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.
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