from the environment. - Lower the temperature setting of the water heater.

Bipolar Disorder: Interventions for Mania

- Set limits on inappropriate behaviors and be ready to use deescalation techniques. - Monitor calorie intake; provide high-calorie finger foods and fluids (but avoid caffeine-containing products). - Monitor the client's bowel pattern; offer foods and fluids that contain fiber. - Assess the client for fatigue; ensure frequent rest periods and institute comfort measures to promote sleep, including a private room if possible. - Maintain a low level of stimulus in the environment. - Provide simple and direct explanations for routine procedures. - Supervise the client's choice of clothing. - Encourage the client to express his or her feelings. - Help the client focus on one topic during conversation. - Distract the client from grandiose thinking. - Present reality but do not argue with the client. - Provide structured activities or one-on-one activities with the nurse; avoid competitive games. - Encourage physical activities (gross motor) such as walking if the client exhibits aggressive behavior; otherwise, solitary and quiet activities are appropriate to prevent exhaustion. - Supervise the administration of medication.

Phobias: Interventions

- Stay with the client when anxiety is high to promote safety and security. - Identify the basis of the anxiety and allow the client to verbalize feelings about the anxiety-producing object or situation; talking frequently about the feared object is the first step in the desensitization process. - Do not force contact with the phobic object or situation. - Teach the client relaxation techniques. - The mental health care professional can induce desensitization by gradually introducing the individual to the feared object or situation in small doses.

Dissociative Disorders: Depersonalization/derealization Disorder

- The client experiences altered self-perception in which his or her reality is temporarily lost or changed. - The client experiences feelings of detachment from his or her own body or from the environment.

Bulimia Nervosa

- The client indulges in eating binges followed by purging behaviors. - Most clients remain within the normal weight range but feel that their lives are dominated by the eating-related conflict.

Anorexia Nervosa

- The client intensely fears obesity. - The client is preoccupied with weight gain and has a phobia regarding foods that are perceived to produce weight gain. - Onset is often associated with a stressful life event. - Body image is distorted, and the client has a disturbed self-concept. - Death may occur as a result of starvation, electrolyte imbalance, or suicide.

Bulimia Nervosa: Assessment

- The client is preoccupied with body shape and weight. - High-calorie food is consumed in secret; the client feels guilt about secretive eating. - The client engages in binge-purge syndrome; attempts at weight loss are made through the use of diets, vomiting, enemas, cathartics, and amphetamines or diuretics. - The client feels the need for control yet experiences feelings of powerlessness or loss of control. - Bulimics generally have low self-esteem. - The client may have a history of poor interpersonal relationships and be subject to mood swings. - Self-mutilating behavior is common; the affected client may have thoughts of and make attempts at suicide. - Physical manifestations that affect every body function may occur as deficiencies (e.g., fluid, vitamin, mineral, electrolyte) develop.

Somatic Symptom Disorders: Hypochondriasis

- The client is preoccupied with fears of a serious disease. - The disorder is often marked by the extensive use of home remedies or nonprescription medications. - The client repeatedly visits health care providers.

Dissociative Disorders: Dissociative Amnesia

- The client is unable to recall important personal information because it provokes anxiety. - Memory loss may be localized (i.e., the client blocks out all memories about a specified period), selective (i.e., the client recalls some but not all memories about a specified period), or generalized (i.e., the client loses all memory). - The client may assume a new identity in a new environment, may drift from place to place, develop few relationships, then return home unable to remember the amnesia.

Personality Disorders: Characteristics

- The client with a personality disorder generally has poor impulse control, using acting-out behaviors — for instance, physical and verbal attacks, manipulation, substance abuse, sexually promiscuous behavior, and suicide attempts — to manage internal pain. - The client has feelings of abandonment and depression; moods may include rage, guilt, fear, or emptiness. - Impaired judgment: The client has difficulty with problem-solving and is unable to perceive the consequences of his or her behavior. - Impaired reality testing: The client distorts reality and often projects his or her own feelings onto others. - Impaired object relations: The client is rigid and inflexible and has difficulty developing and maintaining existing intimate relationships. - The client experiences distorted self-perception, including self-hate or self-idealization. - Impaired thought processes: The client has difficulty concentrating, and memory is impaired. - Impaired stimulus barrier: The client is unable to regulate incoming sensory stimuli and experiences increased excitability, poor attention span, agitation, and insomnia.

Bipolar Disorder

- The disorder is characterized by episodes of mania and depression interspersed with periods of normal mood and activity. - Clients with bipolar disorder are treated with medication such as lithium carbonate, psychotherapy, and sometimes electroconvulsive therapy. - Participation in support and self-help groups may be beneficial.

