Author: Mark Moran

Christian Counseling, the DSM-V-TR & Sexual/Paraphilic/Gender Deviations & Issues

Posted on by Mark Moran

Forewarning, this blog presents adult topics regarding a sexual nature but also from a Christian perspective for purposes of Christian Counseling and Direction.  As a program of AIHCP, the content regarding morality is for purposes of Christian Counseling and sexuality not official views of AIHCP.  Regardless, the material presented represents a detailed and academic description of these issues and presents the various understandings of them, while maintaining a Christian mandate that requires love and respect of differing opinions regarding the subject.  For those of differing morality and faith or sexual orientation, please feel invited to still review in an attempt to foster better understanding of different views.

Please also review AIHCP’s numerous spiritual based programs in Christian Counseling, Christian Spiritual Direction,  general Spiritual Counseling and Spiritual Trauma Informed Care.

DSM-V-TR /Sexuality/Christian Worldview

Love and sex can become distorted within the DSM-V list of paraphilias. Please also review AIHCP’s Christian Counseling Program

Correlated with the free love movement of the 1960s, there has been a shift in society’s view of morality.  This is not to say that sexual morality was restructured by the movement, but it did challenge the then existing social norms regarding sexuality in regards to public discourse outside the bedroom and also looked to challenge the Judeo-Christian morality that dominated these social norms.  What was once labeled “sinful” or at least socially not publicly consumable became more open to the masses and questioned.  In addition, society itself and its definitions of marriage, gender and appropriate sexual interaction became redefined. The DSMs also evolved with the changing perceptions.  This was not just due to the cultural shift of a more open sexual morality in the public sphere, but also as science and psychology advanced, new studies and discoveries about the human brain and its development emerged which forced the DSM to re-evaluate the sexual norm.  This led to various acts that were once considered a disorder to not even be listed.  For instance homosexuality as a way of life became a non-disorder and an equally healthy mental and emotional way of expressing love.  The DSM-IV as it evolved into the present DSM-V in 2013 also emerged with different understandings of gender identity reversing the title of Gender Identity Disorder to Gender Dysphoria.   In addition, multiple paraphilias became labeled disorders only if harming others, self, or causing impairment (DSM-V-TR, 2022).

From a Christian Counseling perspective this has caused some friction.  The Christian worldview is at odds with many secular and  sexual actions .  What is seen as a disorder also can carry the weight of sin within itself – at least with action tied to the thought.  Furthermore, various paraphilia which carry  negative values in Christian morality are reduced to alternative drives that if not causing harm to others or self, or causing impairment, then become not spiritual problems but only mental.  This is expected to some extent since psychology is a science and should not be biased with religious belief.  Sexual deviations should be listed in a scientific and non-biased way that does not reflect one religious morality over the other but it does show a shift in what was once considered a disorder.  One can even speculate that some of the science itself may have become biased based upon the new social norms shaping it.  These are issues that Christian Counselors must acknowledge within the DSM-V-TR and learn to properly integrate the science of the DMS-V-TR with a Christian world view when counseling in a pastoral setting.

So what is the Christian worldview on sexual morality before continuing?  The Christian world view holds to an objective morality that is binding upon everyone that is based within Scripture and Christian tradition, theology and morality.  It recognizes that humanity is fallen and mental illness is a result of sin (McRay, et al., 2016).  It views sexuality and gender as a gift from God for purposes of reproduction, but also unifying love between husband and wife.  It recognizes two sexes that are tied to only two genders.  It holds that God created male and female and saw that this was good.  Christian Counseling, especially integrated Christian Counseling does not reject mental illness as an ingredient for sinful actions.  Furthermore, Christian Counseling does not look to judge others but to merely understand not only the morality but also the psychology of the person in helping individuals find a healthy spiritual, emotional and mental health that is tied to Christ.  This  means that sexual morality must coincide with one’s moral actions, despite urges, and that one must accept the commandments and follow Christ.  Christian Counseling recognizes failure and sins, but it does not look to marginalize one particular group but to hold all sexual sins accountable to God.  Unfortunately, many Christians condemn one group’s sins over another group’s of sins.  For instance, it can appear at times that some Christian churches will single out homosexual sins or Transgender sins over the sexual sins of heterosexuals.

Due to the fall, human nature has become inclined to sexual sin.  It can easily gravitate towards these sins and become engulfed with the sin of lust (McRay,  et al., 2016).  Not all sexual sins are deviations from the norm, but all sexual sins still nonetheless lead one away from God and corrupt His original design and intention.  Christian Counseling recognizes this fall, the need of Redeemer in Christ and the need for sanctification of the Holy Spirit in everyday life.  While some may not be tempted in the area of lust as others, it still remains a powerful urge that can be corrupted into deeper immorality.  This is the goal of the demonic.   Sadly, due to the fall of humanity, many also suffer not only from the vice of lust, but are also afflicted with mental disorder, or unnatural urges.  Many of these urges are not choices but come to the person and can be stronger due to a variety of biological issues.   These individuals not only face a temptation but also mental issues.  In this way, Christian Counseling not only recognizes many paraphilias as mental disorders but also sins.  In treating the paraphilia, it is more than just merely recognizing impairment or harm to self and others, but is also understood in a spiritual way.    This spiritual focus in Christian Counseling recognizes many paraphilias as sins within themselves and unnatural to the sexual act not merely in a physical way but in a completely body, mind and soul way.  It recognizes the role mental health plays in spiritual warfare with the devil and how treating many of these disorders also requires spiritual and pastoral care.  In this way, the DSM-V-TR serves as tool but a tool that only brushes the top of the surface.

Paraphilias of the DSM-V-TR

Paraphilias distort and corrupt God’s original plan for man and woman

The DSM-V-TR lists many odd, as well as socially unacceptable paraphilias.  In definition, the DSM-V-TR recognizes paraphilias as “any intense or persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners (2022)”.  According to the DSM-V-TR a disorder differs from a mere urge and thought in that the intensity is causing impairment, harm to self or others, as well as becoming the dominant of way of sexual expression over normal means.  In this way, the value of morality based on right or wrong is merely replaced with these thoughts as deviation from the norm without any moral questions.  Of course, one may question this distinction between thought and action when discussing pedophilia or zoophilia or necrophilia.  Are the presence of these thoughts not a disorder within themselves because they are so unnatural?  While acting upon a urge is far worst, the presence of these urges represent a serious problem within themselves that should not require impairment or harm of others or self to red flag it. As it stands, zoophilia (sexual intercourse with animals), necrophilia (sexual attraction or intercourse with corpses) as well as urophilia (urine) and coprophilia (feces) all find classification with the DSM-V-TR under “other specified paraphilic disorders”.

Other than the “other” list, the DSM-V-TR lists 8 paraphilias with diagnosis for disorder again to include impairment of quality of life in all areas, as well as harming oneself or others.  Many of these disorders are inherently tied to harm of others, while others can be merely addictive in nature.  Interestingly enough, pornography is not even listed as an addiction, much less a deviation although it is gateway to many of these disorders and can become a type of disorder if it inhibits social and professional activities.

Voyeurstic Disorder

This involves an intense and recurrent interest and sexual arousal over a 6 month period of observing other naked people or watching them engage in sex without their consent.  The person must be at least 18 to differentiate between adolescent curiosity versus a full blown disorder.  For diagnosis as disorder it requires action taken on these urges and if these fantasies or actions lead to significant distress or impairment in social, occupational or important areas of functioning (DSM-V-TR, 2022).

Exhibitionist Disorder

This involves intense or recurrent sexual arousal  over a 6 month period regarding exposing one’s genitals to an unexpecting person.  Specifiers include the target audience as children only, adults only, or both (DSM-V-TR, 2022).

Frotteuristic Disorder

This involves intense or recurrent sexual arousal over a 6 month period from touching or rubbing up against unexpecting and nonconsenting individuals (DSM-V-TR, 2022).

Sexual Masochism Disorder

This involves intense and recurrent sexual arousal over a 6 month period from being humiliated, beaten, bound, and made to suffer.  It can have a specifier tied to strangling or asphyxiophilia (DSM-V-TR, 2022).

Sexual Sadism Disorder

This involves intense and recurrent sexual arousal over a 6 month period in the suffering or causing of suffering in another human person.  This disorder is tied to bondage-domination-sado masochism where two disorders interact in bondage.  The sadism in this particular case is not ruled as a disorder if with a consenting adult.  However, sadists are tied to sexual crimes and rape, albeit, most rapes are still tied to control and authority than mere pleasure of others pain (DSM-V-TR, 2022).

