Midterm 3: SUD, eating, sexual disorder, PD, ethics

SUD criteria

Problematic patt of use that impair functioning, at least 2 symptoms in 1 yr

Craving to use the substance is strong (Craving is most imp outcome of assessment)

Craving, tolerance, and withdrawal determine severity of SUD

Etiology of SUD: Bio/envi, and models, and what each of them predicts

Bio influ drug use pattern than psyc!

High genetic: Influ progression

Envi: Influ drug type

Vulnerability model: Bio risk (esp if plus stress), predict onset

Toxic effect model: Long-term use → changes in brain, predict maintenance & progression

Personality factors that predict onset of SUDs

Negative affect

Low A & C

Low constraint (can predict risk since child)

Advertising and media impact on SUD

No evidence

Why ppl w SUD don’t get treated

Not many ppl get treatment, cuz

1. Low availability of centers

2. Ambivalence: Don’t wanna stop using

3. Detox process might be dangerous (strong withdrawal, might seizure, coma, death for Delirium tremens — alcohol)

Med for SUD

Most effective in preventing overdose + improve outcome

Most effective when combined w CBT (prevent relapse)

Antabuse, Methadone (opioid agonist — activate receptor, decrease withdrawal, lower reward, low craving)

Neuromodulation

Prevent relapse by targeting electrical/chemical agents to prefrontal cortex (frontal lobe circuit) for impulse control, relieve symptoms, restore function

Contingency management

• Emphasize positive outcomes (reward) of NOT using / decrease drugs 

• Difficult to maintain that mindset, high relapse

Can you have all eating disorders at the same time

No, can only have 1 at a time

Two subtypes of AN

pattern of binging or purging in the last 3 m

• Restricting: Neither binging or purging for 3 m

• Binge-eating-purging:Either binge or purge, or both for 3 m

Bulimia Nervosa (BN) Criteria

BOTH binging and compensatory behav must be present (unlike AN) to prevent weight gain

A. Recurrent episodes of binge-eating: uncontrollable binge for 2 hrs

B. Recurrent compensatory behaviors (not limited to purging, cuz there’s like excessive exercise)

C. At least once a week for 3 m

D. Self-evaluation is influenced by body shape and weight

E. Does not occur exclusively during episodes of AN

Suicide rate BN

BN attempt and completions higher than popul (lower death than AN)

Physical changes in BN

• Women: Menstrual irregularities

• Potassium depletion

• Laxative use depletes electrolytes which can cause cardiac irregularities

• Loss of dental enamel from vomiting: Teeth appear Jagged

• 4% mortality

Prognosis of BN

• 75% recover (higher than AN),

• If depression, SUD present

• Benefits of early intervention: Prevent from maintaining BN or crossing to AN

BED

At least once a week for 3m of:

• Recurrent binges

• Loss of control during binge

• Causes distress

Lack of compensatory behav, usually overweight (BMT>30)

60% recover

Problems of BED, independent of obesity

• Sleep problems

• Anxiety/depression

• Irritable bowel syndrome

• Early menstruation in women

Misunderstanding of EDs in men

• Timing of ED onset for men is in 30s (maybe gaining belly fat, etc.)

• Men report EDs less 

• Misclassification (ex. Classifying as Muscle dysmorphia disorder than ED)

  • Acceptance in certain behaviors: Overexercising in men are more normalized than for women

Tm effectiveness for AN vs BN

Antidepressants: BN > AN

CBT: BN. But CBT most effective for AN when combined w med

Family-based therapy: AN

Sexual dysfunction DSM

at least 6m of 3 symps (but a bit more flexible)

Not explained by mental disorder, severe rela distress, other sig stressor (ex. Diff not caused by SA, not cuz depression, med)

Sexual dysfunction specifiers

Insight for onset and generalized ability for therapists to treat

• Lifelong (diff present since first sexual exp) vs acquire (diff develop after period of healthy sexual exp)

• Generalized (not limited to situation/stimulation/partner) vs situational (ex. diff limited to only penetration or oral)

Female-sexual interest/Arousal disorder

Can be interest, or arousal or BOTH

Male hypoactive sexual desire disorder

Absent/reduced BOTH sexual fantasies AND desire for sexual activities

Male electile disorder

at least 1 of 3

Diff maintaining, obtaining hardness, low rigidity

Is med effective for sexual dysfunction disorder?

