PSYS EXAM 3

Body image disturbance

• overestimate actual size

• unrealistically low ideal size

• social comparison

• sensitivity to fullness

Basic eating disorder (ED) classifications

• Anorexia = restricting subtype, binge-eating/purging subtype

• Bulimia = purging subtype, non-purging subtype

Binge eating

• usually large amounts of food *

• Lack of control *

• most likely at home, at night, after unstructured activity, in a negative mood

Purging

attempts to compensate for binge eating and prevent weight gain

• self-induced vomiting

• laxative misuse

• diuretics

• excessive exercise

• enemas

• chewing/spitting out food

Anorexia nervosa (AN)

• Consuming less calories/food than required to maintain a normal body weight, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health

• intense fear of gaining weight or persistent behavior that interferes with weight gain

• disturbance in the way in which one’s body weight or shape is experienced, undue influence (when someone unfairly pressures or manipulates another) of body weight/shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Restricting type = no binges/ purges

Binge-eating/purging type = as defined

Bulimia Nervosa (BN)

• recurrent binge eating episodes

• recurrent, inappropriate compensatory behavior

• at least 1x/wk. for 3 mos.

• undue influence of body weight/shape on self-evaluation

Binge eating disorder (BED)

binge eating at least 1x/wk. for 3 mos.

requires 3 or more:

• eating rapidly

• uncomfortably full

• not physically hungry

• eating alone (embarrassment)

• disgusted, depressed, or guilty

no compensatory behavior

distress

Risk factors

Family

• maternal body dissatisfaction, internalization of thin-ideal, dietary restraint, bulimic symptoms

• parents of higher weight

Sociocultural

• internalization of thin-idea

Personal

• dieting

• childhood obesity

• body image dissatisfaction

• low self-esteem

• depression/anxiety/OCD

Peer influence

• teasing

• peers value thin ideal

• peers diet or purge

Overvalued beliefs

• perfectionism

• asceticism (self-disciplined)

Personality

• control

• impulsivity

Complications: Anorexia

• weight loss

• amenorrhea (loss of menstrual cycle)

• dehydration and electrolyte imbalance

• bradycardia and arrhythmias (irregular heartbeats)

• postural hypotension (drop in blood pressure)

This can result in hypothermia, dental problems, osteopenia (low bone density), delayed gastric emptying, irritability, infertility, morality, suicide

Complications: Bulimia

• electrolyte imbalance

• gastrointestinal distress

• delayed gastric emptying

• menstrual irregularities

• postural hypotension (drop in blood pressure)

This can result in esophageal tears/ruptures, arrhythmias, dental problems, parotid swelling (the salivary gland located between the jaw and ear), weight fluctuations, metabolic alkalosis (acid imbalance), chronic renal failure

Treatments for AN and BN

Nutrition support

• nasogastric tube

• nutritional supplements

Medication

• antidepressants

• neuroleptics and antipsychotics

• appetite stimulants

psychotherapy

• psychodynamic

• family systems

• interpersonal

• cognitive-behavioral - focuses on nutrition interventions (meal planning, weekly goals, hydration), psychoeducation (food pyramid, truth about purging), distraction/alternative behaviors, cognitive restructuring, body image interventions (no weighing/checking, in vivo body exposure), in vivo food exposure, exposure with response prevention, relapse prevention

Personality Disorders (PD)

Personality = individual’s beliefs, traits, actions

Personality traits = how an individual acts and and respond to situations — build your personality

• Personality disorder = an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment—cognition, emotions, interpersonal functioning, and/or impulse control

Problems in diagnosing PDS

• moderate inter-rather reliability

• poor test-retest reliability

• overlap between PDS

• heterogeneity (dissimilar) within each PD

• high comorbidity—2 or more medical conditions in the same person at the same time

• gender distribution and gender bias

categorical vs. dimensional PDS

Categorical view

• PDs qualitatively distinct from normal—not just more extreme versions of normal personality traits, they’re fundamentally different in kind, not just degree

Dimensional View

• PDs are extremes on personality dimension(s)

• 5-factor model: extraversion (outgoing), agreeableness (cooperative/empathetic), conscientiousness (organization/self discipline), emotional stability, openness to experience

Personality Disorder clusters

Cluster A—odd or eccentric

• Paranoid, schizoid, schizotypal

Cluster B—dramatic, emotional, or erratic

• Antisocial, borderline, histrionic, narcissistic

Cluster C—anxious or fearful

• Avoidant, dependent, obsessive-compulsive (WE DON’T GET TO CLUSTER C)

