Psychopathology Exam 3

Has been linked to feelings of disgust in people who have anorexia, and may explain their lack of interest in food.

Anterior Insula

What about pharmacology and eating disorders is true?

SSRIs appear to help those with bulimia diagnoses more than those with anorexia diagnoses.

“Heres the key to working with your client,” said the supervisor. “Don’t let her spend too much time simply describing her eating problems. Instead, you must focus on how her eating problems relate to her dysfunctional relational patterns.” What approach is the supervisor using?

Interpersonal Therapy

Which two spectra are suspected of being important in assessing eating disorders?

Somatoform and internalizing

As anorexia patients recover and gain weight, brain volume is believed to what?

Increase

What are the least to most intensive and restrictive levels of care for eating disorders?

Outpatient treatment, intensive outpatient treatment, partial hospitalization, residential treatment, medical hospitalization.

When it comes to comparing different kinds of psychotherapy for treating symptoms of eating problems, is there evidence that any of them are effective?

There is evidence for cognitive-behavioral-therapy(CBT), interpersonal therapy(IPT), and even psychodynamic therapies.

What is the most central distinction between feeding and eating disorders?

Eating disorders involve distorted body image, while feeding disorders usually do not.

Who is not engaging in an act of purging?

Denise, who exercises strenuously after a binge.

Dick binges and purges regularly. His therapist is considering diagnosing him with bulimia. What piece of information is most important to consider?

If Dick isn’t maintaining minimal body weight, then the diagnosis should be anorexia.

Feeding Problems

Characterized by concern over food preferences; involves fussy or faddish eating habits in which certain foods are avoided or refused because of taste, texture, or a basic dislike for them.

Eating Problems

Characterized by disturbed body image; involve concerns about being overweight or experiencing one’s body negatively or in ways that appear distorted.

Anorexia Nervosa

 DSM and ICD diagnosis that involves seriously low body weight due to restricted food intake. 

Bulimia Nervosa

DSM and ICD diagnosis that is characterized by binge eating followed by compensatory behavior.

Binge Eating

A form of overeating in which a person eats a huge amount of food in a single sitting–much more than most people would eat in a comparable period. There is a sense of being unable to control or limit how much one eats. 

Compensatory Behavior

A behavior to counteract having binged. Includes purging, fasting and excessive exercising.

Purging

A form of compensatory behavior where a person who has binged actively removes the food from their body through self-induced vomiting or misuse of laxatives, diuretics, or other drugs.

Restricting Type Anorexia

Lose weight mainly by dieting, fasting, and exercising excessively without bingeing or purging. 

Binge-eating/purging type anorexia

Engage in bingeing/purging. They binge and then make themselves vomit or use laxatives or diuretics to rid their bodies of what they’ve eaten.

What is the key to distinguishing anorexia from bulimia?

If the person is not maintaining body weight, then the diagnosis must be anorexia. If someone with a bulimia diagnosis becomes excessively thin and refuses to maintain body weight, the diagnosis is changed to anorexia.

Lifetime prevalence of Anorexia

Prevalence is higher in women than men, and in higher income countries. In the U.S. prevalence is higher in White Americans.

Binge-eating Disorder

DSM and ICD diagnosis characterized by recurrent binge eating. 

Avoidant/restrictive food intake disorder (ARFID)

DSM and ICD disorder characterized by extremely picky eating and failure to eat enough to meet basic nutritional needs.

What is commonly comorbid with ARFID?

Anxiety disorders, OCD, autism, ADHD, and intellectual disability.

Pica

DSM and ICD disorder involving the eating of non-food substances. Common in pregnant women.

Rumination Disorder

DSM disorder characterised by rechewing, reswallowing, or spitting out food after intentionally regurgitating it.

Rumination and Regurgitation Disorder

The ICD version of DSM Rumination Disorder. 

Other Specified Feeding or Eating Disorder

DSM and ICD diagnosis for those who do not meet criteria for other feeding or eating disorders but warrant a diagnosis.

Atypical Anorexia

diagnosed when all other criteria for anorexia are met but the personal is normal or over-weight.

Geophagia

Form of pica where a person intentionally eats dirt, soil, or clay.

What neurotransmitter is low in individuals with bulimia and anorexia nervosa?

Serotonin, because these patients are not obtaining tryptophan which is required to make serotonin.

Dopamine

A neurotransmitter that appears to play a major role in eating problems, particularly in Anorexia.

What drug can be used to treat Rumination Disorder?

Baclofen, a skeletal musle relaxant.

What kinds of drugs have been used to treat Pica?

SSRIs, tricyclics, and bupropion.

What medications are used in Anorexics?

SSRIs are used however they are not often effective until patients start eating to produce tryptophan which makes serotonin for the drugs to act on.

What medications are used on people with Bulimia Nervosa?

SSRIs work on patients with Bulimia, with Fluoxetine being the best, however they are not a cure.

