Answer discussion questionon 250 words. Respond to 3 classmates 250 words each.

Discussion #7: This week’s readings provide an overview of treatment of many of these disorders that this class examined. Identify one disorder of your choice and provide evidence that either supports or refutes that treatment can be effective for this disorder. For example you might cite that pedophiliacs are not treatable and cite evidence to support that, be sure to debate amongst yourselves if you agree or disagree with your peer’s assessment of the disorder.

Objectives:

CO1: Summarize the link between mental illness and criminal behavior.

CO2: Debate how mental health issues influence behavior.

CO3: Synthesize the mental health diagnosis of conduct disorder.

Classmate 1 Kassy: There have been a plethora of various mental disorders that have been brought up during this course. A mental disorder that stands out is sexual sadism due to the severe nature of this mental disorder. According to the DSM-5, the definition of sexual sadism is “Characterized by the involvement of reoccurring and extreme arousal sexually from the psychological and or physical anguish of another person which can be expressed through varying behaviors, sexual urges and dreamed up fantasies by a person suffering from sexual sadism. In addition to the aforementioned definition, sexual sadism is also defined as a person who acts on the sexual urges with a partner who does not consent to the outlined paraphilia, the fantasies and urges of a sexual nature may cause considerable distress, the fantasies and urges of a sexual nature may also inflict social impairment, the fantasies and urges of a sexual nature may also cause occupational difficulties, and the fantasies and urges of a sexual nature may also inhibit the function and development of significant parts of the brain” (American Psychiatric Association, 2013, p. 695).

The treatment of paraphilic mental illnesses such as sexual sadism can be done through psychotherapeutic and pharmacological methods. Selective Serotonin Reuptake Inhibitors and antiandrogen treatments are amongst the most common treatments. Selective Serotonin Reuptake Inhibitors are commonly referred to as anti-depressants and can be utilized to treat more mild forms of paraphilia as well as when the treatment is for juvenile patients being treated for more mild forms of paraphilia. In addition to Selective Serotonin Reuptake Inhibitors, antiandrogen treatments (commonly referred to as testosterone blockers or even commonly referred to as androgen antagonists). In order to try to minimize re-offense and victimization, androgen antagonists target the sexual urges that are inherently problematic. Androgen antagonists are utilized for more severe cases which include diagnosed sexual sadists in addition to sexual offenders. However, the most effective results for sexual sadism treatments are stemmed from the utilization of both androgen treatments in culmination to selective serotonin reuptake inhibitor usage (Garcia, 2013).

It is likely through medicinal breakthroughs and the coming years that sexual sadism will continue to be treated pharmaceutically and psychotherapeutically. However some of the more common sexual sadism activities are becoming normalized and it is possible that sexual sadism will soon no longer be considered a mental illness or even deviant behavior (Berner, Berger, & Hill, 2003). Taking into consideration the normalization that is starting to occur from the term sexual sadism, it seems fair that it cannot truly be treated as opposed to just keeping symptoms at bay. Or it can be taken into account that maybe people do not want treatment because sexual sadism is now something that people are becoming more accepting of.

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders

(5th ed.) (DSM‐5). Arlington, VA: American Psychiatric Publishing.

Berner, W., Berger, P., & Hill, A. (2003). Sexual sadism. International Journal of Offender

Therapy and Comparative Criminology, 47(4), 383-395.

Garcia, F.D., Delavenne, H.G., Assumpção, A.F.A. et al. Curr Psychiatry Rep (2013) 15:

356.https://doi.org/10.1007/s11920-013-0356-5

Classmate 2 Brennyn: I am currently serving a temporary assignment as a School Resource Officer, so conduct disorder really caught my attention when looking into the subject earlier in the course. Many of the students that I seem to be dealing with on frequent basis, I believe, may have some diagnosed or undiagnosed emotional/behavioral disorder(s). For this reason, I researched the treatment of conduct disorder and how effective the different approaches may be, particularly when the treatment is implemented at different ages. Overall, however, I do believe that the symptoms of conduct disorder can be mitigated and managed through treatment.

Children diagnosed with conduct disorder also have a high incidence of comorbid mental disorder diagnoses, such as major depressive disorder and ADHD. In fact, cases of conduct disorder and oppositional defiant disorder are almost invariably associated with other comorbid conditions (Kazdin, 2010). For this reason, treatment of conduct disorder is oftentimes concurrent with treatment of these comorbid disorders. Unfortunately, several studies have found that treatment methods such as pharmacology and cognitive-behavioral therapeutic techniques seem to have a more significant impact on the comorbid diagnoses than they do on the symptoms of conduct disorder, especially when treatment efforts are focused on the comorbid conditions (Rohde et al., 2004).

