Abnormal Psych Final Exam May 13th (8,11,12)

Insomnia Disorder

condition in which insufficient sleep interferes with normal functioning

Bulimia

• disorder involving recurrent episodes of excessive consumption followed by compensatory purges

Recurrent binge-eating episodes

➢At least once a week for three months

➢Abnormally large amount in a short time (≤2 hours)

➢Inappropriate compensatory behaviors

➢ vomiting, laxatives, fasting, exercise

➢Behaviors occur at least once a week for 3 months

➢Self-evaluation overly influenced by body shape/weight

sleep efficiency (SE)

percentage of time actually spent sleeping of the total time spent in bed

night eating syndrome

consumption of 1/3+ daily calories after the evening meal, leaving bed to have a snack

actigraph

small electronic device that is worn on the wrist like a watch and records body movements

polysomnographic (PSG) evaluation

assessment of sleep disorders with monitoring of heart, muscle, respiration, and brain wave functions

Binge

brief episode of uncontrolled, excessive consumption

binge-eating disorder (BED)

distress-inducing excessive food consumption not followed by purging behaviors

sleep terrors

episode of apparent awakening from NREM with panic and amnesia for the event

bariatric surgery

surgical approach to extreme obesity

purging technique

self-induced vomiting or laxative abuse used to compensate for excessive food ingestion

disorder of arousal

sleep disorder during NREM sleep that includes sleepwalking and sleep terrors

rebound insomnia

worsened sleep problem that can occur when medications used to treat the condition are withdrawn

rapid eye movement (REM) sleep

period when the eyes move rapidly from side to side and dreams occur

Obesity

excess body fat resulting in a body mass index (BMI, a ratio of weight to height) of 30 or more

Sleepwalking

abnormal sleep behavior that involves leaving the bed during nonrapid eye movement sleep

microsleep

seconds-long nap that occurs when someone has been deprived of rest

sleep apnea

sleep disorder characterized by brief periods when breathing ceases during slumber

primary insomnia

difficulty initiating, maintaining, or gaining from sleep

dyssomnias

difficulty getting to sleep or in obtaining sufficient quality sleep

anorexia nervosa

disorder characterized by calorie restriction and dangerously low body weight

parasomnias

abnormal behavior such as nightmares or sleepwalking that occurs during sleep

hypersomnolence disorder

sleep dysfunction involving an excessive amount of sleep that disrupts normal routines

circadian rhythm disorder

condition caused by the body’s inability to synchronize with current day/night patterns

narcolepsy

disorder involving sudden and irresistible sleep attacks

nightmares

frightening and anxiety-provoking dream occurring during rapid eye movement sleep

breathing related sleep disorder

sleep disruption leading to excessive sleepiness or insomnia, caused by a breathing problem

dialectical behavioral therapy (DBT)

treatment for a condition by exposing the client to stressors in a controlled situation

dependent personality disorder

excessive need to be taken care of with submissiveness, clinginness behavior and separation fear

narcissistic personality disorder

grandiosity in fantasy or behavior, need for admiration, and lack of empathy

obsessive-compulsive personality disorder

preoccupation with orderliness, perfectionism, and mental and interpersonal control

APD

pervasive pattern of disregard for and violation of the rights of others

schizoid personality disorder

detachment from social relationships and a restricted range of expression of emotions

schizotypal personality disorder

acute discomfort with, and reduced capacity for, close relationships; cognitive or perceptual distortions; eccentric behavior

psychopathy

non-DSM-5 category including superficial charm and lack of remorse

histrionic personality disorder

pervasive pattern of excessive emotionality and attention seeking

avoidant personality disorder

pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to criticism

borderline personality disorder

pervasive pattern of instability of interpersonal relationships, self-image, affect, and impulse control

personality disorder

enduring maladaptive pattern for relating to the environment and self

paranoid personality disorder

pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent

Cluster B

dramatic, emotional, or erratic personality disorders; it consists of antisocial, borderline, histrionic, and narcissistic personality disorders

