Behavior Disorders Exam 3

anorexia nervosa

- restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, development, and physical health

- intense fear of gaining weight or becoming fat, persistent behavior that interferes with weight gain

- disturbance in the way in which one's body weight or shaped is experienced, undue influence of body weight or shape on self-evaluation

restricting type (anorexia)

- person has not engaged in binge eating or purging

- weight lost is accomplished primarily through dieting, fasting, and/or excessive exercise

binge-purging type (anorexia)

individual has engaged in recurrent episodes of binge eating or purging behavior (e.g., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

bulimia nervosa

- recurrent episodes of binge eating, characterized by both of the following:

- eating an amount of food that is definitely larger than what most individuals would eat in a similar period of time

- a sense of lack of control over eating during the episodes

- recurrent inappropriate compensatory behaviors (e.g., self-induced vomiting, laxative use, fasting, excessive exercise)

- bing eating and inappropriate compensatory behaviors occur at least once a week for three months

AN binge-type vs. BN

bulimic-type AN patients suppress their weight below normal limits, whereas BN tend to be at least of normal weight

general thesis

anorexia and bulimia are the same disorder, expressed differently as a function of individual life experiences and temperament (e.g., impulsivity/lack of self-control more common in BN patients)

societal factors (eating disorders)

- ideals tend toward body shapes that are difficult to achieve under certain circumstances

- exposure to the "thin ideal" may underscore body dissatisfaction and encourage behaviors that are aimed at attaining this ideal

- meta-analytic work suggests only small effects for media exposure to thin ideal

- impact heightened in cultures that impede women's access to other means of self-definition

thin ideal (eating disorders)

- person begins to assume seemingly dominant cultural perspective that equates adherence to certain physical standards with personal or social value

- individuals internalize attitudes that are approved of by significant or respected others

- socialization agents (e.g., media) reinforce the thin-ideal body image for women

body dissatisfaction (eating disorders)

- sometime operationalized as the gap between one's actual and ideal body weight/shape

- however, one may see one's body as far from ideal and yet still be reasonably satisfied with it

- viewed as final common pathway for social risk factors; however, not all of those dissatisfied with their bodies develop EDs

peer influences (eating disorders)

- peer influences on body dissatisfaction appear stronger than media effects

- may actively influence women through verbal comments, communication of beauty norms, explicit verbal comparisons, and attributions of persona value based on beauty

- may passively influence body dissatisfaction by provoking internal or unconscious body comparisons

family influence (eating disorders)

- families (and friends) often praise AN patients' slenderness, and envy the self-control and discipline required to achieve it

- this reinforcement frequently persists even when the anorexic becomes severely emaciated

- mothers of girls with ED think their daughters should lose more weight, are dissatisfied with the functioning of the family system, and are more eating disordered than mothers of girls without EDs

- direct maternal comments are very powerful influences

abuse and EDs

- there does appear to be a connection between childhood sexual abuse (CSA) and bulimic symptomatology

- childhood emotional abuse is the only type of childhood trauma that predicts eating pathology in adults

- by refocusing one's attention onto weight, shape, and eating, one enters a domain in which one can gain some emotional control or by providing a stable sense of identity to guide behavior

emotional problems (eating disorders)

- one can gain emotional control by focusing their attention on weight, shape, and eating

- AN patients achieve partial emotional gratification by avoiding food and achieving slimness

- BN patients gain emotional relief by bingeing (and then by purging)

- for both, obsessive focus on weight loss and its associated tactics provide a narrow, apparently viable way to channel identity concerns (and to avoid ealing with broader issues)

eating disorders age of onset

- symptoms of ED are evident in early adolescents, with actual emergence typical in early adulthood

- AN tends to develop earlier than BN

personality traits (eating disorders)

- perfectionism

- tendency to pursue unrealistically high standards despite aversive consequences (tends to be moderated by self-esteem)

