Ataques de Nervios

Ataque de nervios has been studied for half a century, and is one of the best assessed cultural concepts of distress. Ataques were initially studied in Puerto Rican, Dominican, and Cuban samples by Latino researchers and anthropologists. Research indicates that ataques typically occur immediately after, or within a day of, a significant stressor. The characteristic symptoms of an ataque can be quite dramatic, and include emotional and physical symptoms along with displays of aggression and alterations in consciousness. In addition, 7%–14% of ataques result in suicide attempts. The chapter discusses this cultural concept of distress common among Latinos and shows how its relationship with psychopathology can vary depending upon the context, and can range from a normative response to stress to a marker of severe psychopathology.

Necrophilia

Necrophilia consists of erotic fantasies about and/or sexual contact with the dead. The practice of necrophilia has been documented since ancient times, and there appears to have always been both a recognition and a fear of it. The chapter opens by discussing well-known cases of necrophilia and several etiological theories. The numerous classification systems for necrophilia are summarized, and the authors also present some potential commonalities. .Unfortunately, research into the world of necrophiles is hampered by the secrecy of their desires and difficulties in detecting their activities. Given its clandestine nature, the chapter suggests that clinicians more frequently screen for the presence of necrophilia when evaluating individuals who present with other deviant sexual behaviors.

Persistent Genital Arousal Disorder

Persistent genital arousal disorder (PGAD) is a newly recognized condition of uncertain etiology with limited data on successful treatment. It best can be described as persistent physiological arousal in the absence of conscious feelings of sexual desire. PGAD consists of extended periods of sexual excitement that neither diminish on their own nor resolve with ordinary orgasmic experiences. The arousal is distressing, unwanted, and often painful. The majority of PGAD cases have been identified in women. Although the disorder can occur in men, there is no data on prevalence in men and little is known about whether or not there a common etiology is shared with female cases of PGAD. The chapter ends by discussing several possible etiologies and four main treatment options.

Cotard’s Syndrome

Cotard’s syndrome involves nihilistic delusions about the patient’s own body, such as believing that he or she is a walking corpse. The syndrome is named for Jules Cotard (1840–1889), a French neurologist who first described this condition in 1880. He formulated the syndrome as a new type of depression characterized by symptoms such as anxious melancholia, ideas of damnation or rejection, insensitivity to pain, delusions of nonexistence concerning one’s own body, and delusions of immortality. Along with discussing the typical progression of symptoms and associated features, this chapter situates Cotard’s syndrome within the context of several other disorders and well-known neuropsychological deficits.

Capgras and Other Misidentification Syndromes

Capgras is the delusional belief that people in the sufferer’s life are not who they seem to be, but are identical duplicates who have been substituted for the originals. The copy looks just like the original, although the patient may sometimes notice minor and imaginary differences between the original and the copy, differences that the patient cites as confirmatory evidence that the person is indeed an impostor. Although Capgras was initially thought to occur only during psychotic episodes, it has now been recognized to occur in patients suffering from certain brain conditions as well. Capgras is one of several misidentification syndromes. Other misidentification syndromes, such as the Fregoli delusion and delusion of intermetamorphosis, also are discussed.

Body Integrity Identity Disorder

Body integrity identity disorder involves a patient’s desire to amputate a healthy body part or obtain an unnecessary body modification (e.g., paraplegia, blindness). Dramatic cases of surgical amputation of otherwise functional body parts have come to the attention of the media and medical professionals. Most known cases of body integrity identity disorder appear to have originated in the United States, Germany, and Switzerland. At present, the field knows very little about this condition, but the neurosciences have explored various possibilities for etiology and assessment. After discussing these topics, the chapter reviews treatment options and outcomes , including the results of self-amputations and illegal medical procedures.

Factitious Disorders

In Factitious Disorders, the patient exaggerates, fabricates, simulates, and/or induces symptoms of medical and/or psychiatric illnesses—in himself or in another person—with no concrete incentive beyond the pleasure, consolation, or status conferred by being a patient (or by being closely identified with a patient). This condition can go unrecognized for years, as most physicians assume that descriptions of medical symptoms are presented in good faith. Variations have sometimes been termed factitious disorder imposed on another or Munchausen syndrome by proxy. The secretive and sometimes criminal nature of these behaviors provides numerous barriers to research, but important data have been collected. After discussing the available research base of the factitious disorders, potential assessment procedures using medical records are detailed.

Alice in Wonderland Syndrome

The symptoms that are considered characteristic of Alice in Wonderland Syndrome (AIWS) are quite diverse and constitute distortions of regular sense perception (i.e., distortions of visual, somaesthetic, temporal, and self-perception). Although these symptoms are often of short duration, especially in children, extended episodes can occur. Many cases are benign and self-limiting, but symptoms of Alice in Wonderland Syndrome can occur in the context of Epstein-Barr virus encephalitis, cerebral lesion, epilepsy, and schizophrenia. Most of the symptoms characteristic of AIWS traditionally are attributed to central (as opposed to peripheral) nervous mechanisms. Epidemiological surveys and clinical prevalence studies of AIWS are lacking, but the syndrome is generally considered rare. Studies among clinical populations, however, indicate that its prevalence may well be underestimated.

Taijin Kyofusho

Anxiety in social situations presumably is found in every culture. However, there may be differences across cultures in the specific ways that this anxiety manifests itself and is subjectively experienced by the sufferer. Taijin kyofusho is a broad term for various socially directed fears. Manifestations range from classic social anxiety disorder symptoms to those found in body dysmporphic disorder, delusional disorder, and olfactory reference syndrome. Though originally thought to be a culturally bound variation of social anxiety found only in East Asian populations, a growing body of evidence also locates it in the West. In contrast to egocentric fears found in social anxiety disorder (e.g., “I will embarrass myself”), prototypical taijin kyofusho symptoms are more other directed (e.g., “I will offend others or make them uncomfortable”). Assessment and treatment options are summarized.

Exploding Head Syndrome

Exploding head syndrome is the colorful name given to the experience of loud noises during sleep-wake and wake-sleep transitions that result in abrupt arousal and fright. The specific sounds reported during episodes of exploding head syndrome are quite variable and can include perceptions of fireworks, lightening cracks, or nondescript screaming. Visual experiences (e.g., light flashes) may also be involved. A variety of etiological theories exist for exploding head syndrome, but the most popular of these implicates abnormal surges of neuronal activity within the brainstem during sleep-wake transitions—surges which then are perceived as the loud and startling sounds. Although episodes are more common than initially thought and can have important clinical impacts on sufferers, exploding head syndrome is still a relatively unknown disorder. Further, its characteristic symptoms have also been incorporated into several current conspiracy theories, of which many clinicians may be unaware.