Review of Eating Disorders, Substance Use Disorders, and Personality Disorders

Exam Number 4 Review

Overview of the Exam

• Dates: Opens on November 13 and closes on November 18

• Location: Testing center (schedule a date within this range)

• Duration: 60 minutes to complete

• Format: 35 multiple choice questions worth a total of 50 points

Types of Questions to Expect:

• Matching symptoms with the disorder

• Identifying diagnostic criteria for a disorder

• Identifying a disorder based on a case study

• Describing the etiology underlying a condition (includes neurophysiology)

• Identifying epidemiological factors associated with the conditions being studied

• Identifying appropriate treatments for the disorders

Chapters Covered in the Exam

1. Chapter 8: Feeding and Eating Disorders

2. Chapter 10: Substance Use Disorders

3. Chapter 12: Personality Disorders

Feeding and Eating Disorders

Key Conditions to Understand:

1. Anorexia Nervosa

   • Diagnostic Criteria:

     • Restricted food intake leading to low body weight (below what is considered normal for age and height)

     • Intense fear of gaining weight or behaviors to prevent weight gain

     • Distorted body perception and inability to recognize consequences of restricted intake

     • Amenorrhea (loss of menstruation)

   • Subtypes:

     • Restrictive Type:

     • Characterized purely by reduced food intake with no bingeing or purging cycles.

     • Binge-Purge Type:

     • Includes cycles of eating large amounts of food followed by purging behaviors such as:

       • Self-induced vomiting

       • Excessive exercise

       • Use of laxatives

   • Physiological Features:

     • Dehydration

     • Electrolyte imbalance

     • Osteoporosis (weakened bones)

     • Lanugo (fine hair growth)

     • Dry and brittle hair

     • Low body temperature

     • Changes in heart function (hypotension, bradycardia)

     • Slow growth in younger individuals

     • Gastrointestinal symptoms (bloating, constipation) and dental problems

   • Psychological Features:

     • Cognitive impairments

     • Body checking behaviors

     • Depression

     • Neuroticism

     • Low self-esteem

     • Obsessive and ritualistic behaviors regarding food

     • Extreme perfectionism and self-consciousness

   • Epidemiology:

     • Most commonly found in adolescent girls; has the highest mortality rate of any psychological disorder.

     • Causes of death can be starvation or suicide.

2. Bulimia Nervosa

   • Symptoms:

     • Recurrent episodes of binge eating followed by compensatory behaviors such as purging (vomiting) or restricting.

     • Symptoms must occur at least once a week for three months.

     • Characterized by body dysmorphia.

   • Physiological Features:

     • Dehydration

     • Electrolyte imbalances

     • Esophageal injuries and acid reflux

     • Loss of tooth enamel and dentin

     • Swollen parotid glands

     • Gastrointestinal symptoms (constipation, bloating)

     • Irregular menstruation

   • Etiology:

     • Onset is typically later than anorexia, generally in late adolescence.

3. Binge Eating Disorder

   • Symptoms:

     • Recurrent binge eating characterized by:

     • Eating rapidly

     • Eating until uncomfortably full

     • Eating when not hungry

     • Eating alone due to embarrassment

     • Feelings of severe self-disgust following binge episodes

     • Distress must occur after episodes, and symptoms must appear at least once a week over three months.

     • No compensatory behavior following binge eating.

Treatments for Eating Disorders

• DBT (Dialectical Behavioral Therapy):

  • Based on the premise that eating disorders stem from severe emotional dysregulation and attempts to control unpleasant feelings through eating behavior.

• Family Model:

  • Eating disorders develop in families with:

    • Enmeshment: excessive involvement in one member's life.

    • Rigidity: inflexibility and inability to adapt to new situations.

    • Overprotectiveness

    • Poor conflict resolution

• Biological Etiology:

  • Hypothalamus is implicated in regulating appetite and weight.

Substance Use Disorders

Key Vocabulary:

1. Substance Use vs. Substance Abuse:

   • Substance abuse involves significant impairment or distress.

2. Dependence:

   • Continued substance use despite adverse consequences, including psychological urges and physical withdrawal symptoms.

3. Tolerance:

   • Increased amount of substance required to achieve desired effects.

4. Withdrawal:

   • Psychological and physical symptoms from refraining from substance use; symptoms vary by substance.

5. Intoxication:

   • Acute effects of substance use; temporary and varies by drug.