- obsessive-compulsive traits

- high levels of self-criticism and sensitivity to social approval and prone to rapid deflation of self-concept and self-denigration in responses to lack of recognition from others

anorexia-specific traits

- high constraint

- low novelty seeking

- compliant, socially isolated, anxious female who gravitates towards orderliness and control

bulimia-specific traits

- high impulsivity

- lack of forethought

- sensation seeking

- affective instability

psychotic disorders

- involve severe impairment in an individual's perception and understanding of reality

- symptoms include delusional thought content and abnormalities in sensory perception

schizophrenia

- behavioral manifestation of structural abnormalities in the brain and their various consequences

- severe impairment in several areas of functioning

positive symptoms (schizophrenia)

- the presence of symptoms indicative of psychosis (break with reality)

- delusions, hallucinations/illusions, vague or unfocused form of thought

negative symptoms (schizophrenia)

- the absence of normal traits or abilities

- affect, volition, interpersonal relationships, identity, psychomotor behavior

hallucinations (schizophrenia)

- a false perception of objects or events involving the senses

- can be auditory (most common), visual, tactile, olfactory, somatic, or gustatory

- hallucinations are fairly common in the general population

delusions (schizophrenia)

false beliefs that meets the following criteria: certainty, incorrigibility, preocupation, impossibility or falsity of content

non-bizarre delusions

theoretically possible but clearly untrue

bizarre delusions

violate the accepted laws of nature (e.g., my stomach has been replaced with a swimming pool)

paranoid subtype

preoccupation with persecutory delusions or auditory hallucinations

disorganized subtype

prominent disorganized speech and behavior; flat or inappropriate emotional expressions

catatonic subtype

motor immobility or excessive motor activity; wavy flexibility

changes in DSM-V (schizophrenia)

- two of these symptoms required instead of one: delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, and negative symptoms

- individual must have one of the most blatant symptoms: delusions, hallucinations, or disorganized speech

- subtypes were removed

- dimensional approach was incorporated to rate the severity of the core schizophrenic symptoms

biological abnormalities (schizophrenia)

- increased volume of lateral ventricular areas in schizophrenic patients

- decreased frontal, temporal, and whole brain volume

- increased levels of dopamine; dysfunction in dopamine release

- excess of glutamate

genetic factors (schizophrenia)

- examine concordance between identical and non-identical twins raised separately

- identical twins: 25-50%

- non-identical: 10-15%

- the closer the level of relatedness the higher the risk

- extensive genetic heterogeneity have been confounding the search for the causes of schizophrenia (1,000 different genes may contribute to the disorder)

concordance

the degree of similarity in a pair of twins with respect to the presence or absence of a particular disease or trait

familial factors (schizophrenia)

- concordance rates are not 100%; therefore, this implicates some role of environment in expression of genetic vulnerability

- schizophrenia significantly more likely to develop in children reared in dysfunctional families

- more likely to occur when reared in institutional setting

hypoxia (schizophrenia)

- deprivation of oxygen during delivery

- increases risk of developing schizophrenia

season-of-birth effect

- individuals born in late winter months are more likely to develop schizophrenia

- may reflect seasonal exposure to viral infections

maternal stress

chronic prenatal stress or stressful life events associated with higher rates of schizophrenia

childhood trauma (schizophrenia)

early trauma increases risk of later psychosis through sensitization of the dopaminergic system or through lasting affects on the HPA axis, which is associated with stress reactivity

bipolar disorder

- characterized by severe changes in mood, thinking, and behavior from extreme highs to extreme lows

- classic presentation involves mania and depression alternating in distinct episodes that can last anywhere from a few days to a year or more

- depressive phases as defined by criteria for major depression

manic episodes

- include elated, expansive, or irritable mood, or increased goal directed activity, with at least three of the following:

- inflated self-esteem (grandiosity)

- decreased need for sleep

- racing thoughts or flight of ideas

- rapid or pressured speech

- reckless and impulsive behavior (e.g., indiscreet sexual liaisons, spending sprees, reckless driving)

- enhanced energy

- distractibility

bipolar I

- presence of 1 manic or mixed episode

- in DSM-IV, criteria are met for both manic and depressive episode nearly every day for 1 week

