psychopathology test 3 miller

hallmark of Bulima

Binge- eating excess amounts of food

eating is perceived as uncontrollable

associated medical features of bulimia

most are within 10% of normal weight

purging can result in severe medical problems

erosion of dental enamel, electrolyte imbalances

kidney failure, cardiac arrhythmia, seizures, intestinal problems, permanent colon damage

associated psychological features of bulimia nervosa

most are overly concerned with body shape

fear gaining weight

between binges, individuals typically restrict calories and avoid high fat foods and "trigger" foods

high comorbidity- anxiety, mood, and substance abuse

***Stice's dual pathway model of bulimic pathology***

distal to more proximal

longitudinal module

hallmark of anorexia

successful weight loss

anorexia nervosa defining features

restriction of energy intake relative to requirements that leads to significantly low body weight in context of age, sex, developmental trajectory, and health

-defined as 15% below expected body weight (DSM- IV; DSM-V doesn't say this)

often begins with dieting

intense fear of obesity

disturbance in way one's body shape is perceived; denial of seriousness of the problem; large impact on self-evaluation

DSM-5 subtypes of anorexia

restricting subtype

binge-eating-purging subtype

restricting subtype

limit caloric intake via diet, fasting, and excessive exercise

binge-eating-purging subtype

like bulimia but with significant weight loss

associated features of anorexia nervosa

marked disturbance in body image

high comorbidity with other psychological disorders

weight loss methods have life threatening consequences

never satisfied with weight- need continuous loss to feel comfortable

medical consequences of anorexia nervosa

amenorrhea (women not having regular periods)

dry skin

brittle nails and hair

sensitivity to cold temperatures

lanugo- downy hair on limbs and cheeks

cardiovascular problems

psychological consequences of anorexia

depression, withdrawal, anxiety, irritability, reduced sex drive

-may be secondary to starvation

binge-eating disorder: overview and defining features - appendix of DSM-IV-TR; "full" diagnosis in DSM-5

engage in food binges without compensatory behaviors

perceived loss of control during binges

binging associated with: eating more rapidly until uncomfortable fully; when not hungry; feeling embarrassed about intake; feeling disgusted/guilty afterwards

distressed about binge eating

1 a week for at least 3 months

binge-eating disorder associated features

many are normal weight/overweight or obese

often older than bulimics and anorexics

more psychopathology vs. non-binging obese people

concerned about shape and weight

binging used as a coping mechanism

no major difference across gender or cultural/racial groups (unlike anorexia and bulimia) -- this used to not be true

bulimia facts and statistics

-Majority are female - 90%+

-Onset typically in adolescence (16-19)

-Lifetime prevalence is about 1.1% for females, 0.1% for males

-6-8% of college women suffer from bulimia at some point

-Tends to be chronic if left untreated

-childhood obesity and early pubertal onset risk factors

anorexia facts and statistics

Majority are female from middle- to upper-middle-class families

Usually develops around age 13 or early adolescence

More chronic and resistant to treatment than bulimia

bulimia and anorexia are found in westernized cultures

immigrants from other countries often develop symptoms

lower rates in African American and Asian females

integrative model ~ causes of bulmia and anorexia

media and cultural considerations

-being thin= success, happiness

-cultural imperative for thinness translates into

dieting

- media standards of the ideal are difficult to

achieve

-"playmates"

- peer groups may act as a transmission path

for body image concerns and coping

behaviors (e.g., dieting, exercise)

