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Types of Communication Communication is the process of conveying information verbally, through the use of words,and non-verbally, through gestures and behaviors that accompany words. Verbal Communication – a individual uses verbal communication to convey contents such as ideas, thoughts or concepts to one or more listeners. FIVE LEVELS OF COMMUNICATION Level 5 (Cliché Conversations) – No sharing of oneself occurs during this interaction. No personal growth can occur at this level. Level 4 (Reporting of facts) - Communicating at this level reveals very little about oneself and minimal or no interaction is expected from others. No personal interaction occurs at this level. Level 3 (Revelation of Ideas and Judgments) – Such communication occurs under strict censorship by the speaker, who is watching the listener’s response for an indication of acceptance or approval. If the speaker is unable to read the reactions of the listeners, the speaker may revert to safer topics rather than face disapproval or rejection. Level 2 (Spontaneous here-and-now emotions) – Revealing one’s feelings or emotions takes courage because one faces the possibility of rejection by the listener. Level 1 ( Open, honest communication) – When this type of communication occurs, two people share emotions. Open communication may not occur until people relate to each other over a period of time, getting to know and trust each other Nonverbal Communication – Noneverbal communication is said to reflect a more accurate
description of one’s true feelings because people have less control over nonverbal reactions. VOCAL CUES Pausing or hesitating while conversing, talking in a tense or flat tone and speaking tremulously are vocal cues that can agree or contradict a client’s verbal message. PHYSICAL APPEARANCE People who are depressed may pay little attention to their appearance. They may appear unkempt and unconsciously don dark-colored clothing, reflecting their depressed feelings. GESTURES Pointing, finger-tapping, winking, handclapping, eyebrow-raising, palm rubbing, hand wringing and beard stroking a re all examples of non-verbal gestures that communicate various thoughts and feelings. DISTANCE OR SPATIAL TERRITORY Intimate zone – body contact such as touching, hugging and wrestling Personal zone – 1 ½ to 4 feet; “arm’s length”; some body contact such as holding hands; therapeutic communication/touch occurs at this zone. Social zone – 1 to 12 feet; formal businesses; social discourse. Public zone – 12 to 25 feet; no physical contact; minimal eye contact; people remain strangers. POSITION OR POSTURE The position one assumes can designate authority, cowardice, boredom, or indifference. TOUCH Reactions to touch depend on age, sex, cultural background, interpretation of the gesture and appropriateness of the touch. FACIAL EXPRESSION
Ineffective Therapeutic Communication Failure to listen Conflicting verbal and nonverbal messages A judgmental attitude Misunderstanding because of multiple meanings Giving of advice Therapeutic Communication Using Silence Giving Recognition or Acknowledging Offering Self Giving broad openings or asking open-ended questions Offering general leads or door-openers Placing the event in time or in sequence Encouraging description of perceptions Encouraging comparison Restating Reflecting Exploring Seeking clarification Presenting reality Voicing doubt Summarizing Asking direct questions Transference During the therapeutic communication. Counter-Transference When the nurse responds unrealistically. Phases of a Therapeutic Relationship INITIATING OR ORIENTING PHASE The first step of the therapeutic relationship. and is able to discuss mutually agreed-on goals with the nurse as the assessment process continues and a plan of care develops.A blank stare. place and duration for each meeting. clients may distort their perceptions of others. Exploring the client’s perception of reality Helping the client develop positive coping behaviors Identifying available support systems Promoting a positive self-concept Encourage verbalization of feelings Developing a plan of action with realistic goals Implementing the plan of action Evaluating the results of the plan of action Promoting client independence TERMINATING PHASE The nurse terminates the relationship when the mutually agreed-on goals are reached. or the nurse has finished the clinical rotation. Building trust and rapport by demonstrating acceptance Establishing a therapeutic environment Establishing a mode of communication acceptable to both client and nurse Initiating a therapeutic contract by establishing time. Mutually agreed-on goals resulting in the termination of a therapeutic relationship include the client’s ability to: Provide self-care or maintain his or her own environment Demonstrate independence and work interdependently with others Recognize sign of increased stress or anxiety . the nurse sets the stage for a one-on-one relationship with the client. trusts the nurse. They may relate to the nurse not on the basis of the nurse’s realistic attributes. and a broad smile are examples of facial expressions denoting one’s innermost feelings. during this phase. but wholly or chiefly on the basis of interpersonal relationships with important figures in the client’s life. a startled expression. WORKING PHASE The client begins to relax. the client is transferred or discharged. to the client’s behavior or interaction. Assessing the client’s strengths and weaknesses. as well as the length of time the relationship will be in effect. sneer. grimace.
