Stereotypy/Habit Disorder
The essential features of this disorder are intentional and repetitive behaviors that
are nonfunctional, i.e., serve no constructive, socially acceptable purpose. The
behaviors may include: body-rocking, head-banging, hitting or biting parts of one's
own body (e.g., face-slapping, hand-biting), skin-picking or -scratching,
teeth-grinding (bruxism), bodily manipulations (e.g., incessant nose-picking,
hair-pulling, eye- and anus-poking), noncommunicative, repetitive vocalizations,
breath-holding, hyperventilation, and swallowing air (aerophagia). Frequently the
behaviors are performed in a rhythmic fashion.
The diagnosis is given only when the disturbance either causes physical
injury to the child or markedly interferes with normal activities. The diagnosis is
not given when a Pervasive Developmental Disorder or a Tic Disorder is
present.
Associated features. Stereotypy/Habit Disorder, especially In Its more
severe forms, is frequently associated with Mental Retardation. Stereotypic
"blindism" behaviors are seen in some congenitally blind people, such as
head-rocking and other maneuvers to create sensory stimuli (pressing the
eyeballs, directing eyes at strong light source, smelling objects and persons).
Characteristic self-restraint behaviors, such as keeping hands inside the shirt, are
seen in people who injure themselves with these behaviors.
Age at onset. Behaviors such as thumb-sucking, rocking (especially before
falling asleep), and bruxism may be observed in normal infants and young
children. The pathologic Stereotypy/Habit Disorder is usually first seen in
childhood, and may intensify in adolescence.
Course. The course may be brief if it is apparently linked to an episodic
disorder, such as a brief psychotic episode. It may be chronic if linked to a
chronic disorder, such as severe or profound Mental Retardation. The course is
likely to be chronic if there are treatment or environmental factors that maintain
the symptoms, such as a caregiver's paying attention to the self-injurious
behavior. In some children with Mental Retardation, the symptoms disappear in
later childhood, especially with treatment. Stereotypy/Habit Disorder associated
with disorders of the central nervous system, such as Lesch-Nyhan syndrome,
are more likely to be refractory to treatment.
Impairment. Severe forms may interfere with self-care and other skills.
Depending on the type of behavior, the disorder may result in social rejection.
Complications (see below) may lead to physical impairment.
Complications. In extreme cases, severe mutilation and life-threatening injury
may result. Self-inflicted wounds may become infected and lead to septicemia.
Severe eye-poking or -hitting may produce retinal detachment and blindness.
Scarring from chronic, self-inflicted injuries may limit limb movement or be
disfiguring in other ways. Some people with Lesch-Nyhan syndrome may virtually
amputate distal parts of the upper limbs through biting.
Predisposing Factors. People with severe or profound Mental Retardation,
especially those who have multiple handicaps, are more predisposed to develop
Stereotypy/Habit Disorder than those with milder Mental Retardation. The
disorder is more common in nonstimulating institutional environments, where it
may serve the adaptive function of attracting staff attention. It may be associated
with sensory handicaps (blindness and deafness, especially when congenital),
degenerative and central nervous system disorders (Lesch-Nyhan syndrome,
temporal lobe epilepsy, postencephalitic syndrome), and other mental disorders in
their most severe forms (e.g., Schizophrenia and Obsessive Compulsive
Disorder). It may be induced by certain psychoactive substances such as
amphetamine, in which case both the diagnosis Stereotypy/Habit Disorder and
Psychoactive Substance-induced Organic Mental Disorder should be made.
Prevalence. No information. Self-injurious behaviors have been estimated to
occur in 10% to 23% of institutionalized people with Mental Retardation.
Differential diagnosis. Self-stimulating behaviors, such as rocking
(especially before falling asleep) and thumb-sucking, are common in normal
infants and young children. Stereotypy/Habit Disorder should not be diagnosed if
the behavior occurs in the context of a Pervasive Developmental Disorder. The
stereotyped behavior present in Tic Disorders is involuntary, even though it can
be suppressed for varying periods of time.
(Diagnostic Criteria for Stereotypy/Habit Disorder)
A. Intentional, repetitive, nonfunctional behaviors, such as hand-shaking or
-waving, body-rocking, head-banging, mouthing of objects, nail-biting,
picking at nose or skin.
B. The disturbance either causes physical injury to the child or markedly
interferes with normal activities, e.g., injury to head from head-banging;
inability to fall asleep because of constant rocking.
C. Does not meet the criteria for either a Pervasive Developmental Disorder or
a Tic Disorder.
