The instrument is called a semiological mental exam that helps identify signs and

psychopathological symptoms for an adequate diagnosis.

Diagnosis is an important step in the process identification and classification of a
clinical condition. A correct diagnosis is useful, not only as a way of classifying a
condition, but also as the basis of effective treatment.
Semiology: Part of medicine that studies the symptoms of diaseases, which
constitute the instrument of work that allows us to appreciate the clinical situation
of a patient and establish a diagnosis.

A classification report, or diagnosis, places a disorder within a system of

conventional groupings that are based on significant similarities in symptoms from
both contextual factors and innate abilities.
• Abnormal behavior must be understood in the context os several factors: recent
stressful events in a persons life, such as grief or job loss; the persons general
vulnerabilities, such as a tendency toward low self-esteem (perhaps generated
by experiences during early childhood or by a highly reactive nervous system)
• What an individual has, such as coping skills, intellectual ability, and family
and friends who want and can help.
• An especially important value in coping with stress is resilience, the ability to
think clearly and function well, despite adverse circumstances.

Before completing the diagnostic report or mental examination, an initial interview

is carried out. Diagnostic interviews (sometimes called assessment interviews) are
used to collect information and evaluate behavior. The clinician tries to determine
the reason why the patient sought help, their mood and outlook on life, the history
of the problem, and how they currently function.
Subsequently, a clinical history is taken; it constitutes a fundamental pillar in the
diagnostic process since it is the chronological record document of the patients
health conditions and all the procedures carried out in their care.
The clinical history is part of the clinical record which is private, mandatory
document in which the patients health conditions, medical acts and other
procedures carried out by the health team involved in their care are
chronologically recorded. This document can only be known by third parties with
prior authorization from the patient or in the cases provided for by law.
The medical history must contain the following data:
• Patient identification
• Reason for consultation
• Current condition: based on mental examination
• Organic background
• Family history
• Personal history

The mental examination is prepared by selecting the psychometric or psychiatric

instruments that are created necesary to confirm or deny the hypothesis of a
possible pathology. Therefore, after the interview, makes a specific appointment to
perform the exams, the professional applies said instruments and delivers a
mental examination report which must contain the following structure:
1. General Information: Name of institution, medical record number, date, name
of the patient, sex, race, marital status, age, address, occupation or trade.
2. Evaluation Objective: Hypotheses to discard or reaffirm
3. Applied Evaluation Instrument: Depending on the objective, the following can
be applied: Medical tests, inventories, projective tests, attitutes, skills, etc.
4. Diagnosis: Test results, attitude, bearing and behavior.
5. Forecast: Consequences of the condition, treatment ( type of intervention
suggested and duration).
A disorder is a change or alteration with respect to the permanent or normal
characteristics of a process, in the case of an organism it refers to the alteration of
its functioning or part of it.
Personality disorders are a group of mental conditions that amplify that the
behavior, thoughts and emotions that make up a persons way of being, present a
prolonged deviation over time from the personality patterns considered "healthy"
within their culture.

The DSM-5 considers a total of 10 Personality Disorders (PD) and classifies them
into the following groups:
It is characterized by a pervasive pattern of unjustified distrust and suspicion that
involves interpreting their motives as malicious.
• Diagnosis: It is made by clinical criteria
• Treatment: it is done with cognitive-behavioral therapy

It is characterized by a tendency toward indifference, introversion, and distancing

from social relationships, accompanied by a restricted range of emotional and
relational experiences.
It is a serious mental illness, referring to a brain disorder that impairs peoples
capacity in psychological aspects such as thinking, perception, emotions or will.
Schizophrenia is a disease that presents many and varied symptoms but none are
specific to it; they can also be present in other mental disorders.
Furthermore, the symptoms are for the most part subjective, that is, only the
patient experiences them, which means they cannot be verified.
The most common symptoms are:
• Delusions
• Hallucinations
• Thought Disorders
• Isolation
• Deterioration of emotions

It is characterized by a general pattern of intense discomfort with personal

relationships, a reduced ability to maintain them, distortion, cognitive, perceptual
and eccentric behavior.
• Diagnosis: It is made by clinical criteria.
• Treatment: Includes antipsychotics, antidepressants, and cognitive behavioral
therapy.
Antisocial personality disorder, also called sociopathy, is a mental disorder in
which a person does not demonstrate discernment between good and evil and
ignores the rights and feelings of others. People with antisocial personality
disorder tend to garass, manipulate, or treat others with cruelty or indifference.
They show no guilt or remorse for their behavior.
Signs and symptoms of antisocial conduct disorder include severe and persistent
behavioral problems, such as:
• Aggression towards people and animals
• Destruction or property
• Deception
• Theft
• Serious violation of the rules around them
Signs and symptoms of antisocial personality disorder are:
• Contempt for good and evil
• Persistent lies or deception to exploit others
• Being insensitive, cynical and disrespectful towards others
• Using charm or wit to manipulate others for personal benefit or pleasure
• Arrogance, sense of superiority and being extremely persuasice
• Recurring problems with the law, including criminal behavior
• Repeatedly violating the rights of others through intimidation and dishonesty
• Impulsiveness or lack of planning
• Hostility, significant irritability, agitation, aggression or violence
• Lack of empathy for others and remorse for harming others
• Taking unnecessary risks or dangerous behavior without regard for the safety of
oneself or others
• Poor or abusive relationships
• Do not think about negative consequences of the behavior or learn from them
• Being irresponsible and repeatedly failing to fulfill their job or financial duties
• It is characterized by a continuous pattern of unstable moods, self-image, and
behaviors.
• These symptoms often result in impulsive actions and problems in relationships
with other people.
• A person with BPD often has episodes of anger, depression, and anxiety that can
last from a few hours to several days.
The following factors of origin of this disorder are:
• Family History: People who have a close family member tend to be at greater
risk of developing BPD or characteristics of it.
• Brain Factors: Studies show that people with BPD may have structural and
functional changes in the brain, especially in areas that control impulses and
emotional regulations.
• Environmental, cultural and social factors: Records of people with this disorder
report traumatic events during childhood, such as abuse, abandonment or
adversity, or hostile conflicts and unstable relationships, in which they felt
invalidated.