- in DSM-V, there is simply a specifier about the presence of manic features

bipolar II

- presence of MDD and one hypomanic episode

- only about 1 in 10 bipolar II patients ever experience a manic or mixed episode

- bipolar II patients spend more time depressed (37:1) weeks vs. hypomanic; bipolar I spend more time in depressed vs manic (3:1 weeks)

cyclothymia (bipolar subtype)

two or more years switching between hypomanic and depressive symptoms that do not meet criteria for a hypomanic or major depressive episode

hypomania

the mood disturbance is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features

bipolar, not otherwise specified

patients with manic symptoms that do not meet criteria for any of the other bipolar disorders

bipolar age of onset

- typical onset is in late childhood and early adolescence

- age of onset is getting younger and younger in subsequent age cohorts

bipolar epidemiology

- 2.1% lifetime prevalence

- frequently comorbid with impulse control disorders, substance use disorders, ADHD, and anxiety disorders

suicidality (bipolar)

- 15 times greater risk for completed suicide than general population

- 4 times greater risk than patient with depression

- risk factors for completed suicide include younger age, recent illness onset, male gender, prior suicide attempts, family history of suicide, comorbid substance abuse problems, rapid cycling course, social isolation, anxious mood, and impulsive aggression

- patients with more depressive course than more severely manic course are more likely to commit suicide

impairment in functioning (bipolar)

- occurs even between episodes; consequences of behavior can be observed up to 5 years after episode

- only about 1 in 3 bipolar patients maintain full-time employment

bipolar etiology

- the focus on etiology swings back and forth between genetic/biological factors and social/environmental factors

- family, twin, and adoption studies highlight that bipolar aggregates in families

- concordance rates are 85-93%; among the most heritable disorders

biological factors (bipolar)

- major role of dopamine and serotonin dysfunction in bipolar

- dopamine is enhanced during amnia and diminished during depression

- diminished functioning of serotonin in bipolar

- lithium and anticonvulsant medications are successful in controlling cycling

social factors (bipolar)

- there has been a resurgence in research highlighting the psychosocial processes in the onset, course, and expression of bipolar

- two main factors are stressful life events and social support processes

vulnerability-stress model (bipolar)

- studies show that life stress (e.g., work stress) does precede relapse, but differences in the specific findings emerge, perhaps due to methodological difference

- evidence to suggest chronic stress or more severe stressors are predictive

- stress ties with with both depressive and manic explodes with equal frequency

circadian rhythm (bipolar)

- a roughly-24-hour cycle in the biochemical, physiological, or behavioral processes of living beings

- allow organisms to anticipate and prepare for precise and regular environmental changes

- onset of bipolar thought the effect of life events on sleep-wake cycles

- disruption in daily routines (social rhythms) can impact sleep-wake presence through two pathways: presence of zeitstorers and loss of zeitgebers

- manic, but not depressive, episodes can be triggered by minor changes in sleep patterns (e.g., changing time zones)

presence of zeitstorers (sleep)

disrupt established social/circadian rhythms (e.g., caretaking an infant)

loss of zeitgebers (sleep)

factors that maintain stability or rhythms (e.g., job loss)

social support processes (bipolar)

- the presence of supportive versus non-supportive persons in the environment link with risk for relapse

- social support appears to buffer against life stress

- interpersonal distress ties with greater risk of relapse

PTSD

- a cluster of physiological, psychological, and behavior symptoms that can occur following a traumatic event

- previously called traumatic neurosis, gross stressreaction, war neurosis, combatfatigue, nostalgia, shell shock,soldier's heart, Da Costa'sSyndome

traumatic experiences

- natural disasters

- abuse, rape, sexual abuse

- war-related

- common trauma (e.g., car accident, sudden and unexpected death of a loved one)

traumatic event

- an event involving actual or threatened death, serious injury, or threat to physical integrity to self or others