Pedophilic Disorder

This involves intense and recurrent sexual arousal over a 6 month period with prepubescent children under the age of 13 years.  Specifiers include those who are attracted to only children, or both children and adults, as well as those attracted to only males, females or both (DSM-V-TR, 2022).  Obviously this disorder, like sadism also carries legal and criminal prosecution, beyond just being a disorder, much less within Christian theology a horrible sin.

Fetishistic Disorder

This involves intense and recurrent sexual arousal over a 6 month period with objects, or nonliving things with a high focus on non-genital body parts (DSM-V-TR, 2022).

Transvestic Disorder

This involves intense and recurrent sexual arousal over a 6 month period from crossdressing (DSM-V-TR, 2022).

All of these disorders above relate to sexual deviations from the social norm.  In this way, psychology does not necessarily give to them a moral value.  Instead psychology looks at impairment, harm to self and harm to self and others.  This does not mean that these thoughts in themselves are not dangerous and sinful.  In addition, many of these disorders can become addictive.  Starting with the smallest thing, pornography can open a window of deviations which hamper a person’s social functioning.  Individuals then become slaves to their passion of lust and it begins to dominate the person.  From a Christian perspective, this is the goal of the demonic.  The goal is to corrupt, mock and displace sexuality with crude and disgusting acts and use human beings as the tool leading them farther away from God and deeper into addictive and dark practices.  These actions look for pleasure and gratification as the primary purpose of sexuality.  However, the norm of sexual expression or attraction ceases to arouse, so one slowly goes deeper and deeper into corruption.  This not only dismisses the original intent of the conjugal act, but it also reduces people to things and objects to find pleasure.  Whether consenting or not, it still represents a a deep corruption (McRay,et al. 2016).

Mental health can biological factors can play a role in the deviations, but also trauma, sexual abuse, and mistreatment in one’s  youth.  Others never learn about sexuality or how to properly express it.  Not surprisingly, many of the differential diagnoses of these actions are also tied to impulse control disorders as well anti-social personality disorders (DSM-V-TR, 2022).

Gender Dysphoria

Gender dysphoria is incongruence between physical sex and perceived gender and the anxiety resulting from within

As sexual orientation and gender idealogy became more prominent within the social norms of modern society, the DSM-V responded as well with less emphasis of any mental defect in regards to gender identity, much like previous versions adjusted to mental diagnosis of same sex attraction.  The current trend is to one day even remove gender dysphoria as it did prior with homosexuality from the manual, but many lament if diagnostics do not remain, then this may affect gender altering elective surgeries for purposes of medical insurance and payment.

As it stands gender dysphoria in itself does not point towards a disorder but only when impairment, anxiety, depression and suffering result from it due to a lack of congruence between assigned sex at birth and chosen gender (DSM-V-TR, 2022).   Due to this, the DSM-V carefully redefines sex and gender.  Sex is defined as biological and physical manifestations of male or female.  It is also referred to as the birth assigned gender or assigned sex.  Gender, according to the DSM-V denotes the social, cultural and public role a person chooses as a boy or girl (2022).    When someone does not adhere to the assigned birth they are said to be gender atypical, gender nonconforming, gender diverse, or gender variant (DSM-V-TR, 2022).   One’s gender identity is what one adheres to, which can be male or female, or even gender fluid which is neither male nor female.  Transgender refers to a broad spectrum of individuals whose identity is different than their assigned sex at birth.  However, only if incongruence and distress occur, does the DSM-V-TR list it as a disorder within itself (2022).  A transsexual is a person who has undergone surgery altering procedures to their physical/biological appearance as male or female.

The DSM-V-TR points out that gender dysphoria can be both experienced in children but also with adolescents and adults.  In its diagnosis, the DSM-V-TR lists the following as criteria for children and adults.  For both groups, the first criteria requires a marked incongruence between ones expressed gender and assigned gender at birth for a period over 6 months.  In children, the manifestations include.

  1. strong desire to be the other gender
  2. with boys, crossdressing
  3. strong preference for cross gender roles in play and make believe
  4. strong preference for toys of the opposite sex
  5. strong preference for playmates of the other gender
  6. rejection of toys associated with opposite sex
  7. strong dislike of one’s anatomy
  8. strong desire to possess characteristics of the other sex

Within adults

  1. marked incongruence with assigned sex
  2. strong desire to rid oneself of one’s primary and secondary sex characteristics
  3. strong desire for sexual characteristics of other sex
  4. strong desire to be the other gender
  5. strong desire to be treated like the other gender
  6. strong conviction that one has the feelings or reactions of the other sex

Specifiers include if one was born with a sexual abnormality or congenital defect such as adrenogenital disorder, adrenal hyperplasia or androgen insensitivity.    For these individuals, there is less mental perception but a reality that one was physically born with varying degrees of both genitals.  Many within this category of DSDs require immediate medical intervention and surgery when sex is assigned at birth (DSM-V-TR, 2022).  This often results in some type of gender dysphoria in what gender they align with.

It is extremely important to show intense care for especially children who express these symptoms in life.  Many in teen years are going through changes that may be only temporary, or dealing with a body dysmorphic disorder.  Some, in the case of girls, may just be the classical tomboy.  Hence from a purely secular perspective, any major operations or assignments should be withheld until adulthood.  In addition, from a Christian perspective, it is important to help children understand their gender and work with them.  For many, Gender Affirming Therapy can help individuals come to congruity with their gender and sex (McRay, et al., 2022).  While this group represents a very small percentage of the population, their inner turmoil is real.  Empathy and nonjudgement are critical.  These are not choices but true inner turmoil.   Christianity teaches that this inner turmoil is a result of sin but the disgust with one’s body can also be demonic in origin.  Satan wishes for humanity to hate itself from the original design of the Creator.

Etiology and Treatment

Moral decisions about sexuality are very personal.  They touch not only the mental aspect of oneself but also the very spiritual.  When spiritual understanding of sexual issues are disconnected from the mental, it can cause a deeper misunderstanding of the sexual paraphilias.  From a purely mental and biological perspective, trauma, abuse, anxiety, and sexual experiences as child or teen can play a big role in not only sexual paraphilias but also sexual disorders. Experts also agree that psychosocial factors play a large role in paraphilia as well as sexual dysfunctions that stem from poor communication skills and inabilities to form meaningful relationships (McRay, et al., 2016).  Rape victims obviously can have trauma that is innately tied to the conjugal act.  Others may have experiences with conjugal sex at an early age which misshaped their future experiences.  This can lead to a variety of inabilities to sexually function.  These types of sexual disorders are also listed in the DSM-V.  They lead to physiological issues that affect sexual performance, or also negatively affect sexual arousal or even sexual interest.

However, the darker deviations while also tied to past trauma or events, or even some biological markers within the brain have spiritual origins.  This is where the DSM-V-TR as a tool has reached its limit to help.  The darker issues of sexual deviations are tied to sin, lust, vice and addiction.  They can transform into deeper issues if not met on the spiritual battlefield.  Christian Counselors need to be aware of the mental issues behind them but they must also understand how these mental issues are utilized by the enemy to distort the moral fabric of a person’s soul in regards to a host of immoral sexual actions.  Lust is a distortion of love.  Lust rejects temperance.  Lust corrupts the heart to see God.   It is of no wonder then that this capital sin is employed so frequently by the enemy to lead the soul away from true happiness and true design.  Lust ultimately leads to addictions that become more demanding and more perverse until the person loses sight of control and respect of one’s body and others.

Treatments usually only include treating the symptoms of anxiety or depression or the past trauma associated.  More dangerous and predatory in nature paraphilias sometimes require peer groups and also legal intervention.  Those seeking to avoid dangerous sexual behavior need to remove themselves from places that facilitate their urges.  Isolating from stimuli is key.  This could involve for a pedophile staying away from a school area, or one to avoid strip clubs, or drink, or even the internet and porn.   Changing behaviors and breaking addictions may require behavioral and cognitive therapies and token systems.  Positive reinforcements.  From a psychoanalytical school, it would involve understanding one’s childhood and why these sexual issues are manifesting.  Christian Counseling can present a blue print of right versus wrong with emphasis on prayer, penance and the formation of virtue.  Virtue of purity and habit takes time but with patience and prayer, God’s grace can transform and help one carry one’s cross.

Conclusion

Christ heals and makes whole the broken. Please also review AIHCP’s Christian Counseling Certification

The four D’s of mental health regarding danger, distress, dysfunction and deviation play a large role in defining disorder (McRay, et al. 2016).  These are based on standards.  Obviously Christian standards will differ from secular standards and create friction between the label of sin.  However, the DSM-V-TR still recognizes the distress sexual paraphilias and even gender dysphoria can cause.  In this Christian Counselors and secular counselors can agree.  This distress robs the person of peace and the sense of being loved.  This is why it is so important to never judge but also try to help individuals who suffer from such deviations.  While one is tied to ones choices and legal consequences, many of these feelings flow through these individuals creating difficulties in life.  Christian Counselors are called to help individuals in distress but also to align oneself with the commandments and God.