Anterior Insula

Important brain structure in regulating autonomic activities such as hunger. Correlates with feelings of disgust among anorexics, possibly explaining their lack of interest in food. It could provide too strong a hunger signal in bulimia and BED.

Interpersonal Therapy in eating disorders

Instead of talking solely about eating problems, therapists talk with their patients about how their problems relate to their interpersonal relationships and dysfunction in those. 

In Vivo Food Exposure

Exposure to food in real life, where patients are prevented from purging after bingeing. This reconditions foods so they are no longer conditioned stimuli for bingeing. In anorexia this is used by gradually exposing food to reduce fear of food and food avoidance.

Aversion Therapies

Used in treating Pica; where patients are punished for eating things they shouldn’t.

Overcorrection Therapies

Used in treating Pica where an undesired behavior is punished by requiring repeated engagement in an opposite kind of behavior. 

Diaphragmatic Breathing

A breathing technique used in treating Rumination Disorder. It is a breathing technique that fully engages the diaphragm.

Satiation Techniques

Behavioral technique in which regular meals are supplemented with extra food. Because rumination often occurs when hungry, it discourages rumination by making the patient less hungry. 

Enhanced Cognitive-behavioral Therapy

Attributes a “core psychopathology” to all eating disorders, in which self-worth is based not on achievements, but on ability to control body weight and shape. Also called the transdiagnostic model. 

Cognitive-behavioral Therapy for ARFID

Holds that some people are highly sensitive to sensory stimulation; they may also fear unpleasant consequences, or not find food especially interesting. This predisposes them to negative reactions to the odor, texture, and taste of many foods. CBT-AR is a twenty-session intervention administered over six to twelve months. It combines in-session exposure to feared foods with psychoeducation about CBT, ARFID, and nutritional deficiencies. 

Acceptance and Commitment Therapy

The main premise of this therapy is that people’s thoughts about events, including their desire to avoid these thoughts, are the root of emotional distress. Rather than directly challenging negative thoughts or asking clients to change them, ACT teaches cognitive defusion, in which clients dispassionately observe their thoughts and recognize that they are just thoughts, not absolutes.

Emotion-focused Therapy

The EFT perspective holds that people who experience anorexia, bulimia, and binge eating have been raised in environments where emotions were “dismissed, avoided, or ... expressed in unpredictable and uncontrollable ways,” leading them to suffer “from an impaired capacity to access, identify, and be guided by adaptive emotions”. Emotion-focused therapists help clients with eating problems better identify and feel comfortable with their emotions.

Narrative Therapy

One of the main techniques in narrative therapy is externalizing the problem, in which problems are talked about as entities outside people that get the best of them. By recasting anorexia, bulimia, or binge eating as independent entities, narrative therapists help clients change the stories they tell about themselves and pinpoint exceptions—times when they were able to resist the pernicious influence of their eating problems.

Objectification Theory

Media images present women as sexual objects to be judged based on their looks (objectification), which leads women to objectify their bodies (self-objectification) and makes them vulnerable to body image and eating issues.

Muscle Dysmorphia

Body dysmorphia in which (mostly) males obsessively worry that they aren’t muscular enough.

Family Based Treatment

anorexia and bulimia that focuses on weight restoration and/or the establishment of healthy eating while not blaming parents; the family is encouraged to work together to help address the family member’s eating disorder; also called the Maudsley approach.

Orthorexia

Preoccupation with healthy eating that leads to eating a nutritionally unbalanced diet, excessive worry and guilt with eating “unhealthy” foods, and intolerance of others’ dietary habits.

Addiction

A non-diagnostic term describing a lack of control over doing, taking, or using something, despite potentially harmful consequences.

What is the difference between abuse and dependence?

Abuse is the ongoing misuse of a substance, whereas dependence is physically or psychologically needing the substance to function.

Depressants

Drugs that slow the central nervous system.

Alcohol

A depressant substance in many popular drinks.

Binge Drinking

Drinking 4 or more drinks as a female, or 5 or more drinks as a male in roughly two hours.

Fetal Alcohol Syndrome

Syndrome in children whose mothers drank excessively while pregnant. Characterized by retarted growth, developmental delays, and atypical facial features. Atypical facial features include: small head or microencephaly, small eyes or microphthalmia, thin upper lips with no ventromedial indentation in the middle, and flat upper jaw bones. 

Delirium Tremens

Syndrome in extreme cases of alcohol withdrawal in which the person becomes delirious, experiences intense body tremors, and has terrifying hallucinations. 

Cirrhosis

Irreversible scarring to the liver, often due to chronic excessive alcohol use. 

Korsakoff Syndrome

Serious deterioration in short and long term memory, as well as the inability to remember new information. It is caused by a thiamine deficiency, usually from chronic excessive alcohol use.

Sedative Hypnotics

A class of depressants sometimes simply called sedatives; barbiturates and benzodiazepines are types of sedative-hypnotic drugs.

Barbiturates

Highly addictive sedative-hypnotic drugs such as secobarbital and pentobarbital, previously used as anxiety drugs, but have generally been replaced by benzodiazepines.