- typically associated with fear, helplessness, or horror

- criterion A: must have experienced, witnessed, or learned about a traumatic event of a loved one; repeated exposure to the aftermath of a trauma

course of PTSD

- symptoms typically emerge shortly after trauma (about 1 month), but delayed expression is possible (6 months)

- cases of true delayed expression are rare and likely reflect reactivation or exacerbation of prior symptoms

schema disconfirmation (PTSD)

- sometimes our experiences are inconsistent with what would be expected on the basis of our schemas

- personal invulnerability, the world as a meaningful and predictable place (e.g., Just World assumption)

- self as positive and worthy

- leads to criterion E (hyperarousal and reactivity): hyper vigilance, startle response, sleep difficulty, concentration impairments

- also leads to criterion D (strong negative emotions): guilt, distorted self-blame, responsibility for outcome, shame about behavior

assimilation (schemas)

- inconsistent information is made consistent with existing schemas

- denial is a core component of assimilation

accommodation (schemas)

- existing schemas are altered to account for inconsistent information

- traumas are so salient that they force individuals to in some way accommodate the experience

consequences to trauma

- criterion B (intrusions): intense physiological and psychological response when exposed to trauma-related cues

- criterion C (avoidance): effortful avoidance of cues related to the traumatic event; such as persons, places, or situations

- criterion D (negative mood): emotional numbing; feeling distant from others; inability to express positive emotions

PTSD risk factors

- men are more likely to experience trauma but women are more likely to develop PTSD, even controlling for the type of drama experienced

- personal trauma (e.g., rape, combat) is more of a risk factor than impersonal trauma (e.g., natural disasters, accidents)

- multiple traumas can lead to complex PTSD

cognitive factors (PTSD)

- lower cognitive ability is a risk for PTSD development (e.g., verbal ability, processing speed, retrieval of autobiographical memory)

- also included negative self-evaluation, extinction learning, and military trainability

coping styles (PTSD)

negative cognitive bias, rumination, and avoidant coping styles a risk factor for PTSD

personality (PTSD)

neuroticism/negative affectivity, trait anger/hostility, harm avoidance, and trait dissociation risk factors for PTSD

pre-trauma psychopathology (PTSD)

- having some form of pre-trauma psychopathology is a risk for PTSD development

- individuals who are already experiencing symptoms of anxiety and depression are more likely to develop PTSD than those not already anxious and depressed

intrusion (Criterion B)

persistent and distressing memories of the trauma, recurrent distressing nightmares about the traumatic event, dissociative reactions (e.g, flashbacks) and intense psychological or physiological responses when exposed to cues that resemble the trauma)

avoidance (criterion C)

effortful avoidance of internal cues and efforts to avoid external reminders of the trauma like places, people, or situations

negative cognitions and mood (criterion D)

these symptoms reflect the range of affect, from numbing and amnesia (and inability to have positive feelings) to strong negative emotions such as guilt, anger, or fear; distorted self-blame or erroneous blame of others who did not cause or intend the event; and negative beliefs about self, others, and the world as a consequence of the traumatic event

arousal and reactivity (criterion E)

sleep difficulties, concentration impairment, exaggerated startle response, and hyper-vigilance, but also irritable or aggressive behaviors and reckless or self-destructive behavior

simple PTSD

those who scored low on both internalizing and externalizing subtypes

externalizing PTSD

characterized by the tendency to outwardly express distress through antagonistic interactions with others, blaming others, and coping through acting out

internalizing PTSD

characterize by the tendency to direct post traumatic distress inwardly through shame, self-defeating and self-deprecating beliefs, anxiety, avoidance, depression, and withdrawal

autobiographical memories (verbally accessible memories)

include information the individual attended to before, during, and after the traumatic event with sufficient conscious processing to be transferred to long-term memory

situationally accessible memories

contain extensive nonconscious and nonverbal information about the traumatic event that cannot be deliberately accessed or easily altered - these can, however, be triggered in the forms of flashbacks, nightmares, or intrusive images

paradoxical memories of trauma

- someone with PTSD may have trouble intentionally accessing his or her memory of the event but have voluntary intrusions of parts of it