Cluster A

odd or eccentric personality disorders; includes paranoid, schizoid, and schizotypal personality disorders

Cluster C

anxious or fearful personality disorders; it includes avoidant, dependent, and obsessive-compulsive personality disorders

Anorexia associated features

▪ Medical Consequences

➢ Amenorrhea

➢Dry skin, brittle hair/nails, sensitivity to cold

➢Lanugo (fine hair), low blood pressure/heart rate

➢Electrolyte imbalance if purging

▪ Psychological Consequences

➢High rates of anxiety and mood disorders

➢Depression in up to 71%

➢OCD, substance abuse common

➢Increased suicide risk

Anorexia subtypes (2)

• Restricting- Type

• Binge-eating-Purging Type

Bulimia associated features

Medical Consequences

▪ Most are within 10% of normal body weight

▪ Salivary gland enlargement (“chubby cheeks”)

▪ Dental enamel erosion, esophageal tears

▪ Electrolyte imbalance: risk of arrhythmia, seizures, kidney

failure

▪ Intestinal problems from laxative abuse

▪Psychological Comorbidities (Bulimia)

▪ High rates of anxiety (80%), mood disorders (20–70%)

▪ Substance abuse common

▪ Depression often follows bulimia

DSM 5 Binge Eating Disorder

Recurrent binge-eating episodes

▪ 3+ associated features (rapid eating, uncomfortably full,

eating when not hungry, eating alone, guilt)

▪ Marked distress, no compensatory behavior

▪ Occurs at least once a week for 3 months

Binge eating disorder associated features

Binge-eating without compensatory behaviors

▪More common in males, later onset

▪Higher remission, better treatment response than

bulimia/anorexia

▪Common among those in weight-loss programs

▪20% of obese individuals in such programs have BED

▪Up to 50% of bariatric surgery candidates have BED

Pathways to BED (2)

Two Pathways into BED

▪ Diet before their first binge episode

▪ Characteristics

▪ Binge-First group

▪ Characteristics

▪Concerns About Shape and Weight in BED

▪Distinguishes BED from simple obesity:

Eating Disorder Facts

Age of Onset & Course

➢Median onset: 18–21 years

➢Anorexia: often earlier (as young as 15)

➢Bulimia: can begin as early as age 10

➢Binge Eating Disorder – Average 25 years

➢Predictors of Chronic Course

➢ Anorexia: persistent low BMI, body image distortion

➢Bulimia: childhood obesity, overemphasis on thinness

➢Both can be chronic and resistant to treatment

▪Eating Disorders Among Young Women

➢13% of girls experience an eating disorder by age 20

Bulimia and Anorexia Stats

Bulimia

◦ Majority are female – 90%+

◦ At-risk age: Adolescence

◦ At-risk Males

◦ Gay males or bisexual

◦ Athletes: Requiring weight regulation

◦ The incidence among males is increasing

◦ Tends to be chronic if left untreated

Anorexia

◦ Majority are female and white

◦ From middle- to upper-middle-class families

◦ Usually develops around early adolescence

◦ More chronic and resistant than bulimia

Cross-cultural factors

◦ Develop in non-Western women after moving to Western countries

◦ Rare in African American women

Eating Disorders among POC’s

Recent research shows rising rates among people of color,

including Black, Hispanic, Asian, and Native American

populations

▪Cultural Food Norms and Stigma

▪Family and Community Influences

▪Healthcare Disparities

Eating Disorders and Women of Color

• Black teenagers are 50% more likely than white teenagers

to exhibit bulimic behavior

Studies comparing Hispanic and Non-Hispanic adolescents

◦ Hispanics were significantly more likely to suffer from

bulimia nervosa than their non-Hispanic peers

Gordon, Brattole, Wingate, & Joiner (2006) Study

◦ Presented Identical case studies depicting eating disorder

symptoms – The only differences in the cases were whether

the woman was described as white, Hispanic, Black

Eating Disorders and Women

Results:

◦ 44% identified the white woman’s behavior as problematic;

◦ 41% identified the Hispanic woman’s behavior as problematic, and only

◦ 17% identified the Black woman’s behavior as problematic.

