Psyc 337 Midterm 2

Definition of Anorexia Nervosa

pursuit of thinness that involves behaviours that result in a significantly low body weight

Two types of Anorexia

restricting type and binge-eating/purging type

anorexia restricting type

effort is made to limit the quantity of food consumed

anorexia binge eating/purging type

binge: out-of-control consumption of an amount of food that is greater than most would eat in same time/circumstances
purge: remove food that is been eaten

DSM-5 criteria for Anorexia Nervosa

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

bulimia nervosa

uncontrollable binge eating and efforts to prevent resulting weight gain by self-inducing vomiting and excessive exercise

difference between bulimia nervosa & anorexia binge eating/purging type

while those with anorexia are seen to be severely underweight, those with bulimia nervosa are normal/slightly above normal weight

How many calories can someone consume in the average binge

4,800

binge eating disorder

a disorder characterized by compulsive overeating however does not engage in inappropriate compensatory behaviour
are often overweight/obese
much less dietary restraint

anorexia age of onset

16-20

Bulimia nervosa age of onset

21-24, highest risk in women

Binge-eating disorder age of onset

30-50

Binge-eating disorder prevalence

most common form of eating disorder
worldwide prevalence = 2%
lifetime prevalence 3.5% for women 2% men
prevalence higher in obese people (6.5-8%)

Bulimia prevalence

1% worldwide
lifetime prevalence in U.S. = 1.5% women 0.5% men

Anorexia nervosa prevalence

lifetime prevalence US = 0.9% women 0.3% men
risk increased in 20th century

Anorexia Nervosa Medical Complications

mortality rater 5x higher than females 15-34 in general pop
malnutrition causes thinning hair, dry skin, weakness, etc
thiamin deficiency can lead to depression & cognitive changes
laxative abuse can lead to dehydration, electrolyte imbalances, kidney disease, damage to bowels and gastrointestinal tract

Bulimia Nervosa Medical Complications

calluses on their hands
damage to teeth
mouth ulcers
smalll red dots around eyes from pressure of throwing up

eating disorder outcomes

anorexic individuals: 18x more likely to die by suicide
binge-eating: high rates of clinical remission
Even when "well," many individuals who recover from anorexia nervosa and bulimia nervosa still harbor residual food issues (able to change behaviour but not necessarily psychological component)

Binge-eating diagnostic crossover

majority of women experienced diagnostic crossover
bidirectional transitions between two subtypes of anorexia is common
shift from anorexia to bulimia nervosa occured in 1/3 patients
binge-eating disorder and anorexia nervosa = distinct disorders

Comorbid disorders with eating disorders

depression: 68% anorexia, 63% bulimia, 50% binge eating
OCD often found in patients with anorexia nervosa and bulimia nervosa
comorbid personality disorders often seen

Eating disorders and genetics

risk of anorexia for relatives is 11.4x greater than control
risk of bulimia for relatives is 3.7x higher
association with genes linked to psychological and metabolic problems

Eating disorders and neurostransmitters

Serotonin implicated in obsessionality, mood disorders and impuslsivity; also modulates appettite and feeding behaviours
theory that reward and punishment (dopamine) systems get contaminated where normally rewarding stimuli (food) becomes adversive, stimuli associated with self-starving becomes valued

eating disorders and family dysfunction

over 1/3 patients report family dysfunction contributed to development of anorexia (parents preocuppied with thiness/dieting, excessive control, etc)
bulimic family characteristics: hightparental expectations

Eating disorders and psychological factors

internalizing thin ideal
perfectionism: maintains pathology, more common in women, may have genetic basis
negative body image (sociocultural pressure)
dieting
negative emotionality: negative affect (feeling bad is causal risk factor for body dissatisfaction)

treatment for anorexia

patients generally pessemistic about recovery
immediate concern is restoring to a non-life-threatning level
medications: antidepressants may be used, antipsychotic medication may be beneficial - Olanzapine
family therapy: most effective treatment (particularly for younger women)

treatment of bulimia

CBT and antidepressants

treatment of binge-eating disorder

antidepressents due to high comorbidity with depression
appetite suppresants and anticonvulsants
interpersonal psychotherapy may work best

Transdiagnostic approach

enhanced cognitive behavioural therapy; targets eating issues as well as concerns about shape, weight, extreme dieting, purging, binge eating

Problem of obesity

obesity: BMI above 30
increased risk for high cholesterol, hypertension, heart disease, arthritis, diabetes and cancer
reduced life expectancy
more prevalent in minorities
more prevelant in men

weight stigma

increasing with media
seen more agaisnt obese women
bias also seen among health care professionals

Leptin

hormone that acts to reduce our intake of food
inability to produce leptin associated with morbid obese
overweight people tend to have high levels of leptin in bloodstream but are resistant to its effects

Clinical features of personality disorders

Chronic interpersonal difficulties, Problems with identity or sense of self, inability to function adequately in society
diagnosed when enduring pattern of behaviour or inner experience is pervasive and inflexible, and stable over long duration
causes clinically significant distress or impairment in funcitoning in at least two areas: cognition, affecticity, interpsersonal functioning, impulse control
often cause as much difficulty in others lives as in their own
not stress induced, but gradual development of inflexbile and distorted personality
core feature = RIGIDITY

Personality disorders: three clusters in DSM-5

cluster A: paranoid, schizoid, schizotypal (most serious)
cluster B: histrionic, narcissistic, antisocial, borderline (no significant emotional distress)
Cluster C: avoidant, dependent, obsessive-compulsive (emotional destress)

Paranoid Personality disorder

distrust and suspiciousness of others, tendency to see self as blameless; on guard for perceived attacks by others
1.5%
males and females equal
(Hitler) - I cannot trust people.

schizoid personality disorder

imparied social relations; inability and lack of desire to form attachment to others
1.2%
males > females
Relationships are messy, undesirable.

Shizotypal Personality Disorder

eccentric in thoughts, oddities of perception and speech that interfere with communication and social interaction
1.1%
males > females
(Doc Brown) - It's better to be isolated from others.

histrionic personality disorder

self-dramatization; overconcern with attractiveness; tendency to irritability and temper outbursts if attention seeking is frustrated
1.2%
females>males
(Paris Hilton) -People are there to serve or admire me.

narcisistic personality disorder

grandiosity, need for admiration, lack of empathy

antisocial personality disorder

lack of moral or ethical development; inability to follow approved models of behaviour; deceitfulness; shameless manipulation of others; history of conduct problems as a child
3% males, 1% females
(joker) - I am entitled to break rules.

borderline personality disorder

condition marked by extreme instability in mood, identity, and impulse control; drastic mood shifts; innapropriate anger; chronic feelings of boredom attempts at self-mutilation or suicide
1.4%
females = males
I deserve to be punished.

Borderline Personality disorder & psychosocial causal factors

Psychosocial causal factors (e.g., childhood adversity) have been identified as increasing the likelihood of developing borderline personality disorder. People with susceptible temperaments or those who are more impulsive and emotional are thought to be most at risk when they experience early maltreatment.

avoidant personality disorder

Hypersensitivity to rejection or social derogation; shyness; insecurity in social interaction and initiating relationships. substantial overlap with social anxiety disorder
2.5%
females>males
If people know the "real" me, they will reject me.

dependent personality disorder

-difficulty in separating in relationships
-discomfort at being alone
-subordination of needs to keep others involved in a relationship
-indecisiveness
- individuals high on neuroticism and agreeableness with authoritarian/overprotective parents may be at hightened risk of developing
(Buster) - I need people to survive, be happy.

obsessive-cumpulsive personality disorder

excessive concern with order, rules and trivial details; perfectionistic; lack of expressiveness and warmth; difficulty in relaxing and having fun
2.1%
males>females
steve jobs - People should do better, try harder.

Difficulties in diagnosing personality disorders

Diagnostic criteria not sharply defined
diagnostic reliability/validity still low despite availability of semi-structured interviews and self-report inventories
no unified dimensional classification of personality disorders

Difficulties in Studying the Causes of Personality Disorders

Not much is known of development of personality disorders (high levels of comorbidity among disorders)
not incident based but happens slowly over time therefore hard to see risk factors
biological/psychological factors: infant's temperament may predispose development of particular personality traits and disorders (infant not getting enough gratification, learn maladaptive habit/cognitive styles)

Treatments and outcomes of personality disorders

very difficult to treat - enduring, pervasive, inflexible patterns of behaviour and inner experience
goals: reducing subjective distress, changing specific dysfunctional behaviors, and changing whole patterns of behavior or the entire structure of the personality
cluster A and B mau have difficulty forming therapeutic relationship

Treating Borderline Personality Disorder

dialectic behavioral training- change the way they think
(accept negative affect without engaging in self-destructive/maladaptive behaviours) - problem-solving
antidepressants widely used since highly comormid
second-generation antipsychotic medication and mood stabilizers may slightly reduce symptoms over short term

Treamtent of Schizotypal

low doses of antipsychotic drugs may have modest results; SSRIs may also be useful

treatment of cluster c disordres (dependent, avoidant)

Active and confrontational short-term therapy shows improvement.
Cognitive-behavior and psychodynamic therapies significant and lasting treatment gains
Antidepressants from the MAOI and SSRI categories may sometimes help in treating avoidant personality disorder

psychopathy criteria

incapacity for love

Four dimensions of Psychopathy

(1) interpersonal - superficial charm, grandiose, pathologicla lying, manipulation
(2) affective - lack of remorse/empathy, shallow affect, failure to accept responsibiliyu
(3) lifestyle - need for stimulation, parasitic, lack of realistic goals, impulsivity
(4) antisocial - poor behavioural controls, early behavioural problems, criminal versatility

Clinical picture of psychopathology

inadequate conscience development: unable to understand/accept ethical values, Behave as though social regulations and laws do not apply to them
irresponsible & impulsive behaviour: learn to take rather than earn, Prone to thrill-seeking and deviant and unconventional behavior, high rates of alcohol abuse and dependence and other substance abuse/dependence disorder
ability to impress/exploit others

Causal factors in psychopathology

genetic influences: psychopathy shows considerable heritability (43-56% of variance)

Treatments and Outcomes in Psychopathic Personality

Psychopaths experience little personal distress, so they do not believe they need treatment
punishment is ineffective
Cognitive-behavior treatments offer the greatest promise, but even the best programs produce only modest results (increasing self-control, social perspective taking, etc)

Substance-related disorders

using substances in excessive amounts that result in impairment

Addictive behavior

behavior based on the pathological need for a substance

Psychoactive substances

those that affect mental functioning in the central nervous system

Substance Abuse

involves an excessive use of a substance that results in:
▪ Potentially hazardous behavior
▪ Continued use despite persistent personal and health problems
Substance dependence: includes more severe forms of substance use disorders

Alcohol use disorder

use of alcohol even though there are detrimental effects associated with it
all age, educational, occupational, and socioeconomic boundaries
High comorbidity between alcohol use and mental illness and other substance use disorders

Clinical Picture of Alcohol- Related Disorders

Alcohol's effects on brain: Low levels of alcohol stimulate the release of dopamine from the pleasure centers of the brain.
At higher levels, alcohol depresses brain function
Development of alcohol dependence: progressive
physical effects: 15-30% heavy drinkers develop cirrhosis of the liver. Excessive alcohol use my lead to malnutrition
Psychosocial effects of abuse and dependence:
Chronic fatigue, oversensitivity, and depression may occur along with impaired reasoning and personality deterioration

Biological Causal Factors in Alcohol Use Disorder

Neurobiology of addiction: Addictive drugs activate the mesocorticolimbic dopaminepathway (MCLP)—the "pleasure pathway"
Genetic vulnerability: can't achieve higher levels of dopamine so they seek it

Psychosocial Causal Factors in Alcohol Abuse and Dependence

failures in parental guidance (family dysfunction)
psychological vulnerability (correlated to mental disorders)
stress, tension reduction and reinforcement (exposure to trauma correlated)
expectations of social stress
relationship issues
more prevalent in social life in western civilization

Use of Medications in Treating Alcohol Abuse and Dependency

medication to block desire to drink: Disulfiram (Antabuse) causes vomiting when followed by ingesting alcohol, Naltrexone helps to reduce the cravings for alcohol
medications to reduce side effects of acute withdrawal: tranquilizers

treatment/Behavioural therapy for alcohol abuse

Aversive conditioning: conditioning noxious stimuli with drinking to suppress drinking behaviour
skills training: provide life and coping skills to help reduce alcohol use in the future
self-control training: reduce alcohol intake
Controlled drinking vs abstinence
alcoholics anonymous

Alcohol abuse treatment outcome

low rates among hardcore substance abusers
motivational interviewing to see who is motivated to change
relapse prevention: recognize decisions that serve as signs of relapse

Substance Use Disoder: Psychoactive drugs

after alcohol, the most common
- 1) Opiates (such as opium and heroin)
- 2) Stimulants (such as cocaine and amphetamines as well as
caffeine and nicotine)
- 3) Sedatives (such as barbiturates)
- 4) Hallucinogens (such as LSD)
- 5) Antianxiety drugs (such as benzodiazepines)
- 6) Pain medications (such as OxyContin)

Sedatives

Alcohol (ethanol):
Reduces tensionFacilitates social interaction "Blots out" feelings or events
Barbiturates:
Nembutal (pentobarbital)
Seconal (secobarbital)
Veronal (barbital)
Tuinal (secobarbital and amobarbital)

Stimulants

Amphetamines:
Benzedrine (amphetamine)
Dexedrine (dextroamphetamine)
Methedrine (methamphetamine)
Cocaine (coca)
Effects:
Increase feelings of alertness and confidence Decrease feelings of fatigue Stay awake for long periods Increase endurance
Stimulate sex drive

Opiates

Opium and its derivatives
• Opium
Morphine
• Codeine
• Heroin
Alleviate physical painInduce relaxation and pleasant reverieAlleviate anxiety and tension
- methadone (synthetic narcotic, treatment of heroin dependence)

Hallucinogens

Cannabis
• Marijuana
• Hashish
Induce changes in mood, thought, and behavior
Mescaline (peyote)
Psilocybin (psychotogenic
mushrooms)
LSD (lysergic acid diethylamide-25)
PCP (phencyclidine)
"Expand" one's mind Induce stupor

Antianxiety drugs (minor tranquilizers)

Librium (chlordiazepoxide)
Miltown (meprobamate)
Valium (diazepam)
Xanax
Alleviate tension and anxiety Induce relaxation and sleep

Opium and its Derivitaives

Opium: mixture of about 18 chemical substances known as alkaloids
Morphine: introduced in America around 1856; used to treat the wounded in the Civil War
Heroin: more potent and acts more rapidly than morphine and is even more addictive

Biological Effects of Morphine and Heroin

rush is followed by a high, where addict is in a lethargic state
withdrawal symptoms: tearing eyes, prespiration, restlessness, increased respiration rate, intensified desire for the drug

Neural bases for physiological addiction

Endorphins: opium-like substances in the brain (involved in pain responses)
dopamine theory of addiction: addiction is result of a dysfunction of the dopamine reward pathway
reward deficiency syndrome: addiction is more liekly to occur in people with genetic deviations in reward pathway

addiction associated with psychopathology

• Opioid use is associated with dramatically increased risk of other forms of psychopathology

Treatments and Outcomes
Medications like methadone and buprenorphine help substitute for heroin
Combining medications with therapy yield the best results

Stimulants: Cocaine

plant product (crack cocaine processed to free base for smoking; cheaper)
Effects of cocaine abuse:
Increases the availability of dopamine; creates a 4-6 hour euphoric state
Experienced as feelings of contentment and confidence
Acute toxic psychotic symptoms may result from chronic abuse

Treatments cocaine abuse

Methadone and naltrexone reduce cravings
CBT and contingency management approaches are
effective for cocaine dependence
Psychological treatments; decreases in cocaine use

Stimulants: Amphetamines

psychologically and physiologically addictive; chronic use leads to tolerance
Effects of abuse:
- greater expendature of own energy can cause hazardous fatigue
- side effects: excitability, profuse sweating, rapid/unclear speech, sleeplessness, tremors, loss of appetite, confusion

Stimulants: Methamphetamine

one of the most dangerous illegal drugs
highly addictive (immediate long lasting 'high')
raises levels of dopamine
Prolonged use causes changes to brain structure—can result in severe psychiatric symptoms
Highly resistant to treatment; relapse is common

Barbituates

"downers" act as depressants
high risk of tolerance, overdose and addiction
can lead to brain damage and personality deterioration

Causal Factors in Barbiturate Abuse and Dependence

Middle/older age people susceptible to dependency (sleeping pills)
treatment: withdraw slowly to minimize anxiety (Withdrawal symptoms are more severe than those of opiate withdrawal)

Hallucinogens (LSD, Mescaline, Psilocybin)

LSD:
- most potent; causes 8 hours of change sensory perception, mood swings, and feelings of depersonalization and detachment
- flashback: involuntary recurrence of perceptual
distortions or hallucinations weeks or months after taking
Mescaline: derived from the small growths ("mescal buttons") at the top of the peyote cactus
Psilocybin is obtained from a variety of "sacred" Mexican mushrooms known as Psilocybe mexican

Hallucinogens (Ecstacy)

