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In the case of pathological gambling, along with fluvoxamine, clomipramine has been shown effective in the treatment, with reducing the problems of pathological gambling in a subject by up to 90%. Whereas in trichotillomania, the use of clomipramine has again been found to be effective, fluoxetine has not produced consistent positive results. Fluoxetine, however, has produced positive results in the treatment of pathological skin picking disorder, although more research is needed to conclude this information. Fluoxetine has also been evaluated in treating IED and demonstrated significant improvement in reducing frequency and severity of impulsive aggression and irritability in a sample of 100 subjects who were randomized into a 14-week, double-blind study. Despite a large decrease in impulsive aggression behavior from baseline, only 44% of fluoxetine responders and 29% of all fluoxetine subjects were considered to be in full remission at the end of the study. Paroxetine has shown to be somewhat effective although the results are inconsistent. Another medication, escitalopram, has shown to improve the condition of the subjects of pathological gambling with anxiety symptoms. The results suggest that although SSRIs have shown positive results in the treatment of pathological gambling, inconsistent results with the use of SSRIs have been obtained which might suggest a neurological heterogeneity in the impulse-control disorder spectrum.
The psychosocial approach to the treatment of ICDs includes cognitive behavioral therapy (CBT) which has been reported to have positive results in the case of treatment of pathological gambling and sexual addiction. There is general consensus that cognitive-behavioural therapies offer an effective intervention model.
- Pathological gambling
- Pyromania
- intermittent explosive disorder
- Kleptomania
- Compulsive buying
As it has already been mentioned, patients with organic personality disorder show a wide variety of sudden behavioural changes and dysfunctions. There are not a lot of information about the treatment of this mental health disorder. The pharmacological approach is the most common therapy among patients with organic personality disorder. However, the choice of drug therapy relies on the seriousness of patient's situation and what symptoms are shown. The choice and administration of specific drugs contribute to the reduction of symptoms of organic personality disorder. For this reason, it is crucial for patients' treatment to be assessed by clinical psychologists and psychiatrists before the administration of drug.
Additionally, the dysfunctions in expression of behaviour of patients with organic personality disorder and the development of symptom of irritability, which are caused by aggressive and self-injurious behaviours, can be dealt with the administration of carbamazepine. Moreover, the symptoms of this disorder can be decreased by the administration of valproic acid. Also, emotional irritability and signs of depression can be dealt with the use of nortriptyline and low-dose thioridazine. Except from the symptom of irritability, patients express aggressive behaviours. At the onset of drug therapy for effective treatment of anger and aggression, the drug of carbamazepine, phenobarbital, benztropine and haloperidol can be administrated in order to reduce the symptoms of patients with organic personality disorder. In addition, the use of propranolol may decrease the frequent behaviours of rage attacks.
Finally, it is important for patients to take part in psychotherapy sessions during the period of drug therapy. In this way, there is prevention and patients can be protected by negative effects of drugs on their organism and their behaviour. Furthermore, the clinicians can provide useful and helpful support to patients during these psychotherapy sessions. Thus, the combination of drug therapy with psychotherapy can lead to the reduction of symptoms of this disorder and the improvement of patients' situation.
Psychiatrist Kantor suggests a treatment approach using psychodynamic, supportive, cognitive, behavioral and interpersonal therapeutic methods. These methods apply to both the Passive–aggressive person and their target victim.
To date, cognitive behavioral therapy (CBT) is the best established treatment for a variety of somatoform disorders including somatization disorder. CBT aims to help patients realize their ailments are not catastrophic and to enable them to gradually return to activities they previously engaged in, without fear of "worsening their symptoms". Consultation and collaboration with the primary care physician also demonstrated some effectiveness. The use of antidepressants is preliminary but does not yet show conclusive evidence. Electroconvulsive shock therapy (ECT) has been used in treating somatization disorder among the elderly; however, the results were still debatable with some concerns around the side effects of using ECT. Overall, psychologists recommend addressing a common difficulty in patients with somatization disorder in the reading of their own emotions. This may be a central feature of treatment; as well as developing a close collaboration between the GP, the patient and the mental health practitioner.
ASPD is considered to be among the most difficult personality disorders to treat. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. They may only simulate remorse rather than truly commit to change: they can be seductively charming and dishonest, and may manipulate staff and fellow patients during treatment. Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated.