-cultural differences USED TO serve as protective

factors

-now equivalent rates across ethnic groups

in US

- LGBTQ+ at risk, Food insec. at risk

biological considerations for bulimia and anorexia

50% due to genetic factors (not clear what is inherited)

common fears for ED

fear of judgement (weight gain, fear of eating in social situations, disliking how body feels due to weight gain, feeling tense around food

medical treatment for bulimia

antidepressants- help reduce binging and purging

antidepressants are not efficacious in the long term

psychological treatment for bulimia

Cognitive behavior therapy

-Treatment of choice

didactics (consequences of binging and purging; ineffectiveness)

scheduled eating (5-6 meals; short interval between meals)

challenge automatic and dysfunctional thoughts

monitoring purges and graduates plan for decreasing them; use new coping skills or distraction to handle urges to purge

interpersonal psychotherapy- gains similar to CBT but doesn't work as fast

binge eating disorder medical treatment

sibutramine (Merida) -used to control hunger

binge eating psychological treatment

CBT for bulimia

Interpersonal psychotherapy has been as effective as CBT

there is some evidence to suggest self-help books/ techniques are also effective

treatment for anorexia nervosa

medical- none exist with demonstrated efficacy

psychological treatment:

- weight restoration: primary initial goal

- if below 70% of weight, inpatient treatment

preferred

- weight gain is often easiest part

- understand that they are not going to

be made overweight

- use numerous, small meals

- eat under supervision

- reinforcements provided

- confront self-defeating behavior

psychoeducation- food, weight, nutrition, health

behavioral and cognitive interventions

-treatment likely to be unsuccessful without

cognitive restructuring

treatment often involves family

long-term prognosis- poorer than bulimia

schizophrenia vs psychosis

psychosis- broad term (e.g., hallucinations, delusions)

schizophrenia- a type of psychosis

psychosis and schizophrenia are heterogeneous

lots of ways and reasons for psychosis

different "types" of schizophrenia

disturbed thought, emotion, behavior

Emil Kraepelin

father of psychiatric classification

used the term dementia praecox (premature dementia)

-focused on subtypes of schizophrenia (paranoid;

catatonic)

-recognized it as a "disease of the brain"

-recognized that several distinct symptoms

appeared to be part of a broader syndrome

-differentiated "dementia praecox" from manic-

depressive illness

Eugen Bleuler

introduced the term "schizophrenia"

"splitting of the mind"; inability to keep a consistent train of thought

described "positive" and "negative" symptoms

characteristics of schizophrenia

two (or more) of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated)

1. delusions

2. hallucinations

3. disorganized speech (frequent derailment or incoherence)

4. grossly disorganized or catatonic behavior

5. negative symptoms (affect flattening, alogia, avolition)

criteria for schizophrenia

social/occupational dysfunction

continuous signs of disturbance for at least 6 months

not schizoaffective or mood disorder

positive symptoms of schizophrenia

active and obvious manifestations of abnormal behavior

excess or distortion of normal behavior

delusions

distortion in thought content

erroneous beliefs that usually involve a misinterpretation of perception or experiences. Beliefs are typically held very strong

gross misrepresentations of reality

types of delusions

persecutory (most common)

referential

erotomanic

somatic

nihilistic

grandiose

"bizarre delusions"

persecutory delusion

"FBI is after me"

most common

referential delusions

"when madonna waves at the audience, she was really waving at me"

erotomanic

madonna is in love with me

somatic

my liver is dead and rotting inside me

nihilistic

the world is ending

grandiose

i am the president of the entire world

bizzare delusions

false beliefs that could not possibly be true, given what is known about the world

Hallucinations

experience of sensory events without environmental input

can experience in any sensory

(auditory, visual, olfactory, gustatory, tactile)

most common hallucination

auditory "voices"

scary form~ "command" hallucinations

2 or more voices running commentary are considered highly characteristic of SZ

delusions and hallucinations may have a congruent theme

findings of imaging studies

subtle structural damage in parts of brain associated with auditory processing

-thinner cortex

in fMRI studies, activation of auditory regions during auditory hallucinations

negative symptoms

absence or insufficiency of normal behavior

spectrum of negative symptoms

Avolition (or apathy) - lack of initiation and persistence

Alogia - relative absence of speech

Anhedonia - lack of pleasure, or indifference

Affective flattening - little expressed emotion

-prodromal symptoms (first seen)