• It is the mental condition where people act in a very emotional and dramatic
way attracting the attention of others to them.
• The causes of the disorder are unknown, but it is associated with childhood
events: it usually occurs more frequently in women. It usually begins in the late
teens or shortly after turning 20.
It is a mental disorder that is characterized by showing people with an excessive
sense of their own importance, a deep need for excessive attention and admiration.
These people have conflictice relationships and a lack of empathy for others.
However, behind the mask of extreme confidence, there is a fragile self-esteem
that is often vulnerable to the slightest criticism.
Signs and symptoms of narcissistic personality disorder typically include:
• Having an exaggerated sense of arrogance.
• Having a sense of privlege and needing excessive and constant admiration
• Expect your superiority to be recognized, even without achievements to justify it
• Exaggerate ones own achievements and talents
• Be preoccupied with fantasies about success, power, brilliance, beauty, or the
perfect partner
• Beleiving that they are superior and tha they can only bond with special people
like them
• Monopolize conversatoons and belittle or look down on people they perceive as
lower
• Expect special favors and unquestioning conformity to your expectations
• Take advantage of others to achieve what they want
• Having an inability or unwillingness to recognize the needs and feelings of
others
• Envy others and believe that others envy them
• Behaving in an arrogant or hughy manner, giving the impression of being
conceited, boastful and pretentious
• Insist on having the best of everything
They are raised as probable causes of narcissistic disorder:
• Environment: Poor relationsips between parents and children, either due to
excessive devotion of excessive criticism that is not in tune with the childs
expereince.
• Genetics: Inherited characteristics
• Neurobiology: The connection between the brain, behavior and thinking
The disorder shows the person a pattern of inhibited behavior, low self-esteem and
feelings of inadequacy. There is fear of being rejected or the object of ridicule, there
is avoidance or interpersonal relationships, and there is a reaction to taking risks
and changes.
It is also common for those who suffer from it to be hypervigilant most of the time,
to be distrustful, to reject physical contact and responsibilities.

Avoidant disorder usually arises in people who have been isolated, marginalized,
when abuse or contempt occurs at key moments in the individuals development,
generating experiences of inferiority before others or extreme shame.

It is characterized by the excessive need for care and not to be abandoned.

This need results in exaggerated submissive and attachment behaviors, which leads
to never being contrary to others, the replacement of close people by never being
left alone, and the lack of autonomy to make decisions.
The dependent person, for example in a relationship, submits, tolerates defects,
infidelities and abuse from his partner (or others) without expressing disagreement,
for fear of losing peoples support. In general, they tend to maintain relationships
whenever possible, even if they are dysfunctional. In the event that they end, they
urgently look for another one.

It is characterized by a pattern of unwanted thoughts and fears (obsessions) that

cause repetetive behaviors (compulsions). These obsessions and compulsions
interfere with daily activities, causing great emotional suffering.
Obsessive-compulsive disorder often focuses on certain issues, for example, an
excessive fear of being contaminated by germs. To alleviate fears of contamination,
you can compulsively wash your hands until they are irritated or cracked.

This is the name given to serious mental disorders characterized by a global

personality alteration that causes people who suffer from them to have abnormal,
distorted ideas and perceptions of reality. The most common disorders are:
• Brief Psychosis: It consists of the appearance of delusional ideas, hallucinations
or other psychotic symptoms that last at least 1 day but less than 1 month,
with eventual return to normal functionality prior to the illness.
• The Shared Psychosis: It is considered a subtype of delusional disorder. It
usually occurs in a person or group of people (usually a family) who are related
to a person who has significant delusional disorder. The socially dominant
member of the relationship suffers the primary disorder and imposes the
delusion or convinces the less dominant person (or persons) of the relationship
of the unusual beliefs.

The diagnostic criteria are presented as guidelines to establish a diagnosis and

their use must be guided by clinical judgement.
Descriptions of each disorder are presented in the DSM-5 as introductory sections.
If the subject meets these descriptions, another assessment if performed to specify
the level of severity (mild. moderate, and severe). But it is important to note that
to diagnose, the subject needs to meet all the criteria.
When the hospitalized patient receives more than one diagnosis, the main one is
the condition that is established as the fundamental cause of the patients
admission and the others are placed in order to need for care and treatment.
When an outpatient receives more than one diagnosis, the reason for the visit is
the underlyning condition responsible for the outpatient care received during the
visit.
In most cases, the main diagnosis or reason for the visit is also the main focus of
care or treatment.

The provisional specifier can be used when there is a well-founded assumption

that all the criteria for a disorder will ultimately be met, even though at the same
time of establishing the diagnosis there is not enough information to consider it
definitive.

Each personality disorder has its own treatment, depending on the symptoms, but
2 elements are commonly combined:

Therapeutic
Pharmacotherapy
Treatment
Psychotic disorders are a group of serious mental disorders that, in addition to
schizophrenia, include, but are not limited to, delusional disorders, schizoaffective
disorder, substance or medication induced psychotic disorder, or psychotic disorder
due to a medical condition.

All of them are defined by a "loss of contact with reality" that is manifested by
alterations in one of the following groups of symptoms: delusions, hallucinations,
disorganized thinking, very disorganized or abnormal motor behavior, and negative
symptoms.

There is a name given to serious mental disorders characterized by a global

personality alteration that causes people who suffer from them to have abnormal,
distorted ideas and perceptions of reality.
The most common psychotic disorders are:
• Brief Psychosis
• Shared Psychosis

Consists of the appearance of delusions, hallucinations or other psychotic

symptoms that last at least 1 day, but less than 1 month, with eventual return to
normal functiinality prior to the illness.

It is considered a subtype of delusional disorder. It usually occurs in a person or

group of people (usually a family) who are related to a person who has significant
delusional disorder. The socially dominant member of the relationship suffers the
primary disorder and imposes the delusion or convinces the less dominant person
(or persons) of the relationship of the unusual beliefs.
Delusional Disorder is a psychotic disorder that is characterized by the presence of
one or more delusional ideas without the presence of other significant pathology.

Delusional ideas beliefs, demonstrably false, that appear due to an incorrect

inference, nor shared by other people and that are maintained due to insuficient
information that goes against their belief. These delusional ideas must be present
for a at least a month or more, and they can be things that can happen (believing
that my partner is cheating on me) or things that are unlikely to appear (aliens
chasing me).

An important aspect to highlight in this disorder is the absence of insight or

awareness, that is, the person is not aware that they have a mental disorder and
this is related to a poor prognosis/evolution of the disease because the person
does not comply with the treatment that has been recommended.

It is an intermediate point between a brief psychotic disorder and schizophrenia. Its

symptoms are identical to those of schizophrenia, but it differs in its duration; This
disorder lasts between a minimum of one month and a maximum of six months.

Its main symptoms are delusions and hallucinations, disorganized speech, thought
disorder, etc. There is usually an impulsive attitude or chatic behavior, etc. or on
the contrary, with a drastic decrease in it, lack of energy, catatonic atitude or
apathy.

At this time of the appearance of this disorder, it is very common for it to be

diagnosed as schizophrenia; This is so since the symptoms are identical. Generally,
prolonged observation is needed to determine if it is one disease or another.
Schizoaffective Disorder is a mental health condition in which individuals suffer
from symptoms synonymous with schizophrenia and a mood disorder or bipolar
disorder.

Individuals often expereince episodes of mania and severe depression and also
struggle with the onset of psychotic symptoms, such as hallucinations and
delusions.

People who suffer from this mental illness often have difficulty caring for
themselves and experience perception problems. Even seemingly trivial activities,
such as going to the grocery store or fulfilling household responsibilities, can seem
overwhelming and often difficult to accomplish.

The causes of schiziphrenia are not known, but researchers think that its a
combination of genetics, brain chemistry and enviromental factors that contribute
to the development of this disorder.

Problems with certain brain chemicals that occur naturally, such as

neurotransmitters called dopamine and glutamate, may contribute to
schizophrenia.

Brain imaging studies show differences in the structure of the brain and central
nervous system of people with schizophrenia.
Although the exact cause of schizophrenia is unknown, certain factors seem to
increase the risk of developing or triggering it, including the following:
• Family history of schizophrenia
• Complications during pregnancy or birth, malnutrition, exposure to toxins
• Use of mind-altering drugs (psychoactive or psychotropic) during adolescene
and youth.
Schizophrenia is a disease that presents many and varied symptoms but none are
specific to it; they can also be present in other mental disorders. Furthermore, the
symptoms are for the most part subjective, that is, only the patient expereinces
them, which means they cannot be verified.

The most common symptoms are:

• Delusions
• Hallucinations
• Thought Disorders
• Isolation
• Deterioration of Emotions

Currently, schizophrenia is primarily treated with certain medications, called

neuroleptics or antipsychotics, which have the ability to correct neurotransmitter
imbalances.

There are two types of antipsychotics: the classic ones (such as chloprozamine,
haloperidol or thiordazine) and other more recent ones called atypical neuroleptics
(clozapine, risperidone, olanzapine, ziprasidone or quetiapine). The latter have the
advantage of producing fewer side effects.

In very specific cases, such as poor response to medication treatment, with serious
risk of suicide or aggression towards others, electroshock treatment may be
indicated in the subtype of catatonic schizophrenia.

Psychosocial therapy is relevant, it is intended to keep patients busy and active.

According to the DSM-5, disorders related to sexual behavior are divided in 3
sectors:
1. Sexual Dysfunctions: They are characterized by an alteration of sexual desire, by
psychophysiological changes in the sexual response cycle and the provocation
of discomfort and interpersonal problems.
2. Paraphilic Disoders: Disorders related to sexual arousal adequate or not very
normative ( fetishism, phillias, unusual attraction to objects).
3. Gender Dysphoria: Disturbance and discomfort due to the gender assigned
socially at birth.

This is what is known as recurrent and persistent problems related to sexual

response, desire, orgasm or pain (which generates anguish or distress, or tension
with your partner). Sexual dysfunctions are subdivided into:
• Hyperactive Sexual Desire Disorder
• Erectile Dysfunction (ED)
• Orgasmic Disorder or Orgasmic Dysfunction
• Vulvodynia
• Genital Arousal Disorder
• Premature Ejaculation
There are many causes of sexual dysfunction and for many people there is more
than one cause, the most common being:
• Stress • Problems in your relationship
• Fear and anxiety related to sex • Treatments or medications
• Tobacco, alcohol and drug use • Menopause
• Hormonal level • Recent pregnanct
• Mental health problems (like depression) • Medical problems
• Having expereinced sexual assault trauma • Multiple scierosis or bladder
problems
HSDD basically consists of a persistent lack of interest in engaging in any type of
sexual activity. A person affected by this disorder does not have ( it happens very
rarely) sexual thoughts or fatasies and is worried about them.
Sexual desire is based on a complex interaction of many factors that can be both
physical and psychological.
For this reason, the causes that can lead to a lack of sexual desire are many.
Since the cause can be so diverse, there is no specific treatment to treat this
condition.
If the reasons behind the loss of libido are mainly psychological, therapy is
recommended, which can be individual or couples or what is known in English as
counselling, which is something like practical psychological support sessions.

Erectile Dysfunction is a common male sexual dysfunction. It occurs when you have
difficulty achieving or maintaining an erection. This dysfunction is more common as
you age but it is not a natural part of aging.
According to the DSM-IV-TR, erectile dysfunction is defined as "the persistent or
recurrent inability to obtain or maintain an appropriate erection until the end of
sexual activity, resulting in marked discomfort or difficulty in erection".
To raise the requirement for psychological or pharmocological treatment, it is
necessary to determine the origin of the dysfunction.
The division is usually established between primary erectile dysfunction, that is,
when an erection has never existed, in these cases it is possibly due to an organic
origin.
Another relevant distinction is that made between situational or generalized
dysfunction; in this case of situational erections, the most likely origin of the
problem is psychological.
The form of evolution provides information about the etiology; A progressive
negative evolution would indicate an organic genesis.
It is the persistent or recurrent absence or delay of orgasm after a phase of normal
or sexual arousal. The alteration causes great discomfort or difficulties in
interpersonal relationships, producing a feeling of dissatisfaction.
Orgasmic Disorders can lead to negative consequences that reduce peoples quality
of life, such as altered body image, decreased self-esteem or dissatisfaction in
relationships.
An adecuate diagnosis facilitates psychological treatment to recover the natural
sex phase of orgasm.
Difficulty experiencing orgasms in women can lead to:
• Dissatisfaction in sexual relations
• Dissatisfaction with ones own image
• Irritability
• Anxiety
• Low self-esteem
• Unsafety
• Rage
• Feeling down
• Tension in the relationship
The treatment of Female Orgasmic Disorder, therapeutic work may cover any of the
following options:
• Psychoeducation on female orgasmic disorder
• Train the patient in the acquisition of major
• Physical and mental control of erotic stimulation
• Identify and address the psychological factors triggering or associated with the
problem, such as anxiety, stress, depression, etc.
• Improve self-esteem
• Manage emotions in a healthy way
In the most common form of male orgasmic disorder, the man cannot reach
orgasm during intercourse, but he can ejaculate with other types of stimulation, for
example, manual or oral.
Some men with this disorder can achieve intravaginal orgasm, but only after a long
period of non-coital stimulation. others can ejaculate only during masturbation an
others reach orgasm only when eaking up after an erotic dream.
Many men who do not reach intravaginal orgasm report feeling excited at the
beginning or intercourse, but intercourse gradually becomes more unpleasant than
pleasureable.
Within the treatment of Male Orgasmic Disorder, therapeutic work can encompass
some of the following options, always adjusting to the specific context of the
person.
• Psychoeducation on Male Orgasmic Disorder
• Train the patient in acquiring greater physical and mental control of erotic
stimulus
• Identify and address the psycholgical factors triggering or associated with the
problem, such as anxiety, stress, depression, etc.
• Improve self-esteem
• Manage emotions in a healthy way

The essential characteristic of premature ejaculation consists of the appearance of

a persistent or recurrent orgasm and ejaculation in response to minimal sexual
stimulation before, during or shortly after penetration and before the person
desires it. The alteration causes marked discomfort or difficulty in interpersonal
relationships.
Therapeutic work may cover any of the following options, always adjusting to the
specific context of the person.
Gender Dysphoria is the term that replaces gender identity disorder in the most
recent edition of the DSM-5. The essential characteristic of this condition is the
discomfort produced by the persistent feeling of incongruence with the gender
assigned at birth or physical characteristics related to sex.

Praphillic disorders are recurrent and intense fantasies of sexual arousal, drives, or
sexual behaviors that are distressing or disabling and involve inanimate objects,
children or nonconsensual adults, or the suffering or humiliation of oneself or ones
partner that is likey to cause harm.
Paraphillias are those problems that some people present in relation to their
anomalous sexual preferences.
• Voyeurism Disorder: Consists of sexual arousal, uncontrollable sexual desires,
fantasies and intense and recurring behaviors due to the need to observe
people - without them realizing it, giving their consent or being unprepared -
when they are naked, undressing or holding sexual relations.
• Exhibitionism Disorder: Consists of sexual arousal, uncontrollable sexual
desires, fantasies and intense and recurring behaviors of exposing your genitals
to other people, without them realizing it, giving their consent of being
unprepared.
• Froteurism Disorder: Sexual arousal, uncontrollable sexual desires, fantasies
and intense and recurrent behaviors derived from touching or rubbing against a
person without their consent.
• Sexual Masochism Disorder: Unlike the peoblem of sexual sadism, people who
suffer from sexual masochism disorder feel intense and persistent desires,
fantasies or behaviors that make them feel sexual arousal when other people
humiliate them, hit them, attack them or submit them, with the purpose of
making them suffer.
Fetishism Disorder: Occurs when the person, in order to achieve sexual arousal,
gives free rein to their desires, fantasies or sexual behaviors by intensly and
recurrently using inanimate objects (female underwear, shoes, leather clothing...)
or feels a specific interest in something/ parts of their body.
Sexual Sadism Disorder: It consists of the peoblem under which people, in order to
become sexually excited, do physically or psychological harm to other people, this
satisfying sexual needs, desires or fantasies in an intense of persistent way.
Cross-dressing Disorder: It occurs when a person intensley and recurrently feels
fantasies, desires or uncontrollable sexual behaviors of dressing in clothes of the
opposite sex, such as form, becomes sexually aroused.
Pedophillia Disorder: They are those people who feel intense and recurrent sexual
arousal, through fantasies, uncontrollable sexual desires or behaviors that involve
sexual activity with one or more prepubescent children (generally under 13 years of
age).

Some dysfunctions are characterized by a disturbance of desire,

psychophysicological changes in some of the phases of the sexual response and by
the feeling of discomfort and difficulties interpersonal relationships that they
generate.
The DSM-4 considers seven categories of sexual dysfunction:
1. Sexual desire disorders
2. Sexual arousal disorders
3. Orgasm disorders
4. Sexual disorders due to pain
5. Sexual dysfunction due to a medical illness
6. Substance-induced sexual dysfunction
7. Unspecified sexual dysfunction
The evaluation determines the most appropriate type of treatment. In some
cases, medical or surgical treatment is privileged , and in others, psychological
treatment. If the organic problem cannot be fully overcome, sexual advice and
rehabilitation is required.

If psychological factors are responsible for the sexual disorder, then

psychotherapy and sex therapy are indicated. Traditionally, psychoanalysis
and psychodynamically oriented psychotherapy were used, but with Masters
and Johnson the stage of sexual therapies was inaugurated, which introduced
- on the one hand - the concept that the couple is the object of therapy, and -
on the other - the prescription of specific sexual activities that the couple must
carry out in the privacy of their home, as basic elements of the therapeutic
approach, which differentiates them from old forms of treatment.

The treatment of paraphilias usually uses psychotherapeutic interventions based

mainly on behavioral/cognitive techniques or medical regimens based on the use
of hormones or psychotropic medications. The cognitive-behavioral orientation
explains the acquisition and maintenance of paraphilias through the paradigms
of conditioning and the formation of cognitive schemas (Muse, 1996).

The vast majority of paraphilias manifest themselves during puberty, giving the
impression that there may be a “window of opportunity” through which
conditioning to sexual stimuli is especially favorable during this time of
maturation.

Although male hormones are inherently involved in maintaining sexual

motivation, it is learning at a young age that determines the direction of sexual
interest and therefore the use of chemicals in the treatment of paraphilias is
usually reserved as therapy. attached to psychotherapy.
Sexual therapy aims to improve the couple's communication, to provide adequate
information and, thus, correct erroneous beliefs about sexuality, so that it is
naturally integrated into a climate of acceptance of pleasure as a vital component
of the relationship. as a couple Hypnotherapy and cognitive-behavioral, group,
marital and systemic-family coping also have a place in the treatment of sexual
disorders.

Some of the general techniques used in sex therapy can be prescribed by the
general practitioner.

Let us mention, for example, coital and orgasmic abstinence, which seeks to free
the patient from the obligation to perform intercourse, thus eliminating the fear of
failure; sensory focusing, which attempts to rediscovery pleasure on the part of the
couple, through the mutual application of caresses; or the activation of sexual
fantasies, via readings, photos or erotic films.

Among the specific techniques we will mention the well-known "squeezing" or

compression of the glans at the moment of imminent ejaculation, in order to
reduce the excitability of the penis and thus inhibit ejaculation, a technique used in
the therapy of premature ejaculation. A variant of this exercise is the start-stop-
start technique, in which the woman stops stimulating the penis when her partner
feels that ejaculation may occur. Another technique is the progressive dilation of
the vagina, which we have referred to before, to cite just a few examples.
The identification of preceptual/conceptual distortions is the first step in the
cognitive treatment of sexual deviations. Although each paraphilia itself will have
particular distortions to the condition it incorporates, the person who suffers from
them is an individual and, consequently, their dysfunctional cognitions have to be
identified individually, specifically; Of little help to the patient is to give him a
theoretical discourse on the errors of paraphilic thinking, or a generic lesson on the
cognitive distortions inherent in paraphilias. On the contrary, the psychologist
needs to capture and show real examples of the patient's own irrational ideas.

An integral part of therapy with most paraphilias should be to make the

paraphiliac aware of the repercussions that their actions may have for others, with
the aim of raising awareness paraphilic to the ethical responsibility of not imposing
one's sexual interests on people outside of one's desires, the Empathy training in
the treatment of paraphilias incorporates five segments (Maletzky, 1997).
• Identification of the victim (in this phase of training the therapist helps the
paraphiliac to identify who his behavior affects.
• Identification of the victimizing act (teaching the paraphilic behavior that hurts
the victim).
• Identification of the damage (making explicit the damage caused to the victim
by the patient's actions).
• Role reversal (help the patient put themselves in the role of the victim).
• The development of empathy itself (helping the patient to experience, through
empathy identification, how the victim of paraphilic acts feels).
Many people who suffer from paraphilic conditions show a notable deficit in their
ability to appreciate appropriate interpersonal behavior.
Depressive disorder are characterized by: sadness of sufficient intensity or duration
to interfere with functionality and, sometimes, by a decrease in interest or pleasure
aroused by activities.
The exact cause is unknown, but it probably has to do with heredity, changes in
neurotransmitter concentrations, an alteration in neuroendocrine function, and
psychosocial factors.
The diagnosis is based on the patients history.
Treatment includes drugs, psychotherapy, or both and sometimes electroconclusive
therapy or rapid transcranial magnetic stimulation.

The term depression is useed to refer to any of the depressive disorders. According
to the DSM-5, there are several types of disorders depending on the specific
symptoms:
• Major Depressive Disorder
• Persistent Depressive Disorder
• Other Specified or Unspecified Depressive Disorder
• Premenstrual Dysphoric Disorder
• Depressive Disorder to another illness
• Substance/drug Induced Depressive Disorder
Depressive Disorders can occur at any age, but their development is typical in mid-
adolescence.

Patients have a sad appearance, watery eyes, frowning, downturned corners of the
mouth, slumped posture, poor eye contact, no facial expression, few body
movements, and changes in speech.
In some patients, the depressed mood is so profound that tears stop: they say they
are unable to suffer the usual emotions and feel the world has become dull.
Nutrition suffers a significant deterioration.
Some patients neglect their personal hygiene or even their children or other loved
ones or their pets.
For the diagnosis of major depression, 5 of the following symptoms must be
present: been present almost every day for a given 2 week period, and one of them
must be the depressed mood or loss of interest of pleasure:
• Depressed mood most of the day
• Marked decrease in interest or pleasure in all or almost all activities for most of
the day
• Significant weight gain or loss, or decreased or increased appetite
• Insomnia or hypersomnia
• Psychomotor agitation or retardation observed by others
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or innappropriate guilt
• Decreased ability to think or concentrate, or indecisiveness
• Recurrent thoughts of death or suicide, attempted suicide, or a specific plan to
commit suicide.

Depressive symptoms persist for 2 years (a category that consolidates disorders

previously called chronic major depressive disorder and dusthymic disorder).
Symptoms usually begin insidiously during adolescence and can last for many
years or decades. The range of symptoms often fluctuates above and below the
threshold for a major depressive episode.
Affected patients may usually appear negative, without a sense of humor, passive,
clouded, introverted, hypercritical of themselves and others, and complainers.
Patients with persistent depressive disorder are also more likely to experience
underlying anxiety disorder, substance abuse disorders, or personality disorders.
For the diagnosis of persistent depressive disorder, patients must have been in
depressed moods most of the day, with more days present than absent for 2 years,
plus 2 of the following:
• Lack of excess of appetite
• Insomnia or Hypersomnia
• Low energy or fatigue
• Low self-esteem
• Lack of concentration or difficulty making decisions
• Feelings of hooelessness

Premenstrual dysphoric disorder involves mood and anxiety symptoms that are
clearly related to the menstrual cycle, with onset in the premenstrual phase and a
symptoms-free interval after menstruation.
Symptoms must be present during most menstrual cycles during the past year.
The manifestations are similar to those of premenstrual syndrome but more
intense, causing clinically significant discomfort and/or notable deterioration in
work or social activity.
The disorder can begin at any time after menarche; ot may worse as menopause
appraoches, but stops, after menopause.
The prevalence is estimated to be 2 to 6% of menstruating women in a given 12-
month interval.
For the diagnosis of premenstrual dysphoric disorder, patients must present 5
symptoms during the week before menstruation. Symptoms should begin to
subside within a few days after the onset of menstruation and are minimal or
absent in the week after menstruation. Symptoms must include the following:
• Noticeable mood changes ( sudden sadness or urge to cry)
• Noticeable irritability or anger or increased interpersonal conflicts
• Very depressed mood, feeling of hopelessness and thoughts of personal
devaluation
• Marked anxiety, tension or nervousness
Additionally, 1 of the following symptoms must be present:
• Decreased interest in usual activities
• Difficulties concentrating
• Low energy of fatigue
• Marked change in appettite, binges orcravings for specific foods
• Hypersomnia or insomnia
• Feeling that things are overwhelming you or that you are out of control
• Physica symptoms such as breast tenderness or swelling, joint or muscle pain,
bloating, and weight gain.

Symptom clusters with features of a depressive disorder that do not meed full
criterios for other depressive disorders but cause significant distress or impairment
in functioning are classified as other depressive disorders (specified or unspecified)
Inclded are recurrent periods of dysphoria with 4 other depressive symptoms
lasting greater than two weeks in people who have never met criterios for another
mood disorder and periods of depression lasting longer, but that do not include
enough symptoms for the diagnosis of another depressive disorder.

The exact cause of depressive disorders is unknown, but genetic and environmental
factors contribute.
Heredity accounts for 50% of the etiology (less in the so-called late-onset
depression). Therefore, depression is more common among first-degree relatives of
patients with this condition; Concordance between identical twins is high.
Furthermore, genetic factors likely influence the development of depressive
responses to adverse events.