Undifferentiated Attention-deficit Disorder
This is a residual category for disturbances in which the predominant feature is
the persistence of developmentally inappropriate and marked inattention that is
not a symptom of another disorder, such as Mental Retardation or
Attention-deficit Hyperactivity Disorder, or of a disorganized and chaotic
environment.
Pedophilia
The essential feature of this disorder is recurrent, intense, sexual urges and
sexually arousing fantasies, of at least six months' duration, involving sexual
activity with a prepubescent child. The person has acted on these urges, or is
markedly distressed by them. The age of the child is generally 13 or younger The
age of the person is arbitrarily set at age 16 years or older and at least 5 years
older than the child. For late adolescents with the disorder, no precise age
difference is specified, and clinical judgment must be used; both the sexual
maturity of the child and the age difference must be taken into account.
People with Pedophilia generally report an attraction to children of a particular
age range, which may be as specific as within a range of only one or two years.
Those attracted to girls usually prefer eight-to-ten-year-olds, whereas those
attracted to boys usually prefer slightly older children. Attraction to girls is
apparently twice as common as attraction to boys. Many people with Pedophilia
are sexually aroused by both young boys and young girls.
Some people with Pedophilia are sexually attracted only to children (exclusive
type), whereas others are sometimes attracted to adults (nonexclusive type).
People with this disorder who act on their urges with children may limit their
activity to undressing the child and looking, exposing themselves, masturbating in
the presence of the child, or gentle touching and fondling of the child. Others,
however, perform fellatio or cunnilingus on the child or penetrate the child's
vagina, mouth or anus with their fingers, foreign objects, or penis, and use
varying degrees of force to achieve these ends. These activities are commonly
explained with excuses or rationalizations that they have "educational value" for
the child, that the child derives "sexual pleasure" from them, or that the child was
"sexually provocative" themes that are also common in pedophilic
pornography.
The person may limit his activities to his own children, stepchildren, or
relatives, or may victimize children outside his family. Some people with the
disorder threaten the child to prevent disclosure. Others, particularly those who
frequently victimize children, develop complicated techniques for obtaining
children, which may include winning the trust of a child's mother, marrying a
woman with an attractive child, trading children with others with the disorder, or,
in rare instances, bringing foster children from nonindustrialized countries or
abducting children from strangers.
Except in cases in which the disorder is associated with Sexual Sadism, the
person may be generous and very attentive to the child's needs in all respects
other than the sexual victimization in order to gain the child's affection, interest,
and loyalty and to prevent the child from reporting the sexual activity.
Age at onset. The disorder usually begins in adolescence, although some
people with Pedophilia report that they did not become aroused by children until
middle age.
Course. The course is usually chronic, especially in those attracted to boys.
The frequency of pedophilic behavior often fluctuates with psychosocial stress.
The recidivism rate for people with Pedophilia involving a preference for the same
sex is roughly twice that of those who prefer the opposite sex.
Predisposing Factors. Many people with this disorder were themselves
victims of sexual abuse in childhood.
Differential diagnosis. Isolated sexual acts with children do not necessarily
warrant the diagnosis of Pedophilia. Such acts may be precipitated by marital
discord, recent loss, or intense loneliness. In such instances the desire for sex
with a child may be understood as a substitute for a preferred but unavailable
adult. When pedophilic behavior involves a family member (incest), a diagnosis of
Pedophilia should be made if the diagnostic criteria are met. In such cases there
often is pedophilic behavior with children outside the family. In Mental
Retardation, Organic Personality Syndrome, Alcohol Intoxication, or
Schizophrenia there may be a decrease in judgment, social skills, or impulse
control, particularly in the elderly, that, in rare instances, leads to isolated sexual
acts with children; but in such cases sexual activity with children Is generally not
the consistently preferred method for achieving sexual satisfaction.
In Exhibitionism, exposure may be to a child, but the act is not a prelude to
further sexual activity with the child. Sexual Sadism may, in rare instances, be
associated with Pedophilia, in which case both diagnoses are warranted.
(Diagnostic Criteria for Pedophilia)
A. Over a period of at least six months, recurrent intense sexual urges and
sexually arousing fantasies involving sexual activity with a prepubescent
child or children (generally age 13 or younger).
B. The person has acted on these urges, or is markedly distressed by
them.
C. The person is at least 16 years old and at least 5 years older than the child
or children in A.
Note: Do not include a late adolescent involved in an ongoing sexual
relationship with a 12- or 13-year-old.