-face immobile and unresponsive

-may not be indicative or experienced emotion

-flat affect may appear before others

Disorganized symptoms

include severe and excess disruptions in speech, behavior, and emotion

nature of disorganized speech

tangentiality-"going off on a tangent"

cognitive slippage/loose associations- conversation in unrelated directions

word salad; neologisms (make-up new words)

nature of disorganized behavior

includes a variety of emotional behavior

(disheveled; odd appearance; inappropriate or unpredictable behavior)

Nature of disorganized affect

inappropriate emotional behavior

-behavior not consistent with context (e.g., smiling when talking about death)

catatonia

disorganized behavior

wild agitation, waxy flexibility, immobility

schizophreniform disorder

schizophrenic symptoms for a few months (less than 6; more than 1)

impaired functioning not required

some never progress on to schizophrenia but more do (schizoaffective disorder)

schizoaffective disorder

Symptoms of schizophrenia and a mood disorder

Both disorders are independent of one another

Prognosis is similar for people with schizophrenia

Such persons do not tend to get better on their own

Need to have delusions and/or hallucinations that are present for at least 2 weeks in the absence of the mood disorder

bipolar type schizoaffective disorder

if mania is part of the presentation

Depressive Type of Schizoaffective Disorder

if only major depressive episodes are part of the presentation

delusional disorder

presence of one or more delusions that persist for 1 month or more

lack other positive and negative symptoms

disorganization is not present

types include:

- erotomanic-someone else is in love with this person

-grandiose

-jealous

-persecutory

-somatic-involves bodily functions or sensations

-bizarre

brief psychotic disorder

-one or more positive symptoms of schizophrenia

-delusions, hallucinations, disorganized behavior/speech

-lasts at least 2 days, but not longer than 1 month

-not due to substance use

-usually precipitated by extreme stress or trauma

-tends to remit on its own

schizotypal personality disorder

may reflect a less severe form of schizophrenia

Process vs. Reactive Distinction

-Process - insidious onset, biologically based, negative symptoms, poor prognosis

-Reactive - acute onset (extreme stress), notable behavioral activity, best prognosis

good vs. poor premorbid functioning in schizophrenia

-focus on functioning prior to developing schizophrenia

-no longer widely used

type 1 vs type 2 distinction

type 1- positive symptoms, good response to medication, optimistic prognosis, and absence of intellectual impairment

type 2- negative symptoms, poor response to medication, pessimistic prognosis, and intellectual impairments

paranoid type of schizophrenia

presence of prominent hallucinations and delusions (usually persecutory or grandeur) but have relatively intact cognitive skills and affect. Organized around coherent theme

do not show disorganized behavior (speech, thought or affect)

later onset

the best prognosis of all subtypes

disorganized type (hebephrenic)

-Marked disruptions in speech and behavior

-Flat or inappropriate affect

-Hallucinations and delusions, if present, tend to be fragmented (unlike paranoid type)

-Develops early, tends to be chronic, associated with a continuous course without remissions

catatonic-type schizophrenia

show unusual motor responses and odd mannerisms

- immobility

-excessive motor activity

-motor negativism (resistance to instructions or attempts to be moved)

-waxy flexibility

tends to be severe and quite rare

examples include echolalia (mimic or repeat words) and echopraxia (mimic movements)

undifferentiated type schizophrenia

Wastebasket category

Major symptoms of schizophrenia

Fail to meet criteria for another type

residual type of schizophrenia

past diagnosis of schizophrenia

absence of prominent delusions, hallucinations, disorganized speech and behavior

continue to display less extreme residual symptoms

-presence of negative symptoms common

-or, attenuated positive symptoms (weird beliefs, eccentric behavior)

cant talk about personality disorders without

personality

funder

Personality is "an individual's characteristic patterns of thought, emotion, and behavior, together with the psychological motivations behind those patterns."

