Abnormal: exam 4

Somatic System DX

• used to be called hypochondriac

• a group of conditions that involve physical systems and complains

• “body language” of medical problems, but cannot be proven one ay or another

• they complain about something but they don’t actually have it

• one or more symptoms that are distressing and disrupt daily life

• persistent/excessive thoughts about the symptoms

• high level of anxiety about the symptom

• typically seen in older people

Treatment for Somatic/Illness Anxiety Disorder

• CBT and medical management (keeping the same doctor so they can monitor the progress of the patient)

• behavior therapy is also used when pain behavior is the primary symptom

Illness Anxiety Disorder DX

• High anxiety about developing a serious disorder

• much less focus on symptoms

• the average age of onset is 20 years old

What are the types of conversion symptoms?

• Sensory: problems with vision, hearing and sensory loss (glove anesthesia)

• motor symptoms: can’t write, walk, talk (but can often whistle)

  • think about Holly in the video

• Seizers: doesn’t follow the EEG, excessive thrashing and lots of misdiagnoses

  • shake/tremble more then actual seizers, looks like they are mimicking someone who is having a seizer

Treatment of conversion disorder from book and Dr. Mcculloch’s suggestion

• Hypnosis sometimes removes the symptom

• textbook mentions behavior treatments

  • reinforces the motor behaviors affected (and physical therapy)

• CBT in one study

  • don’t think CBT is the ultimate treatment for this disorder

• Dr. Mcculloch’s suggestion for treatment: psychodynamic therapy

• Van Der Kolks suggestion: treatment of yoga and massage therapy

  • believes in being in touch with your body

What are the three types of amnesias?

• Retrograde amnesia

• Anterograde amnesia

• Dispositive amnesia

Retrograde Amnesia

• comes from brain injury/pathology

• cannot recall old info

Antegrade amnesia

• from brain injury /pathology

• can’t retain new info

Dissociative amnesia

• failure to recall personal information that is not lost by ordinary forgetting

  • common in reaction to a very stressful event and usually clear up or is still apparent under hypnosis or truth serum

• often confabulate (goes along with everyone else/fakes removing the event)

• can be a gap in memory due to a psychological trauma

• think the camp example

Dissociative Fuge

• actual flight (you flee until it feels comfortable

• they wake up and suddenly don’t have memory of themself to their life

• loss of memory of things prior to the fugue episode

• may seem normal in general- but their behavior may be contrary to prior life behavior

• when they “emerge” several days, weeks or years later- they have no idea how they got there semantic knowledge, Iq intact

DID

• formally called multiple personality disorder

• distinct personalities break off without the persons awareness

• roles like child, protector, opposite sex, scapegoat, etc

• usually switch quickly but can be settle

• there are memory gaps for the time accounted for by alter identity, may or may not know what happened during that time

  • they dont always hear the alters speaking

• often suffered have other severe mental disturbances and symptoms

• caused by trauma in childhood- up until age 6 (usually sexual trauma)

• some people are highly susceptible and some just get it

Christian Aspect of DID

• supernatural aspects are not considered

• similar to demon possession

• DSM has a diagnosis for Dissociative Trance Disorder (DTD) and feels Christian should be supportive of those with DID

• more places of DTD where there is more VOODOO and witchcraft

What are the main controversies of DID and Christian/Spiritual aspects- what DX could be related?

• socio cognitive theory- the people are “acting”/faking it

• artifactual- results from therapy, therapists draws it out, they are a victim to their therapist

• DID is commonly misdiagnosed because the client says they hear things- they may be diagnoses with schizophrenia because the therapist may not see the switch between the alters

Anorexia DX

• lack of appetite due to nervosa”

• restriction of intake leading to significant low body weight

• intense fear of gaining weight- fear of being fat even when they have low weight

• the fear doesn’t go away- even when you loose significant weight- you always want to be smaller

• distorted perception of body shape- undue influence of body weight or persistent lack of recognition of seriousness of low weight

• the cases are usually upper middle class of females/privileged class of people that have the resources to have weight loss pills (Ozempic)

Bulimia DX

• have a fear of gaining weight

• these people are either normal body weight or slightly over weight

• pathogensis- dieting, restricting then then the binge (whatever is available) then vomiting/purging (development disorder)

• food bills are high, food stealing is common (think London student example) (expensive diets then they purge)

• body weight is the big issue

• obsessed with binging and feel a lot of shame, self deprecation/have horrible cognitive thoughts

Binge Eating Disorder (BED) DX

• tend to be overweight

• recurrent episodes of binge eating

• associated with 3 or more of the following:

  • rapid eating

  • consuming large amounts without being hungry

  • overeating

  • eating alone due to embarrassment

  • self disgust after

• significant distress over bingeing

• averages ones a week for 3 weeks

• no pattern of compensatory behavior (exercising or purging)

• the movement son overeating become a habit/addiction

Health Risks of Anorexia

• basically starve themselves to death

• damages organs and could affect the brain

• hair falls out, skin is dry, downy hair and thin skin, blue extremities, constantly cold

  • downy hair is like peach fuzz- its like the “beginning of the end” kind of the last sign before death

  • usually wears sweaters and jackets (to stay warm and to cover up thinness)

• leads to cardiovascular/heart conditions

  • your heart can weaken over a serious amount of time of starvation

• low blood pressure, vitamin defincies and depression is common

  • bread is the best form of serotonin

Health Risks for Bulimia

• at risk for electrolyte inblances and ipecac causes you to have heart irregularities, tooth decay and puffy cheeks

  • your body is not meant to throw up all the time- it will cause heart problems

Causes of Anorexia

• genetics- tends to run in the families, multiple genes involved, not as clear as depression and schizophrenia

• set point theory- body resists significant change and loss (anorexics fight hunger and bulimics restrict but give in to set point pressures)

  • your body had a certain “dial” of weight you should be but they seem to go beyond the dial

• serotonin- implicated in obsessionally, mood disorders and impulsivity, also modulates appetite (patients often do well with antidepressants) It modulates the extremes between not eating and binging, when they take SSRIs they are more likely to eat which is why many patients done want to take them

• pressure to be thin/peer and media influences- western culture idealizes thinness especially in higher SES backgrounds, models Twiggy and Kate Moss (Rex), fashion industry changes in the 70s because of twiggy, she was thin

• Fiji- women in Fiji whoa are overweight are considered strong and competent, kind and generous, all this changes after the widespread introduction of American TV shows, now many Fijian women think poorly of their bodies and disorders have developed since it is not a character of their culture

Outcomes of Anorexia

• 16% of patients died (high morbidity problem)

• 51% had recovered after a series of treatment failures but eventually got better

• many still deal with food issues and body image issues

outcomes of Bulimia

• Mortality for bulimia is less

• 70% recover (similar findings for BED)

• many still deal with food issues and body image issues

Treatments for Anorexia

• CBT is big- especially because of all the distorted thinking in eating disorder (1-2 years)

• feeding tube is only a temporary solution

• medication has no proven track record

• family therapy is also used (best with early onset of the problem) some more than others

• issues of “voices” and self talk- mansion program/love bombing

  • sitting next to someone and talking to them 24 hours a day that that are loved and valued

  • not exactly treatment but attempted to change the cognitive distortions

• multiple trips to inpatient

  • usually go to inpatient 3 times and usually works on the 3rd try

Treatments of Bulimia

• CBT is also big here- same with BED

• food reintroduction

Mandometer

• newer treatment in Sweden but its controversial

• retrains people how to eat

• they lost the ability to know when they are full

• it is a scale where they place their plate on it and it tracks the amount they put on the plate and then pacs their eating with a timer- teaches them to know when to be full/have a good amount of food

• because of them eating more then they are used to- they are very anxious so for the first few sessions, they are told to go into a warm room and law down with blanket for an hour to help them not engage in physical activity or purging

ARFID

• Avoidant/Restrictive Food Intake Disorder

• causes you to limit the amount and type of food you eat

• it is NOT the result of a distorted self image or attempt to lose weight unlike other eating disorders

• symptoms:

  • loose intrest in eating

  • feel anxious about the consequences of eating, like choking on food or vomiting

  • avoid foods that have unwanted color, taste, texture or smell

• “Selective eating”

• they tend to not eat enough so they are usually thin

Description of Obesity

• Genes- hormones without regulation

• sociocultural- restraunts give big portions, ultra processed foods and cheap foods

• family influence- comfort foods

• treatment- lifestyle modification, medication suppresses appetite or decrease fat, bariatric surgery '

• focus on intake, exercise and sleep

• major health issue

• minorities= more obesity in men

• for black women- 1 in 2 are obese

• higher income=less obesity (except for Mexican and African American men)

• stigma- may not be as easy to control as we think