Specify: same sex, opposite sex, or same and opposite sex.
Specify if limited to incest.
Specify: exclusive type (attracted only to children), or nonexclusive type.
Page 17
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The essential features of this disorder are intentional and repetitive behaviors that are nonfunctional, i.e., serve no constructive, socially acceptable purpose. The behaviors may include: body-rocking, head-banging, hitting or biting parts of one's own body (e.g., face-slapping, hand-biting), skin-picking or -scratching, teeth-grinding (bruxism), bodily manipulations (e.g., incessant nose-picking, hair-pulling, eye- and anus-poking), noncommunicative, repetitive vocalizations, breath-holding, hyperventilation, and swallowing air (aerophagia). Frequently the behaviors are performed in a rhythmic fashion.
The diagnosis is given only when the disturbance either causes physical injury to the child or markedly interferes with normal activities. The diagnosis is not given when a Pervasive Developmental Disorder or a Tic Disorder is present.
Associated features. Stereotypy/Habit Disorder, especially In Its more severe forms, is frequently associated with Mental Retardation. Stereotypic "blindism" behaviors are seen in some congenitally blind people, such as head-rocking and other maneuvers to create sensory stimuli (pressing the eyeballs, directing eyes at strong light source, smelling objects and persons). Characteristic self-restraint behaviors, such as keeping hands inside the shirt, are seen in people who injure themselves with these behaviors.
Age at onset. Behaviors such as thumb-sucking, rocking (especially before falling asleep), and bruxism may be observed in normal infants and young children. The pathologic Stereotypy/Habit Disorder is usually first seen in childhood, and may intensify in adolescence.
Course. The course may be brief if it is apparently linked to an episodic disorder, such as a brief psychotic episode. It may be chronic if linked to a chronic disorder, such as severe or profound Mental Retardation. The course is likely to be chronic if there are treatment or environmental factors that maintain the symptoms, such as a caregiver's paying attention to the self-injurious behavior. In some children with Mental Retardation, the symptoms disappear in later childhood, especially with treatment. Stereotypy/Habit Disorder associated with disorders of the central nervous system, such as Lesch-Nyhan syndrome, are more likely to be refractory to treatment.
Impairment. Severe forms may interfere with self-care and other skills. Depending on the type of behavior, the disorder may result in social rejection. Complications (see below) may lead to physical impairment.
Complications. In extreme cases, severe mutilation and life-threatening injury may result. Self-inflicted wounds may become infected and lead to septicemia. Severe eye-poking or -hitting may produce retinal detachment and blindness. Scarring from chronic, self-inflicted injuries may limit limb movement or be disfiguring in other ways. Some people with Lesch-Nyhan syndrome may virtually amputate distal parts of the upper limbs through biting.
Predisposing Factors. People with severe or profound Mental Retardation, especially those who have multiple handicaps, are more predisposed to develop Stereotypy/Habit Disorder than those with milder Mental Retardation. The disorder is more common in nonstimulating institutional environments, where it may serve the adaptive function of attracting staff attention. It may be associated with sensory handicaps (blindness and deafness, especially when congenital), degenerative and central nervous system disorders (Lesch-Nyhan syndrome, temporal lobe epilepsy, postencephalitic syndrome), and other mental disorders in their most severe forms (e.g., Schizophrenia and Obsessive Compulsive Disorder). It may be induced by certain psychoactive substances such as amphetamine, in which case both the diagnosis Stereotypy/Habit Disorder and Psychoactive Substance-induced Organic Mental Disorder should be made.
Prevalence. No information. Self-injurious behaviors have been estimated to occur in 10% to 23% of institutionalized people with Mental Retardation.
Differential diagnosis. Self-stimulating behaviors, such as rocking (especially before falling asleep) and thumb-sucking, are common in normal infants and young children. Stereotypy/Habit Disorder should not be diagnosed if the behavior occurs in the context of a Pervasive Developmental Disorder. The stereotyped behavior present in Tic Disorders is involuntary, even though it can be suppressed for varying periods of time.
(Diagnostic Criteria for Stereotypy/Habit Disorder)
A. Intentional, repetitive, nonfunctional behaviors, such as hand-shaking or -waving, body-rocking, head-banging, mouthing of objects, nail-biting, picking at nose or skin.
B. The disturbance either causes physical injury to the child or markedly interferes with normal activities, e.g., injury to head from head-banging; inability to fall asleep because of constant rocking.
C. Does not meet the criteria for either a Pervasive Developmental Disorder or a Tic Disorder.
Undifferentiated Attention-deficit Disorder
This is a residual category for disturbances in which the predominant feature is the persistence of developmentally inappropriate and marked inattention that is not a symptom of another disorder, such as Mental Retardation or Attention-deficit Hyperactivity Disorder, or of a disorganized and chaotic environment.
Pedophilia
The essential feature of this disorder is recurrent, intense, sexual urges and sexually arousing fantasies, of at least six months' duration, involving sexual activity with a prepubescent child. The person has acted on these urges, or is markedly distressed by them. The age of the child is generally 13 or younger The age of the person is arbitrarily set at age 16 years or older and at least 5 years older than the child. For late adolescents with the disorder, no precise age difference is specified, and clinical judgment must be used; both the sexual maturity of the child and the age difference must be taken into account.
People with Pedophilia generally report an attraction to children of a particular age range, which may be as specific as within a range of only one or two years. Those attracted to girls usually prefer eight-to-ten-year-olds, whereas those attracted to boys usually prefer slightly older children. Attraction to girls is apparently twice as common as attraction to boys. Many people with Pedophilia are sexually aroused by both young boys and young girls.
Some people with Pedophilia are sexually attracted only to children (exclusive type), whereas others are sometimes attracted to adults (nonexclusive type).
People with this disorder who act on their urges with children may limit their activity to undressing the child and looking, exposing themselves, masturbating in the presence of the child, or gentle touching and fondling of the child. Others, however, perform fellatio or cunnilingus on the child or penetrate the child's vagina, mouth or anus with their fingers, foreign objects, or penis, and use varying degrees of force to achieve these ends. These activities are commonly explained with excuses or rationalizations that they have "educational value" for the child, that the child derives "sexual pleasure" from them, or that the child was "sexually provocative" themes that are also common in pedophilic pornography.
The person may limit his activities to his own children, stepchildren, or relatives, or may victimize children outside his family. Some people with the disorder threaten the child to prevent disclosure. Others, particularly those who frequently victimize children, develop complicated techniques for obtaining children, which may include winning the trust of a child's mother, marrying a woman with an attractive child, trading children with others with the disorder, or, in rare instances, bringing foster children from nonindustrialized countries or abducting children from strangers.
Except in cases in which the disorder is associated with Sexual Sadism, the person may be generous and very attentive to the child's needs in all respects other than the sexual victimization in order to gain the child's affection, interest, and loyalty and to prevent the child from reporting the sexual activity.
Age at onset. The disorder usually begins in adolescence, although some people with Pedophilia report that they did not become aroused by children until middle age.
Course. The course is usually chronic, especially in those attracted to boys. The frequency of pedophilic behavior often fluctuates with psychosocial stress. The recidivism rate for people with Pedophilia involving a preference for the same sex is roughly twice that of those who prefer the opposite sex.
Predisposing Factors. Many people with this disorder were themselves victims of sexual abuse in childhood.
Differential diagnosis. Isolated sexual acts with children do not necessarily warrant the diagnosis of Pedophilia. Such acts may be precipitated by marital discord, recent loss, or intense loneliness. In such instances the desire for sex with a child may be understood as a substitute for a preferred but unavailable adult. When pedophilic behavior involves a family member (incest), a diagnosis of Pedophilia should be made if the diagnostic criteria are met. In such cases there often is pedophilic behavior with children outside the family. In Mental Retardation, Organic Personality Syndrome, Alcohol Intoxication, or Schizophrenia there may be a decrease in judgment, social skills, or impulse control, particularly in the elderly, that, in rare instances, leads to isolated sexual acts with children; but in such cases sexual activity with children Is generally not the consistently preferred method for achieving sexual satisfaction.
In Exhibitionism, exposure may be to a child, but the act is not a prelude to further sexual activity with the child. Sexual Sadism may, in rare instances, be associated with Pedophilia, in which case both diagnoses are warranted.
(Diagnostic Criteria for Pedophilia)
A. Over a period of at least six months, recurrent intense sexual urges and sexually arousing fantasies involving sexual activity with a prepubescent child or children (generally age 13 or younger).
B. The person has acted on these urges, or is markedly distressed by them.
C. The person is at least 16 years old and at least 5 years older than the child or children in A.
Note: Do not include a late adolescent involved in an ongoing sexual relationship with a 12- or 13-year-old.
Specify: same sex, opposite sex, or same and opposite sex.
Specify if limited to incest.
Specify: exclusive type (attracted only to children), or nonexclusive type.