May profit from vocational training. rapid or abrupt shifts.describes the meaningless repetition of specific words or phrases. anger or hostility. Variations in Content of Thought Delusions – delusions are fixed false beliefs not true to fact and not ordinarily accepted by bother members of the person’s culture. Perseveration – the person emits the same verbal response to various questions. Moderate – IQ level of 35 to 55. Can achieve social and vocational skills for minimum self-support. Can acquire academic skills up to approximately the sixth-grade level. Impaired Communication During assessment. May learn to perform simple work tasks. “Educable”. They cannot be corrected by an appeal to the reason of the person experiencing them. AUDITORY HALLUCINATION VISUAL HALLUCINATION GUSTATORY HALLUCINATION TACTILE HALLUCINATION Hallucinations – are sensory perceptions that occur in the absence of an actual external stimulus. Verbigeration . clients may demonstrate impaired communication Blocking – refers to a sudden stoppage in the spontaneous flow or stream of thinking or speaking for no apparent external or environmental reason. such as an immobile face and monotonous tone of voice when conversing with others. such as repeated. Can acquire skill at the preschool level. Can acquire skills up to 2nd grade level. Perseveration is also defined as repetitive motor response to various stimuli. “Moron” Profound – IQ level of below 25. Labile Affect – Abnormal fluctuation or variability of one’s expressions. May learn some productive skills. . Cope positively when expressing feelings of anxiety. Inappropriate affect – Discordance or lack of harmony between one’s voice and movements with one’s speech or verbalized thoughts. Demonstrate emotional stability Mutism – refers to the refusal to speak even though the person may give indications of being aware of the environment. Can function in sheltered workshops as skilled or unskilled persons. Require total nursing care and highly structured environment with supervision due to self-care deficit. thus maintaining self-respect or self esteem Types of affective responses Blunted Affect – Severe reduction or limitation in the intensity of one’s affective responses to a situation Flat Affect – Absence or near absence of any signs of an affective response. “Imbecile” Ego Defense Mechanisms Compensation – use of a specific behavior to make up for a real or imagined inability or deficiency. Illusions – are misinterpretations of stimuli in which sensory stimuli is translated into other things Severity of Mental Retardation Mild – IQ level of 50 to70. the person gives much unnecessary detail that delays meeting a goal or stating a point. “Trainable” Severe – IQ level of 25 to 35. Circumstantiality – with circumstantiality. Neologism – describes the use of a new word or combination of several words coined or selfinvented by a person and not readily understood by others.
needs or reality factors that are intolerable. Sublimation – rechanneling of intolerable or socially unacceptable impulses or behaviors into activities that are personally or socially acceptable. attitude or feelings of what one would normally show in a given situation. ORGANIC OR PSYCHOPHYSIOLOGIC THEORY Schizophrenia is a functional deficit occurring in the brain caused by stressors such as viral. Identification – unconscious attempt to identify with personality traits or actions of another to preserve one’s self esteem or to reach a specific goal. Rationalization – justification of one’s ideas. Introjection – application of the philosophy. Some of the more common theories are described here: GENETIC PREDISPOSITION THEORY The genetic predisposition theory suggests that the risk of inheriting Schizophrenia is 10% in those who have one immediate family member with the disease. Undoing – negation of a previous consciously intolerable action or experience. Symptoms of Schizophrenia may appear suddenly or develop gradually over time. usually before the age of 30. Ambivalence. infection. Reaction formation – demonstration of the opposite behavior. and Associative Looseness. BIOCHEMICAL AND NEUROSTRUCTUAL THEORY An excessive amount of the neurotransmitter dopamine allows nerve impulses to bombard the part of the bran normally involved with arousal and motivation. Autistic Thinking. actions or feelings to maintain self-respect. prevent guilt or obtain social approval. toxins. wishes. Suppression – Voluntary rejection of unacceptable thoughts or feelings from conscious awareness. and approximately 40% if the disease affects either parents or an identical twin.Conversion – Unconscious expression of a mental conflict as a physical symptom to relieve tension or anxiety Denial – unconscious refusal to face thoughts. Regression – retreat to the past developmental stages to meet basic needs. Positive Symptoms Excess or distortion of normal functions Delusions Conceptual disorganization Hallucinations Excitement or agitation Hostility or aggressive behavior Suspiciousness. The onset of schizophrenia may occur late in adolescence or early in adulthood. customs and attitudes of another person to oneself Projection – unconscious assignment of unacceptable thoughts or characteristics of self to others. Normal cell communication is disrupted. resulting in the development of hallucinations and delusions. Eugene Bleuler introduced the term Schizophrenia and cited symptoms referred to as Bleuler’s 4 A’s: Affective Disturbance. Displacement – unconscious shifting of feelings such as Hostility or anxiety from one idea. ideas. About 60% of people with schizophrenia have no close relatives with the illness. person or object to another. feelings. ideas of reference . Numerous theories about the cause of schizophrenia have been developed. trauma or abnormal substances. PSYCHIATRIC DISEASES AND DISORDERS Schizophrenia is considered the most common and most disabling of the psychotic disorders.
bright lights and loud noise or music. prominent mannerisms or prominent grimacing Echolalia (repeats all words or phrases heard) or Echopraxia (mimics actions of others. hallucinations. extremely bright colors or flashing lights Attempt to identify precipitating factors by asking the client what happened prior to the onset of hallucinations Monitor television programs to minimize external stimuli that may precipitate hallucinations Monitor for command hallucinations that may precipitate aggressive or violent behavior DELUSIONS Do not whisper or laugh in the presence of the client Negative Symptoms Diminution or loss of normal functions Anergia Anhedonia Emotional withdrawal Poor eye contact Blunted affect or affective flattening Avolition Difficulty in abstract thinking Alogia Dysfunctional relationship with others Types of Schizophrenia PARANOID Preoccupation with one or more delusions or frequent auditory hallucinations Clients tend to experience persecutory or grandiose delusions and may exhibit behavioral changes such as anger. discouragement or frustration when interacting with the client Avoid criticism and do not argue with the client Set limits and follow through with consequences if a violation occurs. in attenuated form. DISORGANIZED Disorganized speech Disorganized behavior Flat or inappropriate affect . Hallucinations and Delusions AGITATION Remove clients from. Avoid display of anger. RESIDUAL Absence of prominent delusions. Pressurized speech Bizarre dress or behavior Possible suicidal tendencies UNDIFFERENTIATED Meets diagnostic characteristics but not the criteria for Paranoid. disorganized speech and grossly disorganized or catatonic behavior Continuing evidence of. or avoid situations known to cause agitation Decrease stimulants such as caffeine.e rigidity) waxy flexibility and stupor Excessive motor activity that is purposeless Extreme negativism or mutism Peculiarities of voluntary movement as evidenced by posturing. the presence of negative symptoms or two or more symptoms of diagnostic characteristics Interventions for Agitation. or violent behavior. CATATONIC Motor immobility (i. stereotyped movements. Monitor for physical discomfort such as pain or physical illness HALLUCINATIONS Decrease environmental stimuli such as loud music. hostility. Disorganized or Catatonic Subtypes.
including medication management Provide for personal space and do not touch the client without warning Maintain eye contact during interactions with the client Provide consistency in care and assigned caregivers to establish trust Significant distress or marked impairment in person’s functioning. Symptoms not related to a medical condition or a use of a substance ANXIETY . Mood that is abnormally and persistently elevated. inflated self-esteem and grandiosity. expansive. Do not argue with the client or attempt to disprove delusional or suspicious thoughts Explain all procedures and interventions. such as in social or occupational areas Symptoms not related to a medical condition or use of a substance Bipolar Disorder Various Descriptive terms are used to describe the labile affect or mood changes of clients with the diagnosis of bipolar disorder. suicide attempt or plan of committing suicide DIAGNOSTIC CHARACTERISTICS Evidence of at least 5 clinical symptoms in conjunction with depressed mood or loss of interest or pleasure Symptoms occurring most of the day during the same 2-week period DIAGNOSTIC CHARACTERISTICS Mood disturbance occurring in conjunction with at least 3 or more clinical symptoms Marked and significant impairment in activities or relationships with potential for self-harm or injury to others. These terms include: Euphoria – an exaggerated feeling of physical and emotional well-being Elation – a state of extreme happiness. or indecisiveness Recurrent thoughts of death. delight or excitability Mania – a state characterized by excessive elation. suicidal ideation. or irritable lasting at least 1 week Inflated self-esteem or grandiosity Decrease in the need for sleep Increased talking or increased pressure to keep talking Flight of ideas or subjective feeling of “racing thoughts” Easily distractible Increased goal-directed activity or psychomotor agitation Excessive over-involvement in pleasurable activities usually associated with a high potential for painful consequences Common Adverse Effects of Antipsychotic Medications Dry Mouth Menstrual Irregularity Sexual Dysfunction Urinary Retention Constipation Photophobia Weight Gain MOOD DISORDERS Major Depression Depressed Mood Significant loss of interest or pleasure Marked changes in weight or significant increase or decrease in appetite Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or excessive or inappropriate guilt Reduced ability to concentrate or think.
intellectual and emotional changes occur as the individual experiences a loss of control. avoidance of touch. Panic state – complete disruption of the ability to perceive takes place. is unable to function normally. physiologic changes and verbalization about expected danger occur. experiences difficulty verbalizing. pacing. Common obsessive thoughts involve religion. Feelings of restlessness may also be present. Alternative and Behavioral Therapies Visual imagery Change of pace or scenery Exercise or massage Transcendental meditation Biofeedback Systematic desensitization Relaxation exercises Therapeutic Touch Healing Touch Hypnosis Implosion Therapy PERSONALITY DISORDERS Three Levels of Consciousness . and contamination. and focus is on small or scattered details. occurs due to increased anxiety and decreased intellectual thought processes. swallowing. rocking and hoarding. and is unable to focus on reality. violence. Moderate Anxiety – the client experiences a narrowing of the of the ability to concentrate with the ability to focus or concentrate on only one specific thing at a time. Severe Anxiety – the ability to perceive is further reduced. voice tremors. but seemingly purposeful act to prevent some future event or situation) or a combination of both. emotion or urge that one is unable to suppress or ignore) or compulsion (the performance of a repetitious. that interferes with normal daily activities. stretching. sexuality. Disintegration of the personality occurs as the individual becomes immobilized. Lack of determination or the ability to perform occurs as the person experiences feelings of purposelessness. Physiologic responses also occur as the individual experiences a sense of impending doom. ritualistic behavior. may become competitive and has the opportunity to be individualistic. Physiologic. increased rate of speech. an individual has an increased ability to learn. and the individual may not be able to relax. experiences a motivational force. Common compulsions include hand washing. or the inability to communicate clearly.Levels of Anxiety Mild Anxiety – the client has an increased alertness to inner feelings or the environment. intrusive thought. Inappropriate verbalization. uncontrollable. Phobias Agoraphobia – fear of being alone in public places Social Phobia – fear of situations in which others may criticize a person Acrophobia – fear of heights Algophobia – fear of pain Androphobia – fear of men Astrophobia – fear of storms Autophobia – fear of being alone Aviophobia – fear of flying Claustrophobia – fear of closed spaces Entomophobia – fear of insects Hematophobia – fear of blood Hydrophobia – fear of water Iarrophobia – fear of doctors Necrophobia – fear of dead bodies Nyctophobia – fear of the night Ochlophobia – fear of crowds Ophidophobia – fear of snakes Pathophobia – fear of disease Pyrophobia – fear of fire Sitophobia – fear of flood Thanathophobia – fear of death Topophobia – fear of a particular place Zoophobia – fear of animals Obsessive-Compulsive Disorder . painful. the need for symmetry. At this level.characterized by recurrent obsessions (a persistent.
Unconscious level – consists of drives. and begins to experience guilt Latency phase – (7 years to adolescence) the person learns to recognize. the child identifies with the parent of the same se. develops sexual identity of male or female role. Conscious level – is aware of the present and controls purposeful behavior Structure of the Personality Id – unconscious reservoir of primitive drives and instincts dominated by thinking and the pleasure principle. Intuitive phase – the child exhibits egocentrism. mores. The child is unable to comprehend the ideas of others if they differ from his or her own. Ego – meets and interacts with the outside world as the integrator or mediator and is the executive function of the personality that operates at all three levels of consciousness Superego – acts as the censoring force or conscience of the personality and is composed of morals. Preoperational Stage – ( 2 to 8 years) Preconceptual phase – involves the child’s learning to think in mental images. Erik Erikson’s Developmental Tasks Trust vs Mistrust (Birth to 18 months) . hearing schemata and sucking schemata. This is the most important level of behavior because of its effect on behavior. plan for the future. these include looking schemata.(18 mos – 3 years) attention focuses on the excretory function. ideas. Concrete Operational Stage – (8 to 12 years) the child is able to think more logically as the concepts of moral judgment.(0-18 months) is a period in which pleasure is derived mainly through the mouth by the actions of sucking or biting Anal Phase . he or she realizes that other people see things differently. The infant also develops schemata. As a child matures. think abstractly and build ideals. and experiences intellectual and social growth Genital Phase – (puberty or adolescence into adult life) the final stage of psychosexual development. has a limited sexual image. drives and ideas that are out one’s ongoing awareness but can be recalled readily. numbers and spatial relationships are developed Formal Operational Stage – (12 years to adulthood) the person develops adult logic and is able to reason. and the environment by exploring objects and events and imitating. form conclusions. or methods of assimilating and accommodating incoming information. the individual develops the capacity for object love and mature sexuality and establishes identity and independence Piaget’s Cognitive Development Theory Views intellectual development as a result of constant interaction between environmental influences and genetically determined attributes. Preconscious level – consists of feeling. and urges outside of the person’s awareness. and the foundation is laid for the development of the superego Phallic stage – (3 to7 years) a stage of growth and development. Senosrimotor stage – (0 – 2 years) the infant uses the senses to learn about the self. feelings. forms a deep attachment to the parent of the opposite sex. and the development of expressive language and symbolic play. develops an inner control over aggressive or destructive impulses. values and ethics largely derived from one’s parents Psychosexual Theory Oral Phase . and handle reality. ideals.
The client also displays arrogance and may display a sense of entitlement and lack of empathy as he or she exploits others. Borderline personality disorder – individuals with borderline personality disorder may exhibit impulsive. Such persons allow others to become responsible for their lives because they experience difficulty making everyday . CLUSTER C DISORDERS. superstitiousness and telepathy. demonstrate peculiarity in speech CLUSTER B DISORDERS: EMOTIONAL. They experience ideas of reference. describe perceptual disturbances such as illusions or depersonalization. behavior related to gambling. Contributing to unstable intense interpersonal relationships are inappropriate. expectation of immediate gratification. sex and substance abuse. lacks close friends or confidants. intense anger. Clients with antisocial behavior demonstrates lack of remorse or indifference to persons who one has hurt or mistreated. has little interest in sexual experiences. does not take pleasure in activities. FEARFUL BEHAVIOR Dependent personality disorder – clients with this disorder lack self-confidence and are unable to function in an independent role. failure to accept social norms. OR DRAMATIC BEHAVIOR Antisocial Personality Disorder – synonyms for antisocial personality disorder include sociopathic. Histrionic personality disorder is characterized by a pattern of theatrical or overly dramatic behavior. Autonomy vs Shame and Doubt – (18 months – 3 yrs) Initiative vs Guilt – (3 to 5 years old) Industry vs Inferiority – (6 to 11 years) Identity vs Role Confusion – (12 – 18 years) Intimacy vs Isolation – (19 – 40 years) Generativity vs Stagnation – (41 to 64 years) Ego Integrity vs Despair – (65 years to death) CLUSTER A DISORDERS: ODD. shoplifting. ECCENTRIC BEHAVIOR Schizoid Personality Disorder – clinical symptoms include. disturbance in self-concept including gender identity. Individuals commonly display discomfort in situations in which the client is not the center of attention. The client makes use of physical appearance. severe dissociation. Behaviors such as paranoid ideation. psychopathic and semantic disorder. dysphoria or anxiety. unstable affect reflecting depression. appears indifferent to praise and criticism and exhibits emotional coldness such as detachment or flattened affect. limit social contacts to those involved in the performance of daily tasks. chooses solitary activities. Narcissistic personality disorder – the main characteristic of a narcissistic personality disorder is an exaggerated or grandiose sense of self –importance. frantic efforts to avoid realor imagined abandonment and suicidal ideation may occur. a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings. The client requires excessive admiration and envies others. The diagnosis of conduct disorder is given to clients who exhibit clinical symptoms before the age of 18. Antisocial behavior isusually seen in clients between the age of 15 and 40 years. ANXIOUS. repeated lying. ERRATIC. believing that they are envious of him or her. and reckless behavior. and the inability to control one’s emotions. The individual avoids close relationships with family or others. inappropriate sexually seductive or provocative behavior and selfdramatization and emotional exaggeration to draw attention to self. masochism. Schizotypal personality disorder – clients generally exhibit a disturbance in thought processes referred to as magical thinking.
Low self-esteem Mood disturbance Possible stimulant use Paraphilias Personality Disorders: Common Descriptive Behaviors* Antisocial personality: Impulsive. stubbornness. eccentric EATING DISORDERS Anorexia Nervosa The client with anorexia nervosa refuses to maintain a normal body weight. Exhibitionism: An adult male obtains sexual gratification from repeatedly exposing his genitals to unsuspecting strangers. timid â€œinferiority complexâ€• Borderline personality: Impulsive. and inefficiency due to dependency upon others. The client also has some or most of the following: Binge eating Excessive influence of body shape and weight on self-evaluation Use of self-Induced vomiting. and exhibits a disturbed perception about his or her body. These behaviors are an expression of a passively expressed underlying aggression. usually women and . Clients go to excessive lengths to obtain nurturance and support from others. distrustful Bestiality or Zoophilia: Sexual contact with animals serves as a preferred method to produce sexual excitement. â€œsuperiority complexâ€• Obsessiveâ€“compulsive personality: Perfectionistic. rigid. humiliation. clinging Histrionic personality: Emotional. manipulative Avoidant personality: Shy. Passive-aggressive personality – exhibits covert obstructionism through manipulative behavior. is classified as bulimia nervosa. submissive. decisions. controlling Paranoid personality: Suspicious. aggressive. a rapid consumption of food in less than 2 hours. disapproval. Schizoid personality: Socially distant. or shame. theatrical Narcissistic personality: Boastful. diuretics. appearing devastated by the slightest amount of disapproval. misuse of laxatives. and the ability to take personal risks or engage in new activities. even with preoccupation with thoughts of food Significant distortion in perception of body size and shape Amenorrhea Depressed mood Social withdrawal Insomnia Decreased interest in sex Inflexible thinking Strong need to control one’s environment Bulimia Nervosa Episodic binge eating. disagreeing with others and initiating projects or doing things independently. egotistical. Avoidant personality disorder – the client with this disorder is highly sensitive to criticism. detached Schizotypal personality: Odd. fasting or excessive exercises. development of interpersonal relationships. dramatic. It is rarely seen. intensely fears weight gain. unstable Dependent personality: Dependent. The extreme sensitivity interferes with participation in occupational activities. procrastination. self-destructive. Symptoms may include: Refusal to maintain a minimally normal weight Intense fear of gaining weight.
Necrophilia: Sexual arousal occurs while the person is using corpses to meet sexual needs. Fetishism: Sexual contact with inanimate articles (fetishes) results in sexual gratification. It is a learned response due to encouragement by family members. Parts of the body may also take on fetishistic significance. Voyeurism: The achievement of sexual pleasure by looking at unsuspecting persons who are naked. The willing recipient of erotic whipping is considered to be masochistic. Individuals engaging in voyeurism are commonly called “Peeping Toms. Severe forms of this behavior may be present in schizophrenia. Frotteurism: Sexual excitement is achieved by touching and rubbing against a nonconsenting person. Transvestic Fetishism: A heterosexual male achieves sexual gratification through wearing the clothing of a woman (cross-dressing).children who are involuntary observers. Sexual Masochism: Sexual pleasure occurs while one is experiencing emotional or physical pain. Its occurrence is almost exclusive to men who fear rejection by members of the opposite sex. or engaged in sexual activity. undressing. Most often it is a piece of clothing or footwear. the person was considered more attractive when dressed up as a girl. Telephone Scatologia: Sexual gratification is achieved by telephoning someone and making lewd or obscene remarks. As a child. Pedophilia can be an actual sexual act or a fantasy.” . Sexual Sadism: Sexual gratification is experienced while the person inflicts physical or emotional pain on others. He has a strong need to demonstrate masculinity and potency. Pedophilia: The use of prepubertal children is needed to achieve sexual gratification.