Types of Substance-Related Disorders:

1. Substance Use Disorder:

   • Characterized by physical or psychological dependence on substances resulting in continued use despite negative effects.

2. Substance-Induced Disorder:

   • Effects of a substance influencing behavior or physiology; includes intoxication, withdrawal, and triggers for other underlying disorders (e.g., psychosis).

Specifics of Alcohol Use Disorder

• Symptoms of Alcohol Abuse:

  • Clinically significant impairment or distress.

  • Increasing quantity due to tolerance.

  • Reduction in social, occupational, or recreational engagement.

  • Continuation of consumption despite interpersonal or psychological problems.

  • Unsafe behaviors (e.g., drunk driving).

• Symptoms of Alcohol Intoxication:

  • Slurred speech, poor coordination, nystagmus, impaired attention/memory, altered consciousness.

• Symptoms of Alcohol Withdrawal:

  • Activation of the autonomic nervous system (excessive sweating, increased heart rate), hand tremors, nausea/vomiting, transient hallucinations, psychomotor agitation, anxiety, and in severe cases, seizures.

  • Delirium Tremens:

  • A severe withdrawal state characterized by disorientation, agitation, hypertension, and fever.

  • Typically appears three days after withdrawal onset.

Etiology of Substance Use Disorders

1. Biological Model:

   • Dysfunction in the brain's reward circuitry contributes to substance use disorders.

   • Phactors include the ventral tegmental area and basal forebrain; sensitive to substance intake.

2. Behavioral Model:

   • Substance use disorders arise from positive (relief) and negative (withdrawal) reinforcement.

3. Cognitive Model:

   • Beliefs and interpretations of drug use influence substance consumption decisions.

Personality Disorders

General Characteristics

• Impairment and Distress:

  • Significant problems in the person's life arising from personality characteristics.

• The Three P's:

  • Persistence: Traits remain consistent over time; usually emerge in childhood/adolescence.

  • Pervasive: Traits exhibited across all situations without adaptation.

  • Pathological: Traits result in significant impairment/distress.

Big Five Personality Traits

1. Openness: Willingness to experience new things.

2. Conscientiousness: Awareness and thoughtfulness regarding self and others.

3. Extraversion: Degree of sociability.

4. Agreeableness: Likelihood of trying to get along with others.

5. Neuroticism: Tendency towards anxiety and emotional instability.

• Mnemonic: OCEAN (Openness, Conscientiousness, Extraversion, Agreeableness, Neuroticism)

Clusters of Personality Disorders

1. Cluster A: Odd or eccentric behaviors (Paranoid, Schizoid, Schizotypal).

2. Cluster B: Dramatic, emotional, or erratic behaviors (Borderline, Antisocial, Narcissistic, Histrionic).

3. Cluster C: Anxiety-related behaviors (Avoidant, Dependent, Obsessive-Compulsive).

Specific Personality Disorders

1. Paranoid Personality Disorder: Mistrust and suspicion that can lead to relationship difficulties.

2. Schizoid Personality Disorder: Social detachment and restricted emotional expression.

3. Schizotypal Personality Disorder: Cognitive distortions and eccentric behavior.

4. Borderline Personality Disorder:

   • Features unstable relationships, self-image, and mood, along with impulsive behaviors.

   • Risk factors include emotional dysregulation, self-injurious behavior, and trauma.

   • Treatment: Dialectical Behavioral Therapy (DBT), specifically developed for this disorder.

5. Antisocial Personality Disorder:

   • Pervasive disregard for others and lack of respect for others’ rights.

6. Narcissistic Personality Disorder:

   • Characterized by grandiosity, need for admiration, and empathy deficits.

7. Histrionic Personality Disorder:

   • Extreme emotionality and attention-seeking behaviors.

8. Avoidant Personality Disorder:

   • Feelings of inadequacy, extreme sensitivity to negative evaluation, and social withdrawal.

9. Dependent Personality Disorder:

   • Need for care from others, leading to clinginess and submissive behavior.

10. Obsessive-Compulsive Personality Disorder:

    • Preoccupation with orderliness, perfectionism, and control, often accompanied by rigidity.

Additional Notes:

• The psychological symptoms of bulimia nervosa, including high impulsivity, were noted as a key differentiator between bulimia and anorexia.

Conclusion

• Best of luck on the exam. Reach out with any questions!