- they suggest that people with PTSD are processing their traumatic events in idiosyncratic ways that produce an appraisal of serious current threat - because the memory encoded at the time of the trauma is poorly elaborated and integrated with other memories with regard to details, context of time, sequence, and so forth

- this might explain why people with PTSD may have poor autobiographical memory and yet may be triggered to have memory fragments that have a here-and-now quality (no time context) or may not have appropriate post trauma appraisals

PTSD and relationships

- PTSD is associated with intimate relationship dysfunction

- those with PTSD are as likely as those without PTSD to be married, but both men and women with PTSD are substantially more likely to divorce, and divorce multiple times, following onset of the disorder

- avoidance and numbing symptoms of PTSD have been specifically implicated in relationship satisfaction, and the hyperarousal symptoms have been associated with violence perpetration

bipolar criteria A

must experience episodes of elated, expansive, or irritable mood plus increased goal-directed activity

bipolar criteria B

at least 3 of these symptoms must also be present: inflated self-esteem (grandiosity), decreased need for sleep, racing thoughts or flight of ideas, rapid or pressured speech, reckless and impulsive behavior (e.g., indiscreet sexual liaisons, spending sprees, reckless driving), increased energy, and distractibility

mixed episode

fully syndromal manic and depressive episodes occur simultaneously (i.e., severely irritable mood along with racing thoughts, decreased need for sleep, suicidal thoughts, feelings of worthlessness, and insomnia for a minimum of 1 week)

bipolar and creativity

- children diagnosed with bipolar disorder and children who are offspring of bipolar parents score higher on a measure related to creativity than healthy control children

- fully syndromal manic episodes are not the cause of elevated creativity - bipolar disorder and risk for mania have been related to several traits that could promote increased creativity, including positive affective traits (e.g., optimism), impulsivity, and increased ambition

expressed emotion

criticism, hostility, ,or emotional over involvement - psychosocial stressors like EE attitudes in parents can increase risk of developing bipolar disorder

life experiences (bipolar)

- childhood abuse, particularly physical abuse, was related to early illness onset, substance abuse, and suicidality in BD

- stressful events that occurred in the year before the study's baseline assessment (e.g., financial hardships) were more closely associated with onsets or recurrences of mania among genetically at-risk individuals with a history of childhood adversity than they were among those without childhood adversity

paranoid delusions

involve a belief that one or more people are trying to harm the individual even thought there is no evidence to support the belief

thought insertion

people are inserting thoughts into my head

thought broadcasting

people can hear my thoughts

grandiose delusions

I am a particularly famous person, even a historical or fictional character

control delusions

my body and actions are controlled by an external force

avolition

a decrease in motivated, self-directed behavior

alogia

a decreased amount of speech output

adhedonia

decrease in the ability to experience pleasurable sensations or imagine experiencing pleasure in response to remembered situations

sensory gating (schizophrenia)

the neurological process of filtering out redundant of unnecessary stimuli in the environment - habituation to repeated exposure to the same sensory stimulus

de novo mutation

- mutations not present in the parents' DNA

- schizophrenia may result from multiple rare genetic variants that can arise from spontaneous e novo mutations, such as 22q11.2 deletion syndrome, where a person's genetic code lacks a long section of DNA on the 22nd chromosome

premorbid symptoms (schizophrenia)

often subtle and occur long before the onset of the illness

prodromal symptoms (schizophrenia)

immediately precede the onset of psychotic symptoms

Fairburn's transdiagnostic theory (eating disorders)

- identifies the centrality of overvaluation of eating, shape, and weight and their control across the range of eating pathology

- he postulates that variations in eating symptomatology are all expressions of this overvaluation and argues that the mechanism of this core belief must be targeted in treatment

physical consequences of AN

- affects most organ systems, as the body responds to manage a starvation state and conserves energy by cutting back on all but the most essential functions

- menstruation can stop or become irregular

- skin becomes dry and hair falls out

- calcium is lost from bones, leading got osteopenia or sometimes osteoporosis

- cardiac muscle weakens