Several intervention options are available and can potentially have a significant impact on the problems that present in children diagnosed with conduct disorder. Treatment options may include cognitive problem-solving skills training as well as parent management training (Kazdin, 2010). When used in conjunction with one another, the child has the highest probability of success in managing their symptoms. The goal of treatment is to teach the children the skills that they lack that are believed to be the primary cause of their behavior problems, specifically interpersonal and problem solving skills (Tcheremissine & Lieving, 2006). Parent training and education programs were found to have a short-term positive effect on the child’s behavior, lasting up to four months. More intensive intervention programs that consisted of longer contact hours with families and additional child involvement tended to be more effective (Dretzke et al., 2005). Multisystemic therapy has been found to be effective in reducing recurrent behavioral problems in delinquent adolescents by combining family therapy, behavioral parent training, interpersonal skills and behavioral training, and marital therapy. Multidimensional treatment foster care targets children in foster homes and includes family therapy and school intervention elements. Such treatment has been shown to be more effective than community group home services in reducing problematic behaviors (Tcheremissine & Lieving, 2006).

Management of conduct disorder differs dependent on the developmental period of the affected child. Treatment most commonly includes psychosocial family-based interventions that involves the parents and/or primary caregivers at every age; however, additional interventions vary dependent on the age of the patient as well as the presence or absence of callous-unemotional traits or comorbid psychiatric disorders (Fairchild et al., 2019). Early to middle childhood psychosocial intervention options tend to focus on parental training and empathy training for the child. Late childhood and adolescence psychosocial intervention options focus more on skills training for the child (Fairchild et al., 2019). Supplemental pharmacologic treatment options for conduct disorder include antipsychotics for children with severe patterns of aggression and disruptive behavior. Additional medications that may be utilized include mood stabilizers, antidepressants, stimulants, and an adrenergic agent. Each category of medication has been found to have some sort of positive effect on the symptoms of conduct disorder including an increase in impulse control and self-restraint, improvement in overt aggression, and reductions in conduct problems and hyperactivity (Tcheremissine & Lieving, 2006).

The cost of a diagnosis of conduct disorder is elevated, with one study suggesting that by age 28, individuals diagnosed with conduct disorder cost approximately ten times as much as an individual with no problems. These costs are primarily incurred by the resulting criminality, educational provisions, and out-of-home care options. Health services make up only a small portion of these costs (Dretzke et al., 2005). Dretzke et al. (2005) found that parent training and education programs appear to be effective and offer a potentially cost-effective treatment option for children diagnosed with conduct disorder. Fairchild et al. (2019) also suggest that the most cost-effective treatment options for conduct disorder focus on the quality of parenting in early and middle childhood. Overall, however, treatment options for conduct disorder do seem to have a positive effect on the prevalence and severity of symptoms, particularly when addressed early on in the development of the disorder.

References:

Dretzke, J., Frew, E., Davenport, C., Barlow, J., Stewart-Brown, S., Sandercock, J., Bayliss, S., Raftery, J., Hyde, C., & Taylor, R. (2005). The effectiveness and cost-effectiveness of parent training/education programmes for the treatment of conduct disorder, including oppositional defiant disorder, in children. Health Technology Assessment, 9(50), 1-233.

Fairchild, G., Hawes, D. J., Frick, P. J., Copeland, W. E., Odgers, C. L., Franke, B., Freitag, C. M., & De Brito, S. A. (2019). Conduct disorder. Nature Reviews: Disease Primers, 5(43), 1-25.

Kazdin, A. E. (2010). Problem-solving skills training and parent management training for oppositional defiant disorder and conduct disorder. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 211-226). The Guilford Press.

Rohde, P., Clarke, G. N., Mace, D. E., Jorgensen, J. S., & Seeley, J. R. (2004). An efficacy/effectiveness study of cognitive-behavioral treatment for adolescents with comorbid major depression and conduct disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 43(6), 660-668.

Tcheremissine, O. V. & Lieving, L. M. (2006). Pharmacological aspects of the treatment of conduct disorder in children and adolescents. CNS Drugs, 20(7), 549-565.

Classmate 3 Natalie: The mental disorder that I am focusing on this week is, Factitious Disorder Imposed on Another. Factitious Disorder Imposed on Another is formerly known as Munchausen Syndrome by Proxy. Regardless, this mental disorder is where an individual, "acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick" (Cleveland Clinic, 2021). In cases, it is often that this mental illness is displayed between an adult and a child, where the adult acts as if the child has an illness by lies or producing the overall thought. This illness can also be displayed in the relationship between an adult and the elderly (Cleveland Clinic, 2021).