Alone is not rlly

Others can be mindfulness, CBT, behav therapy, couple-based or group intervention

Fetishistic Disorder

• Reliance on an inanimate object for sexual arousal

• Compulsive attraction to object irresistible and involuntary

• Fetishes often co-occur with other paraphilias

Pedophilic Disorder

• At least 16 y/o, and at least 5 yr older

• Victims: Neighbors, family members, friends

Frotteuristic Disorder

Sexually oriented touching of a nonconsenting person

• Rubs his genitals against a women’s body or fondles her breast or genitals

• Often occurs in crowded subway or other public place

Exhibitionistic Disorder

• Intense desire to obtain sexual gratification by exposing one’s genitals to unwilling stranger

• Rarely physically touch victim

• Usually involves desire to shock or alarm victim

• Often comorbid with voyeurism and frotteurism

Benefit (?) of sadism & masochism

Less stress and depression than vanila!

Most common symp of Paranoid PD

Suspicious of fidelity (loyalty, keeping promises, faithfulness) of partner

Schizotypal PD linked to Schiz

• Relatives w/ Schizotypal PD at greater risk for Schiz

• Both show cognitive and neuropsychological deficits

• Both show enlarged ventricles and less temporal grey matter

Antisocial PD

At least 18 y/o to be diagnosed

Conduct disorder before 15 y/o

Violating other’s rights & safety since 15 y/o

Comorbid SUD

Differences between Antisocial PD (ASPD) and Psychopathy

• Psychopathy is asso w more affective/emotional symptoms

• ASPD requires a diagnosis of Conduct Disorder before age 15

BPD Core features, and neuro factor

Impulsivity and instability in rela, self, and mood

Decrease serotonin system function, pfc, increase amyg

Linehan’s Diathesis-Stress Theory for BPD

They have difficulty regulating emotions. Increase reactivity and emotional expression to be heard and understood abt their distress.

Also, unrelated to this theory, but rmb to raise them like roses

Kohut’s Self-Psychology Mode for Narcissistic PD

• Low self-esteem cuz parents didn’t give enough validation and approval in childhood

• Used as a tool in childhood to boost parents’ own self-esteem

• Not valued for their own competency and self worth

Social cognitive model

Low self esteem

Not paying enough attention on other ppl to learn social cues, cuz they focus themselves to look good in childhood → now, interpersonal rela is way to increase self-esteem, like getting admiration, instead of diff purpose like genuine friendship to help/be there for e/o

Avoidant PD

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

Model parents’ fears

High comorbid w SAD

• Most people with APD meets criteria for SAD;

• but less people with SAD meet criteria for APD

Dependent PD background

• Overprotective and authoritarian parenting style

• Disruption of early childhood attachment by death, neglect, rejection, or overprotectiveness

Obsessive-Compulsive PD (OCPD)

• Perfectionist, Preoccupied with rules, details, schedules, and organization

• Cope w fears of losing control by overcompensation

• Comorbid with Avoidant PD

Treatment of PD

• Avoidant PD: Antianxiety med or antidepressants

• Schizotypical PD: Antipsychotic and occasionally antidepressant med

• Psychotherapy: Psychodynamic (most useful when address childhood root of problem), CBT (negative beliefs)

Why was BPD Difficult to treat (historically)

Interpersonal problems play out in therapy

Attempts to manipulate therapist

Dialectical Behavioral Therapy

• First created for BPD!

• Acceptance and change

•  Plus CBT

•  Individual therapy

• Holding ice cube in hand to feel pain and focused without physically SH

• Skills group: emotion regulation, mindfulness, distress tolerance, and interpersonal effectiveness

Two ways mental illness can be taken into account

• Not Criminally Responsible on account of Mental Disorder (NCRMD): mental disorder prevented them from understanding their actions or knowing they were wrong at the time of the offence.

• Competency to stand trial

Competency to stand trial (and tool used to assess)

The accused must be able to (These are assessed by Fitness Interview Test-Revised (FIT-R))

• Understand nature of legal system and proceedings

• Understand the consequences of trial (what happens after guilty or not guilty)

• Consult w council to participate in their defense

Must have that disorder from the time crime committed, to the time of trial

Trial can be delayed until they meet these 3 criteria (can also be in forensic hospital)

Determination of competency made before indv is tried

Can you be competent to stand trial but still be NCRMD?

Yes. NCRMD is about not being in the right mind at the time of crime. Competency to stand trial is about their present condition

Synthetic sanity

If med can produce rationality, trial can be held: Even if stop using med would make them incompetent again

Psychologists must breach confidentiality (telling other mental health professionals) and take action if:

• Imminent harm to self or others

• To protect a child or vulnerable adult (check if that PT currently have access to that child/adult)

Ex. so can’t break confidentially if pt just stole a car

Why do ppl have Anosognosia?

Dysfunction of Frontal lobe 

• → doesn’t update self-image → stuck in pre-illness self-image → lack of awareness of symptoms