Personality disorders and paraphilic disorders are both psychiatric conditions that can significantly impact the functioning and well-being of individuals, particularly children and adolescents. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) provides a comprehensive framework for diagnosing and classifying these disorders based on specific criteria. This assignment aims to present a case study of a child/adolescent with a personality disorder and a paraphilic disorder, specifically focusing on pedophilia, exhibitionism, fetishism, and voyeurism.
Case Study: Child/Adolescent with Multiple Disorders
The patient, referred to as John, is a 14-year-old adolescent attending a local high school. He is from a middle-class background and lives with his parents and younger sister in a suburban neighborhood. John has a history of behavioral issues and has been involved in multiple incidents that have led to legal consequences.
Personality Disorder: Antisocial Personality Disorder (ASPD)
According to the DSM-5, a diagnosis of ASPD requires the presence of a pervasive pattern of disregard for and violation of the rights of others, occurring since at least age 15. The individual must exhibit at least three of the following behaviors: failure to conform to social norms with respect to lawful behaviors, deceitfulness, impulsivity, irritability, reckless disregard for the safety of others, consistent irresponsibility, and lack of remorse.
In John’s case, he has displayed a consistent pattern of behavior that aligns with the criteria for ASPD. He has repeatedly engaged in illegal activities, such as stealing, vandalism, and physical altercations. Moreover, he shows little regard for the rights and feelings of others, often engaging in manipulative and deceitful behavior.
Paraphilic Disorder: Pedophilic Disorder
Pedophilic Disorder involves intense and recurrent sexual fantasies, urges, or behavior involving sexual activity with prepubescent children. Additionally, the individual must have acted on these urges or experienced significant distress or interpersonal difficulty as a result of their pedophilic interests. The age difference between the individual and the child victims must be at least five years.
In John’s case, there is evidence of pedophilic tendencies. He has exhibited sexual interest in children who are significantly younger than himself, often engaging in inappropriate conversations and attempting to access explicit online content. This paraphilic disorder poses significant risks to the well-being and safety of potential child victims.
Paraphilic Disorder: Exhibitionistic Disorder
Exhibitionistic Disorder is characterized by a recurrent and intense desire to expose one’s genitals to others, usually strangers, to achieve sexual gratification. The individual must have acted on these urges or experienced significant distress or interpersonal difficulty as a result of their exhibitionistic behavior.
There is no evidence to suggest that John meets the criteria for Exhibitionistic Disorder. However, it is important to note that individuals with multiple paraphilic disorders often present with a range of paraphilic interests and behaviors.
Paraphilic Disorder: Fetishistic Disorder
Fetishistic Disorder involves the use of nonliving objects, such as undergarments or shoes, or non-genital body parts, to achieve sexual arousal and gratification. The individual must be significantly distressed or impaired by these preferences or have engaged in non-consenting individuals or individuals who are unable to give legal consent.
There is no available information to suggest that John meets the criteria for Fetishistic Disorder at present. However, it is worth monitoring this aspect of his behavior to ensure early intervention if such tendencies arise in the future.
Paraphilic Disorder: Voyeuristic Disorder
Voyeuristic Disorder is characterized by recurrent and intense sexual arousal and gratification from observing unsuspecting individuals undressing or engaging in sexual activities. The individual must have acted on these urges or experienced significant distress or interpersonal difficulty as a result of their voyeuristic behavior.
In John’s case, there is no specific evidence to support a diagnosis of Voyeuristic Disorder. However, it is important to note that individuals with paraphilic disorders may exhibit a range of paraphilic interests, and the absence of specific evidence does not entirely rule out voyeuristic tendencies.
In this case study, a child/adolescent patient, John, has been diagnosed with both a personality disorder, specifically Antisocial Personality Disorder (ASPD), and a paraphilic disorder, specifically Pedophilic Disorder. The diagnosis of ASPD is based on John’s consistent disregard for the rights of others and involvement in illegal activities. The diagnosis of Pedophilic Disorder is based on his sexual interest in prepubescent children and attempts to access explicit online content. While there is no evidence to support diagnoses for Exhibitionistic Disorder, Fetishistic Disorder, or Voyeuristic Disorder at present, it is important to monitor these aspects of John’s behavior closely due to the potential for multiple paraphilic disorders co-occurring. Early identification and intervention are essential to ensure the safety and well-being of both the individual and potential victims.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.