Please also review AIHCP’s Christian Counseling Certification

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

Additional AIHCP Blogs

Christian Morality and Sexuality: Access here

Additional Resources

Paraphilias.  WebMD.  Access here

15 Most Common Paraphilias.  Psychology for Mental Health.  Access here

Paraphilic Disorders. APA.  Access here

Signs and Types of Paraphilic Disorders. VeryWellMind.  Access here

Mental Health and Psychotherapy Video Blog

Posted on by Mark Moran

Mental health is health.  Psychotherapy is a proven way to help individuals with mental issues and disorders.  This video looks at mental health and the numerous types of schools of psychotherapy and various therapies that help individuals everyday. Please also review AIHCP’s Healthcare Certification Programs

 

DSM-V-TR & Substance Abuse Disorders and Eating Disorders

Posted on by Mark Moran

Addiction is a powerful thing.  Addiction is a habitual need to keep doing something despite negative outcomes for the taste of a positive reinforcer.   Ironically addiction can be almost anything in excess in life.  It can pertain to an action, such as gambling, gaming, or even sex and sexual acts.  Usually addiction is correlated with substances, food, or drugs.  In this blog, we will focus on substance abuse disorders and eating disorders described in the DSM-V-TR and review diagnosis and etiology of these disorders.

Please also review AIHCP’s Substance Abuse Practitioner Certification Program.

Substance Abuse

Substance abuse is a big problem affecting millions of people. Please also review AIHCP’s Substance Abuse Practitioner Program

Substance use is the involvement and partaking of a particular substance.  Substance use within itself does not entail a disorder.  It can lead to a dangerous outcome or a lesson learned due to a onetime DUI or fine, or severe hangover to never be repeated.  In this case, substance abuse occurred, but a disorder was not existent (Barlow, et al., 2023).   Substance abuse is usually associated with substance intoxication in which the levels of the substance exceed safe and social norms of it.  Obviously some substances within moderation are legal, while other substances are illegal even in moderation.  Unfortunately, substance abuse even once can be a life altering choice when it harms oneself or others.

Substance Abuse Disorders

The DSM-V-TR lists 10 separate classes of substances and drugs with subcategories.  Within these categories include, alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, stimulants and tobacco (2022).  In addition the disorders include the behavioral and psychological craving of the substance, intoxication of the substance and the withdraw of the substance (DSM-V-TR, 2022).

Addiction in general to these substances involves a general and universal footprint that transects the various substances.  Within this general diagnostic criteria, the DSM-V-TR lays out these guidelines for a Substance Abuse Disorder

A.  A problematic pattern that leads to significant impairment with at least 2 of the following occurring within a 12 month period.

  1. substance is ingested in larger amounts that intended
  2. unsuccessful efforts to control or limit intake
  3. great deal of time and energy to obtain substance
  4. cravings or strong desires or urges to use substance
  5. recurrent uses of substance resulting in failure to fulfill obligations at home, work or school
  6. continued use despite negative personal, legal and social issues
  7. reduction of occupational or recreational activities in place of substance use
  8. recurrent use in hazardous situations
  9. continued use of substance despite knowledge of the physical and physiological problem
  10. presence of tolerance
  11. presence of withdrawal

The disorder can be specified as mild if 2 or 3 symptoms are present, moderate if 4 to 5 symptoms and severe if 6 or more symptoms present (DSM-V-T, 2022).

This presents the basic blueprint for all addiction with substances.  Intoxication or withdrawal differ from substance to substance.  For purposes of brevity, we will just review a few substances and encourage those with particular interests to review particular substances in the DSM-V-TR.

Alcohol Intoxication 

With recent ingestion of alcohol (depressant), clinical problematic behavioral and psychological changes include inappropriate sexual or aggressive behavior, mood lability,  and impaired judgement.  Physical symptoms include one or more of the following, slurred speech, incoordination, unsteady gait, nystagmus, poor attention and poor memory,  and stupor or coma (DSM-V-TR).

Alcohol Withdrawal

Alcohol addiction is very common and can exist at numerous levels

Two or more of the following issues develop after cessation of heavy and prolonged drinking.  Autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient visual, tactile or auditory illusions, psychomotor agitation, anxiety and generalized tonic-clonic seizures (DSM-V-TR, 2022).

Cannabis Intoxication

With recent ingestion of cannabis, clinical problematic behavioral and psychological changes include impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgement, and social withdrawal.   Two or more of the following symptoms can manifest including conjunctival injection, increased appetite, dry mouth and tachycardia (DSM-V-TR, 2022)

Cannabis Withdrawal 

Three or more of the following issues develop after 1 week of heavy or prolonged use of cannabis.  They can include irritability, anger or aggression, nervousness or anxiety, sleep difficulty, decreased appetite, restlessness, depressed mood, or at least one physical symptom of abdominal pain, tremors, sweating, fever, chills or headaches (DSM-V-TR, 2022).

Opioid Intoxication

Common Opioids- Heroin, hydrocodone, oxycodone, fentanyl (Barlow, et al, 2022)

With recent ingestion of opioids, clinical problematic behavioral and psychological changes include initial euphoria followed by apathy, dysphoria, psychomotor agitation, retardation and impaired judgement.   Pupillary restriction can occur.  In addition drowsiness, or coma, slurred speech and impairment to attention and memory (DSM-V-TR, 2022).

Opioid Withdrawal

Three or more of the following issues develop after cessation of heavy or prolonged opioid use.  These include dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea (tears or runny nose), pupillary dilation, sweating, diarrhea, yawning, fever or insomnia (DSM-V-TR, 2022).

Stimulant Intoxication

Common Stimulants- Amphetamines ( crystalized-Methamphetamine), (Adderral), Cocaine (Crack in crystal form) (Barlow, et al, 2022)

With recent ingestion of stimulants, clinical behavioral and psychological include euphoria or affective blunting, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, tension, anger, and impaired judgment.  Two or more symptoms include tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, nausea or vomiting, weight loss, psycho motor agitation, muscular weakness, respiratory depression, chest pain, confusion, seizures or coma (DSM-V-TR, 2022).

Stimulant Withdrawl

Two or more of the following issues develop after cessation or reduction of prolonged amphetamine use that include fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor retardation or agitation (DSM-V-TR, 2022).

Tobacco Withdrawal

Tobacco withdrawal can occur after daily use for at least several weeks and with abrupt cessation include irritability, frustration or anger, anxiety, difficulty concentrating, increased appetite, restlessness, depressed mood and insomnia (DSM-V-TR, 2022).

Hallucinogen Intoxication

Common Hallucinogen- Phencyclidine or Angel Dust, LCD or Acid (Barlow, et al., 2023).

With recent ingestion of hallucinogens clinical behavioral and psychological changes include belligerence, impulsiveness, unpredictability, psychomotor agitation,  and impaired judgement.  Symptoms include two or more of the following within an hour such as vertical or horizontal nystagmus, hypertension, numbness, ataxia (Uncoordinated motor movement, dysarthria (impaired speech), muscle rigidity, seizures or coma, hyperacusis (hearing). (DSM-V-TR, 2022).

Eating Disorders

Eating disorders stem from anxiety, body dysmorphia, depression and low self esteem and sometimes even control

Substance misuse can also include how one eats and what one consumes.  In ways, it can become a impulse and compulsion as well due to anxiety, or poor self concept that leads individuals to eat certain ways or binge eat, or to starve oneself or attempt to control one’s weight through purging.  These disorders are very dangerous to overall nutrition and health but also have deep psychological issues.  Among the numerous eating disorders listed by the DSM-V-TR, there are Pica or the eating of nonnutritive or nonfood substances, rumination disorders,  binge eating, as well as the most common Anorexia Nervosa and Bulimia Nervosa disorders.  These disorders usually are tied to control issues, anxiety, low-self esteem, and body dysmorphia (Barlow, et al. 2022).

In regards to the BSM-V-TR,  Anorexia Nervosa meets these diagnostic criteria

A. Restriction of energy intake leading to significant body weight loss.

B. Intense fear of gaining weight or becoming fat and behavior that interferes with weight gain

C. Lack of recognition of the severe loss of weight.

Specifiers include restrictive type in which one has not binge ate or purged within the last 3 months but has severely dieted, exercised or fasted.  The second specifier is binge-eating/purging type in which the person within the last 3 months has self induced vomiting or utilized laxatives, diuretics or enemas (DSM-V-TR, 2022).  Based on one’s weight loss determines mild, moderate, severe or extreme.