MDMA: hallucinogen and stimulant, similar to meth and mescaline, effects last several hours, triggers release of serotonin and blocks reuptake cauing euphoria, energy, well-being
short and long term negative psychological and neurocognitive consequences

Hallucinogens: SYNTHETIC CANNABINOIDS AND CATHINONES

Synthetic cannabinoids: substances that mimic the effects of THC (the active plant-derived substance in marijuana)
- Can cause serious side effects such as anxiety, heart palpitations, and seizures

Synthetic cathinones: substances that mimic the effects of amphetamines and cocaine
- Sold under the name "bath salts"
- Produce motor activity agitation, violence, psychosis-like
effects, and heart problems

Gambling Disorder

Pathological gambling:
- Is considered an addictive disorder
- Involves behavior maintained by short-term gains despite long- term disruption of a person's life

Sexual Dysfunction definition

impairment either in the desire for sexual gratification or in the ability to achieve it
Caused by psychological, interpersonal, or physical
factors
Percentage of population suffering from sexual dysfunction is not known

Sexual Response (4 phases)

1. Desire phase: fantasies about sexual activity/desire to have (cognitive)
2. arousal phase: subjective sense of sexual pleasure and physiological changes
3. Orgasm: release of sexual tension and peaking of sexual pleasure
4. Resolution: sense of relaxation and well-being

Male Hypoactive Sexual Desire Disorder

a male dysfunction marked by a persistent reduction or lack of interest in sex and hence a low level of sexual activity (at least 6 months; causing distress)
Predictors of low desire include daily alcohol use, stress, unmarried status, and poorer health
acquired or situational rather than lifelong

erectile disorder (ED)

recurring or persistent difficulty in achieving or maintaining an erection despite adequate desire (lifelong as well as acquired/situational)
Antidepressants, vascular disease, smoking, obesity, and alcohol abuse are contributors
Viagra

Premature Ejaculation

persistent and recurrent onset of orgasm and ejaculation with minimal sexual stimulation (in 75-100% of occasions of sexual activity)
most common male sexual dysfunction among those under 60 years of age
Treatments include behavioral therapy and some
antidepressants

Delayed Ejaculation Disorder

retarded ejaculation, or the inability to ejaculate following a normal sexual excitement phase
Specific physical problems such as multiple sclerosis and certain medications (especially the SSRIs) may be involved
Treatment is psychologically based and includes couples therapy

Female Sexual Interest/Arousal Disorder

DSM-5 combined dysfunctionally low desire with dysfunctionally low sexual arousal in the disorder
Psychological (relationship problems, daily hassles, history of unwanted sexual experiences) more important than biological (mental illness, low testosterone, use of antidepressants)

Genito-pelvic pain/penetration disorder

persistent (for at least 6 months) experience of physical pain during sexual intercourse that is associated with significant psychological distress
More organic than psychological causes—some argue it should be classified as a pain disorder

Female orgasmic disorder

readily sexually excitable and who otherwise enjoy sexual activity but who show persistent or recurrent delay in or absence of orgasm
Additional mechanical stimulation is required for orgasm
High rates of success with instruction and guidance, but situational cases are often more difficult to treat
causal factors are not well understood

Gender Dysphoria

persistent distress resulting from a perceived mismatch between one's assigned gender at birth and their gender identity
can be diagnosed in children or in adolescence/adulthood (Adults with gender dysphoria suffer elevated risks of other mental disorders)

Treatment for Gender Dysphoria

Children and adolescents often brought in by their parents for psychotherapy, children often have other general psychological and behavioural problems
most children with gender dysphoria don't become adults with gender dysphoria (because if it continues they will likely transform their bodies)

paraphilic disorders

current, intense sexually arousing fantasies, sexual urges, or behaviors
1. abnormal targets of sexual attraction
2. unusual courtship behaviors
3. the desire for pain and suffering of oneself or others

Voyeuristic disorder

Person with recurrent, intense sexually arousing fantasies, urges, or behaviors involving the observation of unsuspecting people who are undressing or of couples engaging in sexual activity
most common, meets individuals needs while avoiding possible rejection, not usually criminal/antisocial

Exhibitionistic disorder

person with recurrent, intense urges, fantasies, or behaviors that involve exposing his genitals to others (usually strangers) in inappropriate circumstances and without their consent
begins in adolescence or young adulthood
most common sexual offense reported
may be related to antisocial personality disorder