The clinicians were also less likely to recommend that

Black woman should receive professional help

Genetic and Biological Contributes to Eating Disorders

Genetics Shape Our Bodies and Risks

◦ Family and Twin Studies: Inherited Risk

◦ Family and Twin Studies: Inherited Risk

◦ What is Actually Inherited?

◦ Neurobiology:

Psychological Dimension

• Diminished sense of control, confidence

▪Low self-esteem, high perfectionism

▪Social Anxiety and Preoccupation With Appearance

▪Emotional Regulation Difficulties

Treatment of Bulimia

Psychosocial treatments

◦ Cognitive-behavioral therapy (CBT)

◦ Treatment of choice

◦ Basic components of CBT: Identifying maladaptive thinking patterns and behavioral habits, then

gradual practice of new habits

Medical and drug treatments

◦ Antidepressants

◦ Can help reduce binging and purging behavior

◦ Usually not efficacious in the long-term

Treatment of BED

Previously used medications for obesity are now not recommended

Psychological treatment

◦ CBT

◦ Similar to that used for bulimia

◦ Appears efficacious

◦ Interpersonal psychotherapy

◦ Equally as effective as CBT

◦ Self-help techniques

◦ Also appear effective

Treatment of Anorexia

General goals and strategies

◦ Weight restoration

◦ First and easiest goal to achieve

◦ Psychoeducation

◦ Behavioral and cognitive interventions

◦ Target food, weight, body image, thought and emotion

◦ Treatment often involves the family

◦ Long-term prognosis for anorexia is poorer than for bulimia

Preventing eating disorders

Prevention Program

The Body Project:

Winzelberg et al., 2000

Derived from the program “Student Bodies) –internet, interactive

health education program – improve body image satisfaction.

Body Project - A Standalone intervention for students designed to

improve body image satisfaction. It also included an online guided

discussion group.

Goals of the Program

▪ Promote Body Acceptance

▪ Reduce current eating disorder symptom

▪ Prevent eating disorders

◦ Verbal, behavioral, & written activities --- to explore unrealistic beauty

ideals.

◦ Program participants reported a significant improvement in body image

and a decrease in drive for thinness

How does societal pressure for a muscular body lead to muscle

dysmorphia in males?

• Social media

• Bigorexia

• Popularity of “gym bros”

What behaviors and health risks are linked to this obsession?

• Severe diet restriction

• Excessive workouts

How can parents recognize eating disorder signs in boys focused

on muscle building?

• Hyper fixation on muscular appearance

• Protein diet fixation

• Avoidance of meals they believe don’t fit sufficant protein

How do the DSM-IV-TR criteria for anorexia fail to identify eating

disorders in boys

• Research and criteria mainly focused on White heterosexual women

schizophrenia

catatonia

disorder of movement involving immobility or excited agitation.

hebephrenia

A silly and immature emotionality, a characteristic of some types of schizophrenia.

paranoia

People’s irrational beliefs that they are especially important (delusions of grandeur) or that other people are seeking to do them harm.

dementia praecox

The Latin term meaning premature loss of mind; an early label for what is now called schizophrenia, emphasizing the disorder’s frequent appearance during adolescence.

associative splitting

A separation among basic functions of human personality (for example, cognition, emotion, and perception) seen by some as the defining characteristic of schizophrenia.

Psychotic Behavior

A severe psychological disorder category characterized by hallucinations and loss of contact with reality.

negative symptoms

A less outgoing symptom, such as flat affect or poverty of speech, displayed by some people with schizophrenia.