Those with ASPD may stay in treatment only as required by an external source, such as parole conditions. Residential programs that provide a carefully controlled environment of structure and supervision along with peer confrontation have been recommended. There has been some research on the treatment of ASPD that indicated positive results for therapeutic interventions.
Psychotherapy also known as talk therapy is found to help treat patients with ASPD.Schema therapy is also being investigated as a treatment for ASPD. A review by Charles M. Borduin features the strong influence of Multisystemic therapy (MST) that could potentially improve this imperative issue. However, this treatment requires complete cooperation and participation of all family members. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance abuse, although others have reported contradictory findings.
Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors. Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of even this form of therapy.
The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD. A 2010 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which 8 studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD. Nonetheless psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co-occur with ASPD for which medications are indicated.
Treatment can include behavior modification therapy, medication, and family therapy. The evidence base criteria for BFRBs is strict and methodical. Individual behavioral therapy has been shown as a "probably effective" evidence-based therapy to help with thumb sucking, and possibly nail biting. Cognitive behavioral therapy was cited as experimental evidence based therapy to treat trichotillomania and nail biting. Another form of treatment that focuses on mindfulness, stimuli and rewards has proven effective in some people. However, no treatment was deemed well-established to treat any form of BFRBs.
Assessing the child's safety is an essential first step that determines whether future intervention can take place in the family unit or whether the child should be removed to a safe situation. Interventions may include psychosocial support services for the family unit (including financial or domestic aid, housing and social work support), psychotherapeutic interventions (including treating parents for mental illness, family therapy, individual therapy), education (including training in basic parenting skills and child development), and monitoring of the child's safety within the family environment
In 2005 the American Academy of Child and Adolescent Psychiatry laid down guidelines (devised by N.W. Boris and C.H. Zeanah) based on its published parameters for the diagnosis and treatment of RAD. Recommendations in the guidelines include the following:
1. "The most important intervention for young children diagnosed with reactive attachment disorder and who lack an attachment to a discriminated caregiver is for the clinician to advocate for providing the child with an emotionally available attachment figure."
2. "Although the diagnosis of reactive attachment disorder is based on symptoms displayed by the child, assessing the caregiver's attitudes toward and perceptions about the child is important for treatment selection."
3. "Children with reactive attachment disorder are presumed to have grossly disturbed internal models for relating to others. After ensuring that the child is in a safe and stable placement, effective attachment treatment must focus on creating positive interactions with caregivers."
4. "Children who meet criteria for reactive attachment disorder and who display aggressive and oppositional behavior require adjunctive (additional) treatments."
Mainstream prevention programs and treatment approaches for attachment difficulties or disorders for infants and younger children are based on attachment theory and concentrate on increasing the responsiveness and sensitivity of the caregiver, or if that is not possible, placing the child with a different caregiver. These approaches are mostly in the process of being evaluated. The programs invariably include a detailed assessment of the attachment status or caregiving responses of the adult caregiver as attachment is a two-way process involving attachment behavior and caregiver response. Some of these treatment or prevention programs are specifically aimed at foster carers rather than parents, as the attachment behaviors of infants or children with attachment difficulties often do not elicit appropriate caregiver responses. Approaches include "Watch, wait and wonder," manipulation of sensitive responsiveness, modified "Interaction Guidance", "Clinician-Assisted Videofeedback Exposure Sessions (CAVES)", "Preschool Parent Psychotherapy", "Circle of Security", "Attachment and Biobehavioral Catch-up" (ABC), the New Orleans Intervention, and parent–child psychotherapy. Other treatment methods include Developmental, Individual-difference, and Relationship-based therapy (DIR, also referred to as Floor Time) by Stanley Greenspan, although DIR is primarily directed to treatment of pervasive developmental disorders.
The relevance of these approaches to intervention with fostered and adopted children with RAD or older children with significant histories of maltreatment is unclear.
The terms attachment disorder, attachment problems, and attachment therapy, although increasingly used, have no clear, specific, or consensus definitions. However, the terms and therapies often are applied to children who are maltreated, particularly those in the foster care, kinship care, or adoption systems, and related populations such as children adopted internationally from orphanages.
