PSYC 372 Unit 8

Internalizing Symptoms

• Experiencing Distress within one’s mind

  • Primarily involves thoughts, moods, bodily symptoms

  • Ex: rumination, obsessions, low mood, racing thoughts, sadness, anxious thoughts, self-isolation, stomach aches, headaches, sweatin

Externalizing Symptoms

• Expressing Distress outside of one’s mind

  • • refers to an external management of affect, somehow using outside stimuli to manipulate internal experience

  • • primarily involves behaviors which are destructive, numbing, or reassuring (i.e., “acting out” rather than “bottling it up”)

  • • examples: substance abuse, overeating, angry outbursts, violence, compulsions, hostility/irritability at others, psychomotor agitation (e.g., “nervous tics”)

Modeling Internalization

Distress

• Major depression, Dysthymia, Generalized Anxiety Disorder

Anxiety

• Agoraphobia, Social Phobia, Specific Phobia, Panic Disorder

Modeling externalization

• Alcohol disorder, drug disorder, conduct disorder, adult antisocial disorder

Are internalizing and externalizing separate?

While they may be helpful ways to frame the “styles” of symptoms and disorders, they ARE correlated and not TRULY separate. (People aren’t exclusive to one or the other)

Vice

an externalizing symptom which is addicting or habit-forming

• the word’s origins refer to practices/behaviors which are immoral, sinful, depraved, degrading, or not accepted by society; but this definition is somewhat outdated

• Examples: Alcohol, drugs, porn, videogames, tobacco

Vicious Cycle

pattern of entrapment in externalizing addictive behaviors involving problematic use, attempts to quit, and subsequent strengthening of desire for the vice.

• Example: “Marijuana is my vice, it’s
  always there when I’m stressed. I’ve tried
  to cut back but then I get even more
  anxious and want to smoke even worse.”

Binge

period of eating which is markedly greater in volume than normal eating, within a 2 hour span, and in which one feels it is difficult to stop/limit eating

Purge

to forcibly rid the body of food/calories consumed via vomiting, inappropriate use of laxatives, diuretics, or enemas

Restriction of Eating

to consume significantly less caloric intake than normal

Compensatory Behaviors

actions to deter weight gain following eating, including purging, restricted eating, extreme exercise, fasting, etc.

BMI

short for “Body Mass Index,” a measure of body weight relative to height
>30 is obese; 25-30 is overweight; 18.5-25 is average/healthy; 17-18.5 is underweight; <17 is anorexic

Anorexia Nervosa

• restriction of energy intake leads to significantly low weight, BMI at or below 17

• extreme fear of weight gain or becoming “fat”despite clearly low body weight

• specify as “binge-purge” or “restricting” subtypes

  • Binge/purge: Individual has recurrent binge/purge episodes

  • Restricitng: weight loss is primarily accomplished through diet, fasting, exercise

• most severe and life-threatening eating disorder

• one-year prevalence 0.9% (women), 0.3% (men)

Severity of low weight on BMI scale

• Mild = BMI less than or equal to 17
• Moderate = BMI between 16 and 16.99
• Severe = BMI between 15 and 15.99
• Extreme = BMI less than or equal to 15

Bulimia Nervosa

A: recurrent episodes of binge eating
B: recurrent inappropriate compensatory behaviors
C: binges and compensatory behaviors average once per week for 3 months or more
D: self-evaluation is unduly influenced by body shape and weight
E: does not occur exclusively during Anorexia Nervosa

• Specify if in remission (either partial or full)

• Specify severity based on average number of weekly binge/compensate episodes:

  • Mild (1-3), Moderate (4-7), Severe (8-13), Extreme (14 or more)
    

one-year prevalence 1.5% (women), 0.5% (men)

Binge Eating Disorder

A: recurrent episodes of binge eating
B: the binge-eating episodes are associated with 3 or more of the following:
- 1) eating more rapidly, 2) eating until uncomfortably full, 3) eating large amounts when not hungry, 4) eating alone due to embarrassment, 5) feelings of disgust with self, depression, or guilt after eating
C: marked distress regarding binge eating
D: binge eating episodes average once per week for 3 months or more
E: not associated with compensatory behaviors and not a part of AN or BN
- Specify if in remission (either partial or full)
- Specify severity based on average number of weekly binge episodes:
Mild (1-3), Moderate (4-7), Severe (8-13), Extreme (14 or more)

• one-year prevalence 3.5% (women), 2.0% (men)
  

Substance Abuse

• excessive or problematic use of the substance (notice the “ab” prefix, as in “abnormal”)
• can be associated with dangerous/hazardous/risky behavior (e.g., intoxicated driving)
• may involve continued use despite consequences to health or personal roles

Substance Tolerance

• level to which a person’s physiological system can handle the substance
• increased tolerance occurs with continued use (e.g., going from 1 cigarette to 5 required for a buzz)
• tolerance increases involve more efficient metabolism and elimination of substance

Substance Dependence

• physiological need for increasing amounts of substance to maintain homeostasis and stave off withdrawal
• involves both highly increased tolerance and withdrawal symptoms upon attempts to quit or reduce use

Withdrawal

• physical symptoms accompanying abstinence from the given substance after dependence has been reached
• vary depending upon the type of substance (headache for caffeine; nausea/hallucinations/seizures for alcohol

• we can categorize psychoactive substances into the following:

  • stimulants (e.g., tobacco, cocaine, amphetamines, caffeine)

    > main effect is increased activity of the central nervous system

  • depressants (e.g., alcohol, barbiturates, valium)

    > main effect is sedating/tranquilizing activity of the central nervous system

  • opioids / narcotics (e.g., heroin, morphine, codeine)

    > main effects are euphoria and reduced pain

  • anti-psychotics (e.g., haldol, risperdal, clozaril)

    > main effect is to dampen psychotic experiences, thus these are often used in treatment

  • hallucinogens (e.g., marijuana, LSD, ecstasy)

    > main effect is psychedelic perceptual experiences (i.e.,hallucinations)

Alcohol Use Disorder

problematic pattern of alcohol use, within a 12-month period, including at least 2 of the following, with clinically significant impairment/distress:

• use is greater amount / time than intended
• persistent desire or failed attempts to limit use
• great deal of time spent on alcohol
• cravings or strong urges to use
• recurrent use resulting in role failures
• continued use despite consequences
• important activities given up or reduced for use
• recurrent use in hazardous situations
• continued use despite knowledge of problem
• tolerance significantly increased
• withdrawal symptoms

Specify if remission (early or sustained)
Specify if in a controlled environment (i.e., continued use in location with alcohol restricted)
Specify severity
> Mild (2-3 symptoms)
> Moderate (4-5 symptoms)
> Severe (6 or more symptoms)

12 month prevalence: 13%

Stimulant Use Disorder

problematic pattern of amphetamine-type substance, cocaine, or other stimulant” use, within a 12-month period, including at least 2 of the following, with clinically significant impairment/distress:

• use is greater amount / time than intended
• persistent desire or failed attempts to limit use
• great deal of time spent on access/use/recovery
• cravings or strong urges to use
• recurrent use resulting in role failures
• continued use despite consequences
• important activities given up or reduced for use
• recurrent use in hazardous situations
• continued use despite knowledge of problem
• tolerance significantly increased
• withdrawal symptoms
Specify if remission (early or sustained)
Specify if in a controlled environment (i.e., continued use in location with alcohol restricted)
Specify severity
> Mild (2-3 symptoms)
> Moderate (4-5 symptoms)
> Severe (6 or more symptoms)

12 month prevalence: 0.2%

Which of the following do the Anorexia Nervosa and Bulimia Nervosa diagnoses inherently have in common?

fear of being or becoming “fat” and undue focus on body-image

Which of the following is not one of the possible core characteristics of a binge-eating episode, as defined in Binge-Eating Disorder by DSM-5?

a. Guilt, disgust, or depressed thoughts and feelings toward self
b. Forcing oneself to vomit after bingeing
c. Eating despite not being not hungry
d. Eating alone due to severe embarrassment

Which of the eating disorders tends to be viewed as the most severe, contributing to the most medical problems and highest lethality?

Anorexia Nervosa

Which characteristic makes substance dependence unique from substance abuse?

physiological tolerance and withdrawal

When Markus stopped drinking after a 4-week binge of constant intoxication, he became very ill: disoriented, nauseated, hallucinating, and paranoid. These would be indicators of:

alcohol withdrawal

Which statement below is NOT an accurate difference between Anorexia Nervosa (AN) and Bulimia Nervosa (BN), according to DSM-5?

BN generally has lower prevalence rates than AN.

Which of the following could most likely be described as a “vice” in the psychological sense?

using marijuana as a means to counteract one’s social anxiety

Which of the following disorders is most purely an “internalizing” condition?

Generalized Anxiety Disorder

While we should never “judge a book by its cover,” there are certain patterns in abnormal psychology which become clear through demographic / epidemiological research. Imagine that
you are a counselor who has received a referral for a new client, and the brief note in the chart based on the initial phone call says “possible anorexia.” Given this starting point, which of the
following would be statistically incorrect to assume about the client? (i.e., Which guess below is least likely or is lacking in evidence?)

it is likely that the client has obese parents, and that they are African American

Clinical Vignette) Over approximately the past 5 weeks, Joey has been having thoughts about
dying, has been crying often and feeling sad, has felt less enjoyment in his hobbies, has gained
approximately 15 pounds, and has been struggling to stay focused and productive at work. He also
has been drinking in excess, consuming approximately 6 beers per day and upwards of 10-15 per
evening on weekends—leading him to make risky decisions such as drinking and driving, and
having unprotected sex in an affair. Although he denies physiological dependence upon alcohol,
he does admit that he is “leaning on it hard,” drinking more to get the same level of buzz, and
acting dangerously. His wife, friends, and boss are all concerned, so he begins therapy with you.

Alcohol Use Disorder and Major Depressive Disorder