Avolition

An inability to initiate or persist in important activities. Also known as apathy

Alogia

A deficiency in the amount or content of speech, a disturbance often seen in people with schizophrenia.

anhedonia

An inability to experience pleasure, associated with some mood and schizophrenic disorder

Asociality

recognized as a separate symptom of schizophrenia spectrum disorders. This symptom captures a lack of interest in social interactions (APA, 2013). Unfortunately, this symptom can also result from or be worsened by limited opportunities to interact with others, particularly for severely ill patients

Flatt Affect

An apparently emotionless demeanor (including toneless speech and vacant gaze) when a reaction would be expected.

Disorganized Symptoms

These include a variety of erratic behaviors that affect speech, motor behavior, and emotional reactions. The prevalence of these behaviors among those with schizophrenia is unclear.

Disorganized Speech

A style of talking often seen in people with schizophrenia, involving incoherence and a lack of typical logic patterns.

tangentiality

going off on a tangent instead of answering a specific question

loose association or derailment

abruptly changing the topic of conversation to unrelated areas,

Inappropriate Affect

An emotional display that is improper for the situation.

catatonic immobility

A disturbance of motor behavior in which the person remains motionless, sometimes in an awkward posture, for extended periods.This manifestation can also involve waxy flexibility, or the tendency to keep their bodies and limbs in the position they are put in by someone else.

schizophreniform disorder

A psychotic disorder involving the symptoms of schizophrenia but lasting less than 6 months.he DSM-5 diagnostic criteria for schizophreniform disorder include onset of psychotic symptoms within four weeks of the first noticeable change in usual behavior, confusion at the height of the psychotic episode, good premorbid (before the psychotic episode) social and occupational functioning, and the absence of blunted or flat affect (Garrabe & Cousin, 2012).

schizoaffective disorder

A psychotic disorder featuring symptoms of both schizophrenia and major mood disorder.DSM-5 criteria for schizoaffective disorder require, in addition to the presence of a mood disorder, delusions or hallucinations for at least two weeks in the absence of prominent mood symptoms

delusional disorder

A psychotic disorder featuring a persistent belief contrary to reality (delusion) but no other symptoms of schizophrenia.DSM-5 recognizes the following delusional subtypes: erotomanic, grandiose, jealous, persecutory, and somatic.DSM-5 allows for one bizarre delusion in delusional disorder, which separates it from a diagnosis of schizophrenia, which requires more than one delusion to be present

Erotomatic Type

delusion is the irrational belief that one is loved by another person, usually of higher status. Some individuals who stalk celebrities appear to have_____ delusional disorder.

Grandiose Type

delusion involves believing in one’s inflated worth, power, knowledge, identity, or special relationship to a deity or famous person

Jealous Type

delusion believes the sexual partner is unfaithful

Persecutory Type

delusion involves believing oneself (or someone close) is being malevolently treated in some way.

Somatic Type

the person feels afflicted by a physical defect or general medical condition.

shared psychotic disorder (folie à deux)

A psychotic disturbance in which individuals develop a delusion similar to that of a person with whom they share a close relationship.

substance-induced psychotic disorder

Psychosis caused by the ingestion of medications, psychoactive drugs, or toxins.

psychotic disorder associated with another medical condition

Condition that is characterized by hallucinations or delusions and that is the direct result of another physiological disorder, such as stroke or brain tumor

brief psychotic disorder

A psychotic disturbance involving delusions, hallucinations, or disorganized speech or behavior but lasting less than 1 month; often occurs in reaction to a stressor

attenuated psychosis syndrome

Disorder involving the onset of psychotic symptoms such as hallucinations and delusions, which puts a person at high risk for schizophrenia; designated for further study by DSM-5.

delusions

disorder of thought content and presence of strong beliefs that are misrepresentations of reality

schizophrenia

psychotic condition that may involve characteristic disturbances in thinking, perception, speech, emotions, and behavior

psychotic behavior

condition characterized by hallucinations and loss of contact with reality

positive symptom

presence of inappropriate thoughts or behaviors displayed by some people with schizophrenia