Cluster A

Paranoid PD — more common in men

• Pervasive, unjustified, mistrust and suspicion of others; hostility; jealously

  • limited close relationships; cold and distant affect

  • excessive trust in own ideas and abilities; critical of weakness and fault in others

Etiology

• possibly genetic

• cognitive: early learning that the world is dangerous and others are devious

Treatment for Paranoid PD

• few seek help, develop trust, cognitive therapy—thoughts about others, lack good outcome studies

Schizoid PD — more common in men

• Pervasive pattern of detachment from social relationships

• perceptions of extrasensory abilities or magical control over others

• attention focus

Etiology

• social isolation preference resembles autism

• cognitive: I am self-sufficient; others are intrusive

Treatment for Schizoid PD

• few seek help, cognitive therapy—value of interpersonal relationships, building empathy and social skills, lack good outcome studies

Schizotypal PD — slightly more common in men

• Odd and unusual behavior, thoughts, and appearance

  • magical thinking, ideas of reference (hidden meaning), illusions (things not present)

  • individuals believe unrelated events pertain to them in important ways; bodily illusions

  • demonstrate difficulty keeping attention focused

  • conversation is typically digressive and vague, even sprinkled with loose associations

Etiology

• a phenotype of schizophrenia genotype?

Treatment

• social skills training, antipsychotic medications, address comorbid depression, lack good outcome studies

Cluster B

Antisocial PD — more common in low SES and highly comorbid with substance use disorders

• noncompliance with social norms, violate rights of others, lack of empathy/remorse

  • lie repeatedly, reckless, and impulsive

  • little regard for other individuals, and can be cruel, sadistic, aggressive, and violent

• Psychopathy vs ASPD

  • Psychopathy-broader term

  • not all those with psychopathy have ASPD and vice-versa

    • there is an overlap and lack of overlap among antisocial personality disorder, psychopathy, and criminality

Etiology

• family factors

  • lack of affection, severe parental rejection, inconsistent (or no) discipline, family history of criminal/violent behavior

• Genetic contributions

  • family, twin, and adoption studies support

  • MZ (identical) > DZ (fraternal) twins for ASPD concordance

  • Gene-environment interaction

• neurobiological influences

  • brain damage—little support

  • imbalance between behavioral inhibition system (BIS) and reward system in brain

Treatment

• few seek help, poor prognosis, incarceration often the only variable alternative, prevention emphasis

Borderline PD — more common in women

• pattern of unstable moods and relationships fear of abandonment, impulsivity, poor self-image

• self harm and suicidal gestures

  • 70% attempt suicide; 10% die by suicide

Etiology

• Runs in families (genetics), early trauma abuse

• Linehan’s biosocial theory = invalidating environment—family members respond erratically to child’s thoughts and feelings

  • emotional dysregulation → great demands on the fam → invalidation by parents through punishing/ignoring the demands → emotional outbursts by child to which parents attend

Treatment

• Antidepressant medications, Dialectical behavior therapy (identify/regulate emotions, problem solving, exposure to traumatic memories, best available treatment—good outcome studies)

Histrionic PD — more common in women

• Overly dramatic, attention-seeking, self-centered, sexually provocative, emotionally shallow, impulsive

Etiology

• Psychoanalytical seductiveness, sext-typed variant of antisocial PD?

Treatment

• Long-term consequences of attention seeking

• address problematic interpersonal behaviors

• lack outcome studies

Our response to fear

Two pathways where the automatic nervous system and the endocrine system produce arousal and fear reactions

• 1. sympathetic nervous system pathway (SNS) = acts on blood vessels, organs, and glands in ways to prepare the body for action, especially in life threatening situations

  • provides resources for the fight/flight response

  • mobilizes the body to attack, defend, or flee when encountering a potential threat

  • works with the peripheral nervous system

• 2. hypothalamic-pituitary-adrenal (HPA) pathway = hormonal (slow, long lasting stress response), it’s apart of the endocrine system and releases cortisol

• parasympathetic nervous system (PNS) = returns the body to a resting state by counteracting the actions of the sympathetic nervous system

  • performs restorative functions — “rest & digest”

  • allows the body to regenerate when it is safe to do so

  • works with the SNS to prepare the body for challenges

Trauma in the DSM-5 and PTSD

trauma = exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

• direct exposure

• witnessing the event in person

• learning that a relative or close friend experienced the event

• experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse)