Other theories focus on changes in neurotransmitter concentrations, including

abnormal regulation of cholinergic, catecholaminergic (noradrenergic or
dopaminergic), glutamatergic, and serotonergic (5-hydroxytryptamine)
neurotransmission. Neuroendocrine dysregulation may be a factor, and 3 axes
stand out in particular: hypothalamus, pituitary-adrenal, hypothalmic-pituitary-
thyroid, and growth hormone.

Psychosocial factors may also be involved. Major stressors in everyday life,

especially separations and losses, usually precede episodes of major depression;
However, these events do not usually cause severe, long-lasting depression, except
in people predisposed to a mood disorder.

Mild depression can be treated with general measures and psychotherapy.

Moderate or severe depression is treated with drugs or psychotherapy, and
sometimes electroconvulsive therapy.

Some patients require a combination of drugs. Improvement may require between

1 and 4 weeks of drug treatment.

Depression may recur, especially in patients who have had > 1 episode; therefore,
severe cases often warrant pharmacological treatment with prolonged
maintenance.
Numerous controlled trials have shown that psychotherapy, particularly cognitive-
behavioral therapy and interpersonal therapy, is effective in patients with major
depressive disorder, both for treating acute symptoms and reducing the likelihood
of relapse. Patients with mild depression tend to have a better prognosis than
those with more severe depression, but the magnitude of improvement is greater in
people with more severe depression.

The following entities are often treated with ECT if medications are ineffective:
•Severe suicidal depression
•Depression with agitation or psychomotor retardation
•Delusional depression
•Depression during pregnancy
Patients who stop eating may need electroconvulsive therapy to prevent death. ECT
is particularly effective for psychotic depression.
The response to 6 to 10 sessions of electroconvulsive therapy is usually dramatic
and life-saving. Recurrence is common, pharmacological treatment should be
continued after discontinuing electroconvulsive therapy.

Various classes of drugs and medications can be used to treat depression. The
choice of drug may depend on the previous response to a specific antidepressant.
Otherwise, SSRIs are the first-line drugs. choice. Although different SSRIs are
equally effective in typical cases, certain properties make them more or less
appropriate for certain patients, among which they can be used are:
According to the World Health Organization, suicide is an act deliberately initiated
and carried out by an individual with the knowledge or expectation that its result
will be death. A suicide attempt, on the other hand, may or may not have death as
the intended end. Suicidal risk is the probability that a person has of trying to
kill themselves. The latter is assessed through epidemiological factors, personal
history, mental state and the current stressors to which the individual is subjected.

People who have psychiatric disorders are more prone to suicide: one in every
two or every four suicides had an affective disorder.

They have a risk of suicide multiplied by 40 compared to the general population.

If a personality disorder, substance abuse or an anxiety disorder is added as a
comorbidity to affective disorders, the possibility of making a suicide attempt
increases much more. Of every 100 patients with major depression, 15 die by
suicide.

Self-inflicted injuries, of low lethality or little intentional bodily harm, of a socially

unacceptable nature, carried out to reduce psychological distress (Walsh, 2006).
Injuries made deliberately, as an attempt to express intolerable feelings, find
immediate relief, generally not to commit suicide, but are psychologically
provoked, for various reasons, including depression and anxiety.

Therefore, the importance of detecting serious depression in time.

Anxiety disorders are those that share characteristics of excessive fear and anxiety,
as well as associated behavioral alterations.
Fear is an emotional response to an imminent threat, real or imagined, while
anxiety is an anticipatory response to a future threat. It is evident that both
responses overlap, although they can also be differentiated, with fear frequently
associated with bouts of autonomic activation necessary for defense or escape,
thoughts of imminent danger, escape behaviors; Anxiety is most often associated
with muscle tension, vigilance regarding future danger, and cautious or avoidant
behaviors. Sometimes the level of fear or anxiety is reduced by generalized
avoidance behaviors. Panic attacks mainly occur with anxiety disorders as a
particular type of fear response. Panic attacks can also be observed in other
mental disorders.

Anxiety is a feeling of fear, fear and restlessness. It may cause the subject to
sweat, feel restless and tense, and have palpitations.

It may be a normal reaction to stress. For example, you may feel anxious when
facing a difficult problem at work, before taking an exam, or before making an
important decision. While anxiety can help you cope, as well as give you a boost of
energy or help you focus, for people with anxiety disorders the fear is not
temporary and can be overwhelming.

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by the

presence of obsessions and/or compulsions. Obsessions are repeated unwanted
thoughts, images, or impulses that cause significant distress and anxiety.
Compulsions are repetitive behaviors or mental acts that a person feels they must
do, usually in response to an obsession.
The experiences of people with OCD vary greatly in terms of specific symptoms. For
example, one person may be overly concerned about germs or pollution and spend
excessive amounts of time washing or cleaning, while another person may have
disturbing violent or sexual images that they struggle to control. Some may count
compulsively in their heads to try to counteract “bad” thoughts or impulses, while
others have difficulty leaving their house because they focus their attention on
checking that the door is locked or that the stove is off.

The causes of anxiety disorders are complicated. Many may occur on the spot,
some may lead to others, some may not lead to an anxiety disorder unless another
is present. Possible causes include:
• Environmental stress: Difficulties at work, relationship problems or family
problems.
• Genetics: People who have family members with a anxiety disorder are more
likely to experience one themselves.
• Medical factors: ymptoms of a different illness, the effects of a medication,
or the stress of intensive surgery or a long recovery.
• Brain chemistry: Psychologists define many mood disorders
anxiety as imbalances in hormones and electrical signals in the brain.
• Withdrawal from an illicit substance: Whose effects could intensify the
impact of other possible causes.
There are several types of anxiety disorders:
• Generalized anxiety disorder: People with this disorder worry about common
problems such as health, money, work, and family. But their worries are
excessive, they have them almost every day for at least 6 months.
• Panic disorder: People with panic disorder suffer from panic attacks. These
are sudden and repeated moments of intense fear without any apparent
danger. Attacks occur quickly, may last several minutes or longer
• Phobias: People with phobias have an intense fear of something that
represents little or no real danger. Your fear may be of spiders, flying, going
to crowded places, or being in social situations (known as social anxiety).
Different types of anxiety disorders can have different symptoms. But they all show
a combination of:
• Anxious thoughts or beliefs that are difficult to control: They make you feel
restless, tense, and interfere with your daily life. They do not go away and can
worsen over time.
• Physical symptoms, such as a strong or fast heartbeat, pain, unexplained
discomfort, dizziness, and shortness of breath.
• Changes in behavior, such as avoiding everyday activities that you used to do.
The use of caffeine, other substances, and certain medications can make your
symptoms worse.
The main treatments for anxiety disorders are psychotherapy, medications, or both:

Cognitive behavioral therapy is a type of psychotherapy often used to treat anxiety

disorders. Teaches different ways of thinking and behaving. It can help you change
how you react to things that cause you fear and anxiety. It may include exposure
therapy, which focuses on confronting your fears so you can do the things you've
been avoiding.