Major Tranquillizers

Antipsychotic drugs which are depressants with sedative-like effects. They decrease dopamine transmission which helps treat psychosis. They are not considered addictive.

Stimulants

drugs that speed up the central nervous system.

Cocaine

Stimulant made from South American coca plant leaves that produces euphoria, excessive confidence, and tremendously high energy levels. 

Amphetamines

Laboratory-manufactured stimulants; include amphetamine, dextroamphetamine, and methamphetamine.

Nicotine

A common stimulant found in tobacco leaves that makes users feel calm and alert.

Acetylcholine

Neurotransmitter important in muscle movement, arousal, memory, and learning.

Caffeine

It is a mild and commonly used stimulant found in many plants, including those used to make coffee, tea, chocolate, and soft drinks; it increases alertness and energy while providing a sense of well-being.

Opioids

Natural, synthetic, or semi-synthetic drugs that depress the central nervous system and serve as powerful painkillers; highly addictive, they mimic endogenous opioids created by our bodies.

Endogenous Opioids

serve as chemical messengers, reducing pain and calming us down. 

Opium

A natural opioid found in the sap of opium poppy plants.

Heroin

A highly addictive semi-synthetic opioid to which dependence develops quickly; tolerance and withdrawal are especially severe. 

Oxycodone

A semi-synthetic opioid used as a pain reliever in prescription drugs, marketed under names like Percocet and OxyContin.

Hallucinogens

Drugs that induce hallucinations, altered thinking and perceptions, out-of-body experiences, and sometimes paranoia; also known as psychedelics. 

Indoleamine Hallucinogens

Drugs such as LSD, DMT, and psilocybin that induce hallucinations and heighten emotional sensitivity by activating serotonin receptors in the prefrontal cortex and anterior cingulate cortex.

Drug Flashbacks

The unexpected re-experiencing of perceptual disturbances of past drug trips.

Phenylalkylamine Hallucinogens

Produce hallucinogenic and stimulant effects by affecting norepinephrine, dopamine, and serotonin receptors.

Phencyclidine

A hallucinogen with hallucinogenic, depressant, and some stimulant effects; reduces influence of glutamate while enhancing dopamine and norepinephrine production.

Cannabis

Drugs derived from the hemp plant, containing cannabinoids like tetrahydrocannabinol(THC) and cannabidiol(CBD); cannabis high is caused by THC and includes feeling relaxed and content, losing track of time, perceptual distortions, and heightened awareness.

Polydrug Use

when drug users take more than one substance. Can involve taking more than one drug simultaneously, or transitioning over time from one drug to another.

Cross-Tolerance

When tolerance for one drug transfers to other drugs with similar chemical effects on the brain.

Synergistic Effects

Effect from taking drugs together; some combinations enhance the effects of both drugs, while other combinations cancel some of the effects of both drugs.

Speedballing

Combining drugs, usually stimulants and opioids, to produce a synergistic effect in which the highs of both drugs are experienced but the negative effects are reduced. This increases the risk of an overdose. 

Behavior Addiction

Addictions involving behaviors rather than substances.

What is the worry with behavioral addictions’ validity?

Some clinicians and researchers worry that behavioral addictions lack evidence and have the risk of becoming too broad and inclusive. 

Harmful Use

ICD diagnosis that involves ongoing misuse of a substance leading to physical or mental health problems, adverse social consequences, and criticism from others. This is also called substance abuse. 

Dependence

ICD diagnosis in which use of a substance takes on a higher priority than it once had; involves things like feeling compelled to take a substance, difficulty controlling use, tolerance, and withdrawal.  

Substance Use Disorder

DSM diagnosis that combines symptoms of abuse and dependence. It is assessed based on the type of drug being used and the severity of use.

Gambling Disorder

DSM and ICD behavioral addiction characterized by a recurrent problem gambling that leads to impairment and distress.

Gaming Disorder

ICD behavioral addiction for those who compulsively play digital or video games.

Substance Use Disorder in HiTOP

Substance users score high on the disinhibited externalizing spectrum

Disinhibited externalizing spectrum

Behavior that entails “tendencies to act on impulse, without consideration for potential consequences,” and this includes “the use of psychoactive substances to excess” 

Moral v.s. Illness Model of drug addictions

the moral model sees addiction as a vice, or a crime to be prosecuted, and the illness model sees it as a disease

Dopamine Hypothesis of Addiction

Says that addictive drugs and behaviors increase dopamine. People either take drugs to compensate for too little dopamine in the brain because the drug increases dopamine. Or because the drugs increase dopamine sensitivity which makes people sensitive to incentive.

Detoxification

The physical process of weaning addicted individuals from the drugs they are addicted to. 

Antagonist Drugs

Drugs that prevent relapse by interfering with the effects of an addictive substance.

Drug Replacement Therapies

Changes delivery method of a drug or exchanges one drug for a chemically similar one, with the goal of weaning people off drugs, or sustaining them on similar, less harmful drugs.