Bulimia Nervosa

The DSM-V-TR points out that diagnosis of Bulimia does not occur exclusively during episodes of anorexia nervosa.  In addition, many individuals with bulimia do are average weight and do not appear thin or weakly (Barlow, et al., 2022).  The DSM-V-TR lists these criteria:

A. Recurrent episodes of binge eating which include eating within a certain 2 hour period of time of an amount of food that is larger than most individuals would eat and a sense of lack of control during that period

B. Recurrent and inappropriate measures to prevent weight gain through self-induced vomiting, laxatives, diuretics or other medications and excessive measures.

C. These behavior occur at least on average at least once a week for a three month period

D. Self evaluation of the body is unduly founded regarding shape and weight

Specifiers can include mild, moderate, severe or extreme (DSM-V-TR, 2022).

Binge Eating

Binge eating leads to guilt and disgust

Binge eating is recurrent episodes of eating large quantities of food to find some type of reduction of anxiety or comfort.  These recurrent binges are defined by the DSM-V-TR within the following parameters.

A.  Eating in a discrete period of time within a 2 hour period of an amount of food larger than what would be consider appropriate with a sense of lack of control.

B.  The binge eating is associated with three or more of the following feelings

  1. eating more rapid than normal
  2. eating until uncomfortably full
  3. eating large amounts when not hungry
  4. eating alone because embarrassed for others to see the amount consumed
  5. feeling disgusted, depressed and guilty with oneself after consuming the meal

C. Marked distress regarding binge eating is present

D. The binge eating occurs once a week for three months

E. The binge eating is not associating with Bulimia or Anorexia

The specifiers include mild, moderate, severe and extreme (DSM-V-TR, 2022)

The Problem and Etiology of Addiction

Addiction is not only psychological and behavioral but also genetically and biologically based. Please also review AIHCP’s Substance Abuse Practitioner Certification

Addiction looks for quick fixes.  It looks for pleasure in place of happiness.  The dopamine high is sought at the expense of the serotonin stability of life.  Many are looking to escape life’s problems and maladaptively cope via escapism.  This coincides also with more than stressors and problems but also comorbidity with other mental disorders such as depression and anxiety (McRay, et al., 2016).   In addition, addiction is many times tied to impulse control disorders as well (Barlow, et. al, 2023).

In addition, the activation of genetic and biological markers are passed down from generation to generation.  Individuals can face more than merely a psychological and mental addiction but also develop a physical addiction and disease.  Obviously some substances are more objectively addictive, but for some, genetic predispositions play a key role in whether someone can become addicted to a certain substance (Barlow, et al., 2023).

One reality is addiction is not always about substances, albeit the DSM-V-TR only lists gambling as a disorder, but addiction can take the form of many things if one considers actions to be repeated for purpose of positive reinforcement but with negative consequences.  All three qualities must be present for an addiction.  Hence, one can include activities that exceed moderation and in some way become harmful.  This could include gaming, pornography, or any type of obsession that takes away from quality of life.  Balance and temperance are key factors in maintaining healthy outlooks on things we do in life.

Addiction Treatment

Addiction treatment depends on a person’s willingness and the level of addiction itself.  For many it is a life long cross that involves will power, peer support, avoidance of the substance and its occasions, as well as developing better coping strategies for stressors, as well as anxiety and depression.  For some, it also involves finding deeper meaning in life and finding a spiritual anchor.  AA utilizes a spiritual based plan that holds one accountable to a higher power (Barlow, et al., 2023).

Depending on the depth of the disorder also plays a large role.  Abuse of a substance is different than a disorder itself.  Disorders can be mild, moderate or severe and the level of chemical dependency is subjective upon individuals.  Also, the nature of the substance plays a large.  Substances such as nicotine and opiates are far more addictive than other substances.  Some individuals may require medical treatment during the detox phase and require in patient care at a addiction facility.  Others may require gradual reduction and doses to avoid withdrawal under medical guidance.   Others with less severe conditions may just need intensive out patient care and psychoeducation, but others may require more peer support, as well as psychotherapy that includes CBT, motivational interviewing or even contingency management (rewards for sobriety).  Others may require medications to curb cravings (Naltrexone for drinking) or even cause nausea or discomfort in drinking (Disulfiram)

AA and the emphasis on spiritual meaning and finding something more than addiction is possible.  Many spiritual traditions see addiction as more than merely a physiological problem but also a spiritual one that involves bad sinful habits and sometimes even forms of spiritual oppression.  The practice of virtue over vice is essential in creating a healthy spiritual balance.  The virtue of temperance is key in implementing a long term solution against the vice of immoderation and addiction.  Understanding addiction in all its forms, just not substances, is an important aspect of spirituality and finding a healthy spiritual life.

Conclusion

Whether addiction is a substance or a practice, it involves maladaptive coping to face life and issues.  It involves a habitual need to engage or indulge oneself in something that has negative consequences for the small price of brief positive reinforcers.  For some addiction is mental and behavioral, but for others it can be inherited and activated.  It is important to never allow something to become so powerful over oneself as to destroy everything in one’s life.  Addiction is not fast, it is insidious and slowly seduces and entraps the victim but individuals can escape it with a strong will and peer support.  Finding meaning in something greater than oneself is key to overcoming habitual vice and addiction.

Please also review AIHCP’s Substance Abuse Practitioner Program and see if it meets your academic and professional goals.

Additional Blogs

12 Steps of AA Video blog: Access here

Dopamine and Serotonin in Addiction Process:  Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

Additional Resources

Addiction and Substance Abuse Disorders. APA. Access here

Drug Addiction.  Mayo Clinic.  Access here

Substance Use Disorder (SUD). Cleveland Clinic.  Access here

Hartney, E. (2026). “DSM 5 Criteria for Substance Use Disorders”. VeryWellMind.  Access here

DSM-V-TR & Somatic and Dissociative Disorders

Posted on by Mark Moran

The DSM-V-TR and many psychopathology texts group Somatic and Dissociative disorders together.  In the DSM-V-TR somatic disorders are listed after dissociative disorders which are tied to stress and PTSD.  They both share created realities that are not true but they also differ in direction.  Somatic disorders attach to physical symptoms without no correlating reality or pathology from a physical sense but find their origin in the mind.  Likewise, many are tied to anxiety, or fear of possessing the actual disease associated with the symptoms.   Dissociate disorders are tied to breaks from reality that do not exist as well but more so in the mind and one’s surroundings.  They are tied to trauma and stress.  This leads to derealization and depersonalization, various amnesias and dissociative identity stemming from trauma.  In this short blog, we will review the basis and criteria of diagnosis for different somatic disorders as well as dissociative disorders.

Please also review AIHCP’s Healthcare Certification Programs, as well as its many Behavioral Health Certifications.

Somatic Disorders

Somatic disorders contain symptoms of a disease created by the mind with no real existence of the disease within the person.  Somatic means coming from the mind and manifesting physiological manifestations of a particular physical disorder (Barlow, et, al., 2023).   Similar to Somatic Symptom Disorder is Conversion Disorder.  Freud believed that the energy associated with mental illness could manifest as physical disease in other parts of the body causing motor control issues that were only a product of the mind (Barlow, et al., 2023).

Hypochondria or Illness Anxiety Disorder can leave a person impaired socially constantly seeking professional and medical help costing the health system millions of dollars

The biggest difference between Somatic Disorder and Conversion Disorder was the the type of physical manifestation and mental state.  In Somatic Disorder there are a broad range of persistent physical disorders including pain and fatigue.  These irks and pains cause discomfort throughout the day and lead to intense anxiety within the individual as the person attempts to understand the nature of their illness.  Conversion differs in the manifestation and reaction.  The manifestation effects motor control and cause paralysis, blindness, or other body movement.  It usually follows an immediate stressor and can resolve itself quicker.  Hence individuals do not deal with it longer over a chronological period (DSM-V-TR, 2022).

The DSM-V-TR lists these criteria Somatic Symptom Disorder for diagnosis .

A. One or more somatic symptoms that cause significant disruption in life

B. Excessive thoughts or behaviors tied to the somatic symptoms with at least one of the following:

1. disproportionate and persistent thoughts about the seriousness of the issue

2.  high levels of anxiety about the symptom or overall health

3. excessive time and energy directed to these symptoms and concerns

C.  These symptoms persist for 6 months.

Somatic Symptom Disorder can be specified with predominant pain, persistent symptoms, and as mild, moderate or severe.

(DSM-V-TR, 2022).

