Chapter Twelve Psychopathologies of the Adolescent Transition: Eating Disorders and Substance Abuse

Vocabulary flashcards covering key terms and concepts from adolescence eating disorders and substance abuse as presented in the lecture notes.

Anorexia Nervosa

An eating disorder characterized by at least a 15% loss of body weight through dieting and/or purging, with an active pursuit of thinness; DSM-IV-TR distinguishes Restricting Type and Binge-Eating/Purging Type.

Restricting Type (Anorexia Nervosa)

Anorexia nervosa subtype defined by weight loss through strict dieting and restriction without regular binge-eating or purging.

Binge-Eating/Purging Type (Anorexia Nervosa)

Anorexia nervosa subtype characterized by periods of binge eating followed by purging (vomiting, laxatives, etc.).

Amenorrhea

Absence of at least three consecutive menstrual cycles in postmenarcheal females; a DSM-IV-TR criterion used in some anorexia nervosa diagnoses.

Bulimia Nervosa

Eating disorder with recurrent binge eating followed by compensatory behaviors (purging or excessive exercise); body weight often normal or near normal.

Purging Type (Bulimia Nervosa)

Bulimia subtype in which vomiting or laxative/diuretic misuse is regularly used to prevent weight gain.

Nonpurging Type (Bulimia Nervosa)

Bulimia subtype that uses fasting or excessive exercise as compensatory behavior without regular purging.

DSM-IV-TR Criteria for Anorexia Nervosa

A: Refusal to maintain minimally normal weight; B: Intense fear of gaining weight; C: Disturbance in self-perception of weight/shape; D: Amenorrhea (in postmenarcheal females).

DSM-IV-TR Criteria for Bulimia Nervosa

A: Recurrent binge eating with a sense of loss of control; B: Inappropriate compensatory behaviors; C: At least twice weekly for 3 months; D: Self-evaluation unduly influenced by body shape/weight; E: Not exclusively during an episode of anorexia.

Ethnicity and Culture in Eating Disorders

Eating disorders occur across ethnic groups; Westernization and subcultural norms influence risk; prevalence and presentation can vary by race/ethnicity and cultural context.

Body Image

Salient mental representation of one’s body; highly relevant during adolescence and influenced by pubertal changes, culture, and social context.

Comorbidity in Eating Disorders

Eating disorders frequently co-occur with depression, anxiety disorders, substance use, and personality disorders; comorbidity can affect onset and course.

Depression with Anorexia Nervosa

High comorbidity; depression may predate eating disorder and can persist or worsen independently of weight restoration.

Anxiety Disorders and Anorexia Nervosa

Anxiety, particularly obsessive-compulsive features, commonly co-occur and often precede eating-disorder symptoms.

Serotonin (5-HT) and Eating Disorders

Serotonergic system implicated in appetite, mood, and weight regulation; dysregulation may contribute to eating-disorder risk and symptom maintenance.

5-HIAA

A serotonin metabolite elevated in recovered eating-disordered individuals, suggesting persistent serotonergic involvement.

Brain-Imaging Findings in Eating Disorders

Many abnormalities reflect effects of starvation; some findings (e.g., frontal-limbic 5-HT activity) relate to impulse control and may persist after weight restoration.

Body Image Distortions (Bruch)

Theory that individuals with anorexia have inaccurate self-perceptions of body size; proprioceptive perception issues may contribute to distortions.

Self-Esteem and Perfectionism in Anorexia

Low self-esteem and traits like perfectionism, rigidity, and obsessiveness commonly predate and accompany anorexia.

Family Context: Enmeshment

Overly involved, diffuse family relationships that hinder adolescent autonomy and support the eating disorder process.

Maudsley Family-Based Therapy

Family-based treatment for anorexia; parents initially take charge of eating to restore weight, then support adolescent's autonomous functioning.

Integrative Developmental Model (Eating Disorders)

Comprehensive model combining biological, psychological, family, and sociocultural factors predicting eating disorders across development.

Developmental Course of Anorexia

About 50–70% recover; 10–20% become chronic; relapse is common; onset often in adolescence with long active periods.

Prevention of Eating Disorders

Prevention programs that are at-risk, interactive, multi-session, and cognitive-behavioral tend to be most effective at reducing thin-ideal internalization and disordered eating.

Cognitive Therapy (Eating Disorders)

Therapy targeting distorted beliefs about body weight and eating; includes self-monitoring and cognitive restructuring to reduce dieting behaviors.

Interpersonal Psychotherapy (IPT) for Bulimia

Therapy focusing on relationships and social functioning; adapted version shown to have durable benefits for bulimia.

Family Therapy for Eating Disorders

Therapies such as Maudsley and BSFT that involve family dynamics to support recovery and adolescent individuation.

Substance Abuse (DSM-IV-TR)

Maladaptive pattern of substance use leading to clinically significant impairment or distress; includes tolerance, withdrawal, and functional impact.

Substance Dependence (DSM-IV-TR)

Pattern of use with tolerance or withdrawal, failure to cut down, time spent, impaired functioning, and continued use despite problems.

ICD-10: Substance Use Disorders

WHO classification of mental and behavioral disorders due to psychoactive substances, with states from intoxication to dependence and withdrawal.

Comorbidity in Substance Abuse

High rates of co-occurring disorders (conduct disorder, internalizing disorders, personality disorders); polydrug use common.

Temperament and Difficulties (Substance Abuse)

Difficult temperament and biobehavioral dysregulation (negative affect, impulsivity) predict earlier initiation and escalation of use.

Genetics and Substance Abuse

Family history increases risk; heritability estimates vary by substance; shared environment also plays a large role.

Prenatal Exposure and Substance Use

Prenatal alcohol/tobacco exposure increases risk for adolescent substance misuse via neurodevelopmental pathways.

Peer Influence and Substance Use

Peers strongly predict initiation and continuation; peer modeling and norms increase risk; peer selection also matters.

Sensation Seeking

A personality trait linked to increased risk-taking and substance use during adolescence.

Emotion Regulation and Substance Use

Difficulties regulating negative emotions predict use and relapse; substances may be used to self-medicate distress.

Cognitive-Behavioral Therapy (CBT) for Substance Abuse

CBT-based interventions modify distorted beliefs, teach refusal skills, and develop coping to prevent relapse; strong empirical support.

Family-Based Interventions (BSFT, MST)

Evidence-based family therapies (Brief Strategic Family Therapy; Multisystemic Therapy) reducing substance use by addressing family and school contexts.

Prevention Programs (HSD)

School-based prevention (Healthy School and Drugs) with psychoeducation, skills training, and parent involvement to reduce early-onset use.

Culturally Informed Prevention

Prevention tailored to cultural contexts, addressing acculturation stress and minority-specific risk factors to enhance effectiveness.

Jessor’s Ecological Model

Development results from interactions between personality and perceived environment; emphasizes risk and protective factors across systems.