While this disorder can be correlated with abuse, which is common, the amount of cases reported in regard to this mental disorder is extremely rare. Despite this disorder often going undetected as stated previously, it can be suggested that, "about 1,000 of the 2.5 million cases of child abuse reported annually are related to FDIA" (Cleveland Clinic, 2021). One reason why this disorder goes undetected is because it is difficult to notice symptoms due to the lengths and levels of deception that the adult perpetrator produces. Some signs and symptoms include extensive knowledge of medical terms and diseases, frequent stays in the hospital, many surgical scars or evidence of numerous procedures (Mayo Clinic, 2019).

A prime example of this type of mental disorder is the infamous case of Gypsy Rose Blanchard and her mother Dee Dee Blanchard. This story can also be seen through the show, The Act. Nonetheless, Dee Dee made countless claims about her daughter, Gypsy Rose's state of health. Dee Dee induced leukemia and muscular dystrophy on Gypsy Rose at eight years old, claiming she required a feeding tube and wheel chair (Kettler, 2021). In addition, Gypsy Rose's mother made her use a breathing machine whenever she slept, as well as, take various types of medications, and undergo unnecessary surgeries. Due to these actions, Gypsy's teeth would rot and she would have to eventually have them pulled out, in addition to having a bald head because Dee Dee shaved it, not because of actual cancer.

Gypsy also endured sitting in a wheel chair the majority of her youth, even though she could walk, and was stuck with a feeding tube, despite the fact that she did not need it, nor was it pertinent to her health. The television show, as mentioned earlier, would display Gypsy Rose tasting frosting off of a cupcake and Dee Dee catching her and franticly running towards her with an epi-pen and stabbing her with it, claiming that she was allergic. While watching the show it is evident that Dee Dee is mentally unstable, however, to the neighbors in the show, Dee Dee seemed like a devoted mother to her child's health and well-being. This facade enabled society to view Dee Dee in this same light. Therefore, "Gypsy and Dee Dee… received benefits that included charity-sponsored visits… a new home… built by Habitat for Humanity… (Kettler, 2021). It was not until, "Gypsy was 14, she saw a neurologist… who came to believe she was a victim of Munchausen Syndrome by Proxy. However, this doctor never reported it" (Kettler, 2021).

This example of the relationship between this mother and daughter demonstrates the mental disorder FDIA, along with everything it entails, such as symptoms. In this case, the "treatment" option that Gypsy chose was to have her boyfriend kill her mother. However, actual treatment options for FDIA are slim to none. "Studies show that the only currently available effective treatment… is psychotherapy" (Carnahan & Jhan, 2021). Medications were a possible treatment option due to some diagnosed with the disorder, suffering from depression, but, it "does not significantly improve symptoms" (Carnahan & Jhan, 2021). A downfall to possible treatment is the unwillingness of those diagnosed. "Oftentimes patients with FDIA will deny their behavior and refuse treatment when confronted" (Carnahan & Jhan, 2021). Therefore, the recommended approach by health care providers is to be straight forward and concise, in addition, to initially trying to build a relationship with the patient, rather than strictly treating the patient.

Based on the information previously discussed, I do not believe that any treatment can help an individual diagnosed with FDIA. The factor that makes me believe that treatment would not be effective is the unwillingness of the individual. Even in previous lessons and knowledge on the mental disorders, it was evident that for treatment to have the potential to work, the patient has to want to change for the better. I also think that the level of deception that these individuals base their lives on is too strong to unravel. In addition, it is evident that due to the level of deception and secrecy, patients are not even diagnosed, therefore, the likelihood of the patient voluntarily opening up about this disorder is extremely low. Even in Gypsy Rose's case, it is apparent that her mother lacked remorse in regard to her daughter being forced to undergo surgeries, so why would she ask for help.

References

Carnahan, K. T., & Jha, A. (2021, August 09). Factitious Disorder. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557547/

Cleveland Clinic. (2021). Factitious Disorder (Munchausen Syndrome by Proxy). Retrieved from https://my.clevelandclinic.org/health/diseases/9834-factitious-disorder-imposed-on-another-fdiahttps://my.clevelandclinic.org/health/diseases/9834-factitious-disorder-imposed-on-another-fdia

Kettler, S. (2021, June 03). The Story of Gypsy Rose Blanchard and Her Mother. Retrieved from https://www.biography.com/news/gypsy-rose-blanchard-mother-dee-dee-murder

Mayo Clinic. (2019, December 14). Factitious disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/factitious-disorder/symptoms-causes/syc-20356028