Medications to treat anxiety disorders include anti-anxiety medications and certain

antidepressants. Some types of medications may work better for specific types of
anxiety disorders. You should communicate well with your healthcare professional
to identify which medication is best for you. You may need to try more than one
medication before you find the right one.
It is evidence that exposure to a traumatic event causes some individuals to
display abnormal thoughts and behaviors, which today we refer to as a mental
illness.
Trauma- and stress-related disorders are serious psychological reactions that
develop in some individuals after exposure to a traumatic or stressful event, such
as childhood neglect, childhood physical/sexual abuse, armed conflict, physical
assault, sexual assault, natural disaster, accident or torture.
The characteristic symptoms of all other trauma- and stress-related disorders can
be classified into four broad categories:
• INTRUSION SYMPTOMS: Symptoms of intrusion include recurring, involuntary,
distressing memories, thoughts, and dreams of the traumatic event. The
individual may also experience flashbacks, a dissociative experience in which
they feel or act as if the traumatic event is repeating itself.
• SYMPTOMS OF AVOIDANCE: Avoidance symptoms are efforts made to avoid
internal (memories, thoughts, feelings) and/or external (people, places,
situations) reminders of the traumatic event. Concern about avoiding trauma-
related feelings and stimuli can become a central focus of the individual's life.
• NEGATIVE ALTERATIONS: Negative alterations in cognition and mood include
problems remembering important aspects of the traumatic event, depression,
fear, guilt, shame, and feelings of isolation from others.
• SYMPTOMS OF HYPERREACTIVITY: Symptoms of hyperreactivity include being
easily nervous and scared, irritability, angry outbursts, self- destructive
behavior, problems concentrating, and difficulty sleeping.
Trauma-related disorders have been classified into the following types:

Reactive attachment disorder (known as RAD) refers to the failure to form the
essential bond between a child and his or her primary caregivers.
It often occurs in children who have been subjected to extreme neglect or abuse, or
who experienced repeated changes in caregivers that gave them limited
opportunities to form selective attachments.
Usual symptoms:
• Limited positive affect or smiling.
• Unexplained episodes of irritability.
• Sad, fearful, inhibited or introverted behavior with caregivers.
• Failure to respond to comfort when offered.
• Attempts to care or calm down in times of distress as opposed to seeking
comfort from caregivers, calming down more quickly without the adult present.
• Lack of reaction to caregivers' attempts to interact or to others moving around
a room.
• Lack of participation in interactive activities or movements such as stretching
when being picked up or responding to a game of hide-and-seek.
Treatment for reactive attachment disorder should involve the child who has been
diagnosed, as well as their current caregivers. Child psychotherapy, family therapy,
parent training, and special education services have been known to be helpful.

It is that pattern of behavior in which the child approaches and actively interacts
with strange adults.
This mainly translates into a lack of reluctance to approach them and an
overly familiar behavior. Furthermore, the child may not turn to his or her primary
caregiver after a risky outing or approach, even in unfamiliar contexts.
The child does not show discomfort when interacting with unknown people, nor
does he actively look for his parents after doing so. This shows a clear deficit in
their social skills, and more specifically, in the type of attachment developed.
Along with this, it must be taken into account that to make the diagnosis the
child must have a developmental age of at least 9 months.
This is because until then, it may be difficult to differentiate those behaviors
considered normal from problematic ones.
The main cause of its appearance is having experienced an extreme pattern of
insufficient care, which is evident through:
• Negligence or social deprivation in which there is a persistent lack of having
needs met basic emotions.
• Having undergone or undergoing repeated changes in primary caregivers that
minimize the possibility of creating a stable attachment.
• Receiving an education in unusual contexts which reduces the opportunity to
establish a type of more selective attachment.
This problem shows the importance of maintaining and creating family and social
stability in the child's environment, since this will encourage them to develop a
positive interaction style.
Sometimes this can be made difficult by the need to make certain changes
(residence, work).
It is important to keep in mind that one should try to work and strengthen the
relationship with the child regardless of the external context, since it is possible
that in this way this type of disorder can be prevented from appearing.

Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are reactions
to traumatic events.
Reactions involve intrusive thoughts or dreams, avoidance of reminders of the
event, and negative effects on mood, cognition, arousal, and reactivity.
Acute stress disorder usually begins immediately after the trauma and lasts from 3
days to 1 month.
PTSD may be a continuation of ASD or may manifest up to 6 months after the
trauma and last > 1 month.
The diagnosis is made by clinical criteria. Treatment consists of behavioral therapy
and sometimes SSRIs or anti-adrenergic drugs.
The symptoms of acute stress disorder and post-traumatic stress disorder are
similar, usually involving a combination of the following:
• Intrusive symptoms: Recurrent, involuntary, distressing memories or dreams
of the traumatic event (in children < 6 years, it may not be clear whether
their distressing dreams are related to the event); dissociative reactions
(typically flashbacks in which patients re-experience the trauma, although
young children can often recreate the event in play); and distress to internal
or external stimuli that resemble some aspect of the trauma (e.g., seeing a
dog or someone who looks like a perpetrator).
• Avoidance symptoms: Persistent avoidance of memories, feelings, or external
reminders of the trauma.
• Negative effects on cognition or mood: Inability to remember important
aspects of the traumatic event, distorted thinking about the causes or
consequences of the trauma (e.g., that they are to blame or could have
avoided the event for certain reasons). actions), a decrease in positive emotions
and an increase in negative emotions (fear, guilt, sadness, shame, confusion), a
general lack of interest, social isolation, a subjective sense of numbness of
feelings and a reduced expectation of the future (e.g., thinking "I'm not going to
live to see 20").
• Disturbed arousal or reactivity (e.g., hyperexcitability): Tremors, exaggerated
startle response, difficulty relaxing, difficulty concentrating, interrupted sleep
(sometimes with frequent nightmares), and aggressive or reckless behavior.
• Dissociative symptoms: Feeling separated from one's body as if in a dream and
the feeling that the world is unreal.

The diagnosis of ASD and PTSD is based on a history of exposure to a severely

frightening and frightening trauma, followed by feelings of re- experiencing the
event, emotional numbness, and hyperarousal. These symptoms must be severe
enough to cause disturbance or distress.
Symptoms that last ÿ 3 days and < 1 month are considered acute stress disorder.
Symptoms lasting > 1 month are considered PTSD, which may be a continuation of
ASD or may manifest up to 6 months after the trauma.
Patients should have a number of manifestations in different symptom areas;
Specific criteria for ASD and PTSD in the Diagnostic and Statistical Manual of
Mental Disorders, (DSM-5) differ slightly.
The treatment is usually used:
• Selective serotonin reuptake inhibitors (SSRIs) and sometimes antiadrenergics
• Psychotherapy
• Behavioral therapy

SSRIs help reduce emotional numbness and the feeling of re-experiencing

symptoms, but are less effective for hyperarousal. Antiadrenergic drugs (eg,
clonidine, guanfacine, prazosin) may help relieve hyperarousal symptoms, but
supporting data are preliminary.

Supportive psychotherapy can help children who have adjustment problems

associated with trauma, as they may be disfigured by burns. Behavioral therapy
can be used to systematically desensitize children from situations that cause them
to re- experience the event (exposure therapy).

Behavioral therapy is effective in reducing distress and disturbance in children and

adolescents with PTSD.
Disruptive disorders of control impulses and behavior (APA, 2013) include
conditions that manifest with problems in the self-control of behavior and
emotions, Disruptive disorders translate into behaviors that violate the rights of
others (for example: aggression, destruction of property), or lead to individual to
important conflicts against norms of society or authority figures.
The causes underlying problems with self-control of behavior and emotions can
vary substantially within disruptive disorders and between individuals within the
same diagnostic group.
Disruptive disorders often occur comorbidly, that is, associated with attention
deficit hyperactivity disorder (ADHD) in its impulsive-hyperactive forms, when there
are biological and/or environmental triggers (environment) such as substance
use. , unstructured environments, experiences of bullying, socio-affective problems
or family history. These situations can act as catalysts for the presence of this type
of pathology, especially during adolescence.

Disruptive impulse control and behavior disorders included in the DSM-5 (APA,
2013) are:
• OPPOSITIONAL DEFIANT DISORDER (ODD) Oppositional Defiant Disorder
presents as a pattern of anger/irritability, arguing/defiant or vindictive attitude
and is exhibited during interaction with at least one individual other than a
sibling.
• INTERMITTENT EXPLOSIVE DISORDER (IED) Intermittent Explosive Disorder (IED)
is a psychological disorder that is characterized by the presence of a random
pattern of aggressive, disproportionate behavioral reactivity without a specific
reason or objective, causing serious alterations or damages in the physical
environment. and social and the individual himself.
• CONDUCT DISORDER Conduct disorder is manifested through a repetitive and
persistent pattern of behavior in which the basic rights of others, norms or
social rules appropriate to age are not respected.
• ANTISOCIAL PERSONALITY DISORDER The person has an antisocial personality
that manifests a general pattern of contempt and violation of the rights of
others that has been present since the age of 15. Among the recurring
compartments we find: failure to adapt to social norms regarding legal
behavior; irritability, aggressiveness, indicated by repeated physical fights or
assaults; lack of remorse, as indicated by indifference or justification for having
harmed, mistreated, or stolen from others; reckless disregard for your safety or
that of others, persistent irresponsibility, indicated by the inability to
consistently maintain a job or take care of financial obligations, impulsivity or
inability to plan for the future, etc.
• PIROMANIA The person called arsonist shows a behavior characterized by the
repetition of acts or attempts to set fire to properties or other objects, for no
apparent reason along with a constant insistence on issues related to fire and
combustion. These people may also be abnormally interested in fire engines or
other fire-fighting equipment, in other fire-related topics, and in making calls
to the fire department.
• KLEPTOMANIA It is a psychological disorder by which the person called
kleptomaniac or kleptomaniac has a repetitive behavior of appropriating what
is foreign to him. It must be distinguished from the activity of the sporadic or
habitual thief, whose objective is illicit enrichment seeking personal benefit. On
the other hand, in kleptomania, the moment of the theft itself becomes the
purpose of the act, not pursuing personal enrichment or harm to the person
from whom it is stolen.
• Other Specified Disruptive, Impulse Control, and Behavior Disorder This
category applies to presentations in which the characteristic symptoms of a
disruptive, impulse, and behavior control disorder predominate, causing
clinically significant distress. or impairment in social, occupational, or other
areas that are important to the individual, but do not meet all the criteria for
any of the disorders in the diagnostic category of disruptive disorder, impulse
control, and behavior.
There are multiple risk factors that initially appear to contribute to and influence
the course of disruptive behavior disorders and represent the critical interaction of
vulnerable individuals with the environment around them.

Although these disorders occur in families, the shared environment exerts a

proportionally greater influence than shared genes.

It is necessary to understand the multiple etiological elements in these

heterogeneous disorders when planning treatment. Currently, it is considered that
there is an interaction between socioeconomic, cultural, family dynamic,
temperamental, genetic, neurobiological, and psychiatric factors to explain
its development, persistence, and transmission from one generation to the next.

Among the factors that cause this disorder are:

• Neurobiological findings include low autonomic activity (observed in low heart
rate at rest).
• Intrauterine alcohol exposure, birth complications, and low birth weight.
• Brain injuries due to accidents or abuse.
• Temperament, it is known that children with difficult temperaments (little
adaptability to change, resistance to parental discipline, intense activity level)
have a certain predisposition to experience these disorders.
• Other psychiatric problems such as post-traumatic stress disorder,
communication disorders, psychosis and paranoia.
There are effective prevention and treatment programs for disruptive behavior
disorders such as parent-child training, family therapy, and medications for
impulsive aggression. There is no evidence to support the use of specific
medications for ODD, but there is evidence that pharmacological treatment
indicated for comorbid disorders (such as ADHD) reduces oppositional symptoms.

Oppositional and defiant behavior may decrease with treatment of parental risk
factors, when children's problem-solving skills improve. Training parents and
caregivers in behavior modification techniques such as positive reinforcement,
giving more effective directives, time out, and token economy can reduce power
struggles and modify oppositionism. The principles of these approaches can be
summarized as follows:
• Reduce positive reinforcement of disruptive behavior.
• Increase reinforcement of prosocial and obedient behavior. •
• Apply consequences or punishments for disruptive behaviors. •
• Make the parental response predictable, contingent and immediate.

Training children to solve problems derives from cognitive-behavioral techniques

aimed at correcting dysfunctional social interactions and focuses on delaying
impulsive responses, increasing reflection on alternative solutions, and practicing
self- assessment of behavior. Logically, early intervention increases the chances of
improvement.