 

The DMS-V-TR lists this criteria for Conversion diagnosis

A. One or more of the symptoms have altered motor or sensory function

B. Clinical findings discover no correlation between the symptoms and recognized neurological disorder

C. There is no rational explanation for the disorder

D. The symptom causes clinically significant distress or functioning

It can be specified as acute, chronic, with psychological or without psychological stressor, with various symptom types such as weakness or paralysis, abnormal movement, swallowing symptoms, speech symptoms, seizures, sensory loss, special sensory loss or mixed symptoms.

(DSM-V-TR, 2022).

Another Somatic related disorder is Illness Anxiety Disorder which deviates from Somatic Symptom Disorder in regards to mild to no symptoms with the fear of disease existing in the mind.  In the past it was referred to as Hypochondria (Barlow, et al., 2023).   The DSM-V-TR lists the following diagnostic criteria for IAD.

A. Preoccupation with having a serious illness

B. Somatic Symptoms or not present or very mild.  Other symptoms related to a different disorder are ignored.

C. High level of anxiety about health

D. The individual performs excessive health related behaviors for checkups

E. Illness preoccupation exceeds 6 months

F. The illness preoccupation has no other mental health disorder explanation

The DSM-V-TR specifies them as either care seeking or care avoidant

Ultimately within all of these disorders, individuals refuse to believe experts and fall more so upon their own anxiety ridden logics.  They tend to seek their own information and insist they know more than medical professionals.

Tied closely to this are other disorders resulting in faking symptoms or purposely re-creating the symptoms for medical help or attention.  Some do this for mental reasons, while others seek financial reward via malingering.  Obviously those who seek medical attention and cause symptoms for no logical or financial reason suffer a deeper issue.   Factitious Disorder results in this deception to gain attention or aid.  Some may also look to keep attention on a person under one’s care by causing or lying about symptoms.   In the past this was referred to as Munchausen Syndrome (Barlow, et al., 2023).

It is interesting to see the power of the mind to cause physiological symptoms.  Yet if one simply realizes the power of worry to cause a stomach ache, then one can see on a large scale how somatic symptoms can manifest in individuals with greater anxiety and distorted beliefs about health.

Dissociative Disorders

Dissociative Amnesia can be general or selective

While the mind can create physiological symptoms, it can also create separations from reality due to traumatic events or high levels of stress.  Many of the dissociative disorders are closely tied to PTSD and trauma induced orders and directly follow the DSM-V-TR’s chapter on Trauma and Stress Related Disorders.  The DSM-V-TR points out that many dissociative disorders are frequently in the aftermath of severe trauma.  Their symptoms include “unbidden intrusions into awareness and behavior, with accompanying losses of continuity in subjective experiences (2022).  This leads to depersonalization, derealization, amnesia and dissociative identity.  They can all play roles in the more general umbrella of PTSD but also be a diagnosis within itself.

Depersonalization/Derealization Disorder

According to the DSM-V-TR, depersonalization is the experience of unreality, detachment or being outside or external from one’s own thoughts, or feelings or even sensations of the body.  One senses a distorted senses of time and feels absent from self as if almost outside of one’s own body (2022).  Similar and also shared frequently between the two is the subjective experience of derealization.  Within derealization one experiences unreality and detachment from one’s surroundings as if reality is dreamlike or foggy or distorted (2022).

Dissociative Amnesia

Loss of memory due to trauma leaves the person with an inability to recall or remember.  The loss of memory can be localized or selective only to the event, or in more severe cases generalized and effecting one’s identity (DSM-V-TR, 2022).   In some cases, it can be specified with dissociative fugue where the individual travels or wanders and cannot relate where they came from (2022).

Dissociative Identity

Dissociative Identity Disorder, formerly known as Multiple Personality Disorder, is a trauma reaction usually formed in early childhood after a traumatic event

One of the most wild and bizarre forms of dissociation is multiple personalities.  The DSM-V-TR now labels it as Dissociative Identity in which the person creates different identities when faced with intense trauma.  These identities are formed at a younger age and usually add new ones as the person needs to adjust to the unresolved trauma.  The DSM-V-TR lists the following criteria for diagnosis

A. Disruption of identity by two or more distinct personality states.  The disruption marks a distinct discontinuity in sense of self which displays changes in behavior, memory, perception, consciousness, cognition and sensory-motor functioning.

B. Recurrent gaps to recall events and personal information are inconsistent with normal forgetfulness

C. The symptoms cause significant distress to all elements of social functioning

D. The disturbance is not part of a cultural or religious practice

E. The disturbance is not associated with other substances or medical conditions

(DSM-V-TR, 2022).

Barlow states that most experience an average of 15 different personalities or alters.  These alters merge from the host identity (2023).   It is believed that under severe cases of trauma, younger children who may possess a genetic and biological vulnerability can develop DID.  Diagnosing DID should be done with great care as not to lead an individual to bias or place falsememories regarding a person’s past.  Ultimately, it is very difficult to fake DID although criminals in the past have attempted to use a DID defense (Barlow, et, al. 2023).

Some identities are classified as possessive identities which can be mistaken for demonic manifestation.  If existing within the religious traditions, one must be careful of cultural and religious beliefs regarding this.  In fact, the Catholic Church goes to great lengths and diagnosis within itself to determine a difference between a possessing identity with what it considers to be an external source in its manual of exorcism.   Obviously before the era of modern science, many DID were considered possessions and did not meet the current diagnosis within the Catholic Church.  Those who are not religious still doubt any form of possession within itself but that is a debate for another day.

Conclusion

Please also review AIHCP’s Healthcare Certifications as well as its Trauma Informed Care program

Physiological symptoms can be very real.  The brain can shut itself off for its own defense and create different realities.  These are all things that modern psychology has discovered.  Many of these issues stem from trauma, anxiety and stress.  When a person has the biological vulnerability, the recipe for the manifestation for these disorders become a reality for the person.  Therapy and medication can play large roles in facing past issues and traumas.  With the exception of DID, many of these mental issues can resolve quickly with proper care.  Obviously DID deals with a far deeper trauma and requires deeper psychotherapy to unify the person.  That involves identifying triggers, reliving trauma, and carefully realigning the past without causing more damage (Barlow, et al., 2023).

Please also review AIHCP’s Behavioral Health Certifications.  AIHCP offers Trauma Informed Care as well for professionals seeking additional training and credentials in this field.

Additional Blogs

Disruptive and Impulse Control Disorders.  Access here

Personality Disorders.  Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

Additional Resources

Goodman, B. 2024. “Somatic Symptom and Related Disorders”. WEBMED.  Access here

“What is Somatic Symptom Disorder?” APA.  Access here

“Dissociative Identity Disorder (Multiple Personality Disorder)” (2024). Cleveland Clinic.  Access here

“Dissociative Identity Disorder (Multiple Personality Disorder)”. PsychologyToday.  Access here

The DSM-V-TR and Disruptive, Impulse Control and Conduct Disorders

Posted on by Mark Moran

Emotional loss of control that translates into disruptions, conduct violations against social norms and laws, and the rights of others are the product of a variety of deeper seeding issues stemming in childhood.  While many of these disruptive, impulse control and conduct disorders manifest in early childhood, if left unchecked, they can continue to develop into early adulthood and root into a person’s personality.  In fact, conduct disorder itself, can be a precursor to anti-social disorder (DSM-V-TR, 2022).  With this in mind, it is important to teach, guide and when necessary reprimand children in accordance with morality, authority and law.  This is especially true for individuals who genetically have a predisposition to  impulse control, emotional outbreaks and defiance.

Disruptive, impulse control and conduct disorders develop during childhood but can cause impairment in adulthood. Please also review AIHCP’s Behavioral Health Certifications as well as its Anger Management Courses

Please also review AIHCP’s behavioral health certifications, including Anger Management Courses, as well as ADHD Consulting.

Types of Disorders

These types of disorders include issues with emotional control but especially when it infringes upon the rights of others.

Oppositional Defiant Disorder

This disorder tends to manifest early in childhood but can continue to persist in adulthood and hamper a person’s future relationships as well as one’s interaction with authority figures.  The DSM-V-TR points out that it is marked with a pattern of an overall angry and irritable mood that displays itself in an argumentative, defiant way, characterizing vindictiveness.  This mood persists for at least 6 months (DSM-V-TR, 2022).  It is important to evaluate this time frame because child development can sometimes mimic these behaviors short term and not necessarily constitute a long term disorder.  During this 6 month period, the individual must exhibit four of the below symptoms with at least one person who is not a sibling.

1.losing temper

2. touch or easily annoyed

3. often angry or resentful

4. often argues with authority figure

5. defies or refuses to comply with requests from an authority figure

6. deliberately annoys others

7. blames other for his or her mistakes or behaviors

8. exhibited spitefulness or vindictive behavior twice within the last 6 months

These symptoms can be specified as mild, moderate or severe (DSM. V-TR, 2022).

Intermittent Explosive Disorder

Loss of control and temporary rage can sometimes be more than a mere temper, loss of patience, or anger issue but can also be an emotional disorder that requires deeper care and therapy.  Intermittent Explosive Disorder emerges in childhood but can also persist into adulthood and cause serious relationship issues in all aspects of life and especially result in criminal charges.  The DSM-V-TR cites that IED exhibits frequent and recurrent outbursts due to a failure to control aggressive impulses (2022).  These outbursts can result in verbal aggression including temper tantrums, tirades, verbal arguments or even physical aggression towards property, animals or other people.  The outbursts can be limited to only verbal but also to physical confrontations that cause damage and injury.  The DSM-V-TR states that 3 serious infractions must occur within a 12 month period that result in damage or destruction, but frequent verbal aggression according to the first standard meets the first criteria.

Intermittent Explosive Disorder deals with sudden anger bursts that are not proportionate to the event

In addition to verbal or physical outbursts, the magnitude of the aggressiveness must not be proportionate with the provocation or to any of the causing stressors.  Individuals with IED react completely out of proportion to life events and daily stresses that others would not react to (DSM-V-TR, 2022).   In addition, these outbursts are not premeditated or meant to achieve some objective but are purely reactive.  In addition, these recurrent aggressions and outbursts cause considerable impairment to the person’s personal, professional, and interpersonal functioning.  Finally, the person must be at least 6 years of age.  This disorder manifests at a higher level in males and exist in both children and adults if left untreated (DSM-V-TR, 2022).  Please also review AIHCP’s Anger Management Consulting Certification.

Conduct Disorder

Conduct Disorder is a repetitive and persistent pattern of behavior which violates the rights of others, social norms and rules and laws of societal norms (DSM-V-TR, 2022). If 3 of the following 15 criteria is met over the past 12 months, with one having to be within 6 months, then an individual may be diagnosed with Conduct Disorder.  The categories of disorder include aggression, destruction of property, deceitfulness and theft, and serious violation of rules.

  1. Often bullies
  2. initiates physical fights
  3. uses weapons to cause harm
  4. cruel to other people
  5. cruel to animals
  6. stolen while confronting a victim
  7. fire setting
  8. destroying other’s property
  9. broken into another’s home
  10. lies to obtain goods or favors
  11. has committed non-violent theft
  12. defies curfews before age 13
  13. ran away from home at least twice
  14. truant from school

The DSM-V-TR points out that these acts constitute great inter-social impairment and have occurred before 18.  If over 18, the individual can qualify for diagnosis of Anti-Social Personality Disorder (2022).   Specifiers include childhood onset and adolescent onset.  In addition, specification can include with limited prosocial emotions, lack of remorse or guilt, callous or lack of empathy, unconcerned about performance, and shallow deficient affect (DSM-V-TR, 2022).   The condition can finally also be classified as mild, moderate or severe.

Within Conduct Disorder as well as Anti-Social Disorder, two other types of disorders can manifest.

Pyromania

This disorder leads to the deliberate and purposeful choice to set fires on more than one occasion.   The DSM-V-TR differentiates the setting of fire for reason or gain to that correlated with an affective arousal before the act that includes a fascination or interest about the attraction to fire.  Pleasure, gratification or relief is associated with setting the fire (2022).

Kleptomania

Like fire setting, the act of stealing in Kleptomania is not tied to gain or need but a recurrent failure to resist the impulse to steal due to the sense of tension to commit theft.   From this theft, comes gratification and relief that is not associated with any motive or need (DSM-V-TR, 2022).

The Role of ADHD in Many Disruptive, Impulse Control and Conduct Disorders

ADHD is not listed with these types of disorders in the DSM-V-TR but is listed under neurodevelopmental disorders, but it does cross lines with many impulse disorders and is commonly comorbid with those who also possess them (DSM-V-TR, 2022. Obviously man individuals with ADHD are not criminals, or have rage, but symptoms of ADHD can contribute to the inner turmoil of those.  This may have something to do with the lack of control of impulses and constant inability to maintain focus on one thing.

ADHD effects both attention and hyperactivity. Although diagnosed before 12, it does exist in adulthood. Please review AIHCP’s ADHD Consulting Program

For purposes of analysis, the DSM-V-TR states that ADHD causes persistent lack of ability to focus attention and/or possess hyperactivity or impulsiveness in behavior.  Some may exhibit only inattentiveness, while others may just display hyperactivity, while some may be burdened with both sets of symptoms.  These symptoms emerge before age 12 and can persist into adulthood.  Some elements of it are later controlled by a more developed brain in adulthood and manifest in other ways.  Inattentive symptoms include at least 6 of the following over a 12 month span

  1. failure to give attention to details resulting in careless mistakes
  2. difficulty sustaining attention
  3. does not seem to listen to instruction
  4. does not follow through on instructions
  5. difficulty organizing tasks
  6. reluctant to engage in tasks involving concentration
  7. loses things
  8. easily distracted by external stimuli
  9. often forgetful

Hyperactive symptoms must include 6 of the following over a 12 month period

  1. fidgets physically
  2. cannot remain seated
  3. runs, moves, climbs on things
  4. cannot engage in leisure activities
  5. unable to relax
  6. talks excessively
  7. blurts out answers without impulse
  8. difficulty waiting turns
  9. interrupts and intrudes

Again, according to the DSM-V-TR, these symptoms can be predominantly inattentive or hyperactive or consist of both symptoms.   It can also be classified as mild, moderate or severe (DSM-V-TR, 2022). It is no wonder then that many of these issues also correlate with various disruptive, impulse control and conduct disorders or later can possible develop into it.  Please also review AIHCP’s ADHD Consulting Program.

Etiology and Treatment of Disruptive, Impulse Control and Conduct Disorders

Many of these disorders include both nature and nurture.  ADHD exists at a level of 4 to 5 percent worldwide within children (Barlow, et al., 2023).  Genetically, individuals can be prone to higher risk taking within the brain that inhibits fear or punishment (Barlow, et al,.2023).  Biologically, levels of serotonin and epinephrine can be low with higher levels of testosterone (McRay, et al, 2016),.  In addition, lack of family discipline, family dysfunction, divorce, and lack of family involvement can lead to deeper seeded issues that manifest in the child’s behavior and if not treated later manifest in adulthood (McRay, et al., 2016).

Treatment for conduct and impulse control issues include behavioral strategies that try to correct the operant conditioning previously experienced in life.  Others include training for parents to better manage the child and teach the child structure.  Also important, includes various forms of CBT that look to help empower the child  with better social cognition skills and problem solving strategies.  For anger issues, sometimes peer groups can help.  Anger Management skills can help many find solutions to their temper.  Finally, stimulant medication can be beneficial due to these disorders high comorbidity with ADHD (McRay, et al., 2016).

Conclusion

Self control is important but is harder for those with impulse and disruptive disorders. Please also review AIHCP’s Healthcare Certification Programs

Ultimately, disorders are not justifications for poor behaviors but they are explanations why some children, and even adults, are more inclined to react and behave certain ways.  Merely because someone feels an urge or a stronger intense feeling to do wrong or be cruel is never a justification but with therapy and sometimes medication, individuals can be taught to better control and maintain disruptive and impulse control behaviors.

A strong moral conviction of right and wrong is always a powerful deterrent in life.  Understanding within one’s conscience that a feeling or urge does not justify a certain behavior is the first step to finding the help one needs.  Obviously at an earlier age, parental guidance and discipline is essential to prevent these disorders from completely transforming an individuals personality into habitual chaos.  Anger, lack of impulse control, defiance of authority and rage lead to many crimes and broken lives.  It is hence important to maintain control in these situations and if one cannot to find the necessary guidance and help to learn how to control one’s inner disorders.

Please also review AIHCP’s Behavioral Health Certifications as well as AIHCP’s Anger Management Consulting Certification as well as its ADHD Consulting Program

Additional Blogs

Intermittent Explosive Disorder.  Access here

ADHD.  Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

Additional Resources

“What are Disruptive, Impulse Control and Conduct Disorders?” APA.  Access here

IED.  Mayo Clinic.  Access here

ODD. (2026). Cleveland Clinic.  Access here

“Oppositional Defiant Disorder”. Psychology Today.  Access here

Bhandari, MD, (2024). “Mental Health and Conduct Disorder”. WebMD.  Access here

DSM-V-TR and Personality Disorders

Posted on by Mark Moran

Personality Disorders are one of the more interesting types of disorders in mental health.  They attract the most attention and curiosity about why individuals act the way they do.  For the secular mind, it attempts to explain right and wrong, criminality, oddities, and other quirks that step out of bounds within the social structure.   As observed in early psychology, it a disorder but the mind still has the ability to possess rationale in its own self.  From a religious perspective, it constitutes the reality of brokenness of humanity and how individual acts of deviation can become habitual aspects of one’s personality (McRay, 2016).  These disorders distort personality to such an extent to cause inner personal turmoil in one’s feelings towards others and one’s assertion of those feelings outside the norms of one’s cultural context (McRay, 2016).   For this reason, many personality orders are not only odd, eccentric, selfish, rude, and withdrawn, but also violent and terrifying to others.

Personality without empathy or ability to properly feel, think and act within the context of its cultural norm is considered disordered. Please also review AIHCP’s Healthcare Certifications

Personality in itself is an essential feature to a person.  It involves a person’s overall demeanor, it includes how a person reacts internally and externally with others and the person’s overall temperament.   Overall, a personality is one’s unique patterns of thinking, acting and feeling (Myers, 2019).  There are numerous theories of personality ranging from the psycho-analytic schools to the humanistic as well as the behavioral schools of psychotherapy.  All emphasize their targeted areas of study to the development of personality and all add unique elements to understanding personality.  Within personality, exist various traits that are essential to proper functioning within the norms of society.  Traits are  characteristics or behaviors or dispositions of how a person feels or acts in certain ways (Myers, 2019).  Experts list the Big Five Factors of traits that determine personality factors.  Myers lists Conscientiousness, Agreeableness, Neuroticism, Openness and Extraversion (2019).  When one sways from one extreme to the other in these traits, then imbalance occurs.  In addition, the DSM-V-TR also lists these traits in its alternate diagnosis for personality disorder with openness being replaced with lucidity (2022).

When an individual deviates from the cultural norms of his or her culture and society and these extremes manifest against the core basic traits, one will witness odd or deviated social behavior, but isolated acts of misconduct or erratic behavior do not constitute a disorder.  A disorder is far more deeper and its duration long lasting.  In this blog, we will take a closer look at personality disorders and their striking deviations from cultural norms and behavior.

Please also review AIHCP’s Healthcare and Behavioral Healthcare Certifications

What is a Personality Disorder?

The DSM-V-TR points out that an enduring pattern of inner experience and behavior that deviates from expectations of one’s culture constitutes a personality disorder.  These disorders manifest in one or two ways, via cognition, affectivity, interpersonal functioning or impulse control.   The DSM-V-TR continues that these enduring patterns are inflexible and pervasive across the range of the person’s personal and social situations and interactions with others (2022).   The DSM-V-TR states that these behaviors cause significant distress and impairment in social and personal relationships and this pattern remains stable and of long duration with origins in adolescence and early adulthood (2022).  Obviously, these issues are not related to substance abuse, medication, or other mental defects.

The DSM-V-TR looks at moderate to severe impairment in traits to affect identity, self-direction, empathy and intimacy.  In addition, these disorders can portray various distortions of personality traits to the extreme.  They can manifest negative affectivity versus emotional stability, detachment versus extraversion, antagonism versus agreeableness, disinhibition versus conscientiousness, and psychoticism versus lucidity (2022).  It is because of this one can witness in personality disorders a wide range of odd, eccentric, emotional, impulsive, egocentric, aggressive, violent, unempathetic, and manipulative traits.

The DSM-V-TR groups personality disorders into three clusters.  Cluster A includes paranoid disorders such as paranoid, schizoid and schizotypal.  Cluster B includes personality disorders such as anti-social (sociopathy/psychopathy), borderline personality disorder, histrionic, and narcissistic disorders.  Finally, Cluster C includes avoidant personality disorders such as avoidant, dependent and obsessive compulsive personality disorders (not to be confused the OCD itself). (2022).

Of particular note, based on different case studies and surveys, the percentage of personality disorders within the general population is 9 to 10 percent suffering from some type of personality disorder in some degree or level (Barlow, et al. 2023).  Ironically, many of the terms associated with these disorders, are used loosely in everyday vernacular towards individuals who may act a certain way in a given situation but not possess the disorder.  Bad behavior, sin, vice, or whatever one wishes to label it is part of the human condition and people are not perfect.  Personality Disorders are merely a persistent form of these behaviors at an extreme and rigid level.  So, when diagnosing, anyone at some time or some point can see at least a couple undesirable traits and feel guilt or shame for exhibiting these actions.  Ultimately guilt and shame and acknowledgement are key signs one does not possess the disorder itself.

Types of Disorders

Personality Disorders are divided into three clusters of paranoid, anti-social and avoidant

Paranoid

Paranoid personality disorders are in the realm of psychotic and the schizotypal form can sometimes be the premorbid phase of schizophrenia itself.   One of the key elements is the disorder is persistent before and after any delusional of psychotic episodes.

Paranoid Personality Disorder constitutes a pervasive distrust and suspicion of others.  Without evidence, they feel they are being exploited or harmed.  They discover unfounded evidence of demeaning actions or threatening meanings in other individual’s remarks or cues.  They are preoccupied with doubts of other’s loyalty to them and find it difficult to confide in others.  They feel information can constantly be used against them.  Emotionally, they can become angry and hold grudges due to the perceived threats (DSM-V-TR, 2022).

Schizoid Personality Disorder is a detachment from social relationships beyond intimate family.  They also possess a restricted range of emotions.  These traits continue before and after remission of possible psychotic episodes (DSM-V-TR, 2022).   Schizotypal Personality Disorder is more severe and resembles Schizophrenia and other schizophrenic spectrums.  It can also co-exist with them but also exists outside the psychotic psychotic episodes (2022).

Anti-Social

Anti-Social Personality Disorder is best known a pervasive and consistent pattern of disregard and violation of the rights of others, occurring since age 15  and must be at least 18 (DSM-V-TR, 2022).  With diagnosis, three of the following traits must persist

  1. failure to comply with social norms and laws
  2. deceitfulness and pathological lying
  3. impulsiveness and failure to plan
  4. irritability and aggressiveness
  5. recklessness and disregard for safety of self or others
  6. consistent irresponsible behavior
  7. lack of remorse or empathy
Anti-Social Personality lacks empathy and recognition of the rights of others

The DSM-V-TR continues in alternative diagnosis with emphasis on a distorted identity based on egocentrism and self-esteem deprived via power and gain and pleasure.  Personal gratification is the primary goal and self direction absence of inhibitions that prevent those gratifications.  There is a lack of emotional connection or empathy within the disordered person and intimacy and relationships are meant for exploitation or manipulation to meet one’s own needs.   The DSM-V-TR in addition lists these traits of which 6 must be met

  1. manipulation (antagonism)
  2. callousness (antagonism)
  3. deceitfulness (antagonism)
  4. hostility (antagonism)
  5. risk taking (disinhibition)
  6. impulsivity (disinhibition)
  7. irresponsibility (disinhibition)

Horrifying enough, there can be a psychotic specifier as well with psychopathic features which would constitute the differences between a sociopath and a psychopath.  Depending on degree and opportunity, these individuals can be very dangerous in what they are willing or not willing to do to others.  Many criminals possess these traits and those in trouble with the law.  Many can understand something is wrong but fail to care or display empathy or guilt or emotion regarding their actions.

Narcissistic Personality Disorder is commonly comorbid with Anti-Social Personality Disorder.  Narcissists, according to the DSM-V-TR, display a pattern of grandiosity.  They require admiration and lack empathy.  The disorder can manifest in early adulthood (2022).  Five or more of the following are necessary for diagnosis.

  1. grandiose self importance
  2. fantasies of unlimited success, power and brilliance
  3. believes oneself is special
  4. requires admiration of others
  5. sense of entitlement
  6. interpersonally exploitative
  7. lacks empathy
  8. envious of others
  9. severe arrogance

In regards to identity, they require excessive reference of others for self-definition.  Deep down, they have lower self-esteems and without these appraisals, they can suffer emotionally.  In addition, self direction is tied to gaining approval of others.  Relationships and intimacy are more superficial as to the image it portrays.  Empathetically, they are restricted in understanding the needs and emotions of others at the expense of their own (DSM-V-TR, 2022).  Closely related is Histrionic Personality Disorder which faces excessive emotionality and seeking of attention (DSM-V-TR, 2022).

If the other anti-social disorders are more intellectual, then Border Line Personality Disorder (BPD) is the chaos of emotion.  According to the DSM-V-TR, BPD is a pervasive pattern of instability in regards to relationships, self-image and affects which onsets in early adulthood (2022).  Five or more attributes must be present.

  1. frantic efforts to avoid real and imagined abandonment
  2. pattern of unstable and intense interpersonal relationships
  3. identity disturbance and unstable self-image
  4. impulsivity with spending, sex, substance abuse, reckless driving or binge eating
  5. recurrent suicidal behavior, gestures, threats or self mutilation
  6. affective instability due to marked reactivity
  7. chronic emptiness
  8. inappropriate anger or controlling anger
  9. transient stress related paranoid ideation

In regards to identity, BPD is marked by poorly developed and unstable self-image.  Self direction consists of instability with goals and plans.  Empathetically, individuals have a difficult time recognizing the feelings and needs of others.  In regards to intimacy and relationships, there is a consistent intense, unstable and constant conflict with others (DSM-V-TR, 2022).  They experience intense emotional lability, anxiousness, separation insecurity, depression, impulsiveness, risks and hostility (DSM-V-TR, 2022).

Avoidant

Avoidant disorders

Avoidant personality disorders include Avoidant Personality Disorder, Dependent Personality Disorder and Obsessive Compulsive Personality Disorder.

Avoidant Personality Disorder involves more than an introvert life style or bouts with anxiety but a pervasive pattern of social inhibition, inadequacy,  and hypersensitivity to negative evaluations of self (DSM-V-TR, 2022).   Four or more of the following are need in diagnosis.

  1. avoids occupational activities
  2. unwilling to get involved with others unless certain of being liked
  3. restraint with intimiate relationships
  4. preoccupied with fear of rejection
  5. feelings of inadequacy
  6. views oneself as unappealing, inferior or inept
  7. avoids risks of engagement or new activities

Avoidant personalities are associated with low self esteem identity wise.  Their self direction is distorted due to reluctance to pursue goals.  Their empathy for others is distracted by their own internal fears and their intimacy is restricted due to shame and fear of rejection.  Their traits include anxiousness, withdrawal, anhedonia and intimacy avoidance (DSM-V-TR, 2022).

Dependent Personality Disorder involves a pervasive or excessive need to be taken care of by others which leads to submission and clinging behaviors marked by separation anxiety which manifests in early adulthood (DSM-V-TR, 2022). Five or more of the following symptoms are required for diagnosis.

  1. difficulty making everyday decisions without excessive advice and reassurance
  2. needs other to assume responsibility in life
  3. difficulty expressing disagreement
  4. difficulty initiating projects
  5. goes to excessive lengths for reassurance
  6. feels helpless when alone
  7. seeks relationships for security
  8. fearful of abandonment

Finally, Obsessive Compulsive Personality Disorder concludes the avoidant disorders.  This disorder is not to be confused with OCD which can be comorbid but unlike OCD which reacts to stressors and anxiety, OCPD exists in all situational relationships.  According to the DSM-V-TR, it is represented by a pervasive pattern of preoccupation with order, perfection and mental and interpersonal control at the expense of flexibility which begins in early adulthood (2022).  Four or more of the following symptoms are necessary for diagnosis

  1. preoccupation with details, rules, lists, order, schedules, organization
  2. perfectionism derails task completion
  3. focused on work before any types of leisure
  4. overconscientious, scrupulous and inflexible in matters of morals, ethics or values (not when accounted to religious or cultural identification)
  5. unable to discard worthless objects
  6. reluctant to delegate tasks to others
  7. adopts miserly spending habits
  8. rigid and stubborn

Those with OCPD compose their identity as correlated with work or productivity.  Their self direction is complicated due to rigidity in completing tasks and meeting standards.  They lack difficulty in empathy to understand the feelings and standards of others.  Finally, their intimacy is restricted in relationships since they put relationships secondary to work and maintain a rigid and stubborn life with others (DSM-V-TR, 2022).  They adhere to rigid perfectionism, perseveration in tasks, intimacy avoidance, and possess restricted affectivity (DSM-V-TR, 2022).

Etiology and Treatment

Personality disorders are both a product of nature and nurture with roughly 10 percent of the population suffering from them

Personality Disorders like all mental pathologies cannot be originated from one aspect of life but is a culmination of biological, genetic, psychological, behavioral and social factors.  In addition, many possess comorbid mood disorders or maladaptive coping strategies involving substances.  In the cases of Anti-Social Personality, it is obvious that there are genetic dispositions as well as biological deformities within the brain that restrict empathy and impulsivity (Barlow, et al., 2023).   In addition, early childhood mistreatment, abuse, trauma, poverty and malnutrition can play roles in the development of life views and emotional affectivity (McRay, 2016).   None of these things guarantee a disorder, but they collectively can contribute to disorders that later develop in early adulthood.

In children, values and morality are also essential to enforce in life.  In early development of a children, egocentrism is important to survival but children are exposed to empathy, love and the needs of others.  Children that are not properly guided can develop vices that later can lead to habitual life styles (McRay, 2016).   Children with natural inclinations to pride, or selfishness, or other vices, without the proper guidance can fall victim to these inclinations as adolescence continues.  These maladaptive behaviors manifest as the person is permitted without consequence to perform these actions.  Obviously from a religious perspective, morality and restrictions are essential guardrails in anti-social personality development (McRay, 2016).   Even without proper social norms and concepts such as the Golden Rule, individuals can develop into habitual disordered individuals in mind, thought, emotion and behavior.

Unfortunately, many individuals with personality disorders do not seek treatment.  Avoidant groups are the most likely to seek help but anti-social and paranoid seek assistance less.  Those who do find help require extensive and consistent counseling that focuses on emotional regulation, identifying distorted thinking, and understanding the needs of others.  This involves comprehensive psychotherapy that includes CBT, DBT and other cognitive therapies.  Humanistic therapies can attempt to at least encourage acknowledgement of the needs of others.  Medication is rarely helpful but only to alleviate secondary symptoms of anxiety or depression, especially in BPD (Barlow, et al., 2023).

Pastoral and Christian Counseling care has existed well before modern psychology.  In these practices, the proposed opposite virtue of the habitual vice was emphasized such as humility over pride or temperance over anger.  In these cases, the spiritual treatment of the sinful condition was considered in addition to the mental pathology.  Moral virtues, spiritual discipline, submission to God and constant regulation over viceful responses were considered critical.  For many, faith left the change to the grace of God  due to the sinful nature of humanity(McRay, 2016).Too many times, pastoral leaders or even counselors and mental healthcare professionals can become over involved in personality disorder cases looking to rescue and save these clients.  Many of these clients unfortunately are sometimes beyond saving and will attempt to manipulate helpers.

In regards to loved ones, family is encouraged to never withdraw love but to always protect themselves from manipulation or abuse.  In addition, they are to set strong boundaries with those facing personality disorders.  Boundaries are essential and must be made clear and definitive of expectations but also demands for treatment.  Family needs to become psycho-educated on the disorders and be able to identify manipulations or emotional states to better protect themselves but also help the person.

Conclusion

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Personality Disorders are habitual, persistent, and impairing traits that affect an individual’s ability to show empathy, regulate emotion, or interact with other people in a fair and just way.  The disorders affect their ability to properly assert themselves in positive or negative ways.  They manifest in types or paranoid, anti-social or avoidant.  All individuals to some extent sometimes deviate from the norm or do something wrong, but personality disorders deviate from the cultural norm on a consistent basis and at disproportionate extreme. While those who suffer from these disorders, especially BPD and Sociopathy must be held accountable for bad actions, one still must understand the unnatural impulse that has habitually sidetracked their ability to operate as normal individuals.  This leads to erratic, odd, distant, dysregulated, manipulative, rigid, emotional, or dangerous behaviors.  These disorders have multiple origins from genetics, biology, as well as past trauma, and behavioral upbringing.  It is difficult to predict what factors will lead to a true disorder but roughly 10 percent of the population suffers from a personality disorder.  In regards to treatment, psychopathology and some medications can help alleviate anxiety and depression, but overall, a person must commit to life long therapy and continually identify their issues.  Ironically, the inability to acknowledge this is the biggest issue for adjustment.  Finally, it is important to form healthy boundaries with loved ones who suffer from these disorders.  While many are hard to understand or even tolerate, it is important to remember they are broken.  This does not mean one surrenders oneself to their desires, nor does it mean one justifies their actions or does not hold one accountable, but it does demand an empathetic condition for their brokenness.

Please also review AIHCP’s Healthcare Certification Programs and see if they meet your academic and professional goals.

Additional AIHCP Blogs

Anti-Social Disorders – Access here

Narcissism Video- Access here

Borderline Personality Disorder- Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

Additional Resources

Personality Disorders. Cleveland Clinic.  Access here

Burton, A. (2024). “The 10 Personality Disorders”. Psychology Today.  Access here

Personality Disorders.  Mayo Clinic.  Access here

Pugle, M. (2026). “10 Types of Personality Disorders”. Very Well Health.  Access here