Cognitive Impairment Disorders: Alzheimer's Disease

- This irreversible form of senile dementia results from nerve cell deterioration. - The client experiences cognitive deterioration and progressive loss of ability to carry out activities of daily living. - The client experiences a steady decline in physical and mental function and usually requires long-term care placement in the final stages of the illness. - The disease first manifests as mild memory impairment; the client has difficulty remembering names, appointments, and where things are located. - As the disease progresses, moderate memory impairment, particularly of recent events, occurs.

Cognitive Impairment Disorders: Interventions for Agitation

- Try to determine the precipitant of the agitation. - Approach the client slowly and calmly from the front, then speak, gesture, and move slowly. - Remove the client to a less stressful environment. - Use touch gently. - Do not argue with or restrain the client. - Distract the client with questions about the problem, then gradually turn the client's attention to something else.

Personality Disorders: Obsessive-Compulsive personality disorder

A client with obsessive-compulsive personality disorder is inflexible, preoccupied with details and rules, orderly, a perfectionist, overly conscientious, devoted to work, and lacks involvement with leisure activities and friendships.

Personality Disorders: Passive-Aggressive personality disorder

A client with passive-aggressive personality disorder passively expresses covert aggression instead of dealing with it directly.

Schizophrenia

A group of mental disorders characterized by psychotic features (hallucinations and delusions), disordered thought processes, and disrupted interpersonal relationships.

Post-Traumatic Stress Disorder (PTSD)

An individual relives a psychologically traumatic event by way of recurrent and intrusive dreams or flashbacks.

Personality Disorders: Avoidant personality disorder

Avoidant personality disorder is characterized by feelings of inadequacy, social withdrawal, and hypersensitivity.

Personality Disorders: Borderline personality disorder

Borderline personality disorder is characterized by instability in interpersonal relationships, mood, and self-image; behavior may be impulsive and unpredictable.

Eating Disorders

Characterized by uncertain self-identification and grossly disturbed eating habits

Sexual Disorders: Pedophilia

Desiring sexual activity with a child

Zoophobia

Fear of animals

Monophobia

Fear of being alone

Hematophobia

Fear of blood

Nyctophobia

Fear of darkness

Mysophobia

Fear of dirt and germs

Astraphobia

Fear of electrical storms

Claustrophobia

Fear of enclosed or narrow spaces

Pyrophobia

Fear of fire

Acrophobia

Fear of heights

Agoraphobia

Fear of open spaces

Social Phobia

Fear of situations in which one might be embarrassed or criticized; fear of making a fool of oneself

Xenophobia

Fear of strangers

Hydrophobia

Fear of water

Personality Disorders: Histrionic personality disorder

Histrionic personality disorder is characterized by overly dramatic and intensely expressive behavior; the client enjoys being the center of attention.

Personality Disorders: Antisocial personality disorder

In antisocial personality disorder, the client exhibits a pattern of irresponsible and antisocial behavior characterized by selfishness, inability to maintain lasting relationships, poor sexual adjustment, failure to accept social norms, irritability, and aggressiveness. The client does not have insight into their own behavior and does not exhibit regret for actions taken.

Personality Disorders: Dependent personality disorder

In dependent personality disorder, the client lacks self-confidence and the ability to function independently; he or she passively allows others to make decisions and assume responsibility for major areas of his or her life.

Sexual Disorders: Zoophilia

Intense sexual arousal or desire for sexual contact with animals

Sexual Disorders: Frotteurism

Intense sexual arousal or desire when rubbing against a nonconsenting person

Personality Disorders: Narcissistic personality disorder

Narcissistic personality disorder is characterized by an increased sense of self-importance; the client is preoccupied with fantasies, including unlimited success, and has a constant need for attention and admiration.

Personality Disorders: Paranoid personality disorder

Paranoid personality disorder is characterized by suspiciousness and mistrust of others.

Personality Disorders: Schizoid personality disorder

Schizoid personality disorder characterized by the inability to form close social relationships.

Personality Disorders: Schizotypal personality disorder

Schizotypal personality disorder involves abnormal or highly unusual thoughts, perceptions, speech, and behavior patterns.

Sexual Disorders: Sexual masochism

Sexual gratification from having pain inflicted on oneself

Sexual Disorders: Sexual sadism

Sexual gratification from inflicting pain

Sexual Disorders: Voyeurism

Sexual gratification obtained through observing others disrobing or engaging in sexual activity

Sexual Disorders: Exhibitionism

Sexual urges and fantasies involving exposure of the genitals to strangers

Paranoid Disorder

The client demonstrates suspiciousness and mistrust of others.

Sexual Disorders: Fetishism

The use of nonliving objects for sexual gratification

Personality Disorders

Various inflexible maladaptive behavior patterns or traits that may impair function and relationships