Millon

a personality trait is "a long-standing pattern of behavior expressed across time and in many different situations"

5 factor model

open to experience

conscientiousness

extraversion

agreeableness

neuroticism

open to experience

tendency to be original, have broad interests, be open to a wide range of stimuli, be daring and take risks

conscientiousness

how dependable, responsible, achievement-oriented, and persistent one is

extraversion

A personality dimension describing someone who is sociable, gregarious, and assertive

agreeableness

how trusting, good-natured, cooperative, and soft-hearted one is

neuroticism

anxiety, insecurity, emotional instability

personality disorders are composed of personality traits that are:

Inflexible

Maladaptive

a significant functional impairment or subjective distress

inflexible

adaptive personality is flexible but not unstable

the nature of personality and personality disorders

enduring and relatively stable predispositions (i.e., ways of relating and thinking)

predispositions are inflexible and maladaptive, causing distress and/or impairment

coded on Axis II of the DSM-IV and DSM-IV-TR

-problems: PD's "neighbor" and reputation

various personality disorders are associated with

-Decreased social functioning

-Decreased occupational functioning

-Increased risk of substance abuse

-Increased risk of depression and anxiety

-Increased risk of schizophrenia

-Increased risk of suicide

-Increased risk of imprisonment

-Increased risk of hospitalization

the DSM-IV/5 gives these general criteria for all personality disorders: (category A)

no one diagnoses on these but he still wants us to know

A. an enduring pattern of inner experience and behavior that deviates markedly from the expectations of an individual's culture. This pattern is manifested in two (or more) of the following areas

Cognition, Affectivity, Interpersonal Functioning, Impulse Control

Christmas | Adds | Interesting Fun | In Children

cognition

i.e., ways of perceiving and interpreting self, other people, and events

affectivity

range, intensity, lability, and appropriateness of emotional response

rest of criteria for personality disorders from DSM

b. the enduring pattern is inflexible and pervasive across a broad range of personal and social situations

c. the enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning

d. the pattern is stable and of long duration, and its onset can be traced back to adolescence or early adulthood

borderline PD: dimensional vs categorical

5 of 9 symptoms have "it"; 4 of 9 do not have "it"

once have "it", presumed to look alike

-126 different ways to have 5 BPD symptoms

- not meeting criteria (e.g., 3-4 symptoms) not the

same as being asymptomatic

cut-offs not empirically derived- don't look different; don't function differently

cause problems with stability and inter-rater reliability

almost unanimous consensus that PDs should NOT be used in a categorial manner

dichotomizing dimensional variables always results in

a loss of information

cause problems with stability and inter-rater reliability

Frances

head of DSM 4; was head of Duke psychiatry for years

"not whether, but when and which"

Comorbidity in Personality disorders

if diagnosed with a PD, likely have more than just 1 personality disorder

gender differences in PD

certain PDs believed to be more common in men vs women

men: paranoid, Schizoid, schizotypal (cluster A), antisocial, narcissistic, OCPD

women: histrionic, borderline, dependent

coverage

most common PD diagnosis in clinical practice - PD NOS (not otherwise specified)

-have a PD not recognized by DSM

-have features or more than one PD but don't meet criteria for any specific PD but features cause distress/impairment

The 10 DSM-5 personality disorders: Cluster A ("the weird")

Paranoid PD (DSM tried to drop )

Schizoid PD (DSM tried to drop)

Schizotypal PD

Please | Stop | Screaming

paranoid PD

is a pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent.

Schizoid PD

a pattern of detachment from social relationships and a restricted range of emotional expression

Schizotypal PD

a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior

Cluster B (wild) personality disorders

antisocial

borderline

histrionic

narcissistic

A | Baboon | Has | Nothing

antisocial PD

pattern of disregard for and violation of the rights of others

borderline PD

Pattern of instability in interpersonal relationships, self-image, affects, and marked impulsivity.

histrionic PD

pattern of excessive emotionality and attention seeking

DSM tried to drop

Narcissistic PD

grandiosity, need for admiration, lack of empathy

DSM tried to drop these

Paranoid PD

Schizoid PD

Histrionic PD

People | Stopped | Having

Cluster C personality disorders ("the worried")

avoidant

dependent

obsessive-compulsive (OCPD)

A | Dark | Open Casket

avoidant PD

pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation