PSY 242 Psychopathology Unit 3

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

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

Anterior insula

What brain structure has been linked to feelings of disgust in people who have anorexia and may explain their lack of interest in food.

increase

As anorexia patients recover and gain weight, brain volume is believed to _________.

Denise, who exercises strenuously after a binge.

Who is NOT engaging in an act of purging?

3 multiple choice options

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

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

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

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

Somatoform and internalizing

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

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

Which of the following about pharmacology and eating disorders is TRUE?

3 multiple choice options

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

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

Interpersonal therapy

"Here's 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?

feeding problems

Characterized by concern over food preferences; involve fussy or faddish eating habits in which certain foods are avoided or refused because of taste, texture, or a basic dislike for them; unrelated to body image and are often related to developmental disabilities

pica

feeding problem; an abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay that lasts for at least 1 month

rumination disorder

feeding problem; the regurgitation of recently eaten food into the mouth followed by either rechewing, re-swallowing, or spitting it out

eating disorders

Severe disturbances in eating behavior characterized by preoccupation with weight concerns and unhealthy efforts to control weight.

anorexia nervosa

eating disorder characterized by restricting food and calorie intake due to a fear of gaining weight; have a disturbed perception of body (see self as bigger than really are); extremely low body weight

low body weight compared to what is expected for age, sex, and height

key feature of anorexia

greater than or equal to 17

BMI for mild anorexia

between 16 and 17

BMI for moderate anorexia

less than 16

BMI for severe anorexia

anorexia nervosa - restricting (AN-R)

anorexia where weight loss is achieved by severely limiting food intake, with no binge-eating/purging for at least three months

anorexia nervosa - binge/purging

anorexia with recurrent binging and purging episodes for at least 3 months

atypical anorexia

disorder identical to anorexia but they have normal body weight

bulimia nervosa

an eating disorder characterized by recurrent episodes of binge eating and compensatory behavior to prevent weight gain at least once a week for 3+ months

binge eating

eating an excessive amount of food and having a lack of control over eating

purging compensatory behavior

Self-induced vomitting or the misuse of laxatives, diuretics, or enemas

non purging compensatory behavior

efforts to "make up for" binging that do not involve getting rid of the food itself (e.g. excessive exercise)

with bulimia you have a normal bodyweight whereas AN-BP has an extremely low body weight

main difference between bulimia nervosa and AN-BP

binge eating disorder (BED)

recurrent episodes of binge eating without compensatory behaviors; must show 3+ symptoms at least once a week for 3+ months

eating rapidly, eat until uncomfortably full, eat large amounts even when not hungry, eat alone because you're embarrassed of how much you eat, feeling disgusting or depressed afterwards

symptoms of BED

orthorexia

obsession with healthy eating; worry excessively about eating unhealthy foods and rigidly avoid unhealthy foods

electrolyte imbalances, low potassium, intestinal problems, colon damage, etc

potential medical complications of those with bulimia

heart issues, kidney damage, amenorrhea, low testosterone, lanugo, dry skin/brittle hair, low blood pressure

potential medical complications of those with anorexia

there are a lot of medical complications may need to be treated or tested for as well

why is it important to have a multi-disciplinary team to treat eating disorders

people are very likely to go back and forth between anorexia types

what eating disorders are people more likely to go back and forth in

bulimia or AN-R

Those with AN-BP are very likely to shift into what other eating disorders

somewhat likely they will shift from bulimia --> BED, but no one has ever gone from BED --> bulimia

how likely is it for someone to shift between bulimia and BED

anxiety disorders, OCD, depression, substance use disorders (higher with bulimia), personality disorders, self harm & suicidality

what are some common comorbidities for those with eating disorders

9%

lifetime prevalence of eating disorders

18 - AN, BN; 21 - BED

onset of anorexia, bulimia, and BED

51% of people will fully recover and 21% will partially recover

what is the course of anorexia like

70% will enter remission

what is the course of bulimia like

66% will fully recover

what is the course of BED like

having a close relative with a disorder, having a history of dieting, having a negative energy balance, having type 1 diabetes

biological risk factors for eating disorders

disrupted monoamine neurotransmitters

neurotransmitters involved with eating disorders

decreased dopamine, decreased serotonin, norepinephrine (somewhat)

neurotransmitters involved with anorexia

serotonin

neurotransmitter involved with bulimia

dopamine

neurotransmitter involved with BED

tryptophan

amino acid made from food, and a precursor to serotonin; reason why they say decreased serotonin may be a result of the ED rather than the cause

perfectionism, body image dissatisfaction, personal history of an anxiety disorder or OCD, behavioral inflexibility

psychological risk factors for eating disorders

50%

average heritability of eating disorders

weight stigma (thinner is better), teasing or bullying, ideal appearance internalization, limited social networks, acculturation, historical trauma

social risk factors for eating disorders

BED and BN

what eating disorders are associated with childhood physical, sexual, and emotional abuse

odds of developing an eating disorder are 3 times higher in those who experienced child abuse; have an earlier onset and greater severity of the disorder

relationship between eating disorders and trauma

anorexia

what eating disorders are associated with childhood physical abuse

higher emotional dysregulation, higher anger levels, dissociation, and higher impulsivity and compulsivity lead to developing an eating disorder to help cope and deal with emotions

why child abuse is associated with eating disorders

males are more likely to have a history of being overweight, focus on muscularity, and have comorbid substance abuse (typically steroids)

key differences between males and females with eating disorders

AN, BN, BED, AFRID, but not beneficial to AN until weight is gained and need much higher dose for BN and BED

what eating disorders are SSRIs used to treat

cautiously used for anorexia because can help improve weight gain, can make BED & BN worse

what eating disorders are antipsychotics used to treat

Interpersonal Therapy (IPT)

therapy used to treat eating disorders that focuses on role transitions and interpersonal conflicts; views eating disorders as a way to avoid interpersonal issues

enhanced cognitive behavioral therapy (CBT-E)

Attributes a "core psychopathology" to all eating disorders, in which self-worth is based not on achievements but on the ability to control body weight and shape; more effective for bulimia

acceptance and commitment therapy (ACT)

a form of cognitive therapy that helps clients focus on accepting things they can't change; used to treat eating disorders

family therapy, nutritional intervention, inpatient treatment

best treatment for anorexia

CBT or IPT, SSRIs

best treatment for bulimia

Maudsley approach

a family treatment for anorexia nervosa that focuses on supporting parents as they determine how to lead their child to eat appropriately; has three phases

1- weight restoration; 2- returning control to the adolescent; 3- establish a healthy identity separate from parents

three phases to the Maudsley approach

avoidant/restrictive food intake disorder (AFRID)

extremely picky eating and fail to eat enough to meet basic nutrition needs

substance abuse

pattern of substance use leading to clinically significant impairment manifested by at least 1 symptom within a year

failing to fulfill major role obligations, recurrent use in physically dangerous situations, recurrent substance related legal problems, continued use despite negative consequences

symptoms of substance abuse

substance dependence

pattern of substance use leading to clinically significant impairment or distress as manifested by at least 3 symptoms within a year

tolerance, withdrawal, continued use despite knowledge of problems caused or worsened by substance, important activities stopped, excessive time spent to obtain or use, unsuccessful attempts to cut back or control use, using greater amounts or over longer periods of time

symptoms of substance dependence

dsm-IV had abuse and dependence, but dsm-5 just has substance use disorders that is diagnosed by severity

difference between dsm-IV and dsm-5 for substance disorders

impaired control over use, social impairment due to use, risky use, pharmacological criteria

SUD criteria domains according to the DSM-5

substance taken in larger amounts or over longer periods of time, unsuccessful efforts to stop, great deal of time spent to obtain, use, or recover from substance, craving

impaired control symptoms of SUD (4)

recurrent use results in failure to fulfill obligations, continued use despite social or interpersonal problems, important activities given up or reduced

social impairment symptoms of SUD (3)

recurrent use in physically hazardous situations, use is continued despite physical or psychological problems

risky use symptoms of SUD (2)

tolerance, withdrawal

pharmacological criteria for SUD (2); also the key features of substance dependence

2-3 symptoms in a 12 month period

mild SUD

4-5 symptoms in 12 month period

moderate SUD

6+ symptoms in a 12 month period

severe SUD

delirium tremens

very severe withdrawal that causes hallucinations; can lead to cardiac problems, strokes, or seizures; happens a lot with heavy alcohol users

addiction

involves compulsive use, obsession, concern, and preoccupation; inability to stop using & continued use despite consequences; not formally part of SUD

tolerance

the diminishing effect with regular use of the same dose of a drug, requiring the user to take larger and larger doses before experiencing the drug's effect; a shift in the dose-response curve

learned tolerance

the idea that individuals addicted to drugs are highly ritualistic so they tend to administer the drug in the same location or with the same people so your body will create an association between the two and increase the levels of drug-metabolizing enzymes when the location is recognized which results in tolerance; reason why being in a new place can be very dangerous because enzymes won't be released and can lead to overdose

cross tolerance

one drug produces tolerance to another drug that acts via the same biological mechanism; related to polysubstance use disorder

synergism

combination of two drugs causes an effect that is greater than the sum of the individual effects of each drug alone (exponential effects)

cancelling out/negating effects

when drugs act in opposition of one another allowing you to use more of both; can be very dangerous and increases the risk of overdosing

substance intoxication

reversible substance-specific syndrome due to recent ingestion of a substance

withdrawal

the discomfort and distress that follow discontinuing an addictive drug or behavior after tolerance has developed; usually the opposite of the drug's effects

perception, wakefulness/attention, thinking/judgement, psychomotor behavior, interpersonal behavior, mood

what is effected when you are intoxicated

cold shakes, chills, sweating, fever-like symptoms, vomiting, diarrhea, bone pain, insomnia, anxiety, depression, mood swings

withdrawal symptoms

alcohol amnestic disorder

Formerly known as Korsakoff's syndrome, is an irreversible condition characterized by a persisting memory deficit (particularly with regard to recent events) that is sometimes accompanied by falsification of events

constitutional (fatigue, weakness), pain, gastrointestinal, sleep, sensory, cognitive, mood, sympathetic hyperactivity

classes of symptoms of hangovers

hangovers can occur after a single bout of drinking while withdrawal occurs after multiple, repeated bouts; hangovers last hours while withdrawal lasts days

differences between hangovers and withdrawal

dopamine hypothesis of addiction

Theory that all addictive drugs increase dopamine in the brain, even though this is often by different biological mechanisms; includes the reward deficiency syndrome (RDS) and incentive-sensitization theory

reward deficiency syndrome (RDS)

people lack dopamine so they use substance to increase it

incentive-sensitization theory

when substances repeatedly stimulate the reward center, the center develops a hypersensitivity to the substances and want them more

mesolimbic dopamine pathway, amygdala, hippocampus, VTA, medial prefrontal cortex (reward system)

brain systems related in addiction

self-medication

the use of drugs to treat symptoms that have not been diagnosed by a medical professional; psychodynamic perspective of substance use

the idea that those with secure attachments have coping resources available to them, but those with insecure attachments do not so they are more likely to develop a substance use disorder

relationship between attachments in early childhood and substance use according to psychodynamic perspective

contingency management

An operant conditioning approach to changing behavior by altering the consequences, especially rewards and punishments, of behavior; put strategies in place to minimize the possibility of being in contact with the substance