  • note: this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related

PTSD disorder

• at least one traumatic event

• at least one re-experiencing symptom

• at least one avoidance symptom

• at least two negative alterations in cognitions and mood symptoms

• at least two arousal and reactivity symptoms

• symptoms last at least a month

• symptoms cause impairment

4 PTSD major symptom clusters

1. re-experiencing: intrusive thoughts, nightmares, flashbacks—feeling like you’re back in the situation, prolonged physiological responses when reminded of the trauma

2. avoidance: avoiding thoughts of feelings related to the event, avoiding people places, or things related to the event

3. negative alterations in cognition and mood: inability to remember important parts of the event, negative beliefs about oneself, other people, or the world, distorted cognitions that lead to blame of self or others related to event, persistent negative emotional state, loss of interest in activities, feelings of detachment from others, inability to experience positive emotions

4. arousal and reactivity: problems with concentration, reckless or self-destructive behavior, irritability, insomnia (difficulty falling or staying asleep), hypervigilance, exaggerated startle response

Developing acute and post traumatic stress disorders

Biological factors

• brain—body stress routes

• brain’s stress circuit

• inherited predisposition

Childhood experiences — can increase risk for later PTSD

• chronic neglect or abuse

• poverty

• parental conflict

• catastrophe

• family members with psychological disorders

Cognitive factors and coping styles

• preexisting memory impairments, intolerance of uncertainty, inflexible coping styles, and negative worldview versus resiliency and manageable stress exposure in childhood

Social supports systems

• weak family and social support systems

Severity and nature of the trauma

• more severe or prolonged trauma

• more direct exposure to trauma

• intentionally inflicted trauma

• mutilation, severe physical injury, or sexual assault

Treatment for acute and post traumatic stress disorders

• antidepressant drug therapy

• cognitive-behavioral therapy

  • cognitive processing therapy

  • mindfulness-based techniques

  • exposure techniques; prolonged exposure

  • eye movement desensitization and reprocessing (EMDR)

• couple or family therapy

• group therapy

Dissociative disorders

• group of disorders triggered by traumatic events

• when changes in memory lack a clear physical cause, they are called dissociative disorders

  • one part of the person’s memory typically seems to be dissociated, or separated, from the rest

Types of dissociative disorders

Dissociative amnesia = inability to recall important info, usually of an upsetting nature, about one’s life

• memory loss is much more extensive than normal forgetting and is not caused by physical factors

• often the amnesia episode is directly triggered by a specific upsetting event or trauma

• leads to significant distress or impairment

Types of dissociative amnesia

• localized: most common type; loss of all memory of events occurring within a limited period

• selective: loss of memory for some, but not all, events occurring within a period

• generalized: loss of memory beginning with an event, but extending back in time; may lose sense of identity; may fail to recognize family and friends

• continuous: forgetting continues into the future; quite rare in cases of dissociative amnesia

Dissociative fugue = extreme version of dissociative amnesia

• people not only forget their personal identities and details of their past, but also flee to an entirely different location

• may be brief or more severe

Dissociative identity disorder (multiple personality disorder)

• person experiences a disruption to his or hers identity, as reflected by at least two separate personality states ir experiences of possession

• person repeatedly experiences memory gaps regarding daily events, key personal info, or traumatic events, beyond ordinary forgetting

• leads to significant distress or impairment

• symptoms are not caused by a substance or medical condition

• each has a unique set of memories, behaviors, thoughts, and emotions

• subpersonalities often display dramatically different characteristics

• sudden movement from one subpersonality to another (switching) is usually triggered by stress

Subpersonalities interact

3 kinds of relationships:

Mutually amnesic relationships= subpersonalities have no awareness of one another

Mutually cognizant patterns = each subpersonality is aware of the rest

One-way amnesic relationships = most common pattern; some personalities are aware of others, but the awareness is not mutual. Those who are aware (“co-conscious subpersonalities”) are “quiet observers”

• average number subpersonalities is now thought to be 15 for women and 8 for men; often appear in groups of 2 or 3

Epidemiology

• women are diagnosed 3x more than men

• men # alters = 13

• childhood onset

• ‘abuse history

• chronic

Etiology

• psychodynamic model = dissociation: extreme repression

• behavioral model = negative reinforcement maintains dissociation

Treatment for DID

Unlike those with dissociative amnesia or fugue, people with DID do not typically recover without treatment

• therapists usually try to help clients:

  • recognize fully the nature of their disorder

  • recover the gaps in their memory

  • integrate their subpersonalities into one functional personality