Outside the mainstream programs is a form of treatment generally known as attachment therapy, a subset of techniques (and accompanying novel diagnosis) for supposed attachment disorders including RAD. These "attachment disorders" use diagnostic criteria or symptom lists different to criteria under ICD-10 or DSM-IV-TR, or to attachment behaviors. Sufferers of "attachment disorder" are said to lack empathy and remorse.
Treatments of this pseudoscientific disorder are called "Attachment therapy". In general, these therapies are aimed at adopted or fostered children with a view to creating attachment in these children to their new caregivers. The theoretical base is broadly a combination of regression and catharsis, accompanied by parenting methods which emphasize obedience and parental control. There is considerable criticism of this form of treatment and diagnosis as it is largely unvalidated and has developed outside the scientific mainstream. There is little or no evidence base and techniques vary from non-coercive therapeutic work to more extreme forms of physical, confrontational and coercive techniques, of which the best known are holding therapy, rebirthing, rage-reduction and the Evergreen model. These forms of the therapy may well involve physical restraint, the deliberate provocation of rage and anger in the child by physical and verbal means including deep tissue massage, aversive tickling, enforced eye contact and verbal confrontation, and being pushed to revisit earlier trauma. Critics maintain that these therapies are not within the attachment paradigm, are potentially abusive, and are to attachment theory. The APSAC Taskforce Report of 2006 notes that many of these therapies concentrate on changing the child rather than the caregiver. Children may be described as "RADs", "Radkids" or "Radishes" and dire predictions may be made as to their supposedly violent futures if they are not treated with attachment therapy. The Mayo Clinic, a well known U.S. non-profit medical practice and medical research group, cautions against consulting with mental health providers who promote these types of methods and offer evidence to support their techniques; to date, this evidence base is not published within reputable medical or mental health journals.
There exist some medications which can be useful specifically for treating sexual addiction.
Alternatively, doctors can prescribe general-purpose medications which have been found to be useful for a variety of behavioral addictions.
Excoriation disorder, and trichotillomania have been treated with inositol and N-acetylcysteine.
The term "pre-exposure prophylaxis" (PrEP) is generally used to refer to the use of [[antiviral drugs]] which can help in [[prevention of HIV/AIDS]]. PrEP is an optional treatment which may be taken by people who are HIV-negative, but who have substantial risk of getting an HIV infection.
In the US, most insurance plans cover these drugs.
The use of antipsychotic medication is commonly the first line of treatment; however, the effectiveness after treatment is in question.
L-DOPA is effective against reduced affect display and emotional withdrawal, aloofness from society, apathy.
Both psychotherapy as well as different drugs (e.g. serotonin reuptake inhibitors - SSRIs or mood stabilizers, e.g. lithium, antiepileptics) have been suggested as treatments. However, no randomized controlled treatment trial of RBD has been conducted.
The first-line psychiatric treatment for schizophrenia is antipsychotic medication, which can reduce the positive symptoms of psychosis in about 7 to 14 days. Antipsychotics, however, fail to significantly improve the negative symptoms and cognitive dysfunction. In those on antipsychotics, continued use decreases the risk of relapse. There is little evidence regarding effects from their use beyond two or three years. However use of anti-psychotics can lead to dopamine hypersensitivity increasing the risk of symptoms if antipsychotics are stopped.
The choice of which antipsychotic to use is based on benefits, risks, and costs. It is debatable whether, as a class, typical or atypical antipsychotics are better. Amisulpride, olanzapine, risperidone, and clozapine may be more effective but are associated with greater side effects. Typical antipsychotics have equal drop-out and symptom relapse rates to atypicals when used at low to moderate dosages. There is a good response in 40–50%, a partial response in 30–40%, and treatment resistance (failure of symptoms to respond satisfactorily after six weeks to two or three different antipsychotics) in 20% of people. Clozapine is an effective treatment for those who respond poorly to other drugs ("treatment-resistant" or "refractory" schizophrenia), but it has the potentially serious side effect of agranulocytosis (lowered white blood cell count) in less than 4% of people.
Most people on antipsychotics have side effects. People on typical antipsychotics tend to have a higher rate of extrapyramidal side effects, while some atypicals are associated with considerable weight gain, diabetes and risk of metabolic syndrome; this is most pronounced with olanzapine, while risperidone and quetiapine are also associated with weight gain. Risperidone has a similar rate of extrapyramidal symptoms to haloperidol. It remains unclear whether the newer antipsychotics reduce the chances of developing neuroleptic malignant syndrome or tardive dyskinesia, a rare but serious neurological disorder.
For people who are unwilling or unable to take medication regularly, long-acting depot preparations of antipsychotics may be used to achieve control. They reduce the risk of relapse to a greater degree than oral medications. When used in combination with psychosocial interventions, they may improve long-term adherence to treatment. The American Psychiatric Association suggests considering stopping antipsychotics in some people if there are no symptoms for more than a year.
Current methods in treating early-onset schizophrenia follow a similar approach to the treatment of adult schizophrenia. Although modes of treatment in this population is largely understudied, the use of antipsychotic medication is commonly the first line of treatment in addressing symptoms. Recent literature has failed to determine if typical or atypical antipsychotics are most effective in reducing symptoms and improving outcomes. When weighing treatment options, it is necessary to consider the adverse effects of various medications used to treat schizophrenia and the potential implications of these effects on development. A 2013 systematic review compared the efficacy of atypical antipsychotics versus typical antipsychotics for adolescents:
Madaan et al. wrote that studies report efficacy of typical neuroleptics such as thioridazine, thiothixene, loxapine and haloperidol, high incidence of side effects such as extrapyramidal symptoms, akathisia, dystonias, sedation, elevated prolactin, tardive dyskinesia.
There are a variety of mainstream prevention programs and treatment approaches for attachment disorder, attachment problems and moods or behaviors considered to be potential problems within the context of attachment theory. All such approaches for infants and younger children concentrate on increasing the responsiveness and sensitivity of the caregiver, or if that is not possible, changing the caregiver. Such approaches include 'Watch, wait and wonder,' manipulation of sensitive responsiveness, modified 'Interaction Guidance,'. 'Preschool Parent Psychotherapy,'. Circle of Security', Attachment and Biobehavioral Catch-up (ABC), the New Orleans Intervention, and Parent-Child psychotherapy. Other known treatment methods include Developmental, Individual-difference, Relationship-based therapy (DIR) (also referred to as "Floor Time") by Stanley Greenspan, although DIR is primarily directed to treatment of pervasive developmental disorders Some of these approaches, such as that suggested by Dozier, consider the attachment status of the adult caregiver to play an important role in the development of the emotional connection between adult and child. This includes foster parents, as children with poor attachment experiences often do not elicit appropriate caregiver responses from their attachment behaviors despite 'normative' care.
Treatment for reactive attachment disorder for children usually involves a mix of therapy, counseling, and parenting education. These must be designed to make sure the child has a safe environment to live in and to develop positive interactions with caregivers and improves their relationships with their peers.
Medication can be used as a way to treat similar conditions, like depression, anxiety, or hyperactivity; however, there is no quick fix for treating reactive attachment disorder. A pediatrician may recommend a treatment plan. For example, a mix of family therapy, individual psychological counseling, play therapy, special education services and parenting skills classes.
The World Health Organization's ICD-10 lists dependent personality disorder as " Dependent personality disorder":
It is characterized by at least 4 of the following:
1. Encouraging or allowing others to make most of one's important life decisions;
2. Subordination of one's own needs to those of others on whom one is dependent, and undue compliance with their wishes;
3. Unwillingness to make even reasonable demands on the people one depends on;
4. Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself;
5. Preoccupation with fears of being abandoned by a person with whom one has a close relationship, and of being left to care for oneself;
6. Limited capacity to make everyday decisions without an excessive amount of advice and reassurance from others.
Associated features may include perceiving oneself as helpless, incompetent, and lacking stamina.
Includes:
- Asthenic, inadequate, passive, and self-defeating personality (disorder)
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
The primary treatment of schizophrenia is antipsychotic medications, often in combination with psychological and social supports. Hospitalization may occur for severe episodes either voluntarily or (if mental health legislation allows it) involuntarily. Long-term hospitalization is uncommon since deinstitutionalization beginning in the 1950s, although it still occurs. Community support services including drop-in centers, visits by members of a community mental health team, supported employment and support groups are common. Some evidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizophrenia.
There are no evidence-based treatments for the condition; health care providers generally try to help people cope with it by recognizing what the person is experiencing, and by working on coping strategies with the person. Some small studies have been published on the use of sound therapy similar to tinnitus retraining therapy and on cognitive behavioral therapy and particularly exposure therapy, to help people become less aware of the trigger sound. None of these approaches have been sufficiently studied to determine their effectiveness.
Dependent personality disorder (DPD), formerly known as asthenic personality disorder, is a personality disorder that is characterized by a pervasive psychological dependence on other people. This personality disorder is a long-term condition in which people depend on others to meet their emotional and physical needs, with only a minority achieving normal levels of independence.
The cause of dependent personality disorder is unknown. A study in 2012 estimated that between 55% and 72% of the risk of the condition is inherited from one's parents. The difference between a "dependent personality" and a "dependent personality disorder" is somewhat subjective, which makes diagnosis sensitive to cultural influences such as gender role expectations.
Passive–aggressive disorder may stem from a specific childhood stimulus (e.g., alcohol/drug addicted parents, bullying, abuse) in an environment where it was not safe to express frustration or anger. Families in which the honest expression of feelings is forbidden tend to teach children to repress and deny their feelings and to use other channels to express their frustration. For example, if physical and psychological punishment were to be dealt to children who express anger, they would be inclined to be passive aggressive.
Children who sugarcoat hostility may have difficulties being assertive, never developing better coping strategies or skills for self-expression. They can become adults who, beneath a "seductive veneer," harbor "vindictive intent," in the words of US congressman/psychologist Timothy F. Murphy, and writer/practicing therapist Loriann Oberlin. Alternatively individuals may simply have difficulty being as directly aggressive or assertive as others. Martin Kantor suggests three areas that contribute to Passive–aggressive anger in individuals: conflicts about dependency, control, and competition, and that a person may be termed Passive–aggressive if they behave so to few people on most occasions.
Murphy and Oberlin also see passive aggression as part of a larger umbrella of hidden anger stemming from ten traits of the angry child or adult. These traits include making one's own misery, the inability to analyze problems, blaming others, turning bad feelings into angry ones, attacking people, lacking empathy, using anger to gain power, confusing anger with self-esteem, and indulging in negative self-talk. Lastly, the authors point out that those who hide their anger can be nice when they wish to be.
Money disorders are the maladaptive patterns of financial beliefs and behaviors that lead to clinically significant distress, impairment in social or occupational functioning, due to financial strain or an inability to appropriately enjoy one’s financial resources. With the exception of pathological gambling and compulsive buying, psychology and the mental health fields have largely neglected dysfunctional money disorders. The term is contentious among mental health professionals and as of 2017, money disorder is not a clinical diagnosis in either the DSM or ICD medical classifications of diseases and medical disorders.
Types of behaviors, or “scripts”, related to money disorders include money avoidance, money worship, money status and money vigilance. Some mental health practitioners say that those afflicted with money disorders or who have problematic money beliefs can seek financial therapy. With financial therapy, financial planners and relationship therapists work together to provide comprehensive treatment to clients experiencing financial distress.
Organic personality disorder (OPD) is not included in the wide variety of group of personality disorders. For this reason, the symptoms and diagnostic criteria of the organic personality disorder are different from those of the mental health disorders, which are included in this various group of personality disorders. According to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems ICD-10, it defines the organic personality disorder as the personality change, which can be caused by traumatic brain injury (TBI) that means there are specific brain areas of patients, which have been injured after a very strong accident. Moreover, according to the ICD-10, the organic personality disorder is associated with a "significant alteration of the habitual patterns of premorbid behaviour". Furthermore, organic personality disorder is associated with "personality change due to general medical condition". There are crucial influences on emotions, impulses and personal needs because of this disorder. Thus, all these definitions about the organic personality disorder support that this type of disorder is associated with changes in personality and behaviour.
According to Professor Emily Simonoff of the Institute of Psychiatry, Psychology and Neuroscience, "childhood hyperactivity and conduct disorder showed equally strong prediction of antisocial personality disorder (ASPD) and criminality in early and mid-adult life. Lower IQ and reading problems were most prominent in their relationships with